Assessing the reliability of patient, nurse, and family caregiver symptom ratings in hospitalized advanced cancer patients

Purpose: The purpose of this study was to examine the reliability of sympto m assessments in advanced cancer patients under various conditions, includi ng multiple raters (patients, nurses, and family caregivers), occasions, an d symptoms. patients and Methods: The study sample consisted of 32 advanced cancer pati ents admitted to ct tertiary palliative care unit. Symptom assessments were completed for each patient on two separate occasions, approximately 24 hou rs apart. On each occasion, the patient, the primary care nurse, and a prim ary family caregiver independently completed an assessment using the Edmont on Symptom Assessment System (ESAS). The ESAS is a nine-item visual analogu e scale for assessing symptoms in palliative patients. The reliability of t he assessments (r) was examined using generalisability theory. Results: Three important findings emerged from this analysis. First, the an alysis of individual symptom ratings provided a more meaningful representat ion of the symptom experience than total symptom distress ratings. Secondly , patients, nurses, and caregivers varied in their ratings across different patients, as well as in their ratings of shortness of breath, which may ha ve been a result of individual rater variability. Finally, reliability esti mates (r), based on a single rater and one occasion, were less than 70 for all symptoms, except appetite. These estimates improved substantially (r gr eater than or equal to .70) for all symptoms except anxiety and shortness o f breath, using three raters on a single occasion or two raters across two occasions. Conclusion: The findings from this study reinforce the need for the develop ment of an integrated symptom assessment approach that combines patient and proxy assessments. Further research is needed to explore individual differ ences among raters. (C) 1999 by American Society of Clinical Oncology.