Scales in Spanish for Assessing People in Palliative Care and their Families: Psychometric Systematic Review
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Jan 19, 2023
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Abstract
Introduction: One of the bases of palliative care is the regular and comprehensive assessment of symptoms in patients and families. In this regard, it is important to recognize the scales used in palliative care in Spanish and their psychometric properties. Objective: Identify the scales in Spanish for the assessment of palliative care patients and their families, evaluate their psychometric properties, and the methodological quality of their properties based on the Cosmin standards. Method: Psychometric systematic review. A literature search of the assessment scales in palliative care in Spanish and its psychometric properties was carried out according to the Prisma proposal. The standards proposed by Cosmin for the evaluation of psychometric properties were used. Results: 21 rating scales were evaluated. The EORTC-QLQ quality of life scale was the one that reported the highest number of properties. Internal consistency, construct validity, content and reliability were the most reported tests. No study reported evidence of cross-cultural validity. Conclusion: The results of this study indicate a wide variety of instruments available in Spanish to assess the patient and the family caregiver in palliative care. However, a large number of psychometric properties of the instruments are still incomplete. The results show the need to continue investigating the psychometric properties of these scales to guarantee the reliability of these instruments, as well as their use in practice and research.
Keywords
Cuidados paliativos, Encuestas y cuestionarios, Reproductibilidad de los resultados, Psicometría, Indicadores de saludcuidados paliativos, inquéritos e questionários, reprodutibilidade dos resultados, sicometría, indicadores básicos de saúdepalliative care, surveys and questionnaires, reproductibility of results, psychometrics, health status indicators
References
Referencias
1. Centeno C, Sitte T, de Lima L, Alsirafy S, Bruera E, Callaway M, et al. Documento de Posición Oficial sobre la Promoción Global de Cuidados Paliativos: Recomendaciones del Grupo Internacional Asesor PAL-LIFE de la Academia Pontificia de la Vida, Ciudad del Vaticano. J Palliat Med. 2018;21(10):1398–407. Disponible en: https://doi.org/10.1089/jpm.2018.0387
2. World Health Organization, Woldwide hospice palliatgive care alliance. Global atlas of palliative care 2nd Edition. Londres; 2020. Disponible en: http://www.thewhpca.org/resources/global-atlas-on-end-of-life-care
3. Pastrana T, De Lima L, Sánchez-Cárdenas M, Van Steijn D, Garralda E, Pons J. Atlas de cuidados paliativos en Latinoamérica 2020. 2nd ed. Houston; 2021.
4. Kaasa S, Loge J, Aapro M, Albreht T, Anderson R, Bruera E, et al. Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol. 2018;19(11):e588–653. Disponible en: https://doi.org/10.1016/S1470-2045(18)30415-7
5. Yates P. Symptom Management and Palliative Care for Patients with Cancer. Nurs Clin North. 2017;52(1):179–91. Disponible en: https://doi.org/10.1016/j.cnur.2016.10.006
6. Dudgeon D. The Impact of Measuring Patient-Reported Outcome Measures on Quality of and Access to Palliative Care. J Palliat Med. 2018;21(S1):S76–80. Disponible en: https://doi.org/10.1089/jpm.2017.0447
7. Sekse J, Hunskår I, Ellingsen S. The nurse’s role in palliative care: A qualitative meta-synthesis. J Clin Nurs. 2018;27(1–2):e21–38. Disponible en: https://doi.org/10.1111/jocn.13912
8. Aslakson R, Dy S, Wilson R, Waldfogel J, Zhang A, Isenberg S, et al. Patient- and Caregiver-Reported Assessment Tools for Palliative Care: Summary of the 2017 Agency for Healthcare Research and Quality Technical Brief. J Pain Symptom Manage. 2017;54(6):961-972.e16. Disponible en: https://doi.org/10.1016/j.jpainsymman.2017.04.022
9. Terwee C, Mokkink L, Knol D, Ostelo R, Bouter L, De Vet H. Rating the methodological quality in systematic reviews of studies on measurement properties: A scoring system for the COSMIN checklist. Qual Life Res; 2012;21(4):651–7. Disponible en: https:// doi.org/10.1007/s11136-011-9960-1.
10. Moher D, Liberati A, Tetzlaff J, Altman D, Altman D, Antes G, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Journal of Chinese Integrative Medicine; 2009;6(7):e1000097. Disponible en: https: // doi.org/10.1371/journal.pmed.1000097
11. Aguayo-Albasini J, Flores-Pastor B, Soria-Aledo V. Sistema GRADE: Clasificación de la calidad de la evidencia y graduación de la fuerza de la recomendación. Cir Esp. 2014;92(2):82–8. https: Disponible en: //doi.org/10.1016/j.ciresp.2013.08.002
12. Ibáñez C, Sánchez R, Oliveros R. Colombian validation of the EORTC QLQ-STO22 for evaluating quality of life in patients diagnosed with gastric cancer. Av en Psicol Latinoam. 2015;33(3):397–412. Disponible en: https://doi.org/10.12804/apl33.03.2015.03
13. Sánchez Pedraza R, Valderamar A. Validación para utilización en Colombia de la escala EORTC QLQ C-30 para evaluación de la calidad de vida de los pacientes con cáncer. Rev Colomb Cancerol. 2020;24(2):61–71. Disponible en: https://doi.org/10.35509/01239015.128
14. Herrero-Hahn R, Montoya-Juárez R, Hueso-Montoro C, Martí-García C, Salazar-Blandón D, García-Caro M. Cultural Adaptation, Validation, and Analysis of the Self-Efficacy in Palliative Care Scale for Use with Spanish Nurses. Int J Environ Res Public Health. 2019;16(23):4840. Disponible en: https://doi.org/10.3390/ijerph16234840
15. Valdelamar Jiménez A, Molina B, Rodríguez L, Sánchez Pedraza R. Traducción y adaptación transcultural de la escala FACIT-PAL para medir la calidad de vida en pacientes con cáncer avanzado en Colombia. Rev Colomb Cancerol. 2020;24(1):18–25. Disponible en: https://doi.org/10.35509/01239015.13
16. Sánchez-Pedraza R, Sierra-Matamoros F, López-Daza D. Colombian validation of the FACT-B scale for measuring breast cancer patients’ quality of life. Rev Colomb Obstet Ginecol. 2012;63(3):196–206.
17. Sánchez R, Ballesteros M, Ortiz N. Evaluation of content validity for the FACT-G quality of life questionaire through multidimensional escalation techniques. Rev Colomb Cancerol. 2010 Jan 1;14(4):225–33.
18. Serra-Prat M, Nabal M, Santacruz V, Picaza J, Trelis J. Validation of the spanish version of the palliative care outcome scale. Med Clin. 2004;123(11):406–12. Disponible en: https://doi.org/10.1016/s0025-7753(04)74535-2
19. Vidal Serrano S, López Alonso S, Fernández M. Validation of the “Palliative Care Difficulties Scale (PCDS)” questionnaire in the spanish population about health professionals’ difficulties in palliative care. Rev Esp Salud Publica. 2019;93:e201911106
20. Pérez-Cruz P, Padilla O, Bonati P, Thomsen O, Tupper L, Gonzalez M, et al. Validation of the Spanish Version of the Quality of Dying and Death Questionnaire (QODD-ESP) in a Home-Based Cancer Palliative Care Program and Development of the QODD-ESP-12. J Pain Symptom Manage. 2017;53(6):1042-1049.e3. Disponible en: https://doi.org/10.1016/j.jpainsymman.2017.02.005
21. Schiappacasse G, González P. Validation of Meaning in Life Scale modified to evaluate the spiritual dimension in a Chilean and Latin-American cancer population on palliative care. Gac Mex Oncol. 2016;15(3):121–127. Disponible en: https://doi.org/10.1016/j.gamo.2016.05.004
22. Pedraza R, Zarate C. Cross-cultural adaptation of the colombian version of the caregiver quality of life index-cancer (CQOLC). Rev CES Psicol. 2018;11(1):134–43. Disponible en: https://doi.org/10.21615/cesp.11.1.10
23. Barallat E, Nabal M, Canal J, Trujillano J, Gea-Sánchez M, Larkin P, et al. The Spanish Adaptation of the Palliative Performance Scale (Version 2) Among Cancer Patients at the End of Life: Psychometric Properties. J Pain Symptom Manage. 2017;54(4):570-577.e5. Disponible en: https://doi.org/10.1016/j.jpainsymman.2017.07.014
24. Cabrera V, Martin-Aragón M, del Carmen Tero M, Núñez R, de los Ángeles Pastor M. Hospital Anxiety and Depression Scale (HADS) in fibromyalgia: sensitivity and specificity analysis. Ter Psicol. 2015;33(3):181–93.
25. Rico J, Restrepo M, Molina M. Adaptación y validación de la escala hospitalaria de ansiedad y depresión (HAD) en una muestra de pacientes con cáncer del Instituto Nacional de Cancerología de Colombia. 2005;3(1):73–86.
26. Calderón R, Krikorian A, Palacio C. Coping with cancer: Spanish adaptation and validation of the mini-mac scale in a colombian population. Av en Psicol Latinoam. 2015;33(3):531–44.
27. Gort A, March J, Gómez X, De Miguel M, Mazarico S, Ballesté J. Escala de Zarit reducida en cuidados paliativos. Med Clin. 2005;124(17):651–3. Disponible en: https://doi.org/10.1157/13074742
28. Grethel A-C, Alejandro V-B. Application of the survival prognosis index (Pap score) in the oncological patient referred to the National Center for Pain Control and Palliative Care in Costa Rica. Rev costarricense salud pública. 2019;28(1):65–76.
29. Portenoy J, Teno J. Hispanic Language Version of the Family Evaluation of Hospice Care. Journal of Pain and Symptom Management. 2007;34(5):459-61. Disponible en: https://doi.org/10.1016/j.jpainsymman.2007.08.003.
30. Arias-Rojas M, Arredondo E, Carreño S, Posada C, Tellez B. Validation of the Latin American-Spanish version of the scale “Quality of Life in Life-Threatening Illness-Family Caregiver Version” (QOLLTI-F). Health Soc Care Community. 2021;30(3):e832-e841. Disponible en: https://doi.org/10.1111/hsc.13453.
31. Arias-Rojas M, Moreno S, López J. Validation of the Uncertainty in Ilness Scale in caregivers of patients in palliative care. Med Paliativa. 2019;26(4):265–71. Disponible en: https://doi.org/ 10.20986/medpal.2019.1021/2018.
32. Sierra F, Sánchez R, Ibáñez C. Cross-cultural adaptation of the Daily Spiritual Experience Scale for its use in Colombia. Rev Colomb Cancerol. 2013;17(4):149–57.
33. Valcárcel A, García M, Cortés C. The Spanish version of the ESAS: A reference tool for evaluating the symptoms of the patient with advanced cancer. Med Paliativa. 2013;20(4):143–9. Disponible en: https://doi.org/ 10.1016/j.medipa.2013.02.001
34. Gamba-Collazos H, Navia C. Adaptación del Inventario de Duelo Complicado en población colombiana. Rev Colomb Psicol. 2017;26(1):15–30. Disponible en: https://doi.org/10.15446/rcp.v26n1.51205
35. Montalvo-Prieto A, Bohórquez-Moreno C, Herrera-Lian A. Validación y adaptación cultural de la versión Argentina escala de cuidados paliativos a Colombia. Duazary. 2019;16(2):270–9. Disponible en: https://doi.org/10.21676/2389783X.2959
36. Pérez-Cruz P, Padilla O, Bonati P, Thomsen O, Tupper L, Gonzalez M, et al. Validation of the Spanish Version of the Quality of Dying and Death Questionnaire (QODD-ESP) in a Home-Based Cancer Palliative Care Program and Development of the QODD-ESP-12. J Pain Symptom Manage. 2017;53(6):1042-1049.e3. Disponible en: http://doi.org/10.1016/j.jpainsymman.2017.02.005
37. Souza A, Alexandre N, Guirardello E. Psychometric properties in instruments evaluation of reliability and validity. Epidemiol e Serviços Saúde. 2017;26(3):649–59. Disponile en: https://doi.org/10.5123/S1679-49742017000300022
38. Sousa V, Rojjanasrirat W. Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: A clear and user-friendly guideline. J Eval Clin Pract. 2011;17(2):268-74. Disponible en: https://doi.org/10.1111/j.1365-2753.2010.01434.x
39. Zamora-Mur A, Nabal-Vicuña M, Zamora-Catevilla A, García-Foncillas R, Calderero-Aragón V, Aubí-Catevilla Ó, et al. Functional decline and presence of symptoms in palliative care: Cause or consequence? Rev Esp Geriatr Gerontol. 2017;52(3):142–5. Disponible en: https://doi.org/ 10.1016/j.regg.2016.10.004
40. Puerto H. Social support perceived in family caretakers of patients being treated against Cancer. Rev Cuid. 2017;8(1):1407. Disponible en: http://dx.doi.org/10.15649/cuidarte.v8i1.345
1. Centeno C, Sitte T, de Lima L, Alsirafy S, Bruera E, Callaway M, et al. Documento de Posición Oficial sobre la Promoción Global de Cuidados Paliativos: Recomendaciones del Grupo Internacional Asesor PAL-LIFE de la Academia Pontificia de la Vida, Ciudad del Vaticano. J Palliat Med. 2018;21(10):1398–407. Disponible en: https://doi.org/10.1089/jpm.2018.0387
2. World Health Organization, Woldwide hospice palliatgive care alliance. Global atlas of palliative care 2nd Edition. Londres; 2020. Disponible en: http://www.thewhpca.org/resources/global-atlas-on-end-of-life-care
3. Pastrana T, De Lima L, Sánchez-Cárdenas M, Van Steijn D, Garralda E, Pons J. Atlas de cuidados paliativos en Latinoamérica 2020. 2nd ed. Houston; 2021.
4. Kaasa S, Loge J, Aapro M, Albreht T, Anderson R, Bruera E, et al. Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol. 2018;19(11):e588–653. Disponible en: https://doi.org/10.1016/S1470-2045(18)30415-7
5. Yates P. Symptom Management and Palliative Care for Patients with Cancer. Nurs Clin North. 2017;52(1):179–91. Disponible en: https://doi.org/10.1016/j.cnur.2016.10.006
6. Dudgeon D. The Impact of Measuring Patient-Reported Outcome Measures on Quality of and Access to Palliative Care. J Palliat Med. 2018;21(S1):S76–80. Disponible en: https://doi.org/10.1089/jpm.2017.0447
7. Sekse J, Hunskår I, Ellingsen S. The nurse’s role in palliative care: A qualitative meta-synthesis. J Clin Nurs. 2018;27(1–2):e21–38. Disponible en: https://doi.org/10.1111/jocn.13912
8. Aslakson R, Dy S, Wilson R, Waldfogel J, Zhang A, Isenberg S, et al. Patient- and Caregiver-Reported Assessment Tools for Palliative Care: Summary of the 2017 Agency for Healthcare Research and Quality Technical Brief. J Pain Symptom Manage. 2017;54(6):961-972.e16. Disponible en: https://doi.org/10.1016/j.jpainsymman.2017.04.022
9. Terwee C, Mokkink L, Knol D, Ostelo R, Bouter L, De Vet H. Rating the methodological quality in systematic reviews of studies on measurement properties: A scoring system for the COSMIN checklist. Qual Life Res; 2012;21(4):651–7. Disponible en: https:// doi.org/10.1007/s11136-011-9960-1.
10. Moher D, Liberati A, Tetzlaff J, Altman D, Altman D, Antes G, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Journal of Chinese Integrative Medicine; 2009;6(7):e1000097. Disponible en: https: // doi.org/10.1371/journal.pmed.1000097
11. Aguayo-Albasini J, Flores-Pastor B, Soria-Aledo V. Sistema GRADE: Clasificación de la calidad de la evidencia y graduación de la fuerza de la recomendación. Cir Esp. 2014;92(2):82–8. https: Disponible en: //doi.org/10.1016/j.ciresp.2013.08.002
12. Ibáñez C, Sánchez R, Oliveros R. Colombian validation of the EORTC QLQ-STO22 for evaluating quality of life in patients diagnosed with gastric cancer. Av en Psicol Latinoam. 2015;33(3):397–412. Disponible en: https://doi.org/10.12804/apl33.03.2015.03
13. Sánchez Pedraza R, Valderamar A. Validación para utilización en Colombia de la escala EORTC QLQ C-30 para evaluación de la calidad de vida de los pacientes con cáncer. Rev Colomb Cancerol. 2020;24(2):61–71. Disponible en: https://doi.org/10.35509/01239015.128
14. Herrero-Hahn R, Montoya-Juárez R, Hueso-Montoro C, Martí-García C, Salazar-Blandón D, García-Caro M. Cultural Adaptation, Validation, and Analysis of the Self-Efficacy in Palliative Care Scale for Use with Spanish Nurses. Int J Environ Res Public Health. 2019;16(23):4840. Disponible en: https://doi.org/10.3390/ijerph16234840
15. Valdelamar Jiménez A, Molina B, Rodríguez L, Sánchez Pedraza R. Traducción y adaptación transcultural de la escala FACIT-PAL para medir la calidad de vida en pacientes con cáncer avanzado en Colombia. Rev Colomb Cancerol. 2020;24(1):18–25. Disponible en: https://doi.org/10.35509/01239015.13
16. Sánchez-Pedraza R, Sierra-Matamoros F, López-Daza D. Colombian validation of the FACT-B scale for measuring breast cancer patients’ quality of life. Rev Colomb Obstet Ginecol. 2012;63(3):196–206.
17. Sánchez R, Ballesteros M, Ortiz N. Evaluation of content validity for the FACT-G quality of life questionaire through multidimensional escalation techniques. Rev Colomb Cancerol. 2010 Jan 1;14(4):225–33.
18. Serra-Prat M, Nabal M, Santacruz V, Picaza J, Trelis J. Validation of the spanish version of the palliative care outcome scale. Med Clin. 2004;123(11):406–12. Disponible en: https://doi.org/10.1016/s0025-7753(04)74535-2
19. Vidal Serrano S, López Alonso S, Fernández M. Validation of the “Palliative Care Difficulties Scale (PCDS)” questionnaire in the spanish population about health professionals’ difficulties in palliative care. Rev Esp Salud Publica. 2019;93:e201911106
20. Pérez-Cruz P, Padilla O, Bonati P, Thomsen O, Tupper L, Gonzalez M, et al. Validation of the Spanish Version of the Quality of Dying and Death Questionnaire (QODD-ESP) in a Home-Based Cancer Palliative Care Program and Development of the QODD-ESP-12. J Pain Symptom Manage. 2017;53(6):1042-1049.e3. Disponible en: https://doi.org/10.1016/j.jpainsymman.2017.02.005
21. Schiappacasse G, González P. Validation of Meaning in Life Scale modified to evaluate the spiritual dimension in a Chilean and Latin-American cancer population on palliative care. Gac Mex Oncol. 2016;15(3):121–127. Disponible en: https://doi.org/10.1016/j.gamo.2016.05.004
22. Pedraza R, Zarate C. Cross-cultural adaptation of the colombian version of the caregiver quality of life index-cancer (CQOLC). Rev CES Psicol. 2018;11(1):134–43. Disponible en: https://doi.org/10.21615/cesp.11.1.10
23. Barallat E, Nabal M, Canal J, Trujillano J, Gea-Sánchez M, Larkin P, et al. The Spanish Adaptation of the Palliative Performance Scale (Version 2) Among Cancer Patients at the End of Life: Psychometric Properties. J Pain Symptom Manage. 2017;54(4):570-577.e5. Disponible en: https://doi.org/10.1016/j.jpainsymman.2017.07.014
24. Cabrera V, Martin-Aragón M, del Carmen Tero M, Núñez R, de los Ángeles Pastor M. Hospital Anxiety and Depression Scale (HADS) in fibromyalgia: sensitivity and specificity analysis. Ter Psicol. 2015;33(3):181–93.
25. Rico J, Restrepo M, Molina M. Adaptación y validación de la escala hospitalaria de ansiedad y depresión (HAD) en una muestra de pacientes con cáncer del Instituto Nacional de Cancerología de Colombia. 2005;3(1):73–86.
26. Calderón R, Krikorian A, Palacio C. Coping with cancer: Spanish adaptation and validation of the mini-mac scale in a colombian population. Av en Psicol Latinoam. 2015;33(3):531–44.
27. Gort A, March J, Gómez X, De Miguel M, Mazarico S, Ballesté J. Escala de Zarit reducida en cuidados paliativos. Med Clin. 2005;124(17):651–3. Disponible en: https://doi.org/10.1157/13074742
28. Grethel A-C, Alejandro V-B. Application of the survival prognosis index (Pap score) in the oncological patient referred to the National Center for Pain Control and Palliative Care in Costa Rica. Rev costarricense salud pública. 2019;28(1):65–76.
29. Portenoy J, Teno J. Hispanic Language Version of the Family Evaluation of Hospice Care. Journal of Pain and Symptom Management. 2007;34(5):459-61. Disponible en: https://doi.org/10.1016/j.jpainsymman.2007.08.003.
30. Arias-Rojas M, Arredondo E, Carreño S, Posada C, Tellez B. Validation of the Latin American-Spanish version of the scale “Quality of Life in Life-Threatening Illness-Family Caregiver Version” (QOLLTI-F). Health Soc Care Community. 2021;30(3):e832-e841. Disponible en: https://doi.org/10.1111/hsc.13453.
31. Arias-Rojas M, Moreno S, López J. Validation of the Uncertainty in Ilness Scale in caregivers of patients in palliative care. Med Paliativa. 2019;26(4):265–71. Disponible en: https://doi.org/ 10.20986/medpal.2019.1021/2018.
32. Sierra F, Sánchez R, Ibáñez C. Cross-cultural adaptation of the Daily Spiritual Experience Scale for its use in Colombia. Rev Colomb Cancerol. 2013;17(4):149–57.
33. Valcárcel A, García M, Cortés C. The Spanish version of the ESAS: A reference tool for evaluating the symptoms of the patient with advanced cancer. Med Paliativa. 2013;20(4):143–9. Disponible en: https://doi.org/ 10.1016/j.medipa.2013.02.001
34. Gamba-Collazos H, Navia C. Adaptación del Inventario de Duelo Complicado en población colombiana. Rev Colomb Psicol. 2017;26(1):15–30. Disponible en: https://doi.org/10.15446/rcp.v26n1.51205
35. Montalvo-Prieto A, Bohórquez-Moreno C, Herrera-Lian A. Validación y adaptación cultural de la versión Argentina escala de cuidados paliativos a Colombia. Duazary. 2019;16(2):270–9. Disponible en: https://doi.org/10.21676/2389783X.2959
36. Pérez-Cruz P, Padilla O, Bonati P, Thomsen O, Tupper L, Gonzalez M, et al. Validation of the Spanish Version of the Quality of Dying and Death Questionnaire (QODD-ESP) in a Home-Based Cancer Palliative Care Program and Development of the QODD-ESP-12. J Pain Symptom Manage. 2017;53(6):1042-1049.e3. Disponible en: http://doi.org/10.1016/j.jpainsymman.2017.02.005
37. Souza A, Alexandre N, Guirardello E. Psychometric properties in instruments evaluation of reliability and validity. Epidemiol e Serviços Saúde. 2017;26(3):649–59. Disponile en: https://doi.org/10.5123/S1679-49742017000300022
38. Sousa V, Rojjanasrirat W. Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: A clear and user-friendly guideline. J Eval Clin Pract. 2011;17(2):268-74. Disponible en: https://doi.org/10.1111/j.1365-2753.2010.01434.x
39. Zamora-Mur A, Nabal-Vicuña M, Zamora-Catevilla A, García-Foncillas R, Calderero-Aragón V, Aubí-Catevilla Ó, et al. Functional decline and presence of symptoms in palliative care: Cause or consequence? Rev Esp Geriatr Gerontol. 2017;52(3):142–5. Disponible en: https://doi.org/ 10.1016/j.regg.2016.10.004
40. Puerto H. Social support perceived in family caretakers of patients being treated against Cancer. Rev Cuid. 2017;8(1):1407. Disponible en: http://dx.doi.org/10.15649/cuidarte.v8i1.345
How to Cite
Useche Cuellar, N. N., Carreño-Moreno, S., & Arias-Rojas, M. (2023). Scales in Spanish for Assessing People in Palliative Care and their Families: Psychometric Systematic Review. Investigación En Enfermería Imagen Y Desarrollo, 25. https://doi.org/10.11144/Javeriana.ie25.eevp
Section
Articles of Integrative or Systematic Review
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