Molassiotis Alexander, Coventry Peter A, Stricker Carrie T, Clements Caroline, Eaby Beth, Velders Luke, Rittenberg Cynthia, Gralla Richard J
School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK.
J Pain Symptom Manage. 2007 Aug;34(2):148-59. doi: 10.1016/j.jpainsymman.2006.10.018. Epub 2007 May 23.
There is a lack of clinical tools to facilitate communication between clinicians and patients about chemotherapy-induced nausea and vomiting (CINV). The Multinational Association of Supportive Care in Cancer (MASCC) has developed such a tool, which is an eight-item scale for the assessment of acute and delayed nausea and vomiting, and is completed once per cycle of chemotherapy. The aim of the current study was to assess its psychometric properties, specifically reliability and validity, cultural transferability and equivalence, and congruence with proxy assessments, as well as to determine if accuracy of recall of CINV events using the MASCC Antiemesis Tool (MAT) differed over time from chemotherapy. A prospective study was carried out with adult cancer patients and their informal carers from two hospitals, one each in the United Kingdom (UK) and United States of America (U.S.). Patients completed the Rhodes Index for nausea, vomiting and retching (INVR) daily for the first five days after chemotherapy and were then asked to complete the MAT at one week, two weeks, or three weeks after chemotherapy. Carers completed an adapted MAT concurrently with patients. The sample consisted of 87 patients and 22 informal carers. The internal consistency reliability of the scale was high, with Cronbach alphas of 0.77 (patient sample) and 0.82 (carer sample). Responses were similar between the UK and U.S. samples in terms of nausea and vomiting, and both samples found the scale easy to use. Contrasted-groups validity (using age as a grouping variable) and concurrent validity (MAT compared with INVR) suggested that the scale is sensitive to detect the different dimensions of CINV and performed well against a daily assessment of nausea/vomiting (total score correlation r=0.86, P<0.001). Recall of events was high even three weeks after chemotherapy (correlations with INVR of 0.44-0.99, all P<0.01). Factor analysis clearly identified three factors, namely vomiting, acute nausea, and delayed nausea. Proxy assessments by carers were congruent with the patients' responses, especially in relation to vomiting. The MAT is a reliable, valid, clear, and easy-to-use clinical tool that could facilitate discussion between clinicians and patients about their nausea and vomiting experience, thereby potentially aiding treatment decisions. Regular assessment of nausea and vomiting after chemotherapy has the potential to significantly improve CINV management.
目前缺乏有助于临床医生与患者就化疗引起的恶心和呕吐(CINV)进行沟通的临床工具。多国癌症支持治疗协会(MASCC)开发了这样一种工具,它是一个用于评估急性和迟发性恶心与呕吐的八项量表,在每个化疗周期完成一次。本研究的目的是评估其心理测量特性,特别是信度和效度、文化可转移性和等效性以及与代理评估的一致性,并确定使用MASCC止吐工具(MAT)回忆CINV事件的准确性是否随化疗时间的推移而有所不同。对来自英国和美国各一家医院的成年癌症患者及其非正式护理人员进行了一项前瞻性研究。患者在化疗后的前五天每天完成恶心、呕吐和干呕的罗兹指数(INVR),然后在化疗后一周、两周或三周时被要求完成MAT。护理人员与患者同时完成一份改编后的MAT。样本包括87名患者和22名非正式护理人员。该量表的内部一致性信度较高,患者样本的克朗巴哈系数为0.77,护理人员样本的克朗巴哈系数为0.82。英国和美国样本在恶心和呕吐方面的反应相似,且两个样本都认为该量表易于使用。对比组效度(以年龄作为分组变量)和同时效度(MAT与INVR比较)表明,该量表对检测CINV的不同维度很敏感,并且在与恶心/呕吐的每日评估对比中表现良好(总分相关性r = 0.86,P < 0.001)。即使在化疗三周后,事件的回忆率也很高(与INVR的相关性为0.44 - 0.99,所有P < 0.01)。因子分析明确确定了三个因子,即呕吐、急性恶心和迟发性恶心。护理人员的代理评估与患者的反应一致,尤其是在呕吐方面。MAT是一种可靠、有效、清晰且易于使用的临床工具,可促进临床医生与患者之间关于恶心和呕吐经历的讨论,从而可能有助于治疗决策。化疗后定期评估恶心和呕吐有可能显著改善CINV的管理。