Association between a validated symptom assessment tool and nurse clinical impression in patients with cancer admitted to a palliative care unit.

Abstract

9112 Background: Advanced cancer inpatients develop multiple severe symptoms. Effective treatment is only possible if appropriate assessments took place. Most clinicians do not routinely use symptoms assessment tools in everyday practice and treat according to their clinical impression only. In this prospective study, we compared the patient reported symptom battery by the Edmonton Symptom Assessment System (ESAS) to bedside nurses’ clinical impression. Methods: Consecutive advanced cancer inpatients admitted to our Acute Palliative Care Unit from April to July 2010 were included. We collected the results from ESAS (10 symptoms: pain, nausea, fatigue, drowsiness, appetite, shortness of breath, sleep, depression, anxiety, feeling of well being rated from 0 to 10) on the day of admission (D1) and on the third day of hospitalization (D3). We also collected the nurses’ clinical impression of patient’s physical and emotional distress on D1 and D3 (none=0, severe=3). Results: 118 patients completed the ESAS on day 1 and 116 on day 3. We found that for D1 there was no significant association between nurses’ perception of symptoms burden and ESAS assessment. The median ESAS physical and psychosocial scores were 31 and 12 in patients with nurse clinical impression of low or no physical distress, versus 34 (p=0.07) and 15 (p=0.18) in patients with nurse clinical impression of moderate or severe distress, respectively. For D3, we found a significant association only for pain (r =0.31, p=0.001) and anxiety (r =0.29, p=0.001). On D1, the nurses’ assessment had low sensitivity as compared to ESAS (cut off score of 5 for fatigue, 2 for depression and anxiety, and 4 for all others) ranging from 0.56 to 0.69, and low specificity ranging from 0.43 and 0.58, without significant improvement on day 3. Conclusions: The clinical impression of highly trained palliative care nurses had no significant association with patient reported ESAS scores. Validated tools are needed for daily clinical assessment of physical and psychosocial distress in advanced cancer patients.