title: Self-report measurement of pain & symptoms in palliative care patients: a comparison of verbal, visual and hand scoring methods in Sub-Saharan Africa.
abstract: BACKGROUND
  Despite a high incidence of life-limiting disease, there is a deficit of palliative care outcome evidence in sub-Saharan Africa. Providers of end of life care call for appropriate measurement tools. The objective is to compare four approaches to self-report pain and symptom measurement among African palliative care patients completing the African Palliative Care Association African Palliative Outcome Scale (APCA African POS).
  
  
  METHODS
  Patients were recruited from five services (4 in South Africa and 1 in Uganda). Research nurses cross-sectionally administered POS pain and symptom items in local languages. Both questions were scored from 0 to 5 using 4 methods: verbal rating, demonstrating the score using the hand (H), selecting a face on a visual scale (F), and indicating a point on the Jerrycan visual scale (J). H, F and J scores were correlated with verbal scores as reference using Spearman's rank and weighted Kappa. A Receiver Operating Characteristic (ROC) analysis was performed.
  
  
  RESULTS
  315 patients participated (mean age 43.5 years, 69.8% female), 71.1% were HIV positive and 35.6% had cancer, 49.2% lived in rural areas. Spearman's rank correlations for pain scores were: H: 0.879, F: 0.823, J: 0.728 (all p < 0.001); for symptoms H: 0.876, F: 0.808, J: 0.721 (all p < 0.001). Weighted Kappa for pain was H: 0.798, F: 0.719 J: 0.548 and for symptoms: H: 0.818, F: 0.718, J: 0.571. There was lower agreement between verbal and both hand and face scoring methods in the Ugandan sample. Compared to the verbal scale the accuracy of predicting high pain/symptoms was H > F > J (0.96-0.89) in ROC analysis.
  
  
  CONCLUSIONS
  Hands and faces scoring methods correlate highly with verbal scoring. The Jerrycan method had only moderate weighted Kappa. POS scores can be reliably measured using hand or face score.
authors.forename: David
authors.initials: D
authors.lastname: Blum
authors.forename: Lucy E
authors.initials: LE
authors.lastname: Selman
authors.forename: Godfrey
authors.initials: G
authors.lastname: Agupio
authors.forename: Thandi
authors.initials: T
authors.lastname: Mashao
authors.forename: Keletso
authors.initials: K
authors.lastname: Mmoledi
authors.forename: Tony
authors.initials: T
authors.lastname: Moll
authors.forename: Natalya
authors.initials: N
authors.lastname: Dinat
authors.forename: Liz
authors.initials: L
authors.lastname: Gwyther
authors.forename: Lydia Mpanga
authors.initials: LM
authors.lastname: Sebuyira
authors.forename: Barbara
authors.initials: B
authors.lastname: Ikin
authors.forename: Julia
authors.initials: J
authors.lastname: Downing
authors.forename: Stein
authors.initials: S
authors.lastname: Kaasa
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000628:therapy; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D010147:Pain Measurement / Q000379:methods*; D010166:Palliative Care; D063868:Patient Outcome Assessment; D011788:Quality of Life; D012372:ROC Curve; D057566:Self Report; D013019:South Africa; D014454:Uganda
references.citation: J Pain Symptom Manage. 2011 Jun;41(6):1073-93
references.pmid: 21621130
references.citation: Am J Clin Oncol. 1982 Dec;5(6):649-55
references.pmid: 7165009
references.citation: Health Qual Life Outcomes. 2010 Jan 25;8:10
references.pmid: 20100332
references.citation: BMJ Support Palliat Care. 2012 Mar;2(1):36-42
references.pmid: 24653497
references.citation: Anaesthesia. 1976 Nov;31(9):1191-8
references.pmid: 1015603
references.citation: Pain Manag Nurs. 2006 Sep;7(3):117-25
references.pmid: 16931417
references.citation: BMC Health Serv Res. 2013 Aug 16;13:319
references.pmid: 23958036
references.citation: BMC Public Health. 2003 Oct 23;3:33
references.pmid: 14572317
references.citation: Indian J Anaesth. 2012 Nov;56(6):553-7
references.pmid: 23325940
references.citation: Health Qual Life Outcomes. 2011 Apr 20;9:27
references.pmid: 21507232
references.citation: Qual Health Care. 1999 Dec;8(4):219-27
references.pmid: 10847883
references.citation: BMJ. 2010 Jan 18;340:c186
references.pmid: 20083546
references.citation: BMC Palliat Care. 2012 Jul 10;11:5
references.pmid: 22512923
references.citation: Lancet. 2005 Jun 4-10;365(9475):1971-7
references.pmid: 15936427
references.citation: J Pain Symptom Manage. 2007 Feb;33(2):229-32
references.pmid: 17280929
references.citation: BMC Palliat Care. 2012 Jan 06;11:1
references.pmid: 22221932
references.citation: Pain. 1981 Apr;10(2):241-248
references.pmid: 7267140
references.citation: Support Care Cancer. 2012 Jul;20(7):1573-8
references.pmid: 22391595
references.citation: Pain. 1999 Oct;83(1):25-35
references.pmid: 10506669
references.citation: Palliat Med. 2011 Jun;25(4):304-13
references.pmid: 21464119
references.citation: Eur J Cancer. 2011 Jan;47(1):51-6
references.pmid: 20822896
references.citation: Lancet Oncol. 2013 Apr;14(4):e183-8
references.pmid: 23561750