title: Development and validation of a medical chart review checklist for symptom management performance of oncologists in the routine care of patients with advanced cancer.
abstract: BACKGROUND
  Oncologists perform a range of pharmacological and nonpharmacological interventions to manage the symptoms of outpatients with advanced cancer.
  
  
  OBJECTIVE
  The aim of this study was to develop and test a symptom management performance checklist (SyMPeC) to review medical charts.
  
  
  METHODS
  First, the content of the checklist was determined by consensus of an interprofessional team. The SyMPeC was tested using the data set of the SAKK 96/06 E-MOSAIC (Electronical Monitoring of Symptoms and Syndromes Associated with Cancer) trial, which included six consecutive visits from 247 patients. In a test data set (half of the data) of medical charts, two people extracted and quantified the definitions of the parameters (content validity). To assess the inter-rater reliability, three independent researchers used the SyMPeC on a random sample (10% of the test data set), and Fleiss's kappa was calculated. To test external validity, the interventions retrieved by the SyMPeC chart review were compared with nurse-led assessment of patient-perceived oncologists' palliative interventions.
  
  
  RESULTS
  Five categories of symptoms were included: pain, fatigue, anorexia/nausea, dyspnea, and depression/anxiety. Interventions were categorized as symptom specific or symptom unspecific. In the test data set of 123 patients, 402 unspecific and 299 symptom-specific pharmacological interventions were detected. Nonpharmacological interventions (n = 242) were mostly symptom unspecific. Fleiss's kappa for symptom and intervention detections was K = 0.7 and K = 0.86, respectively. In 1003 of 1167 visits (86%), there was a match between SyMPeC and nurse-led assessment. Seventy-nine percent (195 of 247) of patients had no or one mismatch.
  
  
  CONCLUSIONS
  Chart review by SyMPeC seems reliable to detect symptom management interventions by oncologists in outpatient clinics. Nonpharmacological interventions were less symptom specific. A template for documentation is needed for standardization.
authors.affiliation: Oncological Palliative Medicine, Section Oncology, Department of Internal Medicine and Palliative Care Centre, Cantonal Hospital, St. Gallen, Switzerland; European Palliative Care Research Center, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: david.blum@ntnu.no.
authors.forename: David
authors.initials: D
authors.lastname: Blum
authors.affiliation: Oncological Palliative Medicine, Section Oncology, Department of Internal Medicine and Palliative Care Centre, Cantonal Hospital, St. Gallen, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rosa
authors.affiliation: Oncological Palliative Medicine, Section Oncology, Department of Internal Medicine and Palliative Care Centre, Cantonal Hospital, St. Gallen, Switzerland.
authors.forename: Susanne
authors.initials: S
authors.lastname: deWolf-Linder
authors.affiliation: Coordinating Center, Swiss Group for Clinical Cancer Research, Bern, Switzerland.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hayoz
authors.affiliation: Quality of Life Office, International Breast Cancer Study Group Coordinating Center, Bern, Switzerland.
authors.forename: Karin
authors.initials: K
authors.lastname: Ribi
authors.affiliation: Section Oncology, Department of Internal Medicine, Cantonal Hospital, St. Gallen, Switzerland.
authors.forename: Dieter
authors.initials: D
authors.lastname: Koeberle
authors.affiliation: Oncological Palliative Medicine, Section Oncology, Department of Internal Medicine and Palliative Care Centre, Cantonal Hospital, St. Gallen, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Strasser
mesh_terms: D057189:Checklist; D019468:Disease Management; D006801:Humans; D008495:Medical Oncology / Q000379:methods*; D008499:Medical Records; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: Chart review; oncology; symptom management; validation