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How to administer POS
The gold standard in palliative care outcome measurement is patient-reported outcome measures (PROMs or PROs), i.e. the best way to measure outcomes is to ask patients themselves.
Self administration
For POS, if the patient version is used it is described as being self-administered.
A clear and concise explanation of what POS is, the purpose of POS, and the benefits of using POS will help patients before they self-administer. Some patients may find reading the POS user manual useful, although this may not be suitable for all.
Informal training in how to self-administer may help, and staff may wish to be present to answer questions when POS is used for the first time. Informal training can include an explanation of why questions should be used as they are (and not changed when used), how to score, and how to share scores with others involved in their care. We advise that guidance is given to patients and carers about what to do if items are scored three or higher.
Staff/Carer administration
Proxy measures can be collected alongside patient completion as well as when self-administration is not possible (e.g., due to cognitive impairment). The staff version is used when staff complete POS, and the carer version is used when informal carers use POS (e.g., family members, close friends or someone close to the patient). Research has shown that staff tend to underestimate some type of symptoms so caution should be exercised if only staff reports are used.
Staff and carers should read the user manual before they use POS. Using POS with a patient requires them to share personal information. It is therefore important that the staff member develops trust and a good rapport with the patient, provides information about POS and uses POS in a quiet, private place, away from distractions. This will help accurate and reliable information to be collected
Courses and workshops in outcome measurement and POS may be useful in developing POS competencies and knowledge. We are in the process of finalising the e-learning modules.
POS can be administered face-to-face, via video-conferences or over the telephone. Any palliative care team member (including volunteers) can administer POS. Sharing POS within the clinical team aids comprehensive assessment and care planning.
Frequency of use
A baseline needs to be established before POS is used routinely. To do this, patients and clinicians need to use POS in their specific setting a few times before routine monitoring can begin. After a baseline has been established, the frequency of use depends on why the measure is being used. For example, symptom measurement might involve more frequent use as compared to measurement of information provision.
POS is quick and easy to use. Research has shown that it can be completed in less than 10 minutes.
‘... a great tool to go through once a week or once every 5 days, and review all the care plans’(Hospice nurse comment)
‘... initially, it took a bit longer but, as they got used to the questions and the questionnaire and the ways they had to fill them in, then it took even less of their time ...’(Nursing home nurse comment)
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