Identifying palliative care needs in children with acute lymphoblastic leukemia: validation of the Chinese paediatric palliative screening scale (C-PaPaS)

Timely identification of pediatric palliative care (PPC) needs is essential to improving the quality of life for children with life-threatening illnesses. The Paediatric Palliative Screening Scale (PaPaS) has been validated internationally, but it has not yet been evaluated in mainland China, where PPC infrastructure remains limited and fragmented. The aim of this study is to adapt the PaPaS into Chinese and evaluate its diagnostic performance in identifying PPC needs among children with acute lymphoblastic leukemia (ALL) during induction chemotherapy. This retrospective diagnostic accuracy study included children aged 0–18 years newly diagnosed with ALL who initiated induction therapy under the CCCG-ALL-2020 protocol at a tertiary pediatric hospital in China (August 2020–August 2023). The Chinese version of the PaPaS (C-PaPaS) was developed through forward–backward translation and expert review. Scores were retrospectively assigned using electronic medical records. Receiver operating characteristic (ROC) analysis was used to assess diagnostic performance and identify the optimal cutoff. Among 153 patients, 28.1% received PPC interventions. Median C-PaPaS scores were significantly higher in the PPC group (23 [IQR 17–25]) than in the non-PPC group (15 [14–19]; P < 0.001). At a cutoff score of > 22, the C-PaPaS demonstrated high sensitivity (93.0%) and moderate specificity (41.8%), with an area under the ROC curve of 0.79 (95% CI: 0.71–0.87). The C-PaPaS demonstrated strong sensitivity and moderate discriminative accuracy in identifying PPC needs among children with ALL. It may serve as a useful triage tool to support early palliative integration, especially in settings with limited PPC infrastructure.