Development and Validation of the Palliative Care Attitudes Scale (PCAS-9): A Measure of Patient Attitudes Toward Palliative Care

Laura M Perry; Michael Hoerger; Sonia Malhotra; James I Gerhart; Supriya Mohile; Paul R Duberstein

doi:10.1016/j.jpainsymman.2019.09.008

Development and Validation of the Palliative Care Attitudes Scale (PCAS-9): A Measure of Patient Attitudes Toward Palliative Care

J Pain Symptom Manage. 2020 Feb;59(2):293-301.e8. doi: 10.1016/j.jpainsymman.2019.09.008. Epub 2019 Sep 17.

Authors

Laura M Perry¹, Michael Hoerger², Sonia Malhotra³, James I Gerhart⁴, Supriya Mohile⁵, Paul R Duberstein⁶

Affiliations

¹ Department of Psychology, Tulane University, New Orleans, Louisiana, USA. Electronic address: lperry5@tulane.edu.
² Department of Psychology, Tulane University, New Orleans, Louisiana, USA; Department of Medicine, Section of Hematology and Medical Oncology, Tulane University, New Orleans, Louisiana, USA.
³ Department of General Internal Medicine & Geriatrics, Section of Palliative Medicine, Tulane University, New Orleans, Louisiana, USA.
⁴ Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA.
⁵ James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
⁶ Department of Health Behavior, Society and Policy, Rutgers University School of Public Health, Piscataway, New Jersey, USA.

PMID: 31539604
DOI: 10.1016/j.jpainsymman.2019.09.008

Abstract

Context: Palliative Care is underutilized, and research has neglected patient-level factors including attitudes that could contribute to avoidance or acceptance of Palliative Care referrals. This may be due in part to a lack of existing measures for this purpose.

Objectives: The objective of this study was to develop and validate a nine-item scale measuring patient attitudes toward Palliative Care, comprised of three subscales spanning emotional, cognitive, and behavioral factors.

Methods: Data were collected online in three separate waves, targeting individuals with cancer (Sample 1: N = 633; Sample 2: N = 462) or noncancer serious illnesses (Sample 3: N = 225). Participants were recruited using ResearchMatch.org and postings on the web sites, social media pages, and listservs of international health organizations.

Results: Internal consistency was acceptable for the total scale (α = 0.84) and subscales: emotional (α = 0.84), cognitive (αs = 0.70), and behavioral (α = 0.90). The PCAS-9 was significantly associated with a separate measure of Palliative Care attitudes (ps < 0.001) and a measure of Palliative Care knowledge (ps < 0.004), supporting its construct validity in samples of cancer and noncancer serious illnesses. The scale's psychometric properties, including internal consistency and factor structure, generalized across patient subgroups based on diagnosis, other health characteristics, and demographics.

Conclusion: Findings support the overall reliability, validity, and generalizability of the PCAS-9 in serious illness samples and have implications for increasing Palliative Care utilization via clinical care and future research efforts.

Keywords: Palliative Care; health knowledge, attitudes, practice; palliative medicine; patient-reported outcome measures; psychometrics.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Attitude*
Humans
Palliative Care*
Psychometrics
Reproducibility of Results
Surveys and Questionnaires

Grants and funding

R01 CA168387/CA/NCI NIH HHS/United States