Screening for palliative care needs in Chinese older adults with chronic diseases: Translation, cultural adaptation and validation of the Palliative Care Screening Tool (PCST-C) and a cross- sectional survey

Background China's rapidly aging population and the high prevalence of chronic diseases among older adults have created a pressing need for accessible palliative care. A critical first step is the early identification of need, yet there is a lack of validated screening tools for community-dwelling older adults with chronic conditions in the Chinese context. Objective This study aimed to: (1) cross-culturally adapt the Palliative Care Screening Tool (PCST) into Mandarin Chinese (PCST-C) for use among community-dwelling older adults with chronic diseases in China; and (2) evaluate its psychometric properties and assess the prevalence and predictors of unmet palliative care needs using the adapted tool. Design A two-phase study comprising instrument adaptation/validation and a cross-sectional survey. Setting Community settings in Changsha, China. Participants Phase 1 involved 266 older adults (≥ 60 years) with chronic diseases for psychometric testing. Phase 2 involved a separate sample of 302 older adults with chronic diseases for the needs assessment survey. Methods The PCST was translated and adapted following international guidelines. Its reliability and validity were assessed via internal consistency, test-retest reliability, content validity, exploratory factor analysis (EFA), and correlations with the SF-12 and ESAS. The validated PCST-C was then used to screen for unmet palliative care needs. Associated factors were analyzed using chi-square tests and multivariable logistic regression. Results The final 20-item PCST-C demonstrated good content validity (S-CVI/UA = 0.95), internal consistency (Cronbach’s α = 0.824), test-retest reliability (r = 0.948), and strong concurrent validity. EFA confirmed a three-domain structure. Using the PCST-C, 17.9% of participants screened positive for unmet palliative care needs. Multivariable analysis identified poorer self-rated health (AOR = 3.62), greater functional dependence (AOR = 3.27), and longer illness duration (AOR = 1.46) as independent predictors of need. Conclusions The PCST-C is a valid, reliable, and culturally appropriate tool for screening palliative care needs among community-dwelling older adults with chronic diseases in China. The significant prevalence of unmet needs and the identified predictors highlight the importance of targeted screening, particularly for those with negative health perceptions, functional decline, and long-term illness, to facilitate timely palliative care integration. Trial registration Not applicable. This study is a cross-sectional survey and does not involve a health care intervention or clinical trial.