评价大学医学中心专科姑息治疗病房的姑息症状负担评分（PSBS）-一项纵向研究。
Evaluation of the palliative symptom burden score (PSBS) in a specialised palliative care unit of a university medical centre - a longitudinal study.
机构信息
Chair of Research Methodology and Statistics in Psychology, Department of Psychology & Psychotherapy, Faculty of Health, Witten/Herdecke University, Witten, Germany.
Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Dusseldorf, Düsseldorf, Germany.
出版信息
BMC Palliat Care. 2018 Jul 7;17(1):92. doi: 10.1186/s12904-018-0342-0.
BACKGROUND
The implementation of standardised, valid and reliable measurements in palliative care is subject to practical and methodological challenges. One aspect of ongoing discussion is the value of systematic proxy-based assessment of symptom burden in palliative care. In 2011, an expert-developed proxy-based instrument for the assessment of symptom burden in palliative patients, the Palliative Symptom Burden Score (PSBS), was implemented at the Specialised Palliative Care Unit of the University Medical Centre in Dusseldorf, Germany. The present study investigated its feasibility, acceptance and psychometric properties.
METHODS
The PSBS was rated by nursing staff three times a day over 5 years (N = 820 patients). Feasibility and nurses' acceptance of PSBS were analysed. Structural validity was investigated by principal component analysis. Construct validity was examined via cross-validation with the Hospice and Palliative Care Evaluation checklist. Discriminative validity of the PSBS was analysed by means of Kruskal-Wallis test of patients' performance score. Reliability of the PSBS was evaluated by internal consistency analysis, test-retest and split-half-reliability. Inter-rater reliability was investigated by observer agreement of nurses' ratings of symptom burden within a day. Sensitivity to change was analysed by Wilcoxon test with repeated measures of the PSBS before and after palliative complex treatment.
RESULTS
A high degree of acceptance and the feasibility of a high-frequency proxy-based symptom burden assessment approach were demonstrated. There were low rates of missing values and no indications of the adoption of prior ratings. PSBS in its present form demonstrates good structural and construct validity (r = .27-.79, p's < .001) and high sensitivity to changes in symptom burden (p's < .01, except sweating), but unsatisfactory reliability (α = .41-.67; test-retest: r .30-.88; p's < .001; split-half: r = .69; p < .001; inter-rater: n.s.).
CONCLUSIONS
The study presents a framework for the post hoc validation of an already existing documentation tool in palliative care. This study supports the notion that PSBS might not be reflective of an overall construct and will therefore require further development and critical comparison to other already established symptom burden instruments in palliative care.
背景
在姑息治疗中实施标准化、有效和可靠的测量受到实际和方法学挑战的影响。正在讨论的一个方面是系统代理评估姑息治疗中症状负担的价值。2011 年，德国杜塞尔多夫大学医学中心的专门姑息治疗病房实施了一种专家开发的姑息患者症状负担代理评估工具，即姑息症状负担评分（PSBS）。本研究调查了其可行性、可接受性和心理测量学特性。
方法
护理人员在 5 年内每天三次对 PSBS 进行评分（N=820 名患者）。分析了 PSBS 的可行性和护士的接受程度。通过主成分分析研究结构效度。通过与临终关怀和姑息治疗评估检查表的交叉验证来检验构念效度。通过 Kruskal-Wallis 检验分析 PSBS 的判别效度，检验患者绩效评分。通过内部一致性分析、测试-重测和分半可靠性评估 PSBS 的可靠性。通过护士在一天内对症状负担的评估观察者间一致性研究观察者间的可靠性。通过 PSBS 前后重复测量分析其变化的敏感性，采用 Wilcoxon 检验。
结果
高程度的接受度和高频率代理评估症状负担的可行性得到了证明。缺失值的比例较低，且不存在采用先前评分的迹象。PSBS 在其现有形式下表现出良好的结构和构念效度（r=.27-.79，p<.001）和对症状负担变化的高敏感性（p<.01，除出汗外），但可靠性不令人满意（α=.41-.67；测试-重测：r=.30-.88；p<.001；分半：r=.69；p<.001；观察者间：n.s.）。
结论
本研究提出了姑息护理中已有文档工具事后验证的框架。本研究支持 PSBS 可能无法反映整体结构的观点，因此需要进一步开发，并与姑息护理中其他已建立的症状负担工具进行批判性比较。
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