Exploring Symptom Clusters and Their Measurements in Patients With Lung Cancer: A Scoping Review for Practice and Research

PROBLEM IDENTIFICATION

This scoping review aimed to explore symptom clusters (SCs) in patients with lung cancer and how included symptoms and symptom dimensions are measured.

LITERATURE SEARCH

PubMed®, CINAHL®, Scopus®, and Cochrane Library were searched for studies published until December 31, 2021. Fifty-three articles were included.

DATA EVALUATION

Data extracted included descriptive items and SC constellations. Patient-reported outcome instruments and measured symptom dimensions were described according to the middle-range theory of unpleasant symptoms.

SYNTHESIS

13 articles investigated SCs a priori and 40 de novo. Thirty-six instruments were used, mostly measuring intensity alone or in combination with timing. Qualitative articles (n = 6) provided rich descriptions within the distress, timing, and quality dimensions.

IMPLICATIONS FOR RESEARCH

Fatigue was the symptom found to most frequently co-occur with other symptoms in SCs. Fatigue, psychological symptoms, and nutritional aspects are emphasized as important areas for oncology nursing practice and further research to improve SC management for patients with lung cancer.

What Outcome Measures Are Reported in the Management of Acromioclavicular Joint Injuries?

Background

Lack of uniformity in reported outcomes makes comparisons between acromioclavicular joint (ACJ) injury studies challenging. Knowledge of common outcome measures and standardization will help orthopaedic surgeons report and compare outcomes more consistently.

Purpose

To identify the most commonly reported outcome measures for ACJ injuries.

Study Design

Systematic review.

Methods

A systematic review was performed to identify all English-language original articles assessing any type of management of ACJ injuries (acute and chronic) in PubMed and Scopus from 2007 to 2017. Review articles, meta-analyses, studies with less than 5 patients, pediatric studies, technique articles, and biomechanical studies were excluded. The 100 top orthopaedic journals in the English literature were selected for review. Included studies were assessed for patient characteristics and the use of outcome variables, including range of motion (ROM), strength, patient-reported outcomes (PROs), satisfaction, return to work, return to sport, and complications.

Results

A total of 605 unique articles were identified; 92 met the inclusion criteria. The average number of ACJ injuries per study was 37, with a mean weighted patient age of 36 years (range, 20.1-57.3 years). The mean follow-up was 36 months (range, 5-290 months). Acute injuries were reported in 59% of studies. ROM and strength measurements were reported in 22.8% and 5.4% of studies. Sixteen different PRO instruments were used. The most commonly reported measures were Constant score (75%), visual analog scale for pain (VAS-pain; 33%) score, American Shoulder and Elbow Surgeons (ASES) score (21%), Simple Shoulder Test (SST) score (19%), and University of California Los Angeles (UCLA; 17%) shoulder score. An average of 2.5 outcome measures per study were reported. The use of 4 or more outcome scores was associated with publication in higher-impact factor journals.

Conclusion

Inconsistent reporting of multiple outcome measures is present in the ACJ injury literature. The best scoring system for assessing ACJ injury and treatment has not yet been agreed upon. Until improved scoring systems come into general use, we recommend that future literature on ACJ injuries use at least 4 outcome scores and include the commonly used outcome measures (Constant, VAS-pain, ASES, and SST scores) to enable future comparison of patient outcomes across publications.

Identification and Evaluation of Items for Vitreoretinal Diseases Quality of Life Item Banks

Purpose: We are developing item banks assessing the impact of retinal and vitreoretinal diseases (excluding age-related macular degeneration, diabetic retinopathy, and retinal detachment, covered elsewhere) on quality of life (QoL) for adults. This study outlines the first two phases of the multi-stage process: content development and item evaluation.Methods: We grouped retinal and vitreoretinal diseases into hereditary and acquired. Development of the item banks involved two phases: item identification and item evaluation. The items were extracted from three sources: (1) 17 pre-existing PRO instruments, (2) 4 qualitative studies and (3) 79 semi-structured interviews. Item evaluation involved three stages namely, binning (grouping) and winnowing (reduction), expert panel opinion and cognitive interviews.Results: The item identification phase yielded 1,217 items. After three sessions of binning and winnowing, items were reduced to a minimally representative set (n = 411) across nine QoL domains namely, activity limitation, emotional, social, health concerns, symptoms, economic, mobility, convenience, and coping. The hereditary group had a total of 345 items and the acquired group had a total of 257 items. After 23 cognitive interviews items were amended for hereditary diseases resulting in a final set of 345 items and 3 items were amended for acquired diseases, resulting in a final set of 254 items. Overall across nine domains 189 items were common to hereditary and acquired retinal and vitreoretinal diseases.Conclusion: As most of the items were unique to hereditary versus acquired retinal and vitreoretinal disease groups separate item banks are required to capture the QoL impacts for hereditary and acquired retinal and vitreoretinal diseases.

Outcome Instruments in Spinal Trauma Surgery: A Bibliometric Analysis

Study Design Literature review. Objective To identify outcomes instruments used in spinal trauma surgery over the past decade, their frequency of use, and usage trends. Methods Five top orthopedic journals were reviewed from 2004 to 2013 for clinical studies of surgical intervention in spinal trauma that reported patient-reported outcome instruments use or neurologic function scale use. Publication year, level of evidence (LOE), and outcome instruments were collected for each article and analyzed. Results A total of 58 studies were identified. Among them, 26 named outcome instruments and 7 improvised questionnaires were utilized. The visual analog scale (VAS) for pain was used most frequently (43.1%), followed by the Short Form 36 (34.5%), Frankel grade scale (25.9%), Oswestry Disability Index (20.7%) and American Spinal Injury Association Impairment Scale (15.5%). LOE 4 was most common (37.9%), and eight LOE 1 studies were identified (10.3%). Conclusions The VAS pain scale is the most common outcome instrument used in spinal trauma. The scope of this outcome instrument is limited, and it may not be sufficient for discriminating between more and less effective treatments. A wide variety of functional measures are used, reflecting the need for a disease-specific instrument that accurately measures functional limitation in spinal trauma.

Comparison of Daily versus Weekly Recording of Gastroesophageal Reflux Disease Symptoms in Patients with a Partial Response to Proton Pump Inhibitor Therapy

BACKGROUND

The Reflux Symptom Questionnaire electronic Diary (RESQ-eD) and the Reflux Symptom Questionnaire 7-day recall (RESQ-7) are versions of a patient-reported outcome instrument that was developed and validated for measuring the frequency and intensity of symptoms in patients with gastroesophageal reflux disease (GERD) who have a partial response to proton pump inhibitor (PPI) therapy.

OBJECTIVE

The aim of these analyses was to assess the ability of the RESQ-7 to reproduce findings based on RESQ-eD reports of the same symptoms.

METHODS

These analyses are based on data from patients with GERD with a partial response to PPI (ClinicalTrials.gov identifier: NCT00703534). Participants completed the RESQ-eD twice daily for 7 days and the RESQ-7 on day 7.

RESULTS

Data from 446 patients were available for these analyses. Symptom-level analyses showed that, for intensity, mean domain scores were higher for the RESQ-7 (range 1.49-2.72) than for the RESQ-eD (range 1.45-2.57); for frequency, scores were lower for the RESQ-7 (range 2.58-4.82) than for the RESQ-eD (range 4.22-6.24). Correspondence analyses of RESQ-7 and RESQ-eD mean domain scores indicated excellent agreement for intensity (correlation-concordance coefficient 0.77-0.83) and fair agreement for frequency (correlation-concordance coefficient 0.40-0.58). Mean RESQ-eD subscale intensity scores for GERD symptoms were higher for symptoms experienced during the daytime than for those occurring at nighttime. Symptom recall was not associated with peak or recency effects.

CONCLUSIONS

Patients with GERD slightly overestimated the intensity of their reflux symptoms and markedly underestimated the frequency on weekly recall compared with twice-daily reporting.

The problem with health measurement

In this review we discuss health measurement with a focus on psychometric methods and methodology. In particular, we examine some of the key issues currently facing the use of clinician and patient rating scales to measure the health outcomes of disease and treatment. We present three key facts and flag one crucial problem. First, the numbers generated by scales are increasingly used as the measurements of the central dependent variables upon which clinical decisions are frequently made. The rising profile of rating scales has significant implications for scale construction, evaluation, and selection, as well as for interpreting studies. Second, rating scale science is well established. Therefore, it is important to learn the lessons from those who have built and established the science over the last century. Finally, the goal of a rating scale is to measure. As such, over the last half century, developments in rating scale (psychometric) methods have caused a refocus in the way we should be measuring health. In particular, newer methods have significant clinical advantages over traditional approaches. These should be seriously considered for inclusion in everyday practice. This leads us to the central problem with health measurement, which is that we cannot currently be sure what most rating scales are measuring. This is because the methods we have in place to ensure the validity of rating scales fall short of what is actually required. We expand on this point, and provide some potential routes forward to help address this important problem.