Assessing symptoms of terminally-ill patients by different raters: a prospective study.
OBJECTIVE
For patients who are terminally ill, the efficiency of symptom management is dependent, among other factors, on an accurate assessment by proxy raters. The aim of this prospective study is to describe differences in symptom severity ratings between patients and their nurses, physicians, and family members during their stay in different departments with acute care, and to identify variables associated with the accuracy of the ratings by others.


METHODS
Physical, psychological, social, and functional disorders were assessed for 41 in-patients with a standardized 13-item Symptom List for Quality Assurance in Palliative Care drafted by the Working Group on the Core Documentation for Palliative Care Units in Germany. Symptom assessment was completed by different raters (patient, nurse, physician, family member) within the first four days after admission. Socio-demographic, disease-related, and hospitalization data were taken from patient charts.


RESULTS
Reliability of the symptom list was computed with Cronbach's alpha measures for the present sample. Between-group-comparisons on the individual items and on the sum-score level were analyzed separately for the different rater-pairs: patients-nurses (n = 41), patients-physicians (n = 39), patients-family members (n = 12). Multiple regression analyses calculated predictive variables of the staff's deviation scores.


CONCLUSIONS
Significant differences for nurses and physicians were found on the sum-score level for psychological and social symptoms, but not for physical and functional symptoms. Family members rated the intensities of the symptoms generally higher than the patients. Suggestions for further analyses are presented and discussed.
Zloklikovits
Silke
S
Section of Palliative Care and Division of Clinical Oncology, Department of Internal Medicine, Medical University Graz, Austria. silke.zloklikovits@klinikum-graz.at
Andritsch
Elisabeth
E
Fröhlich
Brigitte
B
Verebes
Julijane
J
Dietmaier
Gabriele
G
Samonigg
Hellmut
H
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D005260:Female; D005858:Germany; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D010166:Palliative Care; D011446:Prospective Studies; D012044:Regression Analysis; D015203:Reproducibility of Results; D012647:Self-Assessment; D012720:Severity of Illness Index; D019452:Terminally Ill / Q000523:psychology