Physical and psychological needs of patients dying from colo-rectal cancer

Sixty-one patients suffering from terminal cola-rectal cancer were intervie wed in depth by trained research nurses. The nurses used a semistructured i nterview, a concerns checklist and the Psychiatric Assessment Schedule to d etermine patients' key physical complaints, their main concerns and whether or not an affective disorder was present. The interviewers' estimates of t hese aspects were then compared with the assessments of 48 carers and 58 ge neral practitioners (GPs). The congruence between patients' and carers' rep orts was reasonable for appetite loss (77%), nausea and vomiting (75%) and pain (72%), and the rate of false positive reporting was low. However, ther e was much less congruence for breathlessness (48%) and pyrexia (32%). Ther e was even less congruence between the estimates of patients' physical symp toms and GPs' perceptions. The highest congruence was for pain (42%). The c ongruence was low for appetite loss (8%) and breathlessness (5%). The congr uence between patients' and carers' perceptions of the patients' major conc erns was low, being at best 33% for patients' concerns about their physical illness. The rate of false positive reporting by carers was high. The care rs' major concerns included the patients' illness (47%), the future (33%) a nd the emotional demands being put on them (23%). Thirteen (22%) of the 59 patients completing a full interview were suffering from an affective disor der. This had been recognized by the GP in only five cases and six patients who had a normal mood were wrongly diagnosed as being depressed. Of the ca rers interviewed. 22 (46%) considered symptom control had been inadequate a nd 23 (48%) felt they had no relief from the burden of caring or had too li ttle help. Sixteen (33%) had recently suffered from a major depressive illn ess, generalized anxiety disorder or adjustment disorder. It is concluded t hat it is unreliable to rely on carers' proxy reports of the symptoms exper ienced by terminally ill patients; more accurate personal assessments are n eeded where possible. It is likely that this will only be achieved by ensur ing that those health professionals involved in palliative care have traini ng in the relevant assessment skills.