Taiwan-Chinese Version of Palliative Care Outcome Tools Developed Through Expert Adaptation

A Taiwan-Chinese version of the five core Palliative Care Outcomes Collaboration (PCOC) assessment tools has been developed through a systematic cross-cultural adaptation process, according to a study published in BMC Palliative Care. Taiwan began implementing the PCOC framework, which provides a standardized approach to measuring and improving palliative care outcomes, in 2020, making a culturally and linguistically adapted version of the instruments necessary for local clinical use.

The multiphase methodological study combined translation, expert consensus and preliminary clinical evaluation. Researchers prepared preliminary Taiwan-Chinese versions of the tools and reconciled them through multidisciplinary review. Four modified Delphi rounds were then conducted with 12 multidisciplinary experts, followed by independent back-translation by two bilingual experts who were blinded to the original instruments. A representative of the Australian PCOC team carried out an item-level qualitative review of the adapted wording.

The five tools cover the core domains of the PCOC framework, including the Palliative Care Phase and the Palliative Care Problem Severity Score (PCPSS), alongside the patient-reported Symptom Assessment Scale. Expert review confirmed the clarity and relevance of the adapted wording. In the final Delphi round, item-level content validity index values for wording clarity ranged from 0.83 to 1.00, and scale-level indices calculated with the average method ranged from 0.96 to 1.00, indicating strong expert agreement on the translated items.

One structural adaptation concerned the PCPSS. The Taiwan-Chinese version retained four scored domains, with the social, psychological and spiritual items represented as one combined domain carrying a single 0 to 3 severity rating. This modification reflects how the severity items were consolidated for the Taiwanese clinical context.

Preliminary clinical evaluation drew on clinical quality-improvement audits examining interrater agreement for the Palliative Care Phase and the PCPSS, together with clinician ratings of appropriateness and ease of use. A separate retrospective audit assessed documentation completion in 67 patient records. For interrater agreement, there were 55 valid paired assessments for the Palliative Care Phase and 27 paired assessments for each PCPSS domain.

Exact agreement between raters was 74.5 percent for the Palliative Care Phase and ranged from 74.1 percent to 88.9 percent across the PCPSS domains. The pain-domain estimate was imprecise, with a kappa of 0.21 and a 95 percent confidence interval spanning from minus 0.13 to 0.55, meaning the data could not establish reliable agreement for that domain.

Clinician-rated appropriateness and ease-of-use scores were generally favorable, with mean ratings ranging from 3.9 to 4.3. Documentation of all five assessments was most frequently observed during routine care, at 92.5 percent of records, compared with 71.6 percent at admission and 46.3 percent at discharge or episode closure, a pattern that highlights where documentation practices weaken across a care episode.

The authors emphasize that the clinical findings remain preliminary and limited in scope, and that the study does not constitute a full psychometric validation of the entire PCOC tool set. Further research is needed, including cognitive testing with patients, particularly for the patient-reported Symptom Assessment Scale, and larger multicenter psychometric studies to establish the measurement properties of the adapted instruments in Taiwanese palliative care settings.

Subject of Research: Cross-cultural adaptation of the Palliative Care Outcomes Collaboration assessment tools into a Taiwan-Chinese version for palliative care in Taiwan

Article Title: Cross-cultural adaptation of the Palliative Care Outcomes Collaboration assessment tools: development of a Taiwan-Chinese version for palliative care in Taiwan

Article References: Wang, S.-C., Wang, Y.-W., Chiang, C.-C., Chiu, C.-K., & Chen, Y.-Y. (2026). Cross-cultural adaptation of the Palliative Care Outcomes Collaboration assessment tools: development of a Taiwan-Chinese version for palliative care in Taiwan. BMC Palliative Care. https://doi.org/10.1186/s12904-026-02393-6

Image Credits: AI Generated

DOI: 10.1186/s12904-026-02393-6

Keywords: palliative care, PCOC, cross-cultural adaptation, Taiwan-Chinese translation, Delphi method, interrater agreement, Palliative Care Phase, Palliative Care Problem Severity Score, psychometric evaluation, BMC Palliative Care, Cross-cultural, adaptation