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Assessing symptoms of terminally-ill patients by different raters: A prospective study

Published online by Cambridge University Press:  07 December 2005

SILKE ZLOKLIKOVITS ,
ELISABETH ANDRITSCH ,
BRIGITTE FRÖHLICH ,
JULIJANE VEREBES ,
GABRIELE DIETMAIER  and
HELLMUT SAMONIGG
SILKE ZLOKLIKOVITS
Affiliation:
Section of Palliative Care and Division of Clinical Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
ELISABETH ANDRITSCH
Affiliation:
Section of Palliative Care and Division of Clinical Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
BRIGITTE FRÖHLICH
Affiliation:
Section of Palliative Care and Division of Clinical Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
JULIJANE VEREBES
Affiliation:
Section of Palliative Care and Division of Clinical Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
GABRIELE DIETMAIER
Affiliation:
Section of Palliative Care and Division of Clinical Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
HELLMUT SAMONIGG
Affiliation:
Section of Palliative Care and Division of Clinical Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
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Abstract

Objective: For patients who are terminally ill, the efficiency of symptom management is dependent, among other factors, on an accurate assessment by proxy raters. The aim of this prospective study is to describe differences in symptom severity ratings between patients and their nurses, physicians, and family members during their stay in different departments with acute care, and to identify variables associated with the accuracy of the ratings by others.

Methods: Physical, psychological, social, and functional disorders were assessed for 41 in-patients with a standardized 13-item Symptom List for Quality Assurance in Palliative Care drafted by the Working Group on the Core Documentation for Palliative Care Units in Germany. Symptom assessment was completed by different raters (patient, nurse, physician, family member) within the first four days after admission. Socio-demographic, disease-related, and hospitalization data were taken from patient charts.

Results: Reliability of the symptom list was computed with Cronbach's alpha measures for the present sample. Between-group-comparisons on the individual items and on the sum-score level were analyzed separately for the different rater-pairs: patients-nurses (n = 41), patients-physicians (n = 39), patients-family members (n = 12). Multiple regression analyses calculated predictive variables of the staff's deviation scores.

Significance of results: Significant differences for nurses and physicians were found on the sum-score level for psychological and social symptoms, but not for physical and functional symptoms. Family members rated the intensities of the symptoms generally higher than the patients. Suggestions for further analyses are presented and discussed.

Keywords

Symptom assessmentTerminally-ill patientsSelf-assessment vs. assessment by others
Type
Research Article
Information
Palliative & Supportive Care , Volume 3 , Issue 2 , June 2005 , pp. 87 - 98
Copyright
© 2005 Cambridge University Press

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References

REFERENCES

Addington-Hall, J. & Kalra, L. (2001). Measuring quality of life: Who should measure quality of life? British Medical Journal, 322, 1417–1420.Google Scholar
Barresi, M.J., Shadbolt, B., Byrne, D., et al. (2003). The development of the Canberra symptom scorecard: A tool to monitor the physical symptoms of patients with advanced tumours. BMC Cancer, 3, 32.Google Scholar
Brunelli, C., Constantini, M., Di Giulio, P., et al. (1998). Quality-of-Life Evaluation: When Do Terminal Cancer Patients and Health-Care Providers Agree? Journal of Pain and Symptom Management, 15 (3), 151–158.Google Scholar
Faller, H., Lang, H., & Schilling, H. (1995). Emotional distress and hope in lung cancer patients, as perceived by patients, relatives, physicians, nurses and interviewers. Psycho-Oncology, 4, 21–31.Google Scholar
Horton, R. (2002). Differences in assessment of symptoms and quality of life between patients with advanced cancer and their specialist palliative care nurses in a home care setting. Palliative Medicine, 16, 488–494.Google Scholar
Karnofsky, D.A. & Burchenal, J.H. (1949). The clinical evaluation of chemotherapeutic agents in cancer. In Evaluation of chemotherapeutic agents, MacLeod, C.M. (ed.), pp. 191–205. Symposium, Microbiology Section, New York Academy of Medicine, New York: Columbia University Press.
Kristjanson, L.J., Nikoletti, S., Porock, D., et al. (1998). Congruence between patients' and family caregivers' perceptions of symptom distress in patients with terminal cancer. Journal of Palliative Care, 14 (3), 24–32.Google Scholar
Lobchuk, M.M. (2003). The Memorial Symptom Assessment Scale: Modified for use in understanding family caregivers' perceptions of cancer patients' symptom experience. Journal of Pain and Symptom Management, 26, 644–654.Google Scholar
Lobchuk, M.M. & Degner, L.F. (2002a). Symptom experiences: Perceptual accuracy between advanced-stage cancer patients and family caregivers in the home care setting. Journal of Clinical Oncology, 20(16), 3495–3507.Google Scholar
Lobchuk, M.M. & Degner, L.F. (2002b). Patients with cancer and next-of-kin response comparability on physical and psychological symptom well-being. Trends and Measurement Issues. Cancer Nursing, 25 (5), 358–374.Google Scholar
Lobchuk, M.M., Kristjanson, L., Degner, L., et al. (1997). Perceptions of symptom distress in lung cancer patients: I. Congruence between patients and primary family caregivers. Journal of Pain and Symptom Management, 14 (3), 136–146.Google Scholar
Ludbrook, J. (2002). Statistical techniques for comparing measurers and methods of measurement: A critical review. Clinical and Experimental Pharmacology and Physiology, 29, 527–536.Google Scholar
Mann, H.R. & Whitney, D.R. (1947). On a test of whether one of two random variables is stochastically larger than the other. Annals of Mathematical Statistics, 18, 50–60.Google Scholar
McDaniel, R.W. & Rhodes, V.A. (1995). Symptom experience. Seminars in Oncology Nursing, 11 (4), 232–234.Google Scholar
McPherson, C.J. & Addington-Hall, J.M. (2003). Judging the quality of care at the end of life: Can proxies provide reliable information? Social, Science & Medicine, 56, 95–109.Google Scholar
Mercadante, S., Casaccio, A., & Fulfaro, F. (2000). The course of symptom frequency and intensity in advanced cancer patients followed at home. Journal of Pain and Symptom Management, 20, 104–112.Google Scholar
Nekolaichuk, C.L., Bruera, E., Spachynski, K., et al. (1999a). A comparison of patient and proxy symptom assessments in advanced cancer patients. Palliative Medicine, 13, 311–323.Google Scholar
Nekolaichuk, C.L., Maguire, T.O., Suarez-Almazor, M., et al. (1999b). Assessing the reliability of patient, nurse and family caregiver symptom ratings in hospitalized advanced cancer patients. Journal of Clinical Oncology, 17(11), 3621–3630.Google Scholar
Potter, J., Hami, F., Bryan, T., et al. (2003). Symptoms in 400 patients referred to palliative care services: Prevalence and patterns. Palliative Medicine, 17, 310–314.Google Scholar
Radbruch, L., Nauck, F., Ostgathe, Ch., et al. (2003). What are the problems in palliative care? Results from a representative survey. Supportive Care in Cancer, 11, 442–451.Google Scholar
Radbruch, L., Nauck, F., Fuchs, M., Neuwöhner, K., Schulenberg, D., Lindena, & G., and the Working Group on the Core Documentation for Palliative Care Units in Germany. (2002). What is palliative care in Germany? Results from a representative survey. Journal of Pain and Symptom Management, 23 (6), 471–483.Google Scholar
Radbruch, L., Sabatowski, R., Loick, G., et al. (2000a). MIDOS. Validierung eines minimalen Dokumentationssystems für die Palliativmedizin. Schmerz, 14, 231–239.Google Scholar
Radbruch, L., Sabatowski, G.L., Jonen-Thielemann, I., et al. (2000b). Cognitive impairment and its influence on pain and symptom assessment in a palliative care unit: Development of a Minimal Documentation System. Palliative Medicine, 14, 266–276.Google Scholar
Rhodes, V.A., McDaniel, R.W., Homan, S.S., et al. (2000). An instrument to measure symptom experience. Symptom occurrence and symptom distress. Cancer Nursing, 23 (1), 49–54.Google Scholar
Sneeuw, K.C., Aaronson, N.K., Sprangers, M.A., et al. (1999). Evaluating the quality of life of cancer patients: Assessments by patients, significant others, physicians and nurses. British Journal of Cancer, 81(1), 87–94.Google Scholar
Sprangers, M.A. & Aaronson, N.K. (1992). The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease: A review. Journal of Clinical Epidemiology, 45, 743–760.Google Scholar
Strömgren, A.S., Groenvold, M., Pedersen, L., et al. (2002). Symptomatology of cancer patients in palliative care: Content validation of self-assessment questionnaires against medical records. European Journal of Cancer, 38, 788–794.Google Scholar