功能评估流程图（FAF）：一种新的简单可靠的方法，用于测量功能状态，观察者之间的一致性百分比很高。

The Functionality Assessment Flowchart (FAF): a new simple and reliable method to measure performance status with a high percentage of agreement between observers.

作者信息

Paiva Carlos Eduardo, Siquelli Felipe Augusto Ferreira, Santos Henrique Amorim, Costa Marina Moreira, Massaro Daniella Ramone, Lacerda Domício Carvalho, Nunes João Soares, de Pádua Souza Cristiano, Paiva Bianca Sakamoto Ribeiro

机构信息

Department of Clinical Oncology, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil.

Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil.

出版信息

BMC Cancer. 2015 Jul 5;15:501. doi: 10.1186/s12885-015-1526-0.

DOI:10.1186/s12885-015-1526-0

PMID:26142726

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4491220/

Abstract

BACKGROUND

Performance status (PS) assessment is an integral part of the decision-making process in cancer care. Karnofsky Performance Status (KPS) and Eastern Cooperative Oncology Group (ECOG) PS are the most widely used tools. In some studies, the absolute agreement rate of these tools between observers has been moderate to low. The present study aimed to evaluate the inter-observer reliability and construct validity of the new Functionality Assessment Flowchart (FAF) and compare it with ECOG PS and KPS in a sample of cancer patients.

METHODS

The patients were recruited by convenience from the waiting rooms of the Breast and Gynecology Ambulatory in a cross-sectional study. Two trained medical students (observer A) and five medical oncologists (observers B) independently rated women according to the ECOG PS, KPS and FAF. After the determining the PS scores, observer A administered the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) questionnaire to the participants. The agreements between observers A and B were investigated using the absolute agreement rate (%), weighted and unweighted kappa and Spearman's correlation test. For construct validity, the PS scores were correlated with functional and fatigue scores by performing correlation analysis.

RESULTS

Eighty women with a median age of 57 years were included in the study (86% accrual rate). Among these women, 39 (48.8%) had advanced cancer. The overall absolute agreement rate between observers was 49.4% for KPS, 67% for ECOG PS, and 78.2% for FAF. When using unweighted kappa values, the inter-observer reliability was "fair", "moderate" and "substantial" for KPS, ECOG PS and FAF, respectively. However, when using weighted kappa statistics, "substantial" agreement was observed for KPS and ECOG PS and "nearly perfect" agreement was observed for FAF. All of the PS scales correlated very well with the functional and fatigue scores.

CONCLUSIONS

We present a new instrument with moderate to high inter-observer agreement and adequate construct validity to measure PS in cancer patients.

摘要

背景

体能状态（PS）评估是癌症治疗决策过程中不可或缺的一部分。卡氏功能状态量表（KPS）和东部肿瘤协作组（ECOG）体能状态评分是使用最广泛的工具。在一些研究中，这些工具在观察者之间的绝对一致率为中等至较低。本研究旨在评估新型功能评估流程图（FAF）在观察者间的可靠性和结构效度，并在癌症患者样本中将其与ECOG体能状态评分和KPS进行比较。

方法

在一项横断面研究中，通过便利抽样从乳腺与妇科门诊候诊室招募患者。两名经过培训的医学生（观察者A）和五名肿瘤内科医生（观察者B）根据ECOG体能状态评分、KPS和FAF对女性患者进行独立评分。在确定PS评分后，观察者A向参与者发放癌症治疗功能评估-疲劳（FACT-F）问卷。使用绝对一致率（%）、加权和非加权kappa系数以及Spearman相关检验来研究观察者A和B之间的一致性。为了评估结构效度，通过进行相关分析将PS评分与功能和疲劳评分进行关联。

结果

80名中位年龄为57岁的女性纳入研究（纳入率86%）。在这些女性中，39名（48.8%）患有晚期癌症。观察者之间KPS的总体绝对一致率为49.4%，ECOG体能状态评分为67%，FAF为78.2%。使用非加权kappa值时，KPS、ECOG体能状态评分和FAF观察者间的可靠性分别为“一般”、“中等”和“优”。然而，使用加权kappa统计时，KPS和ECOG体能状态评分观察到“优”的一致性，FAF观察到“几乎完美”的一致性。所有PS量表与功能和疲劳评分均具有很好的相关性。