McPherson Christine J, Wilson Keith G, Lobchuk Michelle M, Brajtman Susan
School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
J Pain Symptom Manage. 2008 Jan;35(1):70-82. doi: 10.1016/j.jpainsymman.2007.02.038. Epub 2007 Nov 5.
The purposes of the study were to examine the concordance between patients' and family caregivers' assessments of patients' symptoms, and to identify demographic and psychosocial factors that affect levels of agreement. Sixty-six patients with advanced cancer receiving palliative care, and their primary, informal caregivers assessed patients' symptoms using the Memorial Symptom Assessment Scale (MSAS). Levels of agreement for individual symptoms ranged from poor to excellent (interclass correlation coefficient 0.07-0.75). Analysis of the group means using paired t-tests revealed significant differences for the MSAS subscales (psychological, physical, and general distress index), and for four of the 12 physical symptoms and five of the six psychological symptoms. The magnitude of the observed differences indicated a small to moderate bias for caregivers to overestimate, which was more marked for psychological than for physical symptoms. A number of factors associated with the caregiver (particularly the emotional state, the burden of providing care, and male gender) and the patient (the perception of being a burden to others) were significantly correlated with levels of disparity on some measures. The findings are consistent with the growing body of literature on the validity of proxy respondents' assessments of patients' symptoms.
本研究的目的是检验患者与其家庭护理者对患者症状评估之间的一致性，并确定影响一致程度的人口统计学和社会心理因素。66名接受姑息治疗的晚期癌症患者及其主要的非正式护理者使用纪念症状评估量表（MSAS）对患者的症状进行了评估。各个症状的一致程度从差到优不等（组内相关系数为0.07 - 0.75）。使用配对t检验对组均值进行分析发现，MSAS分量表（心理、身体和总体痛苦指数）以及12种身体症状中的4种和6种心理症状中的5种存在显著差异。观察到的差异程度表明护理者存在小到中度的高估偏差，心理症状比身体症状更为明显。一些与护理者相关的因素（特别是情绪状态、护理负担和男性性别）以及与患者相关的因素（认为自己是他人的负担）在某些测量指标上与差异程度显著相关。这些发现与关于代理应答者对患者症状评估有效性的越来越多的文献一致。
