#POS2015 PARIHS framework: evidence, context and facilitation. CFIR: intervention, outer setting (big picture, policy etc)...

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 focus on team, organisation, practice change rather than symptoms, patient, health outcomes.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Implementation science: aka knowledge transfer. Different to QI and different to research.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Implementation science by Jana Witt. How to think about process of implementing POS.

— Becky Baines (@Becbaines) February 6, 2015

Blimey #PeolcPSP and #POS2015 at the same time...can it be done? @PeolcPSP

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 POS in Africa uses 0-5 as it matches the picture of the hand. No enthusiasm to change IPOS to match.

— Becky Baines (@Becbaines) February 6, 2015

@Becbaines Asked by @superspesh. I missed answer as I was trying to find you Josie, any key pts from answer? #POS2015

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 How long til launch of POS-DemA for clinical practice? Likely to be end of year. First draft going out soon.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Q from floor: Re: dementia what about Abbey Pain Scale?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 From @DrFlissMurtagh: "don't let the search for the perfect be the enemy of the 'good' "

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 How can we have reliable measures of experience? Resilience important, but maybe continuity of care more important?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Q: what to say to staff/managers that want to measure resilience in some way?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Overall, Richard Harding's talk made me think to myself: "stop creating problems and just get on with it" #respect

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Data collection in clinics with hundreds of pts? When power goes down?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 How to develop tool with no written language, only oral tradition? Blimey!

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Amazing! First team to develop POS for children. Now being translated for use in Europe et al

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Looking at effectiveness of education programmes using POS.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Used POS to show better symptom control in places with no #hpm vs clinical teams. Great graph, which I'll tweet later...

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Feeling "at peace" now into IPOS main scale.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Translated into many many languages and different dialects. Amazing!

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 eg. scoring in low literacy areas. Verbal vs hand vs jerry can vs face scale. Hand best. (It's a picture of a hand with fingers up)

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 I just want to take a minute to say: blimey the work in Africa is amazing! Richard Harding giving brilliant presentation @CSI_KCL

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Fascinating that #hpm is much more about diagnosis to death care in Africa, cf high income countries.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Wanted to cover many countries. Reflect urban and rural pops.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Parachuting teams into Africa not the way to develop tool. Needed to bring together local teams.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 key issues: drug availability eg. Clever use of colour coded liquid morphine according to concentration, in used plastic bottles

— Becky Baines (@Becbaines) February 6, 2015

@ClareEllisSmith discussing an adaptation of POS - POS-DemA: an evolving dementia assessment tool at #POS2015

— josie dixon (@superspesh) February 6, 2015

#POS2015 Strategic approach: demonstrate effectiveness of Pall Care. Need pt level data to do that.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 1.1 billion population. HIV and increasingly cancer. Many different challenges. Multiple ethnic groups. Very diverse.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 African Palliative Care Association - APCA very involved with @CSI_KCL

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 72 countries now registered as POS users.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Next up: Richard Harding on the African POS.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Potential to use this version of POS with frail elderly population in the future.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Planning for phase 3 now: aiming to study 65 residents. Look at first language English speaking staff vs not first language.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Version 2 available. Includes staff guide to symptom assessment.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Staff were cautious of reducing pt care to tick boxes and numbers. Should be completed by key worker: who knows the patient best?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Staff wanted to add agitation, wandering, diarrhoea. Wanted a more comprehensive tool.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Guide for pain/depression symptoms for clinical staff. Really useful. (Will photograph slide later and tweet)

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Included swallowing, skin break down, delusions or hallucinations. Able to engage in pleasurable activities?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Included swallowing, skin break down, delusions or hallucinations. Able to engage in pleasurable activities?

— Becky Baines (@Becbaines) February 6, 2015

Adapting and validating a measure the African POS: translation and cultural adaptation, Dr Richard Harding #POS2015 #hpm #palliative care

— CSI Palliative Care (@CSI_KCL) February 6, 2015

#POS2015 Kept core POS, modified for symptoms in Dementia.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Project aimed to develop tool, but also ensure it was relevant/useful. Lay (former carer), stakeholders, clinicians involved

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Did not want clinical team to end up being slaves to the clinical tool

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 How can routine assessment tools be introduced successfully into Care Homes? Wanted to make it a useful and valuable clinical tool

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 POS-DemA can be used as an assessment tool. Facilitate detection of symptoms, especially by HCAs in Residential Homes

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Symptoms become less easy to spot as communication deteriorates. We miss opportunities to improve symptoms.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 High levels of co morbidity and symptom burn in Dementia. Verbal communication becomes more challenging over time.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Next up: Clare Ellis-Smith on using POS for people with dementia. (@docofagesSophie up your street?)

— Becky Baines (@Becbaines) February 6, 2015

@DrFlissMurtagh discussing validation of POS (for what in what circumstance with what population?) at #POS2015

— josie dixon (@superspesh) February 6, 2015

#POS2015 Allowed refinement of certain questions: eg. Separate question on family vs pt info needs now.

— Becky Baines (@Becbaines) February 6, 2015

New POS-derived screening tool for residents with #dementia, Clare Ellis-Smith introduces new tool at #POS2015 #hpm #palliative care

— CSI Palliative Care (@CSI_KCL) February 6, 2015

#POS2015 IPOS cognitive interviews with pts. 25 pts took part from UK and Germany. Mainly cancer pts, only 3 non.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Have completed IPOS validation for research. Data collection finished 31/1/15. Being analysed.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Construct validity of POS tested vs EORTC and STAS (for staff version of POS)

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 History of POS: 1999 initially developed. Has evolved since then.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Spectrum of validity and reliability. Key question is: will it work in my pt population, in my proposed study?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Does it respond to clinically meaningful change? Is it an appropriate format? (Culture, length, language)

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 What matters most to pts? Pain and Sx control. Reduce burden on family. Priorities and prefs listened to. Meaningful.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Good noddy's guide to this in Bland and Altman BMJ 2002

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Reliabilty: does it behave the way we expect it to behave? Inter-rater, Test-retest...

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Criterion validity: compare to gold standard.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Construct validity: does it work with other variables?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Face validity: does it look right subjectively? Content validity: all important concepts included?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Must be "psychometrically robust"? Validity - does it measure what you intend it to measure?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Think about the purpose of using POS. Screening for entry into study? As outcome measure for change in practice/intervention?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Need to think about language: outcome measure eg POS vs primary or secondary research outcome. Different things.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 @DrFlissMurtagh Now talking about validity and reliability.

— Becky Baines (@Becbaines) February 6, 2015

Outcome measurement: POS, POS-S & IPOS validity and reliability @DrFlissMurtagh #POS2015 #hpm #palliative care

— CSI Palliative Care (@CSI_KCL) February 6, 2015

#POS2015 Comment from Katy Pannell from @CSI_KCL. Different when used clinically (as local CNS) vs for research, as research nurse.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Suggestion from Claudia Bausewein. Use POS as clinical tool for structuring conversations and ensuring important symptoms covered

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Helpful to use open questions in clinical interviews/discussions.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 A from @ij_higginson: try to understand why it is difficult to ask the POS questions in a standardised way. What does that mean?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 What about tracking scores for the free text problems raised in IPOS?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Yesterday we were encouraged to be pragmatic for clinical use. Is that the same for research use?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Q: what about difference in subtle way of asking questions for clinical use vs research use?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Suggestion from Claudia Bausewein would be to stick with main IPOS questions for multiple diseases. Key symptoms included.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 A: from @ij_higginson: IPOS will be core, but then can add on modules for specific diseases.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Q: what is the intention re: family of tools? Eg how many different disease will be looked at? What about multiple conditions?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Reference available for modified, 6 q version of ZBI. Will share details later.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Also think FAMCARE family of measures are useful. Often use these two measures alongside POS.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Looking to see how short you can make the ZBI. Can go down to 6 questions, even down to 1: "how burdened are you?"

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 A: from @ij_higginson. One component of POS is caregiver anxiety. But Zarik-Burden inventory for caregivers is helpful.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Q from the floor: what about measurement of caregiver functioning/distress?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Again, @ij_higginson encouraging participation from Twitter users. Happy to take questions/comments from those online.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Team have sought significant feedback from POS users. POS has changed and improved over the years.

— Becky Baines (@Becbaines) February 6, 2015

Links to MORECare guide: research in #palliative & end of life care, http://t.co/UX294EfyR3 or on POS http://t.co/oZlHW9mY6Z #POS2015 #hpm

— CSI Palliative Care (@CSI_KCL) February 6, 2015

#POS2015 Same language, different culture: eg Argentinian Spanish vs European Spanish. Cultural differences did not translate well.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Strengths and weaknesses perceived. Culture makes a difference: eg "life worthwhile", "are you feeling good about yourself?"

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Many different purposes for studies: validation, evaluation used as Gold standard in some studies.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Many translations available. At least 20 languages. Main publications UK, Germany, Africa, but many other countries.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Interestingly there is a POS for renal patients. #hpm Also studies looking at use in HIV, heart failure, neurological disease...

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Found 79 POS papers since 1999. Various versions of POS over the years.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Next up: Claudia Bausewein on systematic review of POS, updated 2014.

— Becky Baines (@Becbaines) February 6, 2015

Systematic review & #Outcome measurement research in Europe and Africa, Prof Claudia Bausewein discusses at #POS2015 #hpm

— CSI Palliative Care (@CSI_KCL) February 6, 2015

#POS2015 How could @CSI_KCL help #hpm community to use the POS tool. How can we all make POS better, more useful?

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 POS has been continuously developed over 28 years. Always evolving.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Timing: clear identification of time pts before starting evaluation. Can be fixed and/or flexible (eg. Something changes for pt)

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Proxy data: need guidelines to help proxies fill in data, capture pt experience, data from pt vs proxy should be differentiated

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 OM's need to be: easy, short, low complexity. Across settings. Responsive to change over time. Clinically imp. Reliable and valid.

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 MORECare looked at properties of OM, use of proxies and timing of measurement.

— Becky Baines (@Becbaines) February 6, 2015

@Becbaines and there you go again! Hope you have another #POS2015 great day! #hpm #palliative @CSI_KCL

— Bárbara Antunes (@B_CP_Antunes) February 6, 2015

#POS2015 MORECare project (overview in BMC medicine 2013, links on @CSI_KCL website) looked at best methods of research in #hpm

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Need research measures that work practically in clinical care

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 @ij_higginson opening the day with an overview of outcome measures. Generic vs specific to #hpm.

— Becky Baines (@Becbaines) February 6, 2015

There will be more epic tweeting today. Hit mute now if you're not interested in #hpm #palliative #POS2015

— Becky Baines (@Becbaines) February 6, 2015

#POS2015 Day 2: Using POS in research.

— Becky Baines (@Becbaines) February 6, 2015

A pretty sunrise from the plane - heading to #POS2015 at the @CSI_KCL. Looking forward to research discussions! pic.twitter.com/RqhkoV5xfG

— Jayne Galinsky (@Jaynegalinsky) February 6, 2015

After a very successful POS clinical training day, looking forward to our research training day #POS2015 day @CSI_KCL

— Liesbeth van Vliet (@Liesbeth_vVliet) February 6, 2015

@ij_higginson welcomes delegates to our second day for using POS family of measures, bring on the research #POS2015 #hpm #palliative care

— CSI Palliative Care (@CSI_KCL) February 6, 2015