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Tradução e validação da escala SPICT™ (Supportive & Palliative Care Indicators Tool) para a população portuguesa
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Resumo(s)
Introdução: A identificação de um doente com necessidade de cuidados paliativos não é direta nem objetiva, o que dificulta a decisão médica. Tal tem um impacto clínico, quer no diagnóstico, quer no tratamento, assim como na referenciação atempada dos doentes. Por este motivo têm sido desenvolvidas várias ferramentas que auxiliam o médico. Objetivo: Contribuir para a tradução, adaptação cultural e validação da The Supportive & Palliative Care Indicators Tool (SPICT™) para a população portuguesa (SPICT™-PT), por forma a facilitar o diagnóstico de doentes com necessidades paliativas (NP). Método: Estudo quantitativo, descritivo, observacional. Foi seguido o processo padronizado de tradução, adaptação cultural e validação de uma escala. Esta foi aplicada a 80 doentes, escolhidos aleatoriamente por quatro médicos de Medicina Geral e Familiar, sendo 20 doentes de cada médico. Resultados: O comité de especialistas assegurou a validade de conteúdo. Os doentes tinham uma idade mediana de 85 anos, com amplitude interquartil de 13; a idade mínima foi de 46 e a máxima de 97 anos. A maioria era do género feminino (71%) e residia em instituições de solidariedade social. Inicialmente, os médicos identificaram apenas 42,5% doentes; com a aplicação da escala SPICT™-PT constatou-se que 56,3% dos casos tinha NP. A escala revelou uma exatidão de uso de 72,5%, com sensibilidade de 75,5% e especificidade de 68,6%. Houve consistência interna, com um alto coeficiente de Kuder-Richardson de 0.890 para a globalidade dos Indicadores (Gerais e Específicos), sendo de 0.911 para a globalidade de items do Plano de Cuidados. Houve concordância inter-observadores, com um coeficiente kappa de Fleiss substancial de 0.794, com intervalos de confiança a 95% de 0.701-0.867. Conclusão A SPICT-PT é válida e fiável nos cuidados primários de saúde em Portugal. A SPICT-PT permitiu identificar facilmente os doentes com NP, quer pelos indicadores gerais de declínio clínico (pelo menos um, em 49% dos doentes), quer pelos indicadores específicos de doença (pelo menos um, em 56% dos casos). A aplicação da SPICT-PT permite a correta adequação dos cuidados prestados a doentes vulneráveis.
Introduction: The identification of a patient with need of palliative care is neither direct nor objective, that makes medical decision difficult. This has a clinical impact, both in diagnosis and treatment, as well as in the timely referral of patients. For this reason, several tools have been developed to assist the physician. Objective: To contribute to the translation, cultural adaptation and validation of The Supportive & Palliative Care Indicators Tool (SPICT™) for the Portuguese population (SPICT ™ -PT), in order to facilitate the diagnosis of patients with palliative needs (NP). Method: Quantitative, descriptive, observational study. The standardized process of translation, cultural adaptation and validation of a scale was followed. This scale was applied to 80 patients, chosen at random by four doctors of Family Medicine, with 20 patients from each doctor. Results: The expert committee ensured content validity. The patients had a median age of 85 years, with an interquartile range of 13; the minimum age was 46 and the maximum was 97 years. The majority were female (71%) and resided in social institutions. Initially, the doctors identified only 42.5% patients; with the application of the SPICT ™ -PT scale, it was found that 56.3% of the cases had PN. The scale revealed an accuracy of use of 72.5%, with a sensitivity of 75.5% and specificity of 68.6%. There was internal consistency, with a high Kuder-Richardson coefficient of 0.890 for all indicators (General and Specific), being 0.911 for all items in the Care Plan. There was inter-observer agreement, with a substantial Fleiss kappa coefficient of 0.794, with 95% confidence intervals of 0.701-0.867. Conclusion: SPICT-PT is valid and reliable in primary health care in Portugal. SPICT-PT made it possible to easily identify patients with PN, either by the general indicators of clinical decline (at least one, in 49% of patients), or by specific disease indicators (at least one, in 56% of cases). The application of SPICT-PT allows the correct adequacy of the care provided to vulnerable patients
Introduction: The identification of a patient with need of palliative care is neither direct nor objective, that makes medical decision difficult. This has a clinical impact, both in diagnosis and treatment, as well as in the timely referral of patients. For this reason, several tools have been developed to assist the physician. Objective: To contribute to the translation, cultural adaptation and validation of The Supportive & Palliative Care Indicators Tool (SPICT™) for the Portuguese population (SPICT ™ -PT), in order to facilitate the diagnosis of patients with palliative needs (NP). Method: Quantitative, descriptive, observational study. The standardized process of translation, cultural adaptation and validation of a scale was followed. This scale was applied to 80 patients, chosen at random by four doctors of Family Medicine, with 20 patients from each doctor. Results: The expert committee ensured content validity. The patients had a median age of 85 years, with an interquartile range of 13; the minimum age was 46 and the maximum was 97 years. The majority were female (71%) and resided in social institutions. Initially, the doctors identified only 42.5% patients; with the application of the SPICT ™ -PT scale, it was found that 56.3% of the cases had PN. The scale revealed an accuracy of use of 72.5%, with a sensitivity of 75.5% and specificity of 68.6%. There was internal consistency, with a high Kuder-Richardson coefficient of 0.890 for all indicators (General and Specific), being 0.911 for all items in the Care Plan. There was inter-observer agreement, with a substantial Fleiss kappa coefficient of 0.794, with 95% confidence intervals of 0.701-0.867. Conclusion: SPICT-PT is valid and reliable in primary health care in Portugal. SPICT-PT made it possible to easily identify patients with PN, either by the general indicators of clinical decline (at least one, in 49% of patients), or by specific disease indicators (at least one, in 56% of cases). The application of SPICT-PT allows the correct adequacy of the care provided to vulnerable patients
Descrição
Tese de mestrado, Cuidados Paliativos, Universidade de Lisboa, Faculdade de Medicina, 2020
Palavras-chave
Cuidados paliativos Estudo de validação Reprodutibilidade dos resultados Traduzir Traduções Avaliação de necessidades SPICT