Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030-4009, USA.
J Palliat Med. 2012 Mar;15(3):301-7. doi: 10.1089/jpm.2011.0403. Epub 2012 Feb 17.
Clinicians typically rely on their own or the nurses' clinical impression (NI) of symptoms rather than patient self-reports. It is unclear whether these means of assessment yield similar results.
To prospectively compare patient-reported symptoms on a modified Edmonton Symptom Assessment System (ESAS) with NI scores.
Consecutive patients with advanced cancer admitted to our acute palliative care unit between April and July 2010 were studied. We collected the results of the ESAS on the day of admission (D1) to the unit and 2 days later (D3). We also collected the NI of each patient's physical and psychological distress on D1 and D3.
One hundred eighteen patients completed the ESAS on D1 and 116 on D3. On D1 there was no significant association between NI score and ESAS assessment except for dyspnea, which was weakly correlated with NI score for physical distress (r=0.22, p=0.02). The median ESAS physical and psychosocial scores were 31 and 12 in patients with NI of low or no physical distress, versus 34 (p=0.07) and 15 (p=0.18) in patients with NI of moderate or severe distress, respectively. On D3, we found a significant association between ESAS and NI only for pain (r=0.32, p<0.001) and anxiety (r=0.30, p=0.001). Sensitivity and specificity of the NIs for ESAS scores were low on both days.
The clinical impression of highly trained palliative care nurses showed poor association with patient-reported symptom intensity. Validated symptom assessment tools are needed for bedside clinical assessment.
临床医生通常依赖于自己或护士对症状的临床印象（NI），而不是患者的自我报告。目前尚不清楚这些评估方法是否会产生相似的结果。
前瞻性比较改良的埃德蒙顿症状评估系统（ESAS）与 NI 评分的患者报告症状。
连续入组 2010 年 4 月至 7 月期间入住我们急性姑息治疗病房的晚期癌症患者。我们收集患者入院当天（D1）和第 2 天（D3）的 ESAS 结果，同时收集每位患者的身心痛苦的 NI。
118 例患者在 D1 完成 ESAS，116 例患者在 D3 完成 ESAS。在 D1，NI 评分与 ESAS 评估之间没有显著关联，除了呼吸困难，它与身心痛苦的 NI 评分呈弱相关（r=0.22，p=0.02）。NI 评分显示身心痛苦程度低或无的患者的 ESAS 身体和心理社会评分中位数分别为 31 和 12，而 NI 评分显示身心痛苦程度为中度或重度的患者分别为 34（p=0.07）和 15（p=0.18）。在 D3，我们发现 ESAS 与 NI 之间仅存在显著关联，即疼痛（r=0.32，p<0.001）和焦虑（r=0.30，p=0.001）。在两天中，NI 对 ESAS 评分的灵敏度和特异性均较低。
训练有素的姑息治疗护士的临床印象与患者报告的症状强度相关性较差。需要使用经过验证的症状评估工具进行床边临床评估。
