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Development and Validation of a Tool to Assess the Structural Quality of Palliative Care Services

  • Aintzane Gallastegui-Brana
    Affiliations
    Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina (A.G.B., A.R.N., J.P., S.S.G., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile

    Escuela de Enfermería (A.G.B.), Pontificia Universidad Católica de Chile, Centro Colaborador OPS/OMS, Santiago, Chile
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  • Alfredo Rodríguez-Nunez
    Affiliations
    Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina (A.G.B., A.R.N., J.P., S.S.G., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile

    Sección Medicina Paliativa, Escuela de Medicina (A.R.N., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile

    Instituto Nacional del Cáncer (A.R.N., F.S.S.), Santiago, Chile
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  • Josefa Palacios
    Affiliations
    Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina (A.G.B., A.R.N., J.P., S.S.G., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile
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  • Fernanda Soto-Soto
    Affiliations
    Instituto Nacional del Cáncer (A.R.N., F.S.S.), Santiago, Chile
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  • Joel Castellano
    Affiliations
    Programa Farmacología y Toxicología (J.C.), Pontificia Universidad Católica de Chile, Santiago, Chile
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  • Sebastián Soto-Guerrero
    Affiliations
    Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina (A.G.B., A.R.N., J.P., S.S.G., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile
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  • Pedro E. Pérez-Cruz
    Correspondence
    Address correspondence to: Pedro E. Pérez-Cruz, MD, MPH, Sección Medicina Paliativa. Facultad de Medicina - Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Oficina 523, Santiago, Chile. 8330077.
    Affiliations
    Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina (A.G.B., A.R.N., J.P., S.S.G., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile

    Sección Medicina Paliativa, Escuela de Medicina (A.R.N., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile
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      Abstract

      Context

      The current gap in access to palliative care requires the expansion of palliative care services worldwide. There is little information about the structural components required by palliative care services to provide adequate end-of-life care. No specific tools have been developed to assess the structural quality of these services.

      Objective

      To develop and validate a tool to assess the structural quality of palliative care services.

      Methods

      A scoping review of literature was performed to identify structural quality indicators of palliative care services. National experts participated in a two-round Delphi method to reach consensus regarding the importance and measurement feasibility of each proposed indicator. Consensus was reached for each indicator if 60% or more considered them both important and feasible. The selected indicators were tested among Chilean palliative care services to assess instrument psychometric characteristics.

      Results

      Thirty-one indicators were identified. Thirty-five experts participated in a two-round Delphi survey. Twenty-one indicators reached consensus and were included in the structural quality of palliative care services tool (SQPCS-21). This instrument was applied to 201 out of 250 palliative care services in Chile. Achievement for each indicator varied between 8% and 96% (mean 52%). The total SQPCS-21 score varied between 3 and 21 points (mean 11 points).

      Conclusion

      The SQPCS-21 tool to assess structural quality of palliative care services, has good content and construct validity and its application provides information about institutions at the individual and aggregated level. This tool can provide guidance to monitor the structural quality of palliative care worldwide.

      Key Words

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