The disparity between patient and nurse symptom rating in a Hospice population

To, THM; Ong, WY; Rawlings, D; Greene, A; Currow, DC

The disparity between patient and nurse symptom rating in a Hospice population

To, THM Ong, WY Rawlings, D Greene, A Currow, DC

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Publication Type:: Journal Article
Citation:: Journal of Palliative Medicine, 2012, 15 (5), pp. 542 - 547
Issue Date:: 2012-05-01

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Field	Value	Language
dc.contributor.author	To, THM	en_US
dc.contributor.author	Ong, WY	en_US
dc.contributor.author	Rawlings, D	en_US
dc.contributor.author	Greene, A	en_US
dc.contributor.author	Currow, DC https://orcid.org/0000-0003-1988-1250	en_US
dc.date.issued	2012-05-01	en_US
dc.identifier.citation	Journal of Palliative Medicine, 2012, 15 (5), pp. 542 - 547	en_US
dc.identifier.issn	1096-6218	en_US
dc.identifier.uri	http://hdl.handle.net/10453/115526
dc.description.abstract	Background: Meticulous assessment, monitoring, and treatment of symptoms are key components of palliative care. The Symptom Assessment Scale (SAS) is a 0-10 numerical rating scale (NRS) used for self-report of sleep, appetite, nausea, bowels, breathing, fatigue, and pain. Ideally, symptom rating should be by self-report; however, the ratings are often completed by nurses. The aim of this study was to examine the relationship between simultaneous symptom ratings of patients and nurses in an Australian inpatient palliative care unit. Methods: All inpatients and their treating nurse (blinded to the patient's report) scored the SAS weekly. Nurse symptom rating was considered accurate if the score for an individual symptom differed by ≤1. The relationship for each dyad was examined by comparing absolute values, mean differences, and Pearson correlations. Results: Sixty-four pairs of symptom ratings were obtained from 29 patients (mean 65 years, male 55%, malignancy 90%, mean Karnofsky 50). The absolute differences were closest for nausea, bowels, and breathing domains, and worst for appetite. Mean differences and Pearson correlations did not adequately reflect the disparity between patient and nurse symptom rating, and nurses systematically underreported symptoms. The total difference for the seven items ranged from nurses overreporting the patients' symptoms by 39 points to underreporting by 31 out of a possible 70 points. Discussion: Proxy symptom assessment only modestly correlates with patient symptom rating, can significantly misrepresent the patient's actual symptom burden, and should only be used when the patient is absolutely unable to contribute his or her own view. © Copyright 2012, Mary Ann Liebert, Inc. 2012.	en_US
dc.relation.ispartof	Journal of Palliative Medicine	en_US
dc.relation.isbasedon	10.1089/jpm.2011.0291	en_US
dc.subject.classification	Gerontology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Palliative Care	en_US
dc.subject.mesh	Severity of Illness Index	en_US
dc.subject.mesh	Karnofsky Performance Status	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Aged, 80 and over	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Patients	en_US
dc.subject.mesh	Hospices	en_US
dc.subject.mesh	Nursing Assessment	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Self Report	en_US
dc.title	The disparity between patient and nurse symptom rating in a Hospice population	en_US
dc.type	Journal Article
utslib.citation.volume	5	en_US
utslib.citation.volume	15	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access
pubs.issue	5	en_US
pubs.publication-status	Published	en_US
pubs.volume	15	en_US

Abstract:

Background: Meticulous assessment, monitoring, and treatment of symptoms are key components of palliative care. The Symptom Assessment Scale (SAS) is a 0-10 numerical rating scale (NRS) used for self-report of sleep, appetite, nausea, bowels, breathing, fatigue, and pain. Ideally, symptom rating should be by self-report; however, the ratings are often completed by nurses. The aim of this study was to examine the relationship between simultaneous symptom ratings of patients and nurses in an Australian inpatient palliative care unit. Methods: All inpatients and their treating nurse (blinded to the patient's report) scored the SAS weekly. Nurse symptom rating was considered accurate if the score for an individual symptom differed by ≤1. The relationship for each dyad was examined by comparing absolute values, mean differences, and Pearson correlations. Results: Sixty-four pairs of symptom ratings were obtained from 29 patients (mean 65 years, male 55%, malignancy 90%, mean Karnofsky 50). The absolute differences were closest for nausea, bowels, and breathing domains, and worst for appetite. Mean differences and Pearson correlations did not adequately reflect the disparity between patient and nurse symptom rating, and nurses systematically underreported symptoms. The total difference for the seven items ranged from nurses overreporting the patients' symptoms by 39 points to underreporting by 31 out of a possible 70 points. Discussion: Proxy symptom assessment only modestly correlates with patient symptom rating, can significantly misrepresent the patient's actual symptom burden, and should only be used when the patient is absolutely unable to contribute his or her own view. © Copyright 2012, Mary Ann Liebert, Inc. 2012.

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http://hdl.handle.net/10453/115526