Validating performance status and activities of daily living assessment tools for Chinese palliative care in a cancer setting: A cross-cultural psychometric study

Objective: National approaches to the routine assessment of palliative care patients improve patient outcomes. However, validated tools and a national methodology for this are lacking in Mainland China. The Australian Palliative Care Outcomes Collaboration (PCOC) model is a well-established national program aimed at improving the quality of palliative care based on point-of-care outcomes assessment. This study aimed to culturally adapt and validate two measures used in PCOC (Australia-modified Karnofsky Performance Status [AKPS], Resource Utilization Groups- Activities of Daily Living [RUG-ADL]) in the Chinese context. Methods: A cross-cultural adaptation and validation study involving forward and backward translation methods, cognitive interviewing, and psychometric testing. Results: Two minor adjustments were made to the scoring instructions for the RUG-ADL, and the AKPS remained unchanged. Twenty-two clinicians participated in psychometric testing, completing 363 paired assessments on 135 inpatients. The correlations between AKPS and the Barthel index (BI) for activities of daily living (r = 0.77, P < 0.001), AKPS and RUG-ADL (r =- 0.82, P < 0.001), RUG-ADL and BI (r =- 0.67 to- 0.76) demonstrated good concurrent validity for both the AKPS and the RUG-ADL. The inter-rater reliability for AKPS (k = 0.63) and RUG-ADL were substantial and moderate (k = 0.51-0.56), respectively. The RUG-ADL also showed good internal consistency (Cronbach's alpha = 0.92). Both tools were able to detect patients'urgent needs. Conclusions: The Chinese version of AKPS and RUG-ADL can be systematically used to assess performance status and dependency among palliative care patients. However, observational assessments and enhanced communication between clinicians and patients/caregivers is also recommended for optimal clinical utility.