Radbruch L, Sabatowski R, Loick G, Jonen-Thielemann I, Kasper M, Gondek B, Lehmann K A, Thielemann I
Department of Anaesthesiology, University of Cologne, Germany.
Palliat Med. 2000 Jul;14(4):266-76. doi: 10.1191/026921600672986600.
Symptom assessment in the palliative care unit must consider the reduced physical and mental status of the patients. Standardized instruments are often not completed by patients with cognitive impairment. We tried to combine minimal burden for patients and staff with sufficient information content in a Minimal Documentation System (MIDOS) for pain and symptom assessment in palliative care patients. From January to July 1998, 108 patients (123 consecutive admissions) with a mean age of 63 years (range 32-87 years) were admitted to the palliative care unit. Pain was reported as the reason for admission in 70% of the patients, and 71% were treated with opioids. Using a cut-off point of 20/21, 35% of the patients were impaired in the Mini Mental State Examination (MMSE). The number of missing values in the Brief Pain Inventory (BPI) and the quality-of-life questionnaire SF-12 correlated highly with each other and with the MMSE sum score, but not with the summary scores of BPI or SF-12. Only 31 patients completed the SF-12 quality-of-life questionnaire. Age was not correlated to MMSE scores, and neither were opioid doses for 26 patients with slow-release oral morphine or for 20 patients with transdermal fentanyl. Only a minority of patients was able to use the numerical scale for symptoms other than pain, though most patients were able to score symptom intensity on the verbal categorical scale. Pain and symptom assessments were performed by the physician for 17% of the patients at admission, and for 16% of the follow-up controls because self-assessment was not possible. In this study, cognitive impairment prevented symptom assessment with longer and more complicated instruments such as the SF-12 in a large number of the patients admitted to the palliative care unit. Assessment instruments for patients with advanced disease must provide simple categorical scales and the possibility of being administered by interview.
姑息治疗病房中的症状评估必须考虑到患者身心状况的下降。认知受损的患者往往无法完成标准化工具。我们试图在一个用于姑息治疗患者疼痛和症状评估的最小化文档系统（MIDOS）中，将患者和工作人员的最小负担与足够的信息内容相结合。1998年1月至7月，108名患者（连续123次入院）入住姑息治疗病房，平均年龄63岁（范围32 - 87岁）。70%的患者报告疼痛为入院原因，71%的患者接受了阿片类药物治疗。以20/21分为切点，35%的患者在简易精神状态检查表（MMSE）中存在认知障碍。简明疼痛量表（BPI）和生活质量问卷SF - 12中的缺失值数量彼此高度相关，且与MMSE总分相关，但与BPI或SF - 12的汇总分数无关。只有31名患者完成了SF - 12生活质量问卷。年龄与MMSE评分无关，26名服用缓释口服吗啡的患者以及20名使用透皮芬太尼的患者的阿片类药物剂量也与MMSE评分无关。除疼痛外，只有少数患者能够使用数字量表来评估其他症状，不过大多数患者能够在言语分类量表上对症状强度进行评分。17%的患者在入院时由医生进行疼痛和症状评估，16%的随访对照患者也是如此，因为无法进行自我评估。在本研究中，认知障碍使得大量入住姑息治疗病房的患者无法使用诸如SF - 12等更长、更复杂的工具进行症状评估。针对晚期疾病患者的评估工具必须提供简单的分类量表，并具备通过访谈进行评估的可能性。
