Radbruch L, Sabatowski R, Loick G, Jonen-Thielemann I, Elsner F, Hörmann E
Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universität Köln.
Schmerz. 2000 Aug;14(4):231-9. doi: 10.1007/s004820000034.
Repeated assessment of pain and other symptoms is required for quality assurance in palliative care. However, physical and cognitive impairment of the patients may impede the use of standardized questionnaires and documentation systems in palliative care setting. We developed a minimal documentation system (MIDOS) for the specific requirements in this setting.
The German versions of the Brief Pain Inventory (BPI) and the quality 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 consultations patients self-assessed average and maximum pain intensity on numeric rating scales and the intensity of drowsiness, nausea, constipation, dyspnea, weakness, anxiety and well-being on verbal categorical scales.
From August 1998 to June 1999 128 patients were documented consecutively. Fifty-nine percent of these patients were treated with WHO-step 3 opioids. Cognitive impairment (MMSE<24) was present in 37% of the patients. Self-assessment with MIDOS was possible for 114 patients at the time of admission, and for 108 patients at the end of therapy. Pain, drowsiness and weakness were documented by most patients, whereas the other symptoms were reported less frequently.
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. MIDOS sum scores showed good pain relief and symptom control for patients discharged home or to other services, whereas the symptom sum score gave an indication of the deterioration in the terminal phase for those patients who died during in-patient treatment. Test-retest stability was good for a subgroup of patients with stable opioid doses.
We conclude that MIDOS is a valid instrument for self-assessment of the patient's symptoms and may be used to monitor the efficacy of symptom management.
在姑息治疗中，为确保质量，需要对疼痛及其他症状进行反复评估。然而，患者的身体和认知障碍可能会妨碍在姑息治疗环境中使用标准化问卷和文档系统。我们针对此环境的特定需求开发了一种最小化文档系统（MIDOS）。
为所有入住姑息治疗病房的患者填写德文版的简明疼痛问卷（BPI）和生活质量问卷SF - 12。使用简易精神状态检查表（MMSE）评估认知障碍。在入院时以及后续会诊时，患者通过数字评分量表自我评估平均和最大疼痛强度，并通过言语分类量表评估嗜睡、恶心、便秘、呼吸困难、虚弱、焦虑和幸福感的强度。
从1998年8月至1999年6月，连续记录了128例患者。这些患者中有59%接受了世界卫生组织第3级阿片类药物治疗。37%的患者存在认知障碍（MMSE < 24）。114例患者在入院时能够使用MIDOS进行自我评估，108例患者在治疗结束时能够进行自我评估。大多数患者记录了疼痛、嗜睡和虚弱情况，而其他症状报告较少。
因子分析显示疼痛为一个因子，其他症状为两个因子。MIDOS的疼痛总分与BPI的因子相关，MIDOS的症状总分与BPI的因子以及SF - 12的心理总分相关，尽管相关性较低。MIDOS总分显示出院回家或转至其他机构的患者疼痛缓解和症状控制良好，而症状总分表明在住院治疗期间死亡的患者在终末期病情恶化。对于阿片类药物剂量稳定的患者亚组，重测稳定性良好。
我们得出结论，MIDOS是一种用于患者症状自我评估的有效工具，可用于监测症状管理的效果。
