Zloklikovits Silke, Andritsch Elisabeth, Fröhlich Brigitte, Verebes Julijane, Dietmaier Gabriele, Samonigg Hellmut
Section of Palliative Care and Division of Clinical Oncology, Department of Internal Medicine, Medical University Graz, Austria.
Palliat Support Care. 2005 Jun;3(2):87-98. doi: 10.1017/s1478951505050169.
For patients who are terminally ill, the efficiency of symptom management is dependent, among other factors, on an accurate assessment by proxy raters. The aim of this prospective study is to describe differences in symptom severity ratings between patients and their nurses, physicians, and family members during their stay in different departments with acute care, and to identify variables associated with the accuracy of the ratings by others.
Physical, psychological, social, and functional disorders were assessed for 41 in-patients with a standardized 13-item Symptom List for Quality Assurance in Palliative Care drafted by the Working Group on the Core Documentation for Palliative Care Units in Germany. Symptom assessment was completed by different raters (patient, nurse, physician, family member) within the first four days after admission. Socio-demographic, disease-related, and hospitalization data were taken from patient charts.
Reliability of the symptom list was computed with Cronbach's alpha measures for the present sample. Between-group-comparisons on the individual items and on the sum-score level were analyzed separately for the different rater-pairs: patients-nurses (n = 41), patients-physicians (n = 39), patients-family members (n = 12). Multiple regression analyses calculated predictive variables of the staff's deviation scores.
Significant differences for nurses and physicians were found on the sum-score level for psychological and social symptoms, but not for physical and functional symptoms. Family members rated the intensities of the symptoms generally higher than the patients. Suggestions for further analyses are presented and discussed.
对于晚期患者，症状管理的效率在其他因素中，取决于代理评估者的准确评估。这项前瞻性研究的目的是描述患者与其护士、医生和家庭成员在入住不同急性护理科室期间症状严重程度评分的差异，并确定与他人评分准确性相关的变量。
采用德国姑息治疗病房核心文件工作组起草的标准化13项姑息治疗质量保证症状清单，对41名住院患者的身体、心理、社会和功能障碍进行评估。症状评估由不同的评估者（患者、护士、医生、家庭成员）在入院后的前四天内完成。社会人口统计学、疾病相关和住院数据取自患者病历。
用Cronbach's alpha测量法计算了本样本症状清单的信度。对不同评估者对（患者-护士，n = 41；患者-医生，n = 39；患者-家庭成员，n = 12）分别分析了各个项目和总分水平上的组间比较。多元回归分析计算了工作人员偏差分数的预测变量。
在心理和社会症状的总分水平上，护士和医生存在显著差异，但身体和功能症状不存在显著差异。家庭成员对症状强度的评分总体上高于患者。提出并讨论了进一步分析的建议。
