Hull York Medical School, University of York, York, UK.
Hull York Medical School, Allam Medical Building, University of Hull, Hull, UK.
J Pain Symptom Manage. 2018 Oct;56(4):602-612. doi: 10.1016/j.jpainsymman.2018.07.002. Epub 2018 Aug 7.
The assessment of patients' needs for care is a critical step in achieving patient-centered cancer care. Tools can be used to assess needs and inform care planning. The Needs Assessment Tool:Progressive Disease-Cancer (NAT:PD-C) is an Australian oncology clinic tool for assessment by clinicians of patients' and carers' palliative care needs. This has not been validated in the U.K. primary care setting.
The aim of this study was to test the psychometric properties and acceptability of a U.K. primary care adapted NAT:PD-C.
Reliability: NAT:PD-C-guided video-recorded consultations were viewed, rated, and rerated by clinicians. Weighted Fleiss' kappa and prevalence- and bias-adjusted kappa statistics were used. Construct: During a consultation, general medical practitioners (GPs) used NAT:PD-C, patient measures (Edmonton Symptom Assessment Scale; Research Utilisation Group Activities of Daily Living; Palliative care Outcome Score; Australian Karnofsky Performance Scale), and carer measures (Carer Strain Index; Carer Support Needs Assessment Tool). Kendall's Tau-b was used.
SETTING/PARTICIPANTS: GPs, nurses, patients, and carers were recruited from primary care practices.
Reliability: All patients' well-being items and four of five items in the carer/family ability to care section showed adequate interrater reliability. There was moderate test-retest reliability for five of six in the patients' well-being section and five of five in the carer/family ability to care section. Construct: There was at least fair agreement for five of six of patients' well-being items; high for daily living (Kendall's Tau-b = 0.57, P < 0.001). The NAT:PD-C has adequate carer construct validity (five of eight) with strong agreement for two of eight patients. Over three-quarters of GPs considered the NAT:PD-C to have high acceptability.
The NAT PD-C is reliable, valid, and acceptable in the UK primary care setting. Effectiveness in reducing patient and carer unmet needs and issues regarding implementation are yet to be evaluated.
评估患者的护理需求是实现以患者为中心的癌症护理的关键步骤。可以使用工具来评估需求并为护理计划提供信息。需要评估工具：进展性疾病-癌症（NAT：PD-C）是澳大利亚肿瘤学诊所用于评估患者和护理人员的姑息治疗需求的工具。该工具尚未在英国初级保健环境中得到验证。
本研究旨在测试英国初级保健中经过改编的 NAT：PD-C 的心理测量特性和可接受性。
可靠性：对经过 NAT：PD-C 指导的视频记录咨询进行了查看、评分和重新评分，由临床医生进行。使用加权 Fleiss' kappa 和流行率和偏差调整的 kappa 统计量。构建：在咨询期间，全科医生（GP）使用 NAT：PD-C、患者测量（埃德蒙顿症状评估量表；研究利用组日常生活活动；姑息治疗结局评分；澳大利亚卡诺夫斯基表现量表）和护理人员测量（护理人员压力指数；护理人员支持需求评估工具）。使用 Kendall's Tau-b。
设置/参与者：从初级保健实践中招募了全科医生、护士、患者和护理人员。
可靠性：所有患者的幸福感项目和五个护理人员/家属照顾能力项目中的四个项目都显示出足够的评分者间可靠性。患者幸福感部分的五项中有五项和护理人员/家属照顾能力部分的五项中有五项测试重测可靠性中等。构建：患者幸福感的五项中有五项，日常生活的五项中有五项至少有适度的一致性（Kendall's Tau-b = 0.57，P < 0.001）。NAT：PD-C 具有足够的护理人员构念有效性（八项中的五项），两项中的两项具有强烈的一致性。超过四分之三的全科医生认为 NAT：PD-C 具有较高的可接受性。
NAT PD-C 在英国初级保健环境中具有可靠性、有效性和可接受性。有效性在于降低患者和护理人员的未满足需求，以及实施方面的问题尚待评估。
