癌症患者安宁疗护质量评估工具方法学质量和测量学特性的系统评价：基于COSMIN指南

doi:10.12114/j.issn.1007-9572.2023.0227

摘要/Abstract

摘要： 背景国内外已开发出多种评估癌症患者安宁疗护质量的适用性工具，但尚无关于癌症患者安宁疗护质量评估工具测量学特性的评价性研究，造成部分安宁疗护团队难以选择最佳评估工具。目的系统评价癌症患者安宁疗护质量评估工具的方法学质量和测量学特性，为临床使用相应评估工具提供循证依据。方法 2023年3月，采用计算机检索中国知网、维普网、中国生物医学文献数据库（CBM）、万方数据知识服务平台、PubMed、Web of Science、Embase，筛选关于癌症患者安宁疗护质量评估工具方法学质量与测量学特性的文献，检索时间为建库至2023-02-06；同时追溯纳入文献的参考文献以避免漏检。由两名研究者对检索到的文献独立进行筛选与评估，采用基于共识选择健康测量工具的标准（COSMIN）对癌症患者安宁疗护质量评估工具的方法学质量与测量学特性进行系统评价，并参考推荐分级的评估、制定与评价（GRADE）系统形成证据推荐等级，最终形成推荐意见。结果最终纳入11篇文献，共涉及7个癌症患者安宁疗护质量评估工具，分别为安宁疗护结果评定量表（POS）、患者角度安宁疗护质量简表（SF-QPP-PC）、CAHPS安宁疗护调查工具（HCAHPS）、癌症治疗功能评估量表（FACT-G）、简易临终关怀清单（BHI）、Missoula-Vitas生活质量指数（MVQOLI）、患者角度护理质量评价量表（CESP）。纳入的11篇文献所涉癌症患者安宁疗护质量评估工具均未报告跨文化效度和测量误差；在内容效度上，HCAHPS、FACT-G、BHI、CESP均为"未提及"，POS、SF-QPP-PC、MVQOLI均为"不确定"；在结构效度上，MVQOLI为"未提及"，SF-QPP-PC为"不充分"，HCAHPS为"充分"，其余4个评估工具均为"不确定"；在内部一致性上，BHI、MVQOLI、CESP均为"充分"，POS、SF-QPP-PC、HCAHPS、FACT-G均为"不充分"；在稳定性上，SF-QPP-PC、MVQOLI均为"未提及"，FACT-G为"充分"，其余4个评估工具均为"不充分"；在效标效度上，POS为"不充分"；在假设检验上，SF-QPP-PC、HCAHPS、BHI均为"未提及"，CESP为"不确定"，其余3个评估工具为"充分"；在反应度上，POS、FACT-G为"不确定"。最终，POS、BHI、MVQOLI推荐等级为B级，SF-QPP-PC、HCAHPS、FACT-G、CESP推荐等级为C级。结论综合考虑，POS可被暂时推荐（推荐等级为B级），但整体上来看，癌症患者安宁疗护质量评估工具的方法学质量与测量学特性仍有待提高。

关键词: 肿瘤, 癌症, 临终关怀和姑息治疗护理, 安宁疗护, 质量评估工具, 方法学质量, 测量学特性, 系统评价

Abstract:

Background

Various tools for assessing the quality of palliative care for cancer patients have been developed both domestically and internationally, however, there is a lack of evaluative research on the measurement properties of these palliative care quality assessment tools, making it difficult for some palliative care teams to choose the best assessment tool.

Objective

To systematically evaluate the methodological quality and measurement properties of the palliative care quality assessment tools for cancer patients, providing evidence-based support for the clinical use of these assessment tools.

Methods

In March 2023, a computer-assisted search was conducted on databases including CNKI, VIP, CBM, Wanfang Data, PubMed, Web of Science, and Embase, for screening literature on the methodological quality and measurement properties of palliative care quality assessment tools for cancer patients. The search period was from the inception of the databases to February 6, 2023, and references of the included literature were traced to avoid missing any studies. Two researchers independently screened and assessed the included literature, using the COnsensus-based Standards for the selection of health Measurement Instrument (COSMIN) to systematically evaluate the methodological quality and measurement properties of palliative care quality assessment tools for cancer patients, and referring to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to form a recommendation grade for the evidence, ultimately forming a recommendation.

Results

A total of 11 literature involving 7 palliative care quality assessment tools for cancer patients were included, namely palliative care outcome scale (POS) , short form of the questionnaire quality from the patient's perspective for palliative care (SF-QPP-PC) , Consumer Assessment of Healthcare Providers and System Hospice Survey (HCAHPS) , functional assessment of cancer therapy-general (FACT-G) , rief hospice inventory (BHI) , Missoula-Vitas quality of life index (MVQOLI) , and care evaluation scale-patient version (CESP) . None of the palliative care quality assessment tools reported cross-cultural validity and measurement error in the included 11 literature; in terms of content validity, HCAHPS, FACT-G, BHI, and CESP were "not mentioned" , POS, SF-QPP-PC, and MVQOLI were "uncertain" ; in terms of structural validity, MVQOLI was "not mentioned" , SF-QPP-PC was "inadequate" , HCAHPS was "adequate" , and the other 4 assessment tools were "uncertain" ; in terms of internal consistency, BHI, MVQOLI, and CESP were "adequate" , POS, SF-QPP-PC, HCAHPS, and FACT-G were "inadequate" ; in terms of stability, SF-QPP-PC and MVQOLI were "not mentioned" , FACT-G was "adequate" , and the other 4 assessment tools were "inadequate" ; in terms of criterion validity, POS was "inadequate" ; in terms of hypothesis testing, SF-QPP-PC, HCAHPS, and BHI were "not mentioned" , CESP was "uncertain" , and the other 3 assessment tools were "adequate" ; in terms of responsiveness, POS and FACT-G were "uncertain" . Ultimately, the recommendation grade for POS, BHI, and MVQOLI was B, and for SF-QPP-PC, HCAHPS, FACT-G, and CESP was C.

Conclusion

Considering comprehensively, POS can be tentatively recommended (with a recommendation grade of B) , but overall, the methodological quality and measurement properties of palliative care quality assessment tools for cancer patients still need to be improved.

Key words: Neoplasms, Cancer, Hospice and palliative care nursing, Palliative care, Quality assessment tools, Methodological quality, Metrological characteristics, Systematic evaluation

中图分类号:

R 739.9　R 473.51

李婧菱,刘宁,郭军. 癌症患者安宁疗护质量评估工具方法学质量和测量学特性的系统评价：基于COSMIN指南[J]. 中国全科医学, 2025, 28(31): 3981-3988. DOI: 10.12114/j.issn.1007-9572.2023.0227.
LI Jingling,LIU Ning,GUO Jun. Methodological Quality and Metrological Characteristics of Palliative Care Quality Assessment Tools for Cancer Patients: a Systematic Evaluation Based on COSMIN[J]. Chinese General Practice, 2025, 28(31): 3981-3988. DOI: 10.12114/j.issn.1007-9572.2023.0227.

图/表 5

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序号	检索策略
#1	neoplasms[Mesh]O R tumor[Title/Abstract] O R neoplasm[Title/Abstract] O R neoplasia[Title/Abstract] O R cancer[Title/Abstract] O R malignant neoplasm[Title/Abstract] O R malignancy*[Title/Abstract] O R neoplasm，malignant[Title/Abstract]
#2	palliative care[Mesh] O R care，palliative[Title/Abstract] O R palliative treatment[Title/Abstract] O R treatment，palliative[Title/Abstract] O R palliative therapy[Title/Abstract] O R therapy，palliative[Title/Abstract] O R palliative supportive care[Title/Abstract] O R supportive care，palliative[Title/Abstract] O R palliative surgery[Title/Abstract] O R surgery，palliative[Title/Abstract]
#3	quality of health care[Mesh] O R health care quality[Title/Abstract] O R quality of care[Title/Abstract] O R care quality[Title/Abstract]
#4	surveys and questionnaires[Mesh] O R questionnaire*[Title/Abstract] O R questionnaires and surveys[Title/Abstract] O R measuring tools[Title/Abstract] O R scale[Title/Abstract] O R survey[Title/Abstract]
#5	（instrumentation[sh] O R methods[sh] O R Validation Studies[pt] O R Comparative Study[pt] O R "psychometrics" [MeSH] O R psychometr[tiab] O R clinimetr[tw] O R clinometr[tw] O R "outcome assessment（health care）" [MeSH] O R outcome assessment[tiab] OR outcome measure[tw] OR "observer variation" [MeSH] O R observer variation[tiab] O R "Health Status Indicators" [Mesh] O R "reproducibility of results" [MeSH] O R reproducib[tiab] O R "discriminant analysis" [MeSH] O R reliab[tiab] O R unreliab[tiab] O R valid[tiab] O R coefficient[tiab] O R homogeneity[tiab] O R homogeneous[tiab] O R "internal consistency" [tiab] O R（cronbach[tiab] AND（alpha[tiab] O R alphas[tiab]））O R（item[tiab] AND（correlation[tiab] O R selection[tiab] O R reduction[tiab]））O R agreement[tiab] O R precision[tiab] O R imprecision[tiab] O R "precise values" [tiab] O R test–retest[tiab] O R（test[tiab] AND retest[tiab]）O R（reliab[tiab] AND（test[tiab] O R retest[tiab]））O R stability[tiab] O R interrater[tiab] O R inter-rater[tiab] O R intrarater[tiab] O R intra-rater[tiab] O R intertester[tiab] O R inter-tester[tiab] O R intratester[tiab] O R intra-tester[tiab] O R interobserver[tiab] O R inter-observer[tiab] O R intraobserver[tiab] O R intra-observer[tiab] O R intertechnician[tiab] OR inter-technician[tiab] O R intratechnician[tiab] O R intra-technician[tiab] O R interexaminer[tiab] O R inter-examiner[tiab] O R intraexaminer[tiab] O R intra-examiner[tiab] O R interassay[tiab] O R inter-assay[tiab] O R intraassay[tiab] O R intra-assay[tiab] O R interindividual[tiab] O R inter-individual[tiab] O R intraindividual[tiab] O R intra-individual[tiab] O R interparticipant[tiab] O R inter-participant[tiab] O R intraparticipant[tiab] O R intra-participant[tiab] O R kappa[tiab] O R kappa's[tiab] O R kappas[tiab] O R repeatab[tiab] O R（（replicab[tiab] O R repeated[tiab]）AND（measure[tiab] O R measures[tiab] O R findings[tiab] O R result[tiab] O R results[tiab] O R test[tiab] O R tests[tiab]））O R generaliza[tiab] O R generalisa[tiab] O R concordance[tiab] O R（intraclass[tiab] AND correlation[tiab]）O R discriminative[tiab] O R "known group" [tiab] O R factor analysis[tiab] O R factor analyses[tiab] O R dimension[tiab] O R subscale[tiab] OR（multitrait[tiab] AND scaling[tiab] AND（analysis[tiab] O R analyses[tiab]））O R item discriminant[tiab] O R interscale correlation[tiab] O R error[tiab] O R errors[tiab] O R "individual variability" [tiab] O R（variability[tiab] AND（analysis[tiab] O R values[tiab]））O R（uncertainty[tiab] AND（measurement[tiab] O R measuring[tiab]））O R "standard error of measurement" [tiab] O R sensitiv[tiab] O R responsive[tiab] O R（（minimal[tiab] O R minimally[tiab] O R clinical[tiab] O R clinically[tiab]）AND（important[tiab] O R significant[tiab] O R detectable[tiab]）AND（change[tiab] O R difference[tiab]））O R（small[tiab] AND（real[tiab] O R detectable[tiab]）AND（change[tiab] O R difference[tiab]））O R meaningful change[tiab] O R "ceiling effect" [tiab] O R "floor effect" [tiab] O R "Item response model" [tiab] O R IRT[tiab] O R Rasch[tiab] O R "Differential item functioning" [tiab] O R DIF[tiab] O R "computer adaptive testing" [tiab] O R "item bank" [tiab] O R "cross-cultural equivalence" [tiab]）
#6	#1 AND #2 AND #3 AND #4 AND #5

序号	检索策略
#1	neoplasms[Mesh]O R tumor[Title/Abstract] O R neoplasm[Title/Abstract] O R neoplasia[Title/Abstract] O R cancer[Title/Abstract] O R malignant neoplasm[Title/Abstract] O R malignancy*[Title/Abstract] O R neoplasm，malignant[Title/Abstract]
#2	palliative care[Mesh] O R care，palliative[Title/Abstract] O R palliative treatment[Title/Abstract] O R treatment，palliative[Title/Abstract] O R palliative therapy[Title/Abstract] O R therapy，palliative[Title/Abstract] O R palliative supportive care[Title/Abstract] O R supportive care，palliative[Title/Abstract] O R palliative surgery[Title/Abstract] O R surgery，palliative[Title/Abstract]
#3	quality of health care[Mesh] O R health care quality[Title/Abstract] O R quality of care[Title/Abstract] O R care quality[Title/Abstract]
#4	surveys and questionnaires[Mesh] O R questionnaire*[Title/Abstract] O R questionnaires and surveys[Title/Abstract] O R measuring tools[Title/Abstract] O R scale[Title/Abstract] O R survey[Title/Abstract]
#5	（instrumentation[sh] O R methods[sh] O R Validation Studies[pt] O R Comparative Study[pt] O R "psychometrics" [MeSH] O R psychometr[tiab] O R clinimetr[tw] O R clinometr[tw] O R "outcome assessment（health care）" [MeSH] O R outcome assessment[tiab] OR outcome measure[tw] OR "observer variation" [MeSH] O R observer variation[tiab] O R "Health Status Indicators" [Mesh] O R "reproducibility of results" [MeSH] O R reproducib[tiab] O R "discriminant analysis" [MeSH] O R reliab[tiab] O R unreliab[tiab] O R valid[tiab] O R coefficient[tiab] O R homogeneity[tiab] O R homogeneous[tiab] O R "internal consistency" [tiab] O R（cronbach[tiab] AND（alpha[tiab] O R alphas[tiab]））O R（item[tiab] AND（correlation[tiab] O R selection[tiab] O R reduction[tiab]））O R agreement[tiab] O R precision[tiab] O R imprecision[tiab] O R "precise values" [tiab] O R test–retest[tiab] O R（test[tiab] AND retest[tiab]）O R（reliab[tiab] AND（test[tiab] O R retest[tiab]））O R stability[tiab] O R interrater[tiab] O R inter-rater[tiab] O R intrarater[tiab] O R intra-rater[tiab] O R intertester[tiab] O R inter-tester[tiab] O R intratester[tiab] O R intra-tester[tiab] O R interobserver[tiab] O R inter-observer[tiab] O R intraobserver[tiab] O R intra-observer[tiab] O R intertechnician[tiab] OR inter-technician[tiab] O R intratechnician[tiab] O R intra-technician[tiab] O R interexaminer[tiab] O R inter-examiner[tiab] O R intraexaminer[tiab] O R intra-examiner[tiab] O R interassay[tiab] O R inter-assay[tiab] O R intraassay[tiab] O R intra-assay[tiab] O R interindividual[tiab] O R inter-individual[tiab] O R intraindividual[tiab] O R intra-individual[tiab] O R interparticipant[tiab] O R inter-participant[tiab] O R intraparticipant[tiab] O R intra-participant[tiab] O R kappa[tiab] O R kappa's[tiab] O R kappas[tiab] O R repeatab[tiab] O R（（replicab[tiab] O R repeated[tiab]）AND（measure[tiab] O R measures[tiab] O R findings[tiab] O R result[tiab] O R results[tiab] O R test[tiab] O R tests[tiab]））O R generaliza[tiab] O R generalisa[tiab] O R concordance[tiab] O R（intraclass[tiab] AND correlation[tiab]）O R discriminative[tiab] O R "known group" [tiab] O R factor analysis[tiab] O R factor analyses[tiab] O R dimension[tiab] O R subscale[tiab] OR（multitrait[tiab] AND scaling[tiab] AND（analysis[tiab] O R analyses[tiab]））O R item discriminant[tiab] O R interscale correlation[tiab] O R error[tiab] O R errors[tiab] O R "individual variability" [tiab] O R（variability[tiab] AND（analysis[tiab] O R values[tiab]））O R（uncertainty[tiab] AND（measurement[tiab] O R measuring[tiab]））O R "standard error of measurement" [tiab] O R sensitiv[tiab] O R responsive[tiab] O R（（minimal[tiab] O R minimally[tiab] O R clinical[tiab] O R clinically[tiab]）AND（important[tiab] O R significant[tiab] O R detectable[tiab]）AND（change[tiab] O R difference[tiab]））O R（small[tiab] AND（real[tiab] O R detectable[tiab]）AND（change[tiab] O R difference[tiab]））O R meaningful change[tiab] O R "ceiling effect" [tiab] O R "floor effect" [tiab] O R "Item response model" [tiab] O R IRT[tiab] O R Rasch[tiab] O R "Differential item functioning" [tiab] O R DIF[tiab] O R "computer adaptive testing" [tiab] O R "item bank" [tiab] O R "cross-cultural equivalence" [tiab]）
#6	#1 AND #2 AND #3 AND #4 AND #5

第一作者	发表年份	评估工具	研究地区	研究对象	样本量	条目/维度数量（个）	评分方法	完成时间（min）	重测时间（d）
HEARN^[12]	1999年	POS	英国	晚期癌症患者	450	12/2	Likert 5级	10	NR
EISENCHLAS^[13]	2008年	POS	阿根廷	晚期癌症患者	65	12/2	Likert 4级	9~12	2
BAUSEWEIN^[14]	2005年	POS	德国	晚期癌症患者	118	12/2	Likert 4级	9~11	NR
闫敏^[15]	2013年	POS	中国	晚期癌症患者	80	12/2	Likert 5级	NR	NR
SANDSDALEN^[16]	2020年	SF-QPP-PC	挪威	晚期癌症患者	128	24/4	Likert 4级	NR	NR
ANHANG^[17]	2018年	HCAHPS	美国	临终患者	2 500	47/8	0~100分	NR	NR
CELLA^[18]	1993年	FACT-G	美国	癌症患者	466	27/5	Likert 5级	NR	3~7
万崇华^[19]	2006年	FACT-G	中国	癌症患者	552	27/5	Likert 5级	NR	NR
GUO^[20]	2001年	BHI	美国	晚期癌症患者	145	17/4	0~10分	NR	7
BYOCK^[21]	1988年	MVQOLI	美国	晚期癌症患者	257	25/5	Likert 5级	NR	NR
MIYASHITA^[22]	2014年	CESP	日本	癌症患者	405	23/8	0~100分	NR	NR

第一作者	发表年份	评估工具	研究地区	研究对象	样本量	条目/维度数量（个）	评分方法	完成时间（min）	重测时间（d）
HEARN^[12]	1999年	POS	英国	晚期癌症患者	450	12/2	Likert 5级	10	NR
EISENCHLAS^[13]	2008年	POS	阿根廷	晚期癌症患者	65	12/2	Likert 4级	9~12	2
BAUSEWEIN^[14]	2005年	POS	德国	晚期癌症患者	118	12/2	Likert 4级	9~11	NR
闫敏^[15]	2013年	POS	中国	晚期癌症患者	80	12/2	Likert 5级	NR	NR
SANDSDALEN^[16]	2020年	SF-QPP-PC	挪威	晚期癌症患者	128	24/4	Likert 4级	NR	NR
ANHANG^[17]	2018年	HCAHPS	美国	临终患者	2 500	47/8	0~100分	NR	NR
CELLA^[18]	1993年	FACT-G	美国	癌症患者	466	27/5	Likert 5级	NR	3~7
万崇华^[19]	2006年	FACT-G	中国	癌症患者	552	27/5	Likert 5级	NR	NR
GUO^[20]	2001年	BHI	美国	晚期癌症患者	145	17/4	0~10分	NR	7
BYOCK^[21]	1988年	MVQOLI	美国	晚期癌症患者	257	25/5	Likert 5级	NR	NR
MIYASHITA^[22]	2014年	CESP	日本	癌症患者	405	23/8	0~100分	NR	NR

第一作者	评估工具	内容效度			结构效度		内部一致性
第一作者	评估工具	相关性	全面性	理解性	指标	评级结果	Cronbach's α系数	评价结果
HEARN^[12]	POS	Da，b/？	Db/？	Da/？	NR	NR	0.65~0.70	D/-
EISENCHLAS^[13]	POS	Da，b/？	Da，b/？	Da/？	NR	NR	0.68~0.69	D/-
BAUSEWEIN^[14]	POS	Da，b/？	NR	Da/？	NR	NR	NR	NR
闫敏^[15]	POS	NR	NR	NR	EFA：2个因子	A/？	0.63~0.76	V/-
SANDSDALEN^[16]	SF-QPP-PC	Da/？	NR	Da/？	CFA：12个因子，CFI=0.719	A/-	0.59~0.86	V/-
ANHANG^[17]	HCAHPS	NR	NR	NR	CFA：6个因子，CFI=0.955	V/+	0.61~0.85	V/-
CELLA^[18]	FACT-G	NR	NR	NR	EFA：6个因子	A/？	0.65~0.82	V/-
万崇华^[19]	FACT-G	NR	NR	NR	EFA：4个因子	A/？	0.82~0.88	V/+
GUO^[20]	BHI	NR	NR	NR	CFA：2个因子	V/？	0.84~0.94	V/+
BYOCK^[21]	MVQOLI	Da/？	Da/？	NR	NR	NR	0.73	V/+
MIYASHITA^[22]	CESP	NR	NR	NR	CFA：7个因子	A/？	0.95~0.97	V/+
第一作者	稳定性		效标效度		假设检验		反应度
第一作者	ICC/加权Kappa值	评价结果	相关性/AUC	评价结果	指标	评价结果	指标	评价结果
HEARN^[12]	0.74~1.00	A/+	0.43~0.51	I/-	NR	NR	干预方法	D/？
EISENCHLAS^[13]	0.16~0.80	A/-	NR	NR	1个比较量表	A/+	干预方法	D/？
BAUSEWEIN^[14]	0.01~0.39	D/-	NR	NR	NR	NR	NR	NR
闫敏^[15]	NR	NR	0.574	I/-	NR	NR	NR	NR
SANDSDALEN^[16]	NR	NR	NR	NR	NR	NR	NR	NR
ANHANG^[17]	0.67~0.81	D/-	NR	NR	NR	NR	NR	NR
CELLA^[18]	0.82~0.88	D/+	NR	NR	4个比较量表	A/+	NR	NR
万崇华^[19]	0.87~0.91	D/+	NR	NR	NR	NR	干预前后	I/？
GUO^[20]	0.58~0.63	A/-	NR	NR	NR	NR	NR	NR
BYOCK^[21]	NR	NR	NR	NR	3个比较量表	D/+	NR	NR
MIYASHITA^[22]	0.48~0.70	A/-	NR	NR	1个比较量表	D/?	NR	NR