Warnecke Eva, Salvador Comino Maria Rosa, Kocol Dilara, Hosters Bernadette, Wiesweg Marcel, Bauer Sebastian, Welt Anja, Heinzelmann Anna, Müller Sandy, Schuler Martin, Teufel Martin, Tewes Mitra
Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany.
Department of Psychosomatic Medicine and Psychotherapy, West German Cancer Center, LVR-Klinikum Essen, University of Duisburg-Essen, 45122 Essen, Germany.
Cancers (Basel). 2023 Jun 1;15(11):3029. doi: 10.3390/cancers15113029.
For advanced cancer inpatients, the established standard for gathering information about symptom burden involves a daily assessment by nursing staff using validated assessments. In contrast, a systematic assessment of patient-reported outcome measures (PROMs) is required, but it is not yet systematically implemented. We hypothesized that current practice results in underrating the severity of patients' symptom burden. To explore this hypothesis, we have established systematic electronic PROMs (ePROMs) using validated instruments at a major German Comprehensive Cancer Center. In this retrospective, non-interventional study, lasting from September 2021 to February 2022, we analyzed collected data from 230 inpatients. Symptom burden obtained by nursing staff was compared to the data acquired by ePROMs. Differences were detected by performing descriptive analyses, Chi-Square tests, Fisher's exact, Phi-correlation, Wilcoxon tests, and Cohen's r. Our analyses pointed out that pain and anxiety especially were significantly underrated by nursing staff. Nursing staff ranked these symptoms as non-existent, whereas patients stated at least mild symptom burden (pain: mean = 0 (no); mean = 1 (mild); < 0.05; r = 0.46; anxiety: mean = 0 (no); mean = 1 (mild); < 0.05; r = 0.48). In conclusion, supplementing routine symptom assessment used daily by nursing staff with the systematic, e-health-enabled acquisition of PROMs may improve the quality of supportive and palliative care.
对于晚期癌症住院患者,收集症状负担信息的既定标准是由护理人员使用经过验证的评估方法进行每日评估。相比之下,虽然需要对患者报告的结局指标(PROMs)进行系统评估,但尚未得到系统实施。我们推测,目前的做法导致对患者症状负担的严重程度估计不足。为了探究这一假设,我们在德国一家大型综合癌症中心使用经过验证的工具建立了系统的电子PROMs(ePROMs)。在这项从2021年9月持续到2022年2月的回顾性、非干预性研究中,我们分析了230名住院患者的收集数据。将护理人员获得的症状负担与ePROMs获得的数据进行比较。通过进行描述性分析、卡方检验、费舍尔精确检验、Phi相关性检验、威尔科克森检验和科恩r检验来检测差异。我们的分析指出,疼痛和焦虑尤其被护理人员严重低估。护理人员将这些症状列为不存在,而患者表示至少有轻度症状负担(疼痛:平均值=0(无);平均值=1(轻度);<0.05;r=0.46;焦虑:平均值=0(无);平均值=1(轻度);<0.05;r=0.48)。总之,用系统的、基于电子健康的PROMs采集方法补充护理人员日常使用的常规症状评估,可能会提高支持性和姑息性护理的质量。