Brearley Sarah G, Clements Caroline V, Molassiotis Alex
School of Nursing, Midwifery and Social Work, University of Manchester, UK.
Support Care Cancer. 2008 Nov;16(11):1213-29. doi: 10.1007/s00520-008-0428-y. Epub 2008 Jun 13.
The assessment of chemotherapy-induced nausea, vomiting and retching (CINVR) is important and to date no review has comprehensively assessed available patient self-report tools. The aim was to undertake a review of their utility, content and psychometric properties.
One thousand three hundred and forty-seven citations were identified by electronic and hand searches resulting in 24 non-duplicate abstracts, 15 articles for analysis, and six articles, which fitted the inclusion criteria. E-mail investigations discovered a further scale, resulting in seven measures.
The review highlighted the strengths and weaknesses of current tools. The multiple domains, phases and aspects of CINVR signify that the assessment tools varied markedly. The diverse requirements of research and clinicians also contribute to the variation. There was a notable disparity in the quality of scales and paucity in terms of their development and psychometric evaluation. We found that several self-assessment scales currently perceived as well-validated tools have problems in terms of their validity, reliability and appropriateness.
The constituents of a scale relevant for both clinical and research use were assessed and it was recommended that a modular tool focusing on two domains (nausea and vomiting); two phases (acute and delayed); measuring the aspects of occurrence, frequency, intensity alongside duration and functional interference; and antiemetic use and adverse events should be developed. Based on these recommendations, further research into an appropriate scale would minimise conceptual confusion, increase clinicians' understanding and control of CINVR, decrease patient distress and could have equal utility in both a clinical and a research setting.
评估化疗引起的恶心、呕吐和干呕(CINVR)非常重要,迄今为止,尚无综述全面评估现有的患者自我报告工具。目的是对其效用、内容和心理测量特性进行综述。
通过电子检索和手工检索确定了1347条引文,得到24篇非重复摘要、15篇用于分析的文章以及6篇符合纳入标准的文章。电子邮件调查又发现了一个量表,最终得到7种测量方法。
综述突出了当前工具的优缺点。CINVR的多个领域、阶段和方面表明评估工具差异显著。研究和临床医生的不同要求也导致了这种差异。量表质量存在明显差异,在其开发和心理测量评估方面也很匮乏。我们发现,目前一些被视为有效验证工具的自我评估量表在有效性、可靠性和适用性方面存在问题。
评估了适用于临床和研究的量表的组成部分,建议开发一种模块化工具,重点关注两个领域(恶心和呕吐);两个阶段(急性和延迟);测量发生、频率、强度以及持续时间和功能干扰等方面;以及止吐药的使用和不良事件。基于这些建议,对合适量表的进一步研究将最大限度地减少概念混淆,增强临床医生对CINVR的理解和控制,减轻患者痛苦,并且在临床和研究环境中都具有同等效用。