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Montagut-Martínez P, Pérez-Cruzado D, Gutiérrez-Sánchez D. Cancer-related fatigue measures in palliative care: A psychometric systematic review. Eur J Cancer Care (Engl) 2022; 31:e13642. [PMID: 35822246 DOI: 10.1111/ecc.13642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/26/2022] [Accepted: 06/06/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION In palliative care, the prevention and relief of fatigue are regarded as crucial goals in patients with cancer. METHODS A systematic review was carried out according to the COnsensus-based Standards for the selection of health status Measurement INstruments methodology. Searches were conducted in Medline (through PubMed), Web of Science, Open Gray, Scielo, Cochrane, CINAHL and EMBASE. All instruments found in each study were assessed using the COnsensus-based Standards for the selection of health status Measurement INstruments checklist and Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS A total of 5598 articles were identified in the different databases. In total, 57 studies describing 19 instruments were included in this study. The main properties evaluated were internal consistency, cross-cultural validity, hypotheses testing and responsiveness. All studies were evaluated with the Strobe scale with a score greater than 6 points. CONCLUSIONS According to the quality methodological results, Edmonton Symptom Assessment System, Problems and Needs in Palliative Care Questionnaire, European Organisation for Research and Treatment of Cancer Quality of Life 15-item Questionnaire for Palliative Care and Palliative Care Quality of Life Instrument are the recommended instruments used for assessing cancer-related fatigue in palliative care. PROPESRO registration number: CRD42020206783.
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Affiliation(s)
| | - David Pérez-Cruzado
- Department of Occupational Therapy, Universidad Catolica de Murcia UCAM, Murcia, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Daniel Gutiérrez-Sánchez
- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain.,Department of Nursing and Podiatry, University of Málaga, Málaga, Spain
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Cohen SR, Russell LB, Leis A, Shahidi J, Porterfield P, Kuhl DR, Gadermann AM, Sawatzky R. More comprehensively measuring quality of life in life-threatening illness: the McGill Quality of Life Questionnaire - Expanded. BMC Palliat Care 2019; 18:92. [PMID: 31672131 PMCID: PMC6823967 DOI: 10.1186/s12904-019-0473-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/26/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Domains other than those commonly measured (physical, psychological, social, and sometimes existential/spiritual) are important to the quality of life of people with life-threatening illness. The McGill Quality of Life Questionnaire (MQOL) - Revised measures the four common domains. The aim of this study was to create a psychometrically sound instrument, MQOL - Expanded, to comprehensively measure quality of life by adding to MQOL-Revised the domains of cognition, healthcare, environment, (feeling like a) burden, and possibly, finance. METHODS Confirmatory factor analyses were conducted on three datasets to ascertain whether seven new items belonged with existing MQOL-Revised domains, whether good model fit was obtained with their addition as five separate domains to MQOL-Revised, and whether a second-order factor representing overall quality of life was present. People with life-threatening illnesses (mainly cancer) or aged > 80 were recruited from 15 healthcare sites in seven Canadian provinces. Settings included: palliative home care and inpatient units; acute care units; oncology outpatient clinics. RESULTS Good model fit was obtained when adding each of the five domains separately to MQOL-Revised and for the nine correlated domains. Fit was acceptable for a second-order factor model. The financial domain was removed because of low importance. The resulting MQOL-Expanded is a 21-item instrument with eight domains (fit of eight correlated domains: Comparative Fit Index = .96; Root Mean Square Error of Approximation = .033). CONCLUSIONS MQOL-Expanded builds on MQOL-Revised to more comprehensively measure the quality of life of people with life-threatening illness. Our analyses provide validity evidence for the MQOL-Expanded domain and summary scores; the need for further validation research is discussed. Use of MQOL-Expanded will enable a more holistic understanding of the quality of life of people with a life-threatening illness and the impact of treatments and interventions upon it. It will allow for a better understanding of less commonly assessed but important life domains (cognition, healthcare, environment, feeling like a burden) and their relationship to the more commonly assessed domains (physical, psychological, social, existential/spiritual).
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Affiliation(s)
- S Robin Cohen
- Departments of Oncology and Medicine, McGill University, Montréal, Canada. .,Lady Davis Research Institute of the Jewish General Hospital, Palliative Care Research, room E8.06, 3755 Côte Ste. Catherine Road, Montréal, Québec, H3T 1E2, Canada.
| | - Lara B Russell
- Centre for Health Evaluation and Outcomes Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Anne Leis
- Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - David R Kuhl
- Departments of Family Practice and Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne M Gadermann
- Centre for Health Evaluation and Outcomes Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada.,Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Richard Sawatzky
- Centre for Health Evaluation and Outcomes Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada.,School of Nursing, Trinity Western University, Langley, British Columbia, Canada
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Vallely JJ, Hudson KE, Locke SC, Wolf SP, Samsa GP, Abernethy AP, LeBlanc TW. Pruritus in patients with solid tumors: an overlooked supportive care need. Support Care Cancer 2019; 27:3897-3904. [PMID: 30762144 DOI: 10.1007/s00520-019-04693-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 02/05/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE Pruritus is a common symptom in cutaneous malignancies, but its impact on patients with solid tumors is unclear. We explored the impact and management of pruritus in patients with solid tumors, using patient-reported outcomes (PRO) data from a real-world registry. METHODS From 2006 to 2011, patients seen in the Duke Cancer Institute reported their symptoms via the Patient Care Monitor v2.0, a validated PRO tool that includes a 0-10-point question about pruritus severity. From > 25,000 encounters, 203 patients reported severe pruritus (> 6/10) on at least one visit and 506 total visits were abstracted where patients reported either moderate or severe pruritus (> 3/10). From this cohort, we abstracted demographics, diagnosis, stage, cancer therapy, anti-pruritic therapy, and clinicians' responses. RESULTS Mean age was 59.8 (SD 13.3), 134 (66%) were female, 125 (62%) were Caucasian, and 65 (32%) were African American. Breast cancer was the most common tumor (36.5%), followed by lung cancer (23.2%). Mean pruritus severity score was 6.8 (SD 1.8) for patients on chemotherapy, 6.9 (SD 1.8) for patients on targeted therapy alone or in combination, and 7.1(SD 1.8) for patients off treatment. Overall, 67% of patients reported at least two episodes of moderate-severe pruritus (mean # of visits 4.2 (SD 2.7)). Despite frequent report of severe and persistent pruritus, this was mentioned in just 28% of clinician notes and an intervention was recommended/prescribed in only 7% of visits. CONCLUSIONS Pruritus is an under-addressed symptom in patients with solid tumors. Additional research is needed to understand the burden of pruritus in affected populations.
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Affiliation(s)
- Jaxon J Vallely
- Campbell University School of Osteopathic Medicine, Buies Creek, NC, USA
| | | | | | - Steven P Wolf
- Biostatistics Core, Duke University School of Medicine, Durham, NC, USA
| | - Gregory P Samsa
- Biostatistics Core, Duke University School of Medicine, Durham, NC, USA
| | - Amy P Abernethy
- Duke Cancer Institute, Durham, NC, USA.,Flatiron Health, Member of the Roche Group, New York, NY, USA
| | - Thomas W LeBlanc
- Duke Cancer Institute, Durham, NC, USA. .,Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Box 2715, DUMC, Durham, NC, 27710, USA.
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Nguyen LT, Yates P, Annoussamy LC, Truong TQ. The effectiveness of non-pharmacological interventions in the management of symptom clusters in adult cancer patients: a systematic review protocol. ACTA ACUST UNITED AC 2018; 14:49-59. [PMID: 27532309 DOI: 10.11124/jbisrir-2016-2476] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
REVIEW QUESTION/OBJECTIVE To what extent are non-pharmacological interventions effective in reducing symptom clusters in terms of presence, frequency and severity, compared with standard care?More specifically, the objectives are to: CENTER CONDUCTING THE REVIEW:: The Hanoi Medical University Nursing Research Center for Evidence Based Health Care: a Collaborating Centre of the Joanna Briggs Institute; and Centre for Evidence-based Healthy Aging: an Affiliate Centre of the Joanna Briggs Institute, School of Nursing, Queensland University of Technology, Australia.
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Affiliation(s)
- Ly Thuy Nguyen
- 1Hanoi Medical University, Hanoi, Vietnam 2School of Nursing, Queensland University of Technology, Australia 3L'Hôpital Francais de Hanoi, Hanoi, Vietnam
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McCaffrey N, Bradley S, Ratcliffe J, Currow DC. What Aspects of Quality of Life Are Important From Palliative Care Patients' Perspectives? A Systematic Review of Qualitative Research. J Pain Symptom Manage 2016; 52:318-328.e5. [PMID: 27216362 DOI: 10.1016/j.jpainsymman.2016.02.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/03/2016] [Accepted: 02/26/2016] [Indexed: 10/21/2022]
Abstract
CONTEXT Despite the availability of numerous tools professing to measure quality of life (QOL) in the palliative care setting, no single instrument includes all patient-valued domains. OBJECTIVES To identify which aspects of QOL are important from palliative care patients' perspectives, aiding coverage, and content validity evaluation of available tools. METHODS A systematic review and synthesis of qualitative research was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. ASSIA, CINAHL, Cochrane library, Embase, Medline, PsycINFO, and PubMed were searched from database inception to December 31, 2015. Published, peer-reviewed, English-language articles reporting primary qualitative data investigating QOL domains in adults with a progressive, life-limiting illness were included. Studies a priori exploring a chosen aspect of QOL were not included. Articles scoring ≤2 on reporting quality were excluded. Framework synthesis was used to identify key themes across the studies. RESULTS Overall, 3589 articles were screened and 24 studies were included. Eight important aspects of QOL were identified: physical; personal autonomy; emotional; social; spiritual; cognitive; healthcare; and preparatory. All but one study discussed spiritual aspects, whereas only six studies mentioned cognitive aspects. CONCLUSION A broad range of domains are important to the QOL of people with life-limiting illnesses receiving palliation. Refinement of measures is needed to help ensure services address issues valued by patients such as preparation for death and aspects of health care provision, elements which are seldom included in currently available preference-based measures used to inform value for money decisions in palliative care.
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Affiliation(s)
- Nicola McCaffrey
- Flinders Clinical Effectiveness, Flinders University, Bedford Park, South Australia, Australia; Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia.
| | - Sandra Bradley
- Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia
| | - Julie Ratcliffe
- Flinders Clinical Effectiveness, Flinders University, Bedford Park, South Australia, Australia
| | - David C Currow
- Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia
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Paiva CE, Barroso EM, Carneseca EC, de Pádua Souza C, dos Santos FT, Mendoza López RV, Ribeiro Paiva SB. A critical analysis of test-retest reliability in instrument validation studies of cancer patients under palliative care: a systematic review. BMC Med Res Methodol 2014; 14:8. [PMID: 24447633 PMCID: PMC3899385 DOI: 10.1186/1471-2288-14-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/13/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Patient-reported outcome validation needs to achieve validity and reliability standards. Among reliability analysis parameters, test-retest reliability is an important psychometric property. Retested patients must be in a clinically stable condition. This is particularly problematic in palliative care (PC) settings because advanced cancer patients are prone to a faster rate of clinical deterioration. The aim of this study was to evaluate the methods by which multi-symptom and health-related qualities of life (HRQoL) based on patient-reported outcomes (PROs) have been validated in oncological PC settings with regards to test-retest reliability. METHODS A systematic search of PubMed (1966 to June 2013), EMBASE (1980 to June 2013), PsychInfo (1806 to June 2013), CINAHL (1980 to June 2013), and SCIELO (1998 to June 2013), and specific PRO databases was performed. Studies were included if they described a set of validation studies. Studies were included if they described a set of validation studies for an instrument developed to measure multi-symptom or multidimensional HRQoL in advanced cancer patients under PC. The COSMIN checklist was used to rate the methodological quality of the study designs. RESULTS We identified 89 validation studies from 746 potentially relevant articles. From those 89 articles, 31 measured test-retest reliability and were included in this review. Upon critical analysis of the overall quality of the criteria used to determine the test-retest reliability, 6 (19.4%), 17 (54.8%), and 8 (25.8%) of these articles were rated as good, fair, or poor, respectively, and no article was classified as excellent. Multi-symptom instruments were retested over a shortened interval when compared to the HRQoL instruments (median values 24 hours and 168 hours, respectively; p = 0.001). Validation studies that included objective confirmation of clinical stability in their design yielded better results for the test-retest analysis with regard to both pain and global HRQoL scores (p < 0.05). The quality of the statistical analysis and its description were of great concern. CONCLUSION Test-retest reliability has been infrequently and poorly evaluated. The confirmation of clinical stability was an important factor in our analysis, and we suggest that special attention be focused on clinical stability when designing a PRO validation study that includes advanced cancer patients under PC.
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Affiliation(s)
- Carlos Eduardo Paiva
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo CEP 14784-400, Brazil
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Researcher Support Center, Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Eliane Marçon Barroso
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Estela Cristina Carneseca
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Researcher Support Center, Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Cristiano de Pádua Souza
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo CEP 14784-400, Brazil
| | - Felipe Thomé dos Santos
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo CEP 14784-400, Brazil
| | | | - Sakamoto Bianca Ribeiro Paiva
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Researcher Support Center, Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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Cataldo JK, Paul S, Cooper B, Skerman H, Alexander K, Aouizerat B, Blackman V, Merriman J, Dunn L, Ritchie C, Yates P, Miaskowski C. Differences in the symptom experience of older versus younger oncology outpatients: a cross-sectional study. BMC Cancer 2013; 13:6. [PMID: 23281602 PMCID: PMC3576303 DOI: 10.1186/1471-2407-13-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 12/20/2012] [Indexed: 01/31/2023] Open
Abstract
Background Mortality rates for cancer are decreasing in patients under 60 and increasing in those over 60 years of age. The reasons for these differences in mortality rates remain poorly understood. One explanation may be that older patients received substandard treatment because of concerns about adverse effects. Given the paucity of research on the multiple dimensions of the symptom experience in older oncology patients, the purpose of this study was to evaluate for differences in ratings of symptom occurrence, severity, frequency, and distress between younger (< 60 years) and older ( ≥ 60 years) adults undergoing cancer treatment. We hypothesized that older patients would have significantly lower ratings on four symptom dimensions. Methods Data from two studies in the United States and one study in Australia were combined to conduct this analysis. All three studies used the MSAS to evaluate the occurrence, severity, frequency, and distress of 32 symptoms. Results Data from 593 oncology outpatients receiving active treatment for their cancer (i.e., 44.4% were < 60 years and 55.6% were ≥ 60 years of age) were evaluated. Of the 32 MSAS symptoms, after controlling for significant covariates, older patients reported significantly lower occurrence rates for 15 (46.9%) symptoms, lower severity ratings for 6 (18.9%) symptoms, lower frequency ratings for 4 (12.5%) symptoms, and lower distress ratings for 14 (43.8%) symptoms. Conclusions This study is the first to evaluate for differences in multiple dimensions of symptom experience in older oncology patients. For almost 50% of the MSAS symptoms, older patients reported significantly lower occurrence rates. While fewer age-related differences were found in ratings of symptom severity, frequency, and distress, a similar pattern was found across all three dimensions. Future research needs to focus on a detailed evaluation of patient and clinical characteristics (i.e., type and dose of treatment) that explain the differences in symptom experience identified in this study.
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Affiliation(s)
- Janine K Cataldo
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA
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Correia FR, De Carlo MMRDP. Evaluation of quality of life in a palliative care context: an integrative literature review. Rev Lat Am Enfermagem 2012; 20:401-10. [DOI: 10.1590/s0104-11692012000200025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 11/25/2011] [Indexed: 01/29/2023] Open
Abstract
The use of scales that have been validated and standardized for different cultures is very useful for identifying demands in the field of Palliative Care and implementing the most appropriate care. This integrative literature review focuses on instruments assessing the Quality of Life of patients under Palliative Care through a journal search in electronic databases. The study consisted of 49 papers identified in Medline/PubMed, of which 18 met the inclusion criteria previously defined. Information concerning the selected studies is presented and later categorized, with a greater emphasis on the analysis of the psychometric properties of validations of the Palliative Outcome Scale, conducted in three countries. This review enabled the identification of instruments already developed and validated for different cultures, increasing the possibility of knowledge in the field.
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9
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Kwon SH. [Development and validation of the hospice palliative care performance scale]. J Korean Acad Nurs 2011; 41:374-81. [PMID: 21804346 DOI: 10.4040/jkan.2011.41.3.374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to develop and validate a hospice-palliative care performance measure which would cover more than just physical symptoms or quality of life. METHODS Through an intensive literature review, the author chose questions that measured aspects of physical, emotional, spiritual, social, or practical domains pertinent to hospice-palliative care for inclusion in the scale. Content validation of the questions was established by 15 hospice-palliative care professionals. A preliminary Hospice Palliative Care Performance Scale (HPCPS) of 20 questions was administered to 134 pairs of terminal cancer patients from 5 hospice palliative care units and their main family caregiver. A validation study was conducted to evaluate construct validity and internal consistency. RESULTS Factor analysis showed 14 significant questions in five subscales; Physical, Emotional, Spiritual, Social, and Patient' rights. There were no significant differences between the ratings by patients and family members except for three out of the 14 questions. The measure demonstrated construct validity, and Cronbach's alpha of the subscales ranged from .73 to .79. CONCLUSION The HPCOS demonstrated acceptable validity and reliability. It can be used to assess effectiveness of hospice-palliative care for terminal cancer patients in practice and research.
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Affiliation(s)
- So-Hi Kwon
- College of Nursing, Kyungpook National University, The Research Institute of Nursing Science, Daegu, Korea.
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10
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Richards CT, Gisondi MA, Chang CH, Courtney DM, Engel KG, Emanuel L, Quest T. Palliative care symptom assessment for patients with cancer in the emergency department: validation of the Screen for Palliative and End-of-life care needs in the Emergency Department instrument. J Palliat Med 2011; 14:757-64. [PMID: 21548790 DOI: 10.1089/jpm.2010.0456] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE We sought to develop and validate a novel palliative medicine needs assessment tool for patients with cancer in the emergency department. METHODS An expert panel trained in palliative medicine and emergency medicine reviewed and adapted a general palliative medicine symptom assessment tool, the Needs at the End-of-Life Screening Tool. From this adaptation a new 13-question instrument was derived, collectively referred to as the Screen for Palliative and End-of-life care needs in the Emergency Department (SPEED). A database of 86 validated symptom assessment tools available from the palliative medicine literature, totaling 3011 questions, were then reviewed to identify validated test items most similar to the 13 items of SPEED; a total of 107 related questions from the database were identified. Minor adaptations of questions were made for standardization to a uniform 10-point Likert scale. The 107 items, along with the 13 SPEED items were randomly ordered to create a single survey of 120 items. The 120-item survey was administered by trained staff to all patients with cancer who met inclusion criteria (age over 21 years, English-speaking, capacity to provide informed consent) who presented to a large urban academic emergency department between 8:00 am and 11:00 pm over a 10-week period. Data were analyzed to determine the degree of correlation between SPEED items and the related 107 selected items from previously validated tools. RESULTS A total of 53 subjects were enrolled, of which 49 (92%) completed the survey in its entirety. Fifty-three percent of subjects were male, age range was 24-88 years, and the most common cancer diagnoses were breast, colon, and lung. Cronbach coefficient α for the SPEED items ranged from 0.716 to 0.991, indicating their high scale reliability. Correlations between the SPEED scales and related assessment tools previously validated in other settings were high and statistically significant. CONCLUSION The SPEED instrument demonstrates reliability and validity for screening for palliative care needs of patients with cancer presenting to the emergency department.
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Selman L, Harding R, Gysels M, Speck P, Higginson IJ. The measurement of spirituality in palliative care and the content of tools validated cross-culturally: a systematic review. J Pain Symptom Manage 2011; 41:728-53. [PMID: 21306866 DOI: 10.1016/j.jpainsymman.2010.06.023] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 06/23/2010] [Accepted: 07/08/2010] [Indexed: 11/19/2022]
Abstract
CONTEXT Despite the need to assess spiritual outcomes in palliative care, little is known about the properties of the tools currently used to do so. In addition, measures of spirituality have been criticized in the literature for cultural bias, and it is unclear which tools have been validated cross-culturally. OBJECTIVES This systematic review aimed to identify and categorize spiritual outcome measures validated in advanced cancer, human immunodeficiency virus (HIV), or palliative care populations; to assess the tools' cross-cultural applicability; and for those measures validated cross-culturally, to determine and categorize the concepts used to measure spirituality. METHODS Eight databases were searched to identify relevant validation and research studies. An extensive search strategy included search terms in three categories: palliative care, spirituality, and outcome measurement. Tools were evaluated according to two criteria: 1) validation in advanced cancer, HIV, or palliative care and 2) validation in an ethnically diverse context. Tools that met Criterion 1 were categorized by type; tools that also met Criterion 2 were subjected to content analysis to identify and categorize the spiritual concepts they use. RESULTS One hundred ninety-one articles were identified, yielding 85 tools. Fifty different tools had been reported in research studies; however, 30 of these had not been validated in palliative care populations. Thirty-eight tools met Criterion 1: general multidimensional measures (n=21), functional measures (n=11), and substantive measures (n=6). Nine measures met Criterion 2; these used spiritual concepts relating to six themes: Beliefs, practices, and experiences; Relationships; Spiritual resources; Outlook on life/self; Outlook on death/dying; and Indicators of spiritual well-being. A conceptual model of spirituality is presented on the basis of the content analysis. Recommendations include consideration of both the clinical and cultural population in which spiritual instruments have been validated when selecting an appropriate measure for research purposes. Areas in need of further research are identified. CONCLUSION The nine tools identified in this review are those that have currently been validated in cross-cultural palliative care populations and, subject to appraisal of their psychometric properties, may be suitable for cross-cultural research.
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Affiliation(s)
- Lucy Selman
- Department of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom.
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Lin CY, Arnold RM, Lave JR, Angus DC, Barnato AE. Acute care practices relevant to quality end-of-life care: a survey of Pennsylvania hospitals. Qual Saf Health Care 2010; 19:e12. [PMID: 20427307 PMCID: PMC4070305 DOI: 10.1136/qshc.2008.030056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Improving end-of-life care in the hospital is a national priority. PURPOSE To explore the prevalence and reasons for implementation of hospital-wide and intensive care unit (ICU) practices relevant to quality care in key end-of-life care domains and to discern major structural determinants of practice implementation. DESIGN Cross-sectional mixed-mode survey of chief nursing officers of Pennsylvania acute care hospitals. RESULTS The response rate was 74% (129 of 174). The prevalence of hospital and ICU practices ranged from 95% for a hospital-wide formal code policy to 6% for regularly scheduled family meetings with an attending physician in the ICU. Most practices had less than 50% implementation; most were implemented primarily for quality improvement or to keep up with the standard of care. In a multivariable model including hospital structural characteristics, only hospital size independently predicted the presence of one or more hospital initiatives (ethics consult service, OR 6.13, adjusted p = 0.02; private conference room in the ICU for family meetings, OR 4.54, adjusted p<0.001). CONCLUSIONS There is low penetration of hospital practices relevant to quality end-of-life care in Pennsylvania acute care hospitals. Our results may serve to inform the development of future benchmark goals. It is critical to establish a strong evidence base for the practices most associated with improved end-of-life care outcomes and to develop quality measures for end-of-life care to complement existing hospital quality measures that primarily focus on life extension.
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Affiliation(s)
- C Y Lin
- Center for Research on Health Care and the Institute for Clinical Research Education, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Suite 200, Pittsburgh, PA 15213, USA
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