Skip to main content

Research Repository

Advanced Search

Development of a patient-reported palliative care-specific health classification system: the POS-E

Murtagh, Fliss E. M.; Murtagh, Fliss E.M.; Dzingina, Mendwas; Higginson, Irene J.; McCrone, Paul; Murtagh, Fliss


Fliss E. M. Murtagh

Fliss E.M. Murtagh

Mendwas Dzingina

Irene J. Higginson

Paul McCrone



Generic preference-based measures are commonly used to estimate quality-adjusted life-years (QALYs) to inform resource-allocation decisions. However, concerns have been raised that generic measures may be inappropriate in palliative care.


Our objective was to derive a health-state classification system that is amenable to valuation from the ten-item Palliative Care Outcome Scale (POS), a widely used patient-reported outcome measure in palliative care.


The dimensional structure of the original POS was assessed using factor analysis. Item performance was assessed, using Rasch analysis and psychometric criteria, to enable the selection of items that represent the dimensions covered by the POS. Data from six studies of patients receiving palliative care were combined (N = 1011) and randomly split into two halves for development and validation. Analysis was undertaken on the development data, and results were validated by repeating the analysis with the validation dataset.


Following Rasch and factor analyses, a classification system of seven items was derived. Each item had two to three levels. Rasch threshold map helped identify a set of 14 plausible health states that can be used for the valuation of the instrument to derive a preference-based index.


Combining factor analysis and Rasch analysis with psychometric criteria provides a valid method of constructing a classification system for a palliative care-specific preference-based measure. The next stage is to obtain preference weights so the measure can be used in economic evaluations in palliative care.


Murtagh, F. E. M., Murtagh, F. E., Dzingina, M., Higginson, I. J., McCrone, P., & Murtagh, F. (2017). Development of a patient-reported palliative care-specific health classification system: the POS-E. Patient, 10(3), 353-365.

Journal Article Type Article
Acceptance Date Mar 7, 2017
Online Publication Date Mar 7, 2017
Publication Date Jun 1, 2017
Deposit Date Nov 15, 2017
Publicly Available Date Oct 27, 2022
Journal The Patient - Patient-Centered Outcomes Research
Print ISSN 1178-1653
Electronic ISSN 1178-1661
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 10
Issue 3
Pages 353-365
Keywords Nursing (miscellaneous)
Public URL
Publisher URL


Published article (1.1 Mb)

Publisher Licence URL

Copyright Statement
© The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (, which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Development POS-E 2017.docx (146 Kb)

You might also like

Downloadable Citations