title: Comparison of informal caregiver and named nurse assessment of symptoms in elderly patients dying in hospital using the palliative outcome scale.
abstract: OBJECTIVE
  A prospective study of symptom assessments made by a healthcare professional (HCP; named nurse) and an informal caregiver (ICG) compared with that of the patient with a terminal diagnosis. To look at the validity of HCP and ICG as proxies, which symptoms they can reliably assess, and to determine who is the better proxy between HCP and ICG.
  
  
  METHODS
  A total of 50 triads of patient (>65 years) in the terminal phase, ICG and named nurse on medical wards of an acute general hospital. Assessments were made using the patient and caregiver versions of the palliative outcome scale (POS), all taken within a 24 h period. Agreement between patient-rated, ICG-rated and HCP-rated POS and POS for symptoms (POS-S) was measured using weighted-κ statistics. Demographic and clinical data on each group of participants were collected.
  
  
  RESULTS
  ICG assessments have higher agreement with those of the patient than HCP. Better agreement in both groups was found for physical symptoms, and best agreement was for pain. The worst agreements were for psychological symptoms, such as anxiety and depression, and for satisfaction with information given. Psychological symptoms are overestimated by both ICG and HCP.
  
  
  CONCLUSIONS
  ICGs are more reliable proxies than HCPs. A trend for overestimation of symptoms was found in both groups which may lead to undervaluation of the quality of life by proxy and overtreatment of symptoms. This highlights the need to always use the patient report when possible, and to be aware of the potential flaws in proxy assessment. Reasons for overestimation by proxies deserve further research.
authors.affiliation: Department of Palliative Care, Southend University Hospital NHS Trust, Southend-on-Sea, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dawber
authors.affiliation: Marie Curie Hospice West Midlands, Solihull, UK.
authors.forename: Kathy
authors.initials: K
authors.lastname: Armour
authors.affiliation: Department of Geriatric Medicine, Karin Grech Hospital, Pieta, Malta.
authors.forename: Peter
authors.initials: P
authors.lastname: Ferry
authors.affiliation: Department of Care of the Elderly/Stroke, Burton Hospitals NHS Trust, Burton upon Trent, UK.
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Mukherjee
authors.affiliation: Department of Clinical Chemistry, Heart of England NHS Trust, Heartlands Hospital, Birmingham, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Carter
authors.affiliation: Marie Curie Hospice West Midlands and Heart of England NHS Trust, Solihull, UK.
authors.forename: Chantal
authors.initials: C
authors.lastname: Meystre
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010166:Palliative Care / Q000523:psychology*; D010361:Patients / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D063189:Symptom Assessment
keywords: Clinical assessment; Communication; Education and training; Psychological care; Quality of life; Symptoms and symptom management