Oi-Ling Kwok, Man-Wah Doris T S E, Kam-Hung Daniel N G
Department of Medicine & Geriatrics, Caritas Medical Centre, Shamshuipo, Kowloon, Hong Kong SAR.
Palliat Med. 2005 Apr;19(3):228-33. doi: 10.1191/0269216305pm1001oa.
To study the symptom distress as rated by patients with advanced cancer during their last week of life, and to compare patients' ratings with those perceived by caregivers and physicians.
This was a prospective study on all patients admitted to the Hospice Unit of the Caritas Medical Centre with an estimated life expectancy of two weeks or less from May 2002 to September 2002. A questionnaire with a list of 13 symptoms, including pain, dyspnoea, nausea, vomiting, dry mouth, cough, fatigue, cachexia, anorexia, constipation, diarrhoea, insomnia and haemoptysis, was administered to assess the distress. Distress was rated by a verbal rating scale consisting of five grades (grade 0 to grade 4). Patients, caregivers and physicians completed the questionnaire weekly until the patient died. Only the questionnaires completed in the last week of life were included for analysis.
Of 82 patients who were recruited in the study, 30 patients were able to complete the questionnaire within the last week of life. Their median age was 69 years and the gender ratio was 1:1. Lung cancer was the most common primary tumour. Fatigue, cachexia and anorexia caused distress of all grades in nearly all 30 patients and caused significant distress of grade 3 and above in two-thirds of patients. Neither the caregivers nor the physicians gave congruent distress scores for these three symptoms (kappa<0.4). Caregivers' ratings agreed well with those of patients for five symptoms (kappa>0.4, P<0.005), including dyspnoea, cough, dry mouth, constipation and insomnia. For physicians, good agreement was found for three symptoms only, including pain, dyspnoea and cough. Moreover, physicians tended to underrate the distress.
Fatigue, cachexia and anorexia were the three most distressful symptoms in the last week of life in this group of patients, but caregivers and physicians failed to rate them in agreement with patients.
研究晚期癌症患者在生命最后一周的症状困扰程度，并比较患者的评分与护理人员及医生的认知评分。
这是一项对2002年5月至2002年9月入住明爱医院善终服务病房、预期寿命为两周或更短的所有患者进行的前瞻性研究。采用一份包含13种症状的问卷，包括疼痛、呼吸困难、恶心、呕吐、口干、咳嗽、疲劳、恶病质、厌食、便秘、腹泻、失眠和咯血，以评估困扰程度。困扰程度通过由五个等级（0级至4级）组成的语言评定量表进行评分。患者、护理人员和医生每周填写问卷，直至患者死亡。仅纳入生命最后一周完成的问卷进行分析。
在该研究招募的82例患者中，有30例患者能够在生命最后一周内完成问卷。他们的中位年龄为69岁，性别比为1:1。肺癌是最常见的原发肿瘤。疲劳、恶病质和厌食在几乎所有30例患者中均导致各等级的困扰，并且在三分之二的患者中导致3级及以上的显著困扰。护理人员和医生对这三种症状的困扰评分均不一致（kappa<0.4）。护理人员对五种症状（kappa>0.4，P<0.005）的评分与患者的评分一致性良好，这五种症状包括呼吸困难、咳嗽、口干、便秘和失眠。对于医生而言，仅在三种症状上发现良好的一致性，包括疼痛、呼吸困难和咳嗽。此外，医生往往低估困扰程度。
疲劳、恶病质和厌食是该组患者生命最后一周中最困扰的三种症状，但护理人员和医生对这些症状的评分与患者不一致。
