Spanish modified version of the palliative care outcome scale-symptoms renal: cross-cultural adaptation and validation

Nomenclature in Palliative and Kidney Supportive Care: Not Just at the End-of-Life

The multidimensional view of disease is fundamental in the care of complex diseases such as chronic kidney disease (CKD). It is appropriate to define and unify concepts that allow the different professionals involved in care to provide a multidisciplinary approach tailored to the needs of each individual. Given the increasing incidence of CKD worldwide and the fact that the disease may progress at different rates, there is a need to establish personalized, comprehensive approaches for each patient and their families at an earlier stage. This approach goes beyond the simple control of uremic symptoms or congestion and consists of addressing not only symptomatic but also functional, social and coping problems at an early stage, facilitating decision making both in the CKD and in acute situations, potentially irreversible or interventions that do not improve life expectancy. To ensure excellence in care, it is important to assess indicators of palliative care and kidney support, such as the presence of advance and shared care planning, the inclusion of psychosocial, ethical, spiritual and bereavement care. This enables the provision of comprehensive, humanized, and high-quality care for patients and their families. Palliative and kidney care is not just about patients in the last days of life. Defining, unifying, and evaluating the concepts will allow them to be applied in a timely manner at each specific moment of the CKD trajectory.

Pilot Testing Transcreated Spanish-Language Study Materials for Symptom Research With Infants and Parents in the Neonatal Intensive Care Unit

BACKGROUND

Rising admission rates of Hispanic/Latinx families to the neonatal intensive care unit (NICU) have increased the number of non-English-speaking individuals who may wish to participate in research studies. However, a lack of appropriately translated research study materials may limit the opportunity for these families to be involved in research that could impact the care that infants and families receive in the NICU.

PURPOSE

The primary purpose was to pilot test study materials that were transcreated from English to Spanish with the assistance of a bilingual community advisory board with Spanish-speaking parents of NICU infants.

METHODS

A total of 19 Spanish-speaking parents (15 mothers and 4 fathers) who were representative of the population of interest completed paper-and-pencil surveys, along with a cognitive interview. Preliminary data related to decision-making and goals of care, infant symptoms, and their experiences in the NICU were also collected.

RESULTS

The internal reliability of the transcreated study instruments ranged from good to excellent (α= 0.82-0.99). Participants reported that study materials were not offensive and did not make them feel uncomfortable; however, they found some words/phrases to be confusing. Parents had the opportunity to provide suggested wording changes.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Language barriers and a lack of cultural responsiveness can affect the care that infants and their families receive. More accurate and culturally appropriate transcreation of study materials can remove barriers to research participation and facilitate better communication with non-English-speaking families, which may lead to the development of better-informed evidence-based interventions and clinical practices in the NICU.

Consensus document on palliative care in cardiorenal patients

There is an unmet need to create consensus documents on the management of cardiorenal patients since, due to the aging of the population and the rise of both pathologies, these patients are becoming more prevalent in daily clinical practice. Chronic kidney disease coexists in up to 40%-50% of patients with chronic heart failure cases. There have yet to be consensus documents on how to approach palliative care in cardiorenal patients. There are guidelines for patients with heart failure and chronic kidney disease separately, but they do not specifically address patients with concomitant heart failure and kidney disease. For this reason, our document includes experts from different specialties, who will not only address the justification of palliative care in cardiorenal patients but also how to identify this patient profile, the shared planning of their care, as well as knowledge of their trajectory and the palliative patient management both in the drugs that will help us control symptoms and in advanced measures. Dialysis and its different types will also be addressed, as palliative measures and when the decision to continue or not perform them could be considered. Finally, the psychosocial approach and adapted pharmacotherapy will be discussed.

Kannada Translation and Validation of the ESAS-r Renal for Symptom Burden Survey in Patients with End-Stage Kidney Disease

Objectives

End-stage kidney disease (ESKD) is a life-limiting illness that leads to significant health-related suffering for the patients and their caregivers. Moreover, disease-directed options such as dialysis and renal transplant might not be universally accessible. Inadequate assessment and management of symptoms often lead to diminished quality of life. For evaluating symptoms and their associated distress, various tools have been identified. However, these are not available for the native Kannada-speaking population for assessing ESKD symptom burden. In this study, we determined the reliability and validity of the Edmonton Symptom Assessment System Revised Renal (ESAS-r: Renal) in Kannada-speaking ESKD patients.

Materials and Methods

ESAS-r: Renal English version was translated into Kannada using the forward and backward method. The translated version was endorsed by Nephrology, Palliative care, Dialysis technology and Nursing experts. As a pilot study, 12 ESKD patients evaluated the content of the questionnaires for appropriateness and relevance. The ESAS-r: Renal Kannada version was validated by administering this tool to 45 patients twice a fortnight.

Result

The translated ESAS-r: Renal Kannada version questionnaire had an acceptable face and content validity. Experts' opinion was assessed by content validity ratio (CVR), and the value of CVR of ESAS-r: Renal Kannada version was-'1'-. Internal consistency of the tool was assessed among Kannada-speaking ESKD patients; its Cronbach's α was 0.785, and test-retest validity was 0.896.

Conclusion

The validated Kannada version of ESAS-r: Renal was reliable and valid for assessing symptom burden in ESKD patients.

Quality of Life and Related Factors in Patients Undergoing Renal Replacement Therapy at the Hospital General Universitario de Ciudad Real: Cross Sectional Descriptive Observational Study

Background: The aim of the present study was to determine the relationship between the quality of life of patients on renal replacement therapy and the Symptomatology they presented. Methods: Cross-sectional descriptive observational study: quality of life was assessed by means of the KDQOL-SF questionnaire, Symptomatology by the Palliative Care Outcome Scale-Symptoms Renal questionnaire, and sociodemographic and clinical data of patients in the Hemodialysis Unit (HD) of the Hospital General Universitario de Ciudad Real (HGUCR) by means of personal interviews and clinical history data. Results: A total of 105 patients participated in the study, 63 (60.57%) men and 42 (40.38%) female. The mean age was 62.5 dt (14.84) years. Of these, 43 (41%) were on peritoneal dialysis and 62 (59%) were on hemodialysis. The mean quality of life score was 44.89 dt (9.73). People on hemodialysis treatment presented a better quality of life than those on PD treatment: 49.66 dt (9.73) vs. 38.13 dt (9.12) t = 7.302, p < 0.001. A higher score on the symptom impairment scale (post-renal) correlated with worse scores on the total quality of life score: r = −0.807, p < 0.001. It was observed that those who improved the distress symptom scored better on the total quality of life questionnaire: 50.22 dt (8.44) vs. 46.42 dt (9.05), p < 0.001. Conclusions: The presence and management of the large number of symptoms that appear as side effects, such as distress or depression, could determine changes in some components of quality of life.

Development of a preliminary conceptual model of the patient experience of chronic kidney disease: a targeted literature review and analysis

Background

Patient-reported outcome (PRO) instruments should capture the experiences of disease and treatment that patients consider most important in order to inform patient-centred care and product development. The aim of this study was to develop a preliminary conceptual model of patient experience in chronic kidney disease (CKD) based on a targeted literature review and to characterize existing PRO instruments used in CKD.

Methods

PubMed, EMBASE and Cochrane databases and recent society meetings were searched for publications reporting signs/symptoms and life impacts of CKD. Concepts identified in the literature review were used to develop a preliminary conceptual model of patient experience of CKD, overall, and within patient subpopulations of differing CKD causes, severities and complications. PRO instruments, identified from PRO databases, CKD literature and CKD clinical trials, were assessed for content validity, psychometric strength and coverage of concepts in the literature review.

Results

In total, 100 publications met criteria for analysis; 56 signs/symptoms and 37 life impacts of CKD were identified from these sources. The most frequently mentioned signs/symptoms were pain/discomfort (57% of publications) and tiredness/low energy/lethargy/fatigue (42%); the most commonly reported life impacts were anxiety/depression (49%) and decrements in physical functioning (43%). Signs/symptoms and life impacts varied across the subpopulations and were more frequent at advanced CKD stages. The preliminary conceptual model grouped signs/symptoms into seven domains (pain/discomfort; energy/fatigue; sleep-related; gastrointestinal-related; urinary-related; skin−/hair−/nails-related; and other) and life impacts into six domains (psychological/emotional strain; cognitive impairment; dietary habit disruption; physical function decrements; interference with social relationships; and other). Eleven PRO instruments were considered to be promising for use in CKD; all had limitations.

Conclusions

Although preliminary, the proposed conceptual model highlights key PROs for people with CKD and is intended to spur development of more tailored PRO instruments to assess these concepts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-021-02440-9.

On Examining the Quality of Spanish Translation in Telephone Surveys: A Novel Test-Retest Approach

Past research has shown that commonly reported cultural group disparities in health-related indices may be attributable to culturally mediated differences in the interpretation of translated survey questions and response scales. This problem may be exacerbated when administering single-item survey questions, which typically lack the reliability seen in multi-item scales. We adapt the test-retest approach for single-item survey questions that have been translated from English into Spanish and demonstrate how to use this approach as a quick and efficient pilot test before fielding a major survey. Three retest conditions were implemented (English-Spanish, Spanish-English, and English-English) on a convenience sample (n = 109) of Latinos and non-Latinos where translated items were compared against an English-English condition that served as our control. Several items were flagged for investigation using this approach. Discussion centers on the utility of this approach for evaluating the Spanish translation of single-item questions in population-based surveys.

The Palliative Care Outcome Scale: Turkish Validity and Reliability Study

Objective:

To examine the validity and reliability of the Turkish version of the Palliative Care Outcome Scale (POS).

Methods:

This methodological study consisted of 69 patients hospitalized in the palliative care (PC) service of three hospitals between June 2016 and August 2016, 69 carers who undertook continuously primary care of these patients, and 28 staff members working in the PC service and providing care to these patients. The data of the study were collected using the Personal Diagnosis Form, the POS. The scope, structure and criterion validity and internal consistency reliability of the scale were tested. Item analysis, Cronbach's alpha analysis, content validity ratio, confirmatory factor analysis for construct validity, criterion validity, patient validity, and intraclass correlation coefficient for the adaptation of outcomes of patient, carer, and staff groups were conducted.

Results:

The content validity ratio of the scale was found to be higher than 0.80 for patient, carer, and staff questionnaires. Item-total score correlation coefficients were determined between 0.27 and 0.72 for the items in the patient questionnaire, 0.33–0.67 for the carer questionnaire, and 0.34–0.72 for the staff questionnaire. The Cronbach's alpha reliability coefficients were determined as 0.64 for the patient questionnaire, 0.73 for the carer questionnaire, and 0.68 for the staff questionnaire.

Conclusions:

The Turkish version of the POS was determined to be a valid and reliable tool to be used for assessing the needs of PC patients in three dimensions in terms of the perspectives of patient, carer, and staff.

Symptom Burden Clustering in Chronic Kidney Disease Stage 5

Patients with chronic kidney disease (CKD) Stage 5, experience multiple symptoms that negatively affect the health-related quality of life (HRQoL). This study examined the cluster of symptoms and their association with disease severity and comorbidities. The study sample included 123 patients with CKD Stage 5; 60 patients were in the dialysis group and 63 patients in the Conservative Kidney Management group. Symptom data were collected using the Spanish modified version of Palliative Care Outcome Scale-Symptoms (POS-S) Renal, a validated questionnaire to assess symptoms in this population. More than half of the patients described weakness, difficulty sleeping, and feeling depressed. Two symptom clusters were identified. There was no significant statistical correlation between disease severity and symptoms and between comorbidities and symptoms. The tendency of these symptoms to occur together has implications for improving symptom management in this population. Routine symptom assessment can be useful in clinical and research settings.