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

Background The Palliative Care Outcomes Collaboration (PCOC) provides a standardized framework for measuring and improving palliative care outcomes. Taiwan began implementing PCOC in 2020, requiring a culturally and linguistically adapted Taiwan-Chinese version. This study developed and culturally adapted a Taiwan-Chinese version of the five core PCOC tools and conducted a preliminary evaluation. Methods This multiphase methodological study included preparation and multidisciplinary reconciliation of preliminary Taiwan-Chinese versions, four modified Delphi rounds with 12 multidisciplinary experts, independent back-translation by two bilingual experts blinded to the original instruments, and item-level qualitative review by a representative of the Australian PCOC team. Clinical quality-improvement audits examined interrater agreement for the Palliative Care Phase and PCPSS and clinician-rated appropriateness and ease of use; a separate retrospective audit assessed documentation completion in 67 patient records. Results Final-round I-CVI values for wording clarity ranged from 0.83 to 1.00, and scale-level indices using the average method ranged from 0.96 to 1.00. The Taiwan-Chinese PCPSS retained four scored domains; the social/psychological/spiritual label represented one combined domain with a single 0–3 severity rating. There were 55 valid paired assessments for the Palliative Care Phase and 27 for each PCPSS domain. Exact agreement was 74.5% for the Palliative Care Phase and ranged from 74.1% to 88.9% across PCPSS domains. Linear-weighted kappa was 0.62 for the Palliative Care Phase and ranged from 0.21 to 0.71 across PCPSS domains. The pain-domain estimate was imprecise (κ = 0.21, 95% CI − 0.13 to 0.55). 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 (92.5%), compared to 71.6% at admission and 46.3% at discharge or episode closure. Conclusions A Taiwanese version of the five core PCOC assessment tools was systematically created and culturally tailored for application in Taiwanese palliative care. Expert review confirmed clarity and relevance of wording, though the clinical findings remain preliminary and limited in scope. These findings do not represent a full psychometric validation of the entire PCOC set. Further research, including patient cognitive testing—especially for the patient-reported Symptom Assessment Scale—and larger multicenter psychometric studies, is necessary.