Assessment and monitoring by Integrated Palliative care Outcome Scale: an observational study on cancer patients at home.

Abstract

Purpose: Integrated Palliative care Outcome Scale (IPOS) is a specific tool for assessing needs in palliative care, recording and monitoring physical symptoms, emotional concerns, and communication and practical issues. This study aimed to evaluate if the IPOS tool was able to assess the impact of at-home palliative care program on physical symptoms and psychosocial problems in advanced cancer patients.

Methods: This observational prospective longitudinal mixed-method study included advanced cancer patients assisted at home. IPOS questionnaire (patient version-7-day recall) was administered at the entry, after 2 and 4 weeks. A qualitative thematic analysis (TA) of the first open-ended question was performed. Change over time in IPOS scores was analyzed by Friedman's test for repeated measures.

Results: Among the 60 patients included (29 men, 31 women; 68.2 ± 14.0 years), 47 completed the 4-week observation period. TA indicated that the 3 main themes running through the three surveys (at the entry, day 14, and day 28) relate patients' concerns about symptoms and side effects of treatments, family members, the evolution of the disease, and the daily issues. Repeated measures test demonstrated that patients entering with medium-high IPOS total score (n = 27) showed a significant decrease in IPOS total score (p = 0.003), physical symptoms (p = 0.002), and communication and practice (p = 0.028) subscales after 2 and 4 weeks.

Conclusion: Patients entering in home care with higher burden of symptoms and psychosocial problems reported significant decrease in IPOS scores. In these patients, IPOS was responsive to change showing substantial clinical improvements after the activation of home assistance.