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Questionnaires and tools

POS - Palliative care Outcome Scale

For free access to POS resources and to keep up to date with POS developments, please visit the new POS website.

Background to POS

The POS represents a further development in outcome measures in palliative care, following STAS. It has 10 items, plus an open field for patient reports. It builds on some of the strengths of the STAS, such as clinical application and ease of use. It also addresses some of the weaknesses, such as integrating greater direct patient assessment and patient defined fields. It was validated in eight different settings, including hospital, community, in-patient hospice, outpatient, day care and general practice.

Published papers on the Palliative care Outcome Scale
  • BAUSEWEIN C, BOOTH S, GYSELS M, Kühnbach R, Haberland B, HIGGINSON IJ. Understanding Breathlessness: Cross-Sectional Comparison of Symptom Burden and Palliative Care Needs in Chronic Obstructive Pulmonary Disease and Cancer. Journal Of Palliative Medicine 2010;13(9):1109-1118
  • BAUSEWEIN C, Fegg M, Radbruch L, Nauck F, von MS, Borasio GD, et al. Validation and clinical application of the German version of the palliative care outcome scale. J Pain Symptom Manage 2005 Jul;30(1):51-62.
  • BAUSEWEIN C, Le Grice C, SIMON ST, HIGGINSON IJ, on behalf of PRISMA. The use of two common palliative outcome measures in clinical care and research: A systematic review of POS and STAS. Palliative Medicine 2011 [In press] DOI: 10.1177/0269216310395984
  • Brandt HE, Deliens L, van der Steen JT, Ooms ME, Ribbe MW, van der Wal G. The last days of life of nursing home patients with and without dementia assessed with the palliative care outcome scale. Palliat Med 2005 Jun;19(4):334-42.
  • Buchanan D, Milroy R, Baker L, Thompson AM, Levack PA. Perceptions of anxiety in lung cancer patients and their support network Support Care Cancer 2010;18:29–36
  • Cooper J, Hewison A. Implementing audit in palliative care: an action research approach. J Adv Nurs 2002 Aug;39(4):360-9.
  • Corner J, Halliday D, Haviland J, Douglas HR, Bath P, Clark D, et al. Exploring nursing outcomes for patients with advanced cancer following intervention by Macmillan specialist palliative care nurses. J Adv Nurs 2003 Mar;41(6):561-74.
  • Dunckley M, Aspinal F, Addington-Hall JM, Hughes R, HIGGINSON IJ. A research study to identify facilitators and barriers to outcome measure implementation. Int J Palliat Nurs 2005;11(5):218-25.
  • EDMONDS P, Hart S, GAO W, Vivat B, BURMAN R, Silber E, et al. Palliative care for people severely affected by multiple sclerosis: evaluation of a novel palliative care service. Mult Scler 2010 May;16(5):627-36.
  • Eisenchlas JH, HARDING R, Daud ML, Perez M, De Simone GG, HIGGINSON IJ. Use of the palliative outcome scale in Argentina: a cross-cultural adaptation and validation study. J Pain Symptom Manage 2008 Feb;35(2):188-202.
  • Goodwin DM, HIGGINSON IJ, Myers K, Douglas HR, Normand CE. Effectiveness of palliative day care in improving pain, symptom control, and quality of life. J Pain Symptom Manage 2003 Mar;25(3):202-12.
  • HARDING R, HIGGINSON IJ, Leam C, Donaldson N, Pearce A, George R, Robinson V, Taylor L. Evaluation of a short-term group intervention for informal carers of patients attending a home palliative care service. Journal of Pain and Symptom Management 2004;27:396-408
  • HARDING R, HIGGINSON IJ, Donaldson N. The relationship between patient characteristics and carer psychological status in home palliative cancer care. Supportive Care in Cancer 2003;11:638-643
  • HARDING R, SELMAN L, Aguipo G, Dinat N, Downing J, Gwyther L, Mashao T, Mmoledi K, Moll T, Sebuyira LM, Panjatovic B, HIGGINSON IJ. Validation of a core outcome measure for palliative care in Africa: the APCA African Palliative Outcome Scale Health & Quality of Life Outcomes 2010;8(10)
  • Hearn J, HIGGINSON IJ. Development and validation of a core outcome measure for palliative care: the palliative care outcome scale. Palliative Care Core Audit Project Advisory Group. Qual Health Care 1999 Dec;8(4):219-27.
  • Hermann K, Miksch A, Szecsenyi J, Engeser P. [Palliative Care in General Practice – Concordance of Care Assessment Between General Practitioners and Patients on the Palliative Care Outcome Scale (POS)]. Z Palliativmed 2010;11:26-33
  • HIGGINSON IJ, Donaldson N. Relationship between three palliative care outcome scales. Health Qual Life Outcomes 2004;2:68.
  • HIGGINSON IJ, Hearn J. A multicenter evaluation of cancer pain control by palliative care teams. J Pain Symptom Manage 1997 Jul;14(1):29-35.
  • HIGGINSON IJ, Hart S, BURMAN R, Silber E, SALEEM T, EDMONDS P. Randomised controlled trial of a new palliative care service: Compliance, recruitment and completeness of follow-up. BMC Palliat Care 2008;7:7.
  • HIGGINSON IJ, HART S, Silber E, BURMAN R, EDMONDS P. Symptom prevalence and severity in people severely affected by Multiple Sclerosis. Journal of Palliative Care 2006;22:158-165
  • HIGGINSON IJ, McCrone P, Hart SR, BURMAN R, Silber E, EDMONDS PM.Is short-term palliative care cost-effective in multiple sclerosis? A randomized phase II trial. J Pain Symptom Manage. 2009 Dec;38(6):816-26.
  • HIGGINSON IJ, GAO W. Caregiver assessment of patients with advanced cancer: concordance with patients, effect of burden and positivity. Health Qual Life Outcomes 2008;6:42.
  • Horton R. Differences in assessment of symptoms and quality of life between patients with advanced cancer and their specialist palliative care nurses in a home care setting. Palliat Med 2002 Nov;16(6):488-94.
  • Hughes R, Aspinal F, Addington-Hall J, Chidgey J, Drescher U, Dunckley M, et al. Professionals' views and experiences of using outcome measures in palliative care. Int J Palliat Nurs 2003 Jun;9(6):234-8.
  • Hughes R, Aspinal F, Addington-Hall JM, Dunckley M, Faull C, HIGGINSON I. It just didn't work: the realities of quality assessment in the English health care context. Int J Nurs Stud 2004 Sep;41(7):705-12.
  • Hughes RA, Aspinal F, HIGGINSON IJ, Addington-Hall JM, Dunckley M, Faull C, et al. Assessing palliative care outcomes for people with motor neurone disease living at home. Int J Palliat Nurs 2004 Sep;10(9):449-53.
  • Hughes RA, Sinha A, Aspinal F, Dunckley M, Addington-Hall J, HIGGINSON IJ. What is the potential for the use of clinical outcome measures to be computerised? Findings from a qualitative research study. Int J Health Care Qual Assur Inc Leadersh Health Serv 2004;17(1):47-52.
  • Justo R, I, SIMMS V, HARDING R. Multidimensional problems among advanced cancer patients in Cuba: awareness of diagnosis is associated with better patient status. J Pain Symptom Manage 2009 Mar;37(3):325-30.
  • Krug R, Karus D, Selwyn PA, Raveis VH. Late-stage HIV/AIDS patients' and their familial caregivers' agreement on the palliative care outcome scale. J Pain Symptom Manage 2010 Jan;39(1):23-32.
  • Laila M, Rialle V, Nicolas L, Duguay C, Franco A. Videophones for the delivery of home healthcare in oncology. Stud Health Technol Inform 2008;136:39-44.
  • Lerzynski GA, Allen A, Murray SA. An assessment of the ability of the Palliative Care Outcome Scale (POS) in different forms of care to measure palliative care outcomes in different settings. The use of a palliative care outcome measure in cancer patients attending St Columba's day hospice, Edinburgh, and in patients with lung cancer or heart failure in primary care. Journal of Palliative Medicine 2004;5(19):19-27.
  • Lopes FP, Pinto BA. [Measuring quality of life in palliative care]. Acta Med Port 2008 Mar;21(2):111-24.
  • Morita T, Takigawa C, Onishi H, Tajima T, Tani K, Matsubara T, et al. Opioid rotation from morphine to fentanyl in delirious cancer patients: an open-label trial. J Pain Symptom Manage 2005 Jul;30(1):96-103.
  • Morita T, Fujimoto K, Tei Y. Palliative care team: the first year audit in Japan. J Pain Symptom Manage 2005 May;29(5):458-65.
  • MURPHY E, MURTAGH FEM, Carey I, Sheerin NS. Understanding symptoms in patients with advanced chronic kidney disease managed without dialysis: use of a short patient-completed assessment tool. Nephron Clinical Practice 2009;111:c74-c80
  • Pappas G, Wolf RC, Morineau G, HARDING R. Validity of measures of pain and symptoms in HIV/AIDS infected households in resources poor settings: results from the Dominican Republic and Cambodia. BMC Palliat Care 2006;5:3.
  • Powell RA, Downing J, HARDING R, Mwangi-Powell F, Connor S. Development of the APCA African Palliative Outcome Scale. Journal of Pain & Symptom Management 2010;33(2):229-232
  • Rosemann T, Hermann K, Miksch A, Engeser P, Szecsenyi J. The PAMINO-project: evaluating a primary care-based educational program to improve the quality of life of palliative patients. BMC Palliat Care 2007;6:5.
  • Serra-Prat M, Nabal M, Santacruz V, Picaza JM, Trelis J. [Validation of the Spanish version of the Palliative Care Outcome Scale]. Med Clin (Barc ) 2004 Oct 2;123(11):406-12.
  • Sherry KL, McAuley G. Symptom prevalence and the use of systematic symptom assessment. Palliat Med. 2004 Jan;18(1):75-6
  • SIEGERT RJ, GAO W, Walkey FH, HIGGINSON IJ. Psychological well-being and quality of care: a factor-analytic examination of the palliative care outcome scale. J Pain Symptom Manage 2010 Jul;40(1):67-74.
  • Slater A, Freeman E. Patients' views of using an outcome measure in palliative day care: a focus group study. Int J Palliat Nurs 2004 Jul;10(7):343-51.
  • Slater A, Freeman E. Is the Palliative Care Outcome Scale useful to staff in a day hospice unit? Int J Palliat Nurs 2005 Jul;11(7):346-54.
  • Steinmann D, Schafer C, van OB, Wypior HJ, Bruns F, Bolling T, et al. Effects of radiotherapy for brain metastases on quality of life (QoL). Prospective pilot study of the DEGRO QoL working party. Strahlenther Onkol 2009 Mar;185(3):190-7.
  • Stevens AM, Gwilliam B, A'hern R, Broadley K, Hardy J. Experience in the use of the palliative care outcome scale. Support Care Cancer 2005 Dec;13(12):1027-34.
  • Stromgren AS, Groenvold M, Pedersen L, Olsen AK, Sjogren P. Symptomatology of cancer patients in palliative care: content validation of self-assessment questionnaires against medical records. Eur J Cancer 2002 Apr;38(6):788-94.


The POS was devised following a systematic review of outcome measures used in palliative care. This review concluded that there was a paucity of clinical questionnaires that could adequately reflect the holistic nature of palliative care (Hearn & Higginson, 1997). The POS was, therefore, designed to overcome some of the limitations associated with existing outcome measurement scales in palliative care. It evolved using a literature review of measures, work by a multi-professional project group with individuals who worked in different palliative care settings and a patient representative. The POS was then piloted in hospice, home, hospital and other community settings. The questionnaire covers: physical symptoms, psychological symptoms, spiritual considerations, practical concerns, emotional concerns and psychosocial needs.

There are two versions of the POS questionnaire, one for patients to complete the other for staff. Bringing together these two complementary perspectives allows the POS to identify patient's problems and enables staff to provide individualised care. It is a flexible tool, the usage of which can be determined by the needs of local services.

The POS showed acceptable validity when used in a variety of settings, such as, home care, hospice in-patient and day care and hospital inpatient care as well as outpatient and community services. It has also been shown to be a credible, clinical, research and audit tool, which is acceptable to both patients and staff (Hearn & Higginson, 1999). The POS can be used routinely to guide clinical practice and monitor service interventions. Moreover, the POS is a valuable audit tool that can help meet the current statutory requirements on clinical governance.

Impact of POS

Two independent reports have been commissioned to investigate the global impact of the POS and how it is being used to improve care:

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