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Anesthesia information management systems (AIMS) are gradually replacing paper documentation of anesthesia care. This study sought to determine the current status of AIMS adoption and the level of health informatics expertise in Canadian academic anesthesia departments. Department heads or their designates of Canadian academic anesthesia departments were invited by e-mail to complete an online survey between September 2019 and February 2020. The survey elicited information on current AIMS or future plans for an AIMS installation, the number of department members dedicated to clinical informatics issues, the gross level of health informatics expertise at each department, perceived advantages of AIMS, and perceived disadvantages of and barriers to implementation of AIMS. Of the 64 departments invited to participate, 63 (98.4%) completed the survey. Only 21 (33.3%) of the departments had AIMS. Of the 42 departments still charting on paper, 23 (54.8%) reported planning to install an AIMS within the next five years. Forty-six departments (73%) had at least one anesthesiologist tasked with dealing with AIMS or electronic health record issues. Most reported having no department members with extensive knowledge or formal training in health informatics. The top three perceived barriers and disadvantages to an AIMS installation were its initial cost, lack of funding, and a lack of technical support dedicated specifically to AIMS. The top three advantages departments wished to prioritize with AIMS were accurate clinical documentation, better data for quality improvement initiatives, and better data for research. A majority of Canadian academic anesthesia departments are still using paper records, but this trend is expected to reverse in the next five years as more departments install an AIMS. Health informatics expertise is lacking in most of the departments, with a minority planning to support the training of future anesthesia informaticians.

ObjectiveThe lack of precise and inclusive gender, sex, and sexual orientation (GSSO) data in electronic health records (EHRs) is perpetuating inequities of sexual and gender minorities (SGM). We conducted a rapid review on how GSSO documentation in EHRs should be modernized to improve the health of SGM.Materials and MethodsWe searched MEDLINE from 2015 to 2020 with terms for gender, sex, sexual orientation, and electronic health/medical records. Only literature reviews, primary studies, and commentaries from peer-reviewed journals in English were included. Two researchers screened citations and reviewed articles with help from a third to reach consensus. Covidence, Excel, and Atlas-TI were used to track articles, extract data, and synthesize findings, respectively.ResultsThirty-five articles were included. The 5 themes to modernize GSSO documentation in EHRs were (1) creating an inclusive, culturally competent environment with precise terminology and standardized data collection; (2) refining guidelines for identifying and matching SGM patients with their care needs; (3) improving patient-provider relationships by addressing patient rights and provider competencies; (4) recognizing techno-socio-organizational aspects when implementing GSSO in EHRs; and (5) addressing invisibility of SGM by expanding GSSO research.ConclusionsThe literature on GSSO documentation in EHRs is expanding. While this trend is encouraging, there are still knowledge gaps and practical challenges to enabling meaningful changes, such as organizational commitments to ensure affirming environments, and coordinated efforts to address technical, organizational, and social aspects of modernizing GSSO documentation. The adoption of an inclusive EHR to meet SGM needs is a journey that will evolve over time.

Objectives: Single, program wide multi-site prospective study examining the (1) accuracy of non-cancer clinician prediction survival (CPS) by palliative practitioners on 1st assessment. (2) Factors affecting CPS; (3) potential impact on clinical care.Design and methods: Single, program wide multi-site prospective study (n = 282). CPS was divided into four clinically relevant time periods (≤2 weeks, >2 to ≤6 weeks, >6 to ≤12 weeks, and >12 weeks). Multivariate analysis was done on six predictor variables.Results: More than ½ of patients died before their clinically relevant predicted time periods (of more than 2 weeks). Only one out of the six predictor variables impacted on clinician accuracy on logistic regression and that being the survival prediction time periods.Conclusion: Non-cancer CPS, even by palliative practitioners, remains overly optimistic. This raises the question in that these individuals may have been potentially over-treated.

Objective The aim of this paper is to report on the use of the systematised nomenclature of medicine clinical terms (SNOMED CT) by providing an overview of published papers. Methods Published papers on SNOMED CT between 2001 and 2012 were identified using PubMed and Embase databases using the keywords 'systematised nomenclature of medicine' and 'SNOMED CT'. For each paper the following characteristics were retrieved: SNOMED CT focus category (ie, indeterminate, theoretical, pre-development/design, implementation and evaluation/commodity), usage category (eg, prospective content coverage, used to classify or code in a study), medical domain and country. Results Our search strategy identified 488 papers. A comparison between the papers published between 2001-6 and 2007-12 showed an increase in every SNOMED CT focus category. The number of papers classified as 'theoretical' increased from 46 to 78, 'pre-development/design' increased from 61 to 173 and 'implementation' increased from 10 to 34. Papers classified as 'evaluation/commodity' only started to appear from 2010. Conclusions The majority of studies focused on 'theoretical' and 'pre-development/design'. This is still encouraging as SNOMED CT is being harmonized with other standardized terminologies and is being evaluated to determine the content coverage of local terms, which is usually one of the first steps towards adoption. Most implementations are not published in the scientific literature, requiring a look beyond the scientific literature to gain insights into SNOMED CT implementations

Graphical abstract Highlights ► We conducted 13 interviews of SNOMED CT implementations in clinical settings. ► Challenges: SNOMED CT quality; design, use and maintenance; others. ► Success factors: simplicity; clinicians; expertise; demonstrate value; training. ► Benefits: content coverage; direct data entry; data reuse; legibility., The Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT) has been designated as the recommended clinical reference terminology for use in clinical information systems around the world and is reported to be used in over 50 countries. However, there are still few implementation details. This study examined the implementation of SNOMED CT in terms of design, use and maintenance issues involved in 13 healthcare organisations across eight countries through a series of interviews with 14 individuals. While a great deal of effort has been spent on developing and refining SNOMED CT, there is still much work ahead to bring SNOMED CT into routine clinical use.

Aims: This study examined (1) accuracy of clinician prediction of survival (CPS) by palliative practitioners on first assessment with the use of standardised palliative tools, (2) factors affecting accuracy, (3) potential impact on clinical care. Methods: A multi-site prospective study (n=1530) was used. CPS was divided into four time periods (2 to 6wks, >6 to 12wks and >12wks). Multivariate analysis was assessed on six predictor variables. Results: Overall, median survival of the sample was only 5 weeks. CPS category was accurate only 38.6% of the time, with 44.6% patients dying before the predicted time period. Of six candidate variables, on multivariate analysis only (i) the clinical time periods themselves and (ii) Palliative Performance Scale Conclusion: CPS, even by palliative practitioners, remains overly optimistic with the existence of the horizon effect. This raises the question in that these individuals may have been potentially overtreated.

Purpose To determine whether elements of a standard nutritional screening assessment are independently prognostic of survival in patients with advanced cancer. Patients and Methods A prospective nested cohort of patients with metastatic cancer were accrued from different units of a Regional Palliative Care Program. Patients completed a nutritional screen on admission. Data included age, sex, cancer site, height, weight history, dietary intake, 13 nutrition impact symptoms, and patient- and physician-reported performance status (PS). Univariate and multivariate survival analyses were conducted. Concordance statistics (c-statistics) were used to test the predictive accuracy of models based on training and validation sets; a c-statistic of 0.5 indicates the model predicts the outcome as well as chance; perfect prediction has a c-statistic of 1.0. Results A training set of patients in palliative home care (n = 1,164) was used to identify prognostic variables. Primary disease site, PS, short-term weight change (either gain or loss), dietary intake, and dysphagia predicted survival in multivariate analysis (P < .05). A model including only patients separated by disease site and PS with high c-statistics between predicted and observed responses for survival in the training set (0.90) and validation set (0.88; n = 603). The addition of weight change, dietary intake, and dysphagia did not further improve the c-statistic of the model. The c-statistic was also not altered by substituting physician-rated palliative PS for patient-reported PS. Conclusion We demonstrate a high probability of concordance between predicted and observed survival for patients in distinct palliative care settings (home care, tertiary inpatient, ambulatory outpatient) based on patient-reported information.

Mobile work is emerging as an area of major importance in healthcare. However, past literature on this topic remains largely anecdotal, fragmented, and atheoretical. In this paper, we address this gap and adapt the DeLone and McLean model of IS success to the context of mobile work in healthcare, and articulate specific propositions. We then deductively evaluate each proposition based on studies reporting mobile device use in the healthcare context. Through this rigorous evaluation process, we are able to deliver a revised theoretical model that presents a consolidated view of the literature in the area of mobile work in healthcare.

This study describes the significant correlation between the Braden Scale (BS) and the Palliative Performance Scale (PPS) in patients with advanced illness that has not been previously reported. The analysis was based on a prospective sequential case series of 664 patients suffering from advanced illness who were referred to a regional palliative medicine programme in Toronto, Canada. Baseline BS and PPS scores assessed within 24 hours of referral were considered for analysis. After controlling for age, gender, consult site and diagnosis (cancer versus non cancer), we observed a significant positive correlation between baseline PPS and BS scores (r ¼ 0� 885, P , 0� 001). These findings suggest that for patients with advanced illness where BS is not routinely used, PPS could be considered as a proxy for pressure ulcer risk assessment.

With changes in bowel function being a common and often distressful issue for palliative care patients, the ability to easily monitor and record changes in bowel status would be helpful in addressing quality of care. Most bowel tools record either constipation or diarrhea, but not both. A new tool, the Victoria Bowel Performance Scale (BPS), was designed as an ordinal nine-point scale from −4 (severe constipation) to +4 (severe diarrhea) and includes three parameters: visual stool characteristics, bowel pattern, and ability to control defecation. This study tested the reliability of BPS using case scenarios in a test-retest format. Sixty-seven raters in Time Period 1 and 54 raters in Time Period 2 ranked the 18 cases. The intraclass correlation coefficients for absolute agreement were 0.822 and 0.853 for Time Periods 1 and 2, respectively. Results showed that the raters were consistent in their scoring over time, with an average Cohen's kappa of 0.70 over all of the raters. The average Pearson correlation coefficient between Time Periods 1 and 2 scores was 0.92. Further prospective testing in day-to-day clinical care is needed to further confirm the reliability and clinical utility of the BPS. A BPS management guideline has been developed to assist with decision making for each BPS score, which also requires validation.

Current literature suggests clinicians are not accurate in prognostication when estimating survival times of palliative care patients. There are reported studies in which the Palliative Performance Scale (PPS) is used as a prognostic tool to predict survival of these patients. Yet, their findings are different in terms of the presence of distinct PPS survival profiles and significant covariates.This study investigates the use of PPS as a prognostication tool for estimating survival times of patients with life-limiting illness in a palliative care unit. These findings are compared to those from earlier studies in terms of PPS survival profiles and covariates.This is a retrospective cohort study in which the admission PPS scores of 733 palliative care patients admitted between March 3, 2000 and August 9, 2002 were examined for survival patterns. Other predictors for survival included were age, gender, and diagnosis.Study findings revealed that admission PPS score was a strong predictor of survival in patients already identified as palliative, along with gender and age, but diagnosis was not significantly related to survival. We also found that scores of PPS 10% through PPS 50% led to distinct survival curves, and male patients had consistently lower survival rates than females regardless of PPS score.Our findings differ somewhat from earlier studies that suggested the presence of three distinct PPS survival profiles or bands, with diagnosis and noncancer as significant covariates. Such differences are likely attributed to the size and characteristics of the patient populations involved and further analysis with larger patient samples may help clarify PPS use in prognosis.

The term palliative care refers to the care for patients with terminal conditions. Traditionally, much of this end-of-life care has been provided by hospices or acute care centres. As healthcare systems face aging patient demographics and struggle with the need to deliver quality services with fewer resources, we must find new approaches to healthcare delivery. Some of the more established areas of healthcare such as cardiac care or administration are rather advanced in terms of the application of information technologies such as clinical knowledge bases and computer-integrated service delivery models. In palliative care, partly due to its relatively recent emergence as a discipline, informatics has played only a minor role to date. In this paper, we argue that we can achieve cost reduction and increased quality of service by adopting network-enabled information systems (IS) and telematics to advance the boundaries of traditional palliative care towards the patient homes. This vision, called e-Hospice in this article, is not meant to replace but to augment the traditional brick and mortar hospices. We discuss our model of an e-Hospice along with the challenges and opportunities involved in realising it. Our experiences are based on our ongoing tight collaboration with a local hospice as well as our studies of prototype technology infrastructures we have developed in our laboratories. We present a concrete application scenario in this paper, along with a description of the underlying architecture and technologies that underlie the infrastructures developed.

Background The use of palliative radiotherapy (PRT) is variable in advanced cancer. Little is known about PRT utilization by end-of-life (EOL) cancer patients in Canada. This study examined the PRT utilization rates and factors associated with its use in a cohort of cancer patients who died in British Columbia (BC). Methods BC residents with invasive cancer who died between April 1, 2010 and March 31, 2011 were included in the study. Their cancer registry and radiotherapy treatment records were extracted from the BC Cancer Agency information systems and linked for the analysis. The PRT utilization rates by age, sex, primary cancer diagnosis, geographic region, survival time and travel time to the cancer centre were examined. Multivariable logistic regression was used to determine the factors that influenced the PRT utilization rates. Results Of the 12,300 decedents in the study 2,669 (21.7%) had received at least one course of PRT in their last year of life. The utilization rates dropped to 5.0% and 2.2% in the last 30 and 14 days of life, respectively. PRT utilization varied across diagnosis and was highest for lung cancer (45.7%) and lowest for colorectal cancer (8.9%). The rates also varied by age, survival time and travel time to the nearest radiotherapy centre. There was a greater odds of receiving PRT for those with primary lung cancer, survival time between 1.5-26 months from diagnosis or living within 2 hours from a cancer centre. The 85+ age group was least likely to receive PRT in their last year of life. Conclusions This study found PRT utilization rates of EOL cancer decedents to be variable across the province of BC. Age, diagnosis, survival time and travel time to the nearest radiotherapy centre were found to influence the odds of PRT treatment. Further work is still needed to establish the appropriate PRT utilization rates for the EOL cancer population. Electronic supplementary material The online version of this article (doi:10.1186/1472-684X-13-49) contains supplementary material, which is available to authorized users.

This paper describes the diffusion of an evidence-based stroke guidance system (SGS) in a field setting through participatory research. SGS enables physicians to review relevant evidence-based literature, from which patient orders are generated for managing cerebrovascular accident. The paper focuses on the question 'what are the barriers and enablers to adopting SOS?' The research site consisted of eight hospitals within two health regions in Alberta, with 47 physicians as the intended users. The data sources consisted of surveys, education sessions, design feedback, field observations, and usage logs. Preliminary results revealed an initial slow rate of adoption that gradually improved with the influence of clinical champions, more effective communication, sustained education, round-the-clock support and continued system refinement. These initial findings suggest that models of technological diffusion can help us better understand the complexities of changing physician practice behaviors.

Aim: The aim of our study was to assess whether the Karnofsky Performance Status (KPS), the Eastern Cooperative Oncology Group (ECOG) Performance Status, and the Palliative Performance Scale (PPS) are interchangeable individually or within two prognostic tools: the Palliative Prognostic Score (PaP) and the Palliative Prognostic Index (PPI). Methods: We performed a subset analysis of a prospective comparative study of functional and prognostic tools and clinician prediction of survival. We studied 955 patients with advanced life-limiting illnesses (cancer and non-cancer) in the acute care and community settings. We used a descriptive statistical model and Spearman's rank correlation to assess these interchangeabilities. Results: There is a direct positive linear relationship between the KPS and the PPS, and a direct negative linear relationship between these tools and the ECOG. Exchange of the KPS and the PPS was possible within the PaP and the PPI. Conclusion: The PPS and the KPS can be used interchangeably as functional tools and within prognostic tools. The ECOG is interchangeable with the PPS and the KPS, but this interchange-ability is population-specific.

Background Increased investments are being made for electronic medical records (EMRs) in Canada. There is a need to learn from earlier EMR studies on their impact on physician practice in office settings. To address this need, we conducted a systematic review to examine the impact of EMRs in the physician office, factors that influenced their success, and the lessons learned. Results For this review we included publications cited in Medline and CINAHL between 2000 and 2009 on physician office EMRs. Studies were included if they evaluated the impact of EMR on physician practice in office settings. The Clinical Adoption Framework provided a conceptual scheme to make sense of the findings and allow for future comparison/alignment to other Canadian eHealth initiatives. In the final selection, we included 27 controlled and 16 descriptive studies. We examined six areas: prescribing support, disease management, clinical documentation, work practice, preventive care, and patient-physician interaction. Overall, 22/43 studies (51.2%) and 50/109 individual measures (45.9%) showed positive impacts, 18.6% studies and 18.3% measures had negative impacts, while the remaining had no effect. Forty-eight distinct factors were identified that influenced EMR success. Several lessons learned were repeated across studies: (a) having robust EMR features that support clinical use; (b) redesigning EMR-supported work practices for optimal fit; (c) demonstrating value for money; (d) having realistic expectations on implementation; and (e) engaging patients in the process. Conclusions Currently there is limited positive EMR impact in the physician office. To improve EMR success one needs to draw on the lessons from previous studies such as those in this review.

Context Patients, caregivers, and clinicians require high levels of information regarding prognosis when conditions are incurable. Objectives 1) To validate the Palliative Prognostic Score (PaP) and 2) to evaluate prognostic capacity of used clinical tools and the diagnosis of delirium, in a population referred to a palliative care consultation service at a Canadian acute care hospital. Methods This was a prospective observational cohort study on survival prediction based on the PaP and routinely collected clinical data, including the Palliative Performance Scale (PPS) and the Folstein Mini-Mental State Examination (MMSE). Kaplan-Meier survival curves, log-rank tests for significant differences between survival curves, and the Cox proportional hazards model were used to identify the relationship between the hazard ratio for death and the above variables. Results Nine hundred fifty-eight cases underwent final analysis, of which 181 (19%) had a noncancer diagnosis. Median and mean survival were 35 and 131 days, respectively. The three groups, divided based on different ranges of PaP, had significantly different survival curves, with 30-day-survival rates of 78%, 55%, and 11%. Age, PPS, and PaP remained significantly associated with survival, whereas diagnosis group, MMSE, and delirium became insignificant, despite lower hazard of death for cancer vs. noncancer and higher hazard for abnormal vs. normal MMSE and presence vs. absence of delirium. Conclusion The PaP was successfully validated in a population with characteristics that extend beyond those of the population in which it was originally developed. This is the largest sample in which the PaP has been validated to date.

Advanced cancer patients remain highly susceptible to infections, leading to significant morbidity and mortality. A lack of consensus on the management of infections in this population stems from the heterogeneity of the patient group, divergent goals of care, and unknown prognosis with antibiotic treatment.This prospective single cohort study examined the impact of infection and its treatment on the survival of hospitalized advanced cancer patients compared with a similar cohort without infection.A total of 441 patients were referred to the palliative care (PC) consult service in a tertiary hospital over a 12-month period. The occurrence of sepsis, organ-related infection, and antibiotic use were recorded on initial PC consult. Survival was calculated from the point of PC consult to the date of death.Of these patients, 16.6% suffered a recent episode of sepsis (with or without an identifiable organ-related infection) and 23.4% had a recent episode of organ-related infection without clinically evident sepsis. Among the patients with sepsis, organ-related infection, or both, 89.7% received antibiotics (intravenous, oral, or both). Median survival of septic and nonseptic patients was 15 and 42 days, respectively. Septic patients who responded poorly to treatment (nonresponders) had a median survival of five days vs. 142 days in good responders. This equates with a hazard ratio of 9.74 for death in antibiotic nonresponders (P0.05). Median survival for patients with an untreated organ-related infection (no sepsis) was 27 days compared with 48 days in a similar cohort receiving antibiotic therapy. Among patients on IV antibiotics, nonresponders had a median survival of six days vs. 108 days in responders. For patients on oral antibiotics, nonresponders had a median survival of six days vs. 70 days in responders.These findings suggest that a recent episode of sepsis and/or organ-related infection significantly reduces overall patient survival. Favorable antibiotic response is associated with an increase in median survival. These findings suggest that antibiotic treatment may prolong survival, and a time-limited trial may be indicated contingent on goals of care.

This retrospective study analyzed sudden functional decline using the Palliative Performance Scale (PPSv2) for patients recently admitted to a palliative care unit (PCU) to determine if this adversely affects survival. There were 3328 patients in the cohort over a 13-year period admitted to a tertiary palliative care bed (71.1%) or a residential hospice bed (28.9%). Patient age ranged from 17-102 years old with 51.9% female and 48.1% male; the majority (88.3%) had a cancer diagnosis.Given several limitations noted in the study, six preliminary findings emerged: (1) The lower the initial PPS at PCU admission, the higher the likelihood of an abrupt drop occurring shortly after admission; (2) An abrupt decline in function appears to be associated with smaller survival probabilities; (3) A greater increment change in PPS may be associated with shorter survival probabilities; (4) The lower the PPS on admission, the shorter the survival; (5) When dropping a specific increment amount, the new survival projection appears similar to the PPS level dropped to; and (6) Sudden or abrupt functional decline may be a sentinel event.The data provide evidence that abrupt functional decline implies the likelihood of shorter survival in palliative care patients and may act as a sentinel marker. It is unclear whether these findings would be generalizable outside of a PCU. These results should be interpreted with caution as a prospective evaluation is needed to confirm the results. If substantiated, it may be that incorporating sudden functional decline into palliative prognostic models may increase their predictive accuracy.

Although there is a growing body of knowledge on survival prediction in populations with advanced cancer receiving palliative care using the Palliative Performance Scale (PPS), this literature has focused on disease, gender, and care location, and less is known about how to apply such knowledge to be clinically meaningful. To address this issue, we evaluated a database comprising 13 years of initial PPS scores on 6066 patients, which were recorded on their first assessment by the Victoria Hospice palliative care team in the home or palliative care unit setting. Our results reaffirmed PPS as a significant predictor of survival, with increasing survival times associated with higher PPS levels. We explored survival time distributions, a life expectancy table, and a survival nomogram as three potential ways to assist in estimating survival times in palliative care. We also evaluated the concept of Kaplan-Meier survival curve "nose-tail" refinement, and observed that this approach requires more research. More work is needed to better identify those who live "longer than expected" or die "sooner than expected" to provide clinical utility in discussion with patients and families.

This study examines the use of the Palliative Performance Scale (PPS) in end-of-life prognostication within a regional palliative care program in a Canadian province. The analysis was done on a prospective cohort of 513 patients assessed by a palliative care consult team as part of an initial community/hospital-based consult. The variables used were initial PPS score, age, gender, diagnosis, cancer type, and survival time. The findings revealed initial PPS to be a significant predictor of survival, along with age, diagnosis, cancer type and site, but not gender. The survival curves were distinct for PPS 10%, 20%, and 30% individually, and for 40%-60% and > or =70% as bands. This is consistent with earlier findings of the ambiguity and difficulty when assessing patients at higher PPS levels because of the subjective nature of the tool. We advocate the use of median survival and survival rates based on a local cohort where feasible, when reporting individual survival estimates.

Background To analyze how seven Canadian hospice palliative care (HPC) centres and one national surveillance dataset compare with respect to the collection of forty data elements. Research and service delivery implications of the findings are discussed. Methods The data sources consisted of data element names and their definitions collected in a computer based format from seven HPC centres and one surveillance dataset. The data elements were structured into five themes: demographic, patient death, support, contact or informal caregiver; program/consultations/service request, and clinical. Each theme contains a number of data elements with a total of 40 elements included in the analysis. Comparative analysis was done on the data elements to compare their names and definitions. Results Much variation exists in data collection around HPC delivery. Such variation prevents any timely and meaningful comparison of service and care delivery across HPC centres. Patient death data, service/program data and clinical data is particularly varied. Conclusion Developing a common minimum data set is a logical starting point to help overcome data variations between care centres. Greater coordination is needed between care centres and the development of national standards and policies. Moving towards electronic data collection would help facilitate common policy and practice norms.

Background and Purpose —The replicability of the physical and mental component summary scores of the Short Form (SF)-36 has been established using the SF-12 in selected patient populations but has yet to be assessed in stroke patients. If the summary scores of the SF-12 are highly correlated with those of the SF-36, the benefits of using a shorter health-status measure may be realized without substantial loss of information or precision. Both self-reported and proxy assessments were evaluated for replicability. Methods —Intraclass correlation coefficients (ICCs) and linear regression were used to assess the ability of the SF-12 physical component summary (PCS-12) scores to predict PCS-36 scores and the SF-12 mental component summary (MCS-12) scores to predict MCS-36 scores. Multivariate regression was used to explore the relationship between SF-12 and SF-36 scores. Results —The MCS-12 and PCS-12 scores were strongly correlated with the corresponding SF-36 summary scores for surveys completed by proxy or self-report (ICCs ranged from 0.954 to 0.973). Regression analysis of the proxy assessments indicated that patient age was an important effect modifier in the relationship between MCS-12 and MCS-36 scores. Conclusions —The SF-12 reproduced SF-36 summary scores without substantial loss of information in stroke patients. Accordingly, the SF-12 can be used at the summary score level as a substitute for the SF-36 in stroke survivors capable of self-report. However, the mental health summary scores of proxy assessments are influenced by patient age, thereby limiting the replicability of the SF-36 by the SF-12 under these conditions.

Background The Palliative Performance Scale (PPS) was first introduced in1996 as a new tool for measurement of performance status in palliative care. PPS has been used in many countries and has been translated into other languages. Methods This study evaluated the reliability and validity of PPS. A web-based, case scenarios study with a test-retest format was used to determine reliability. Fifty-three participants were recruited and randomly divided into two groups, each evaluating 11 cases at two time points. The validity study was based on the content validation of 15 palliative care experts conducted over telephone interviews, with discussion on five themes: PPS as clinical assessment tool, the usefulness of PPS, PPS scores affecting decision making, the problems in using PPS, and the adequacy of PPS instruction. Results The intraclass correlation coefficients for absolute agreement were 0.959 and 0.964 for Group 1, at Time-1 and Time-2; 0.951 and 0.931 for Group 2, at Time-1 and Time-2 respectively. Results showed that the participants were consistent in their scoring over the two times, with a mean Cohen's kappa of 0.67 for Group 1 and 0.71 for Group 2. In the validity study, all experts agreed that PPS is a valuable clinical assessment tool in palliative care. Many of them have already incorporated PPS as part of their practice standard. Conclusion The results of the reliability study demonstrated that PPS is a reliable tool. The validity study found that most experts did not feel a need to further modify PPS and, only two experts requested that some performance status measures be defined more clearly. Areas of PPS use include prognostication, disease monitoring, care planning, hospital resource allocation, clinical teaching and research. PPS is also a good communication tool between palliative care workers.