|
Sign In to gain access to subscriptions and/or personal tools.
|
Palliative Medicine, Vol. 13, No. 4,
311-323 (1999)
DOI: 10.1191/026921699675854885
A comparison of patient and proxy symptom assessments in advanced cancer patients
Cheryl L Nekolaichuk
Eduardo Bruera
Kathy Spachynski
Tara MacEachern
Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta
John Hanson
Department of Medicine, Cross Cancer Institute, University of Alberta, Edmonton, Alberta
Thomas O Maguire
Department of Educational Psychology, University of Alberta, Edmonton, Alberta
The purpose of this study was to compare patient and proxy (physician and nurse) assessments of symptoms in advanced cancer patients. The sample consisted of 49 patients with advanced cancer admitted to an acute palliative care unit. Three independent assessments were completed for each patient on two occasions within 11 days of admission. On each occasion, symptoms were rated independently by the patient and two proxies (treating physician and nurse), using the Edmonton Symptom Assessment System (ESAS). The ESAS is a nine-item visual analogue scale (VAS) for assessing pain, activity, nausea, depression, anxiety, drowsiness, appetite, well-being and shortness of breath. Symptom ratings were compared using a repeated-measures ANOVA procedure and correlations. Average physician ratings were generally lower than average patient ratings for both occasions. Average nurse ratings agreed more closely with patient ratings, with a trend towards lower ratings on occasion 1 and higher ratings on occasion 2. There was a significant rater (person rating the effects) effect (P < 0.01) for three of the nine symptoms: physicians rated drowsiness, shortness of breath and pain significantly lower than patients. For drowsiness and shortness of breath, these differences were clinically relevant, representing a difference of more than 12 mm on a 100-mm VAS. The accuracy of assessments amongst those rating the symptoms did not improve over time. Proxy assessments of symptom intensity, particularly by physicians, were significantly lower than patient assessments for three of the nine symptoms. Further research regarding the reliability of patient and proxy assessments is needed to assess and manage symptoms in advanced cancer effectively.
Key Words: neoplasms • outcome assessment (health care) • palliative care
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
C. Nekolaichuk, S. Watanabe, and C. Beaumont
The Edmonton Symptom Assessment System: a 15-year retrospective review of validation studies (1991-2006)
Palliative Medicine,
March 1, 2008;
22(2):
111 - 122.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M. van den Beuken-van Everdingen, J. de Rijke, A. Kessels, H. Schouten, M van Kleef, and J Patijn
Prevalence of pain in patients with cancer: a systematic review of the past 40 years
Ann. Onc.,
September 1, 2007;
18(9):
1437 - 1449.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Dorman, A. Byrne, and A. Edwards
Which measurement scales should we use to measure breathlessness in palliative care? A systematic review
Palliative Medicine,
April 1, 2007;
21(3):
177 - 191.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. Kirkova, M. P. Davis, D. Walsh, E. Tiernan, N. O'Leary, S. B. LeGrand, R. L. Lagman, and K. M. Russell
Cancer Symptom Assessment Instruments: A Systematic Review
J. Clin. Oncol.,
March 20, 2006;
24(9):
1459 - 1473.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Oi-Ling, D. T. Man-Wah, and D. N. Kam-Hung
Symptom distress as rated by advanced cancer patients, caregivers and physicians in the last week of life
Palliative Medicine,
April 1, 2005;
19(3):
228 - 233.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. L. Snow, K. J. O'Malley, M. Cody, M. E. Kunik, C. M. Ashton, C. Beck, E. Bruera, and D. Novy
A Conceptual Model of Pain Assessment for Noncommunicative Persons With Dementia
Gerontologist,
December 1, 2004;
44(6):
807 - 817.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. J. Patrick-Miller
Is There a Role for the Assessment of Health-related Quality of Life in the Clinical Evaluation of Novel Cytostatic Agents?: Commentary re: P. M. LoRusso, Improvements in Quality of Life and Disease-related Symptoms in Phase I Trials of the Selective Oral Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor ZD1839 in Non-Small Cell Lung Cancer and Other Solid Tumors. Clin. Cancer Res., 9: 2040-2048, 2003.
Clin. Cancer Res.,
June 1, 2003;
9(6):
1990 - 1994.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. K. George
Research Design in End-of-Life Research: State of Science
Gerontologist,
October 1, 2002;
42(90003):
86 - 98.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Horton
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,
September 1, 2002;
16(6):
488 - 494.
[Abstract]
[PDF]
|
|
|
|
|
|
|
D. Tassinari, I. Panzini, A. Ravaioli, M. Maltoni, S. Sartori, M. S. Jordhoy, S. Kaasa, J. H. Loge, and P. Fayers
Quality of Life at the End of Life: How Is the Solution Far Away?
J. Clin. Oncol.,
March 15, 2002;
20(6):
1704 - 1705.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Addington-Hall and L. Kalra
Measuring quality of life: Who should measure quality of life?
BMJ,
June 9, 2001;
322(7299):
1417 - 1420.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Costello, J. Wiseman, I. Douglas, B. Batten, and M. Bennett
Assessing hospice inpatients with pain using numerical rating scales
Palliative Medicine,
April 1, 2001;
15(3):
257 - 258.
[PDF]
|
|
|
|
|
|
|
R M Pickering
Describing the subjects in a study
Palliative Medicine,
January 1, 2001;
15(1):
69 - 75.
[PDF]
|
|
|
|
