MIDOS - validation of a minimal documentation system for palliative medicine

Introduction. Repeated assessment of pain and other symptoms is required fo r quality assurance in palliative care. However, physical and cognitive imp airment of the patients may impede the use of standardized questionnaires a nd documentation systems in upalliative care setting. We developed a minima l documentation system (MIDOS) for the specific requirements in this settin g. Methods. The German versions of the Brief Pain Inventory (BPI) and the qual ity of life questionnaire SF-12 were completed for all patients admitted to the palliative care unit. Cognitive impairment was assessed with the Mini Mental State Examination (MMSE). With admission as well as on subsequent co nsultations patients self-assessed average and maximum pain intensity on nu meric rating scales and the intensity of drowsiness, nausea, constipation, dyspnea, weakness, anxiety and well-being on verbal categorical scales. Results. From August 1998 to June 1999 128 patients were documented consecu tively. Fifty-nine percent of these patients were treated with WHO-step 3 o pioids. Cognitive impairment (MMSE<24) was present in 37% of the patients. Self-assessment with MIDOS was possible for 114 patients at the time of adm ission,and for 108 patients at the end of therapy. Pain,drowsiness and weak ness were documented by most patients, whereas the other symptoms were repo rted less frequently. Discussion. Factor analysis showed one factor for pain and two factors for the other symptoms. The pain sum score of MIDOS correlated with the factors of the BPI, the symptom sum score of MIDOS correlated with the factors of the BPI and the mental sum score of the SF-12, though on a lower level. MID OS sum scores showed good pain relief and symptom control for patients disc harged home or to other services, whereas the symptom sum score gave an ind ication of the deterioration in the terminal phase for those patients who d ied during in-patient treatment. Test-retest stability was good for a subgr oup of patients with stable opioid doses. Conclusions. We conclude that MIDOS is a valid instrument for self-assessme nt of the patient's symptoms and may be used to monitor the efficacy of sym ptom management.