Translation, cross-cultural adaptation, and validation of the Integrated Palliative Care Outcome Scale Renal (IPOS-Renal) for Brazilian Portuguese

INTRODUCTION: Chronic Kidney Disease (CKD) is associated with a high symptom burden. In Brazil, there is no specific instrument to assess symptoms in CKD patients receiving palliative care. The Integrated Palliative Care Outcome Scale Renal (IPOS-Renal) has been translated and validated in 13 languages. OBJECTIVE: To translate, cross-culturally adapt, and validate the IPOS-renal for Brazilian Portuguese. METHODS: A methodological study conducted in eight phases: conceptual definition, forward translation, back-translation, expert review, cognitive interviews, proofreading, psychometric testing, and final reporting. A total of 153 stage 5 CKD patients were assessed with the IPOS-renal and the Edmonton Symptom Assessment System (ESAS-r) between February and March 2024. Instruments were reapplied after 15 days in 95 patients. RESULTS: The scale demonstrated internal consistency, reliability, temporal stability, and convergent validity with the ESAS-r. The most prevalent symptoms were drowsiness (44%), difficulty walking (44%), fatigue/lack of energy (43%), and pain (36%). Less frequent symptoms included dyspnea (7%), diarrhea (14%), and vomiting (14%). Unbearable symptoms intensity was rare, including emotional symptoms (5%), difficulty sleeping (3%), and fatigue/lack of energy (3%). Symptom intensity varied, being severe for pain (24-25%) and drowsiness (21%); and moderate for difficulty walking (25%) and fatigue/lack of energy (22%). CONCLUSION: The Brazilian Portuguese version of the IPOS- renal is valid, reliable, and suitable for identifying biopsychosocial symptoms in stage 5 CKD patients receiving palliative care.