Department of Nursing Administration, Detroit Receiving Hospital, Detroit, Michigan 48201, USA.
J Palliat Med. 2010 Mar;13(3):285-90. doi: 10.1089/jpm.2009.0229.
Standard measures of dyspnea rely on self-report. Cognitive impairment and nearness to death may interfere with symptom distress reporting leading to underrecognition and overtreatment or undertreatment. Previous psychometric testing of the Respiratory Distress Observation Scale (RDOS) demonstrated internal consistency and convergent validity with dyspnea self-report and discriminant validity with pain and no dyspnea. Additional testing was needed with patients unable to self-report. The aim of this study was to establish further the reliability and construct validity of a revised RDOS.
An observational design was used with 89 consecutive patients referred for inpatient palliative care consultation and at risk for dyspnea who had one or more of lung cancer, chronic obstructive pulmonary disease (COPD), heart failure, or pneumonia. Patients were observed and the RDOS scored once each day for up to three days after the initial consultation. Other measures included: dyspnea self-report, neurologic diagnoses, opioid or benzodiazepine use, peripheral oxygen saturation, end-tidal carbon dioxide level, consciousness, cognitive state, nearness to death, and patient demographics.
Perfect interrater reliability across data collectors was achieved. No differences in RDOS scoring were found by patient demographics. RDOS was associated with use of oxygen (p < 0.01), oxygen saturation (p < 0.01) and nearness to death (p < 0.01). A significant decrease in RDOS was found over time corresponding with treatment (p < 0.01). The reliability of this 8-item scale using Cronbach alpha is 0.64.
Declining consciousness and/or cognition are expected when patients are near death. The RDOS performed well when tested with terminally ill patients who were at risk for respiratory distress, most of whom could not self-report dyspnea. The tool is sensitive to detect changes over time and measure response to treatment. The RDOS is simple to use; scoring takes less than 5 minutes. The RDOS has clinical and research utility to measure and trend respiratory distress and response to treatment.
呼吸困难的标准测量依赖于自我报告。认知障碍和接近死亡可能会干扰症状困扰报告，导致识别不足、过度治疗或治疗不足。先前对呼吸窘迫观察量表（RDOS）的心理测量学测试表明，其与呼吸困难自我报告具有内部一致性和收敛有效性，与疼痛和无呼吸困难具有判别有效性。需要对无法自我报告的患者进行进一步的测试。本研究的目的是进一步确定修订后的 RDOS 的可靠性和结构有效性。
采用观察性设计，对 89 例连续因肺癌、慢性阻塞性肺疾病（COPD）、心力衰竭或肺炎而被转介进行住院姑息治疗咨询并存在呼吸困难风险的患者进行研究。在初始咨询后最多三天的时间内，每天对患者进行一次观察并对 RDOS 进行评分。其他措施包括：呼吸困难自我报告、神经诊断、阿片类或苯二氮䓬类药物使用、外周血氧饱和度、呼气末二氧化碳水平、意识、认知状态、接近死亡以及患者人口统计学信息。
数据收集员之间实现了完美的评分者间可靠性。患者的人口统计学信息对 RDOS 评分没有影响。RDOS 与氧气使用（p < 0.01）、氧饱和度（p < 0.01）和接近死亡（p < 0.01）有关。随着时间的推移，RDOS 评分显著下降，与治疗有关（p < 0.01）。使用 Cronbach alpha 计算的这个 8 项量表的可靠性为 0.64。
当患者接近死亡时，意识和/或认知能力下降是预期的。当对存在呼吸困难风险的终末期患者进行测试时，RDOS 表现良好，其中大多数患者无法自我报告呼吸困难。该工具对检测随时间的变化和衡量治疗反应非常敏感。RDOS 使用简单；评分不到 5 分钟。RDOS 具有临床和研究效用，可以测量和跟踪呼吸窘迫和治疗反应。
