ICU患者安宁疗护筛查工具的研制与信效度检验

Development and reliability and validity of the screening tool for palliative care in the intensive care unit

目的 研制ICU患者安宁疗护筛查工具并检验信效度,为ICU医护人员提供便捷、有效的安宁疗护对象筛查工具。方法 通过文献分析、专家函询构建ICU患者安宁疗护筛查工具;回顾性分析206例ICU患者的相关资料,检验该筛查工具信效度,并确定安宁疗护触发值。结果 ICU患者安宁疗护筛查工具包含3个一级条目、17个二级条目。内容效度指数为0.919,评定者间信度为0.979。2种结局(转出或死亡)患者筛查得分比较,差异有统计学意义(P<0.05);触发值为8.5分,ROC曲线下面积为0.992[95%CI(0.983,1.000),P<0.05],灵敏度为0.936,特异度为0.969,阳性预测值为0.917,阴性预测值为0.981。结论 ICU患者安宁疗护筛查工具的信效度良好,可作为ICU安宁疗护对象的筛查工具。

Objective To develop and test the reliability and validity of the screening tool for palliative care in the intensive care unit,aiming to provide a convenient and effective screening tool for ICU medical staff.Methods Literature review and Delphi expert consultation were performed to develop the screening tool,then 206 ICU patients were retrospectively analyzed to test the reliability and validity of the tool.The value for triggering palliative are was determined.Results The screening tool for palliative care in the intensive care unit included 3 primary-level indicators and 17 secondary-level items.The content validity index of the total scale was 0.919,and the inter-rater reliability was 0.979.Patients transferred out of the ICU had significantly lower screening score than those died in the ICU(P<0.05).The score for triggering palliative care was 8.5 points,with the area under the receiver operating characteristic curve of 0.992[95%CI(0.983,1.000),P<0.05],the sensitivity of 0.936,the specificity of 0.969,the positive predictive value of 0.917,and the negative predictive value of 0.981.Conclusion The screening tool for palliative care in the intensive care unit has good reliability and validity,which can be used to identify patients with palliative care needs in the intensive care unit.