A comparison of cancer patients and nurse specialist's symptom-assessment scores, in an acute hospital

Abstract

The overriding goal of palliative care is to provide the best quality of life for patients and their families. A major component of achieving this goal is the effective assessment and control of symptoms ([O]; [Nekolaichuk et al]), with the assessment of symptom ratings obtained directly from the patients being referred to as the ‘gold standard’. However, there are some occasions when direct patient symptom assessment is not possible for example if a patient is confused. Furthermore it is recognised that as their disease progresses there may be a decline in physical and cognitive functioning ([Nekolaichuk et al]), requiring an assessment of the patients’ symptoms to be made by medical and nursing staff in order to achieve symptom control. Yet previous studies particularly relating to pain, have found that there is a disparity between proxy scores obtained by nurses and patients ( [Camp and Sullivan (1987]; [Camp (1988]; [Hovi and Lauri (1999]; [Nekolaichuk et al]). One explanation is suggested by [Hovi and Lauri (1999] that doctors and nurses have an inadequate knowledge of the complexity of managing cancer symptoms. This inadequate knowledge of cancer symptoms is coupled with the importance of the assessment process, as it is argued by [Bonica (1985] that clinicians often fail to recognise how frequently pain is untreated or poorly controlled. Additionally, the objective assessment of patient's symptoms requires effective communication. Communicating with cancer patients is argued as being complex, with the difficulties that nurses experience when communicating with cancer patients having been widely reported in the literature ( [Wilkinson et al]). In the main, the literature relating to proxy assessments undertaken by nurses has not included specialist nurses within the field of palliative and cancer care. Yet the last decade has seen an escalation in the number of specialist nurses in palliative and cancer care, particularly based in the acute hospital setting ([Hill (2000]). Palliative and cancer care clinical nurse specialists have normally undergone specific palliative-care education. This specialist education includes symptom assessment and management and importantly enhanced communication skills ( [Redmond et al]). These enhanced specialist skills may contribute to a more accurate assessment of cancer patient's symptoms and potentially result in better symptom management. Many patients require hospital admission for symptom control during their cancer journey and approximately 56 per cent of cancer patients in England and Wales die in hospital ([Office for National (Statistics (2000]). Therefore, the aim of this study is to compare the proxy assessment of palliative-care patients symptoms, undertaken by clinical nurse specialists on a hospital palliative-care team, with those symptom scores obtained directly from the patient.