Driving forward better care through outcome measurement in routine practice: The use of the APCA African POS

Since the validation of the APCA African Palliative Care Association Palliative Outcome Scale (APCA POS) in Africa by Harding et al 2010, the APCA POS has become the most commonly used patient-level outcome measure in Africa.  

The POS is not only being used for research purposes but also to improve practice and patient care.  The African Palliative Care Association, in collaboration with King’s College London, developed guidelines for APCA POS users that have increased the level of demand for usage.  As a result, APCA regularly receives requests, from across the continent, from various institutions to use the APCA POS for research, patient care or audits. 

The APCA POS has been translated into several languages in Africa (see Table 1) and has been used in the following patient groups including, HIV/AIDS, cancer, heart failure, liver failure and renal failure.

Table 1: Language translations for the APCA POS

In Uganda, the APCA POS is being used by the Makerere University’s Palliative Care Unit.  One of its palliative care physicians, Dr Elizabeth Namukwaya, has noted:

“The APCA POS is used for prioritising patients’ palliative care needs at the point of first contact.  This helps the palliative care team identify the worst symptoms and these are prioritised for immediate attention.” 

She further noted that the APCA POS helps them identify additional palliative care needs that commonly go undetected.  The Unit has recently noted that very many patients have a high need for information and this could not be diagnosed easily.  In response, the Unit is developing strategies to ensure that patients have access to the right information, information that is central to patient decision making.

Dr Namukwaya also noted that they would like to use the APCA POS longitudinally to monitor patients’ needs improvement over time. Currently it is only used at baseline when patients are referred for palliative care.

In Rwanda, Hospice without Borders is working with Rwanda Hospice and Palliatve Care Cente to monitor patient palliative care outcomes over time as supportive palliative care interventions (like increased access to oral morphine) are introduced at the district hospital of Kibagabaga. The team intends to integrate use of the APCA POS into routine care and to use it for audits.

In The Gambia, the APCA POS is used by the Prevention of Liver Fibrosis and Cancer in Africa organisation in the assessment of symptom burden in cancer patients.  Effective assessment of symptoms is central to directing appropriate care interventions.

The APCA POS has also been used by APCA and Swaziland Hospice at Home (SHAH), Island Hospice in Zimbabwe, and Ramotswa Hospice in Botswana for palliative care standards assessment, with the tool specifically informing Principle 2 of the standards audit dealing with holistic care provision.  The findings informed quality improvement plans that followed and a comprehensive approach to assessing palliative care needs of patients is now emphasised in routine care.

Needs for users

• Standard simplified training guidelines for users preferably in a PowerPoint format.
• Create a database where the APCA POS can be found in different languages.
• Standard simplified training guidelines for translation users, preferably in Power Point format.
• Support on how to integrate use of the APCA POS into routine care.