title: Assessment of discomfort in patients with cognitive failure in palliative care.
abstract: When cognitive impairment precludes patients' report of symptoms, it becomes necessary to use other means. The purpose of our study was to evaluate the validity of the method currently in use on our service.
  
  
  
  Two members of the team simultaneously assessed the patient and independently recorded whether the patient showed signs of discomfort, and a third questioned patients with cognitive failure who maintained some ability to respond if something was bothering them.
  
  
  
  Some 200 assessments were made of 116 patients. The kappa coefficient of agreement was 0.615. The sensitivity was 17% and specificity 99%. The positive predictive value was 88%, and the negative predictive value was 73%.
  
  
  
  Due to the low sensitivity of this method, it cannot be recommended as a screening tool.
authors.affiliation: Palliative Care Service,Portuguese Institute of Oncology,Porto,Portugal.
authors.forename: José António
authors.identifier: 0000-0002-9506-7106
authors.initials: JA
authors.lastname: Ferraz Gonçalves
authors.affiliation: Palliative Care Service,Portuguese Institute of Oncology,Porto,Portugal.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Costa
authors.affiliation: Palliative Care Service,Portuguese Institute of Oncology,Porto,Portugal.
authors.forename: Natércia
authors.initials: N
authors.lastname: Edra
authors.affiliation: Hospital de Matosinhos,Matosinhos,Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Gil
authors.affiliation: Palliative Care Service,Portuguese Institute of Oncology,Porto,Portugal.
authors.forename: Carla
authors.initials: C
authors.lastname: Martinho
authors.affiliation: Palliative Care Service,Portuguese Institute of Oncology,Porto,Portugal.
authors.forename: Emília
authors.initials: E
authors.lastname: Neves
authors.affiliation: Hospital de Santa Maria da Feira,Santa Maria da Feira,Portugal.
authors.forename: Vânia
authors.initials: V
authors.lastname: Peixoto
authors.affiliation: Palliative Care Service,Portuguese Institute of Oncology,Porto,Portugal.
authors.forename: Andreia
authors.initials: A
authors.lastname: Rodrigues
authors.affiliation: Palliative Care Service,Portuguese Institute of Oncology,Porto,Portugal.
authors.forename: Margarida
authors.initials: M
authors.lastname: Silva
authors.affiliation: Palliative Care Service,Portuguese Institute of Oncology,Porto,Portugal.
authors.forename: Sara
authors.initials: S
authors.lastname: Teixeira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010147:Pain Measurement / Q000379:methods / Q000592:standards*; D010166:Palliative Care / Q000379:methods* / Q000592:standards; D000070659:Patient Comfort / Q000592:standards; D011174:Portugal; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: Assessment tools; Cognitive Failure; Discomfort assessment; Palliative care