Background Phase of Illness (POI) is one of the measures in the Outcome Assessment and Complexity Collaborative (OACC) suite of measures, and describes the current stage in the patient’s illness according to the care needs of the patient and their family. The phases are: stable, unstable, deteriorating, dying and deceased. POI is documented at every patient clinical contact by a range of healthcare professionals (HCPs); therefore consistency of phase assessment is important. The aim of this survey was to assess the consistency of POI assessment.
Method A survey was emailed to all clinical staff and had two peer reviewed fictional case studies evolving over time. They were asked to select the POI that best described the patient’s situation at various time points.
Results Fifty-one HCPs completed scenario 1 and 41 completed scenario 2. The range of HCPs included nurses, doctors, physiotherapists, occupational therapists, counsellors, social workers and complementary therapists.
Scenario 1 – Mrs A with metastatic lung cancer, and six phase assessments. There was majority agreement across all phase assessments. The phase assessment with least agreement was Q5 stable 63%; unstable 1%; deteriorating 35%. All other assessments had >70% agreement with a particular POI.
Scenario 2 – Mr B with Motor Neurone Disease (MND), and seven phase assessments. There was less agreement across the phase assessments. Three POI assessments had <70% majority agreement: Q3- Stable 10%, Unstable 45%, Deteriorating 45%; Q4 – Stable 68%, Unstable 7.5%, Deteriorating 24.5%; Q7 – Stable 7.5%, Unstable 55%, Deteriorating 37.5%.
Conclusion There was less consistency of POI assessment in the MND patient scenario, particularly in terms of unstable and deteriorating phases, compared to the cancer patient scenario. This disparity may reflect the different disease trajectories and HCP familiarity with each condition. This has led to further multidisciplinary team training focusing on POI assessment in non-cancer conditions.
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