The Spanish Adaptation of the Palliative Performance Scale (Version 2) Among Cancer Patients at the End of Life: Psychometric Properties

Abstract

Background: Palliative Performance Scale (PPS) is a reliable tool to assess performance status in cancer patients receiving palliative care (PC). Spanish validated and culturally adapted tools are needed.

Objectives: The objectives are to develop PPS translation and cross-cultural adaptation into Spanish and to assess its psychometric properties.

Design: Translation process with cross-cultural adaptation to produce Spanish Palliative Performance Scale (PPS-SPANISH).

Settings: PC Team at one University hospital in Spain.

Participants: Fifteen advanced cancer patients (60 assessments) were included for PPS translation and validation and 250 patients for cross-sectional analysis. All participants were recruited at oncology ward, emergency area, and outpatient clinic by PC team professionals. Informed consent was given. Average age was 66.4 ± 13 years (60% men).

Methods: The process is designed in three steps. In Step 1, PPS translation and reverse translation into Spanish (three bilingual speakers) and linguistic complexity measurement were performed. In Step 2, readability and intelligibility assessment was carried out. In Step 3, a pilot study was conducted to assess test-retest reliability followed by a cross-sectional study to measure internal consistency. Inclusion criteria were the same for two samples. Demographic data were also analyzed by descriptive statistics.

Results: Following cultural, linguistic, and grammatical adaptation, PPS-SPANISH was readable and reliable. The analysis of the test-retest reliability after 48 hours showed intraclass correlations >0.60. Cronbach's alpha coefficient was 0.99 (0.988-0.992). There was high agreement with other functional assessment tools (Barthel Index and Karnofsky Performance Status Index).

Conclusions: PPS-SPANISH showed reliability and validity, and it is suitable to assess performance status in cancer patients receiving PC.

Keywords: Cancer; clinical tools; nursing practice; palliative care; palliative performance scale; spanish; validation studies.