Symptom assessment tools used in a hospital-based pain and symptom care program at the University of North Carolina–A novel proxy rating system

Abstract

8579 Background: Level of consciousness (LOC) often varies in the palliative care patient population. Tools are needed to reliably rate symptoms. The purpose of our analysis was to describe the patient demographics and rating distributions elicited by two distinct measurement tools, one for those able to self-rate (SR) and one for proxy-rated (PR) patients. Methods: Data obtained prospectively over the time period 1/2002–12/2004 was reviewed. A symptom distress scale using 11 items on a 5 point Likert-type scale (5=most severe) was adapted from the revised McCorkle symptom distress scale and used for alert and oriented patients. Symptoms evaluated included nausea, mood, appetite, shortness of breath (SOB), insomnia, pain, mobility, fatigue, constipation, decreased LOC, and delirium. For patients unable to SR, an advanced practice nurse rated symptoms using the Detroit Medical Center non-verbal pain scale and proxy symptom distress measures adapted from the Common Toxicity Criteria Manual, version 2. Rated symptoms included pain, vomiting, constipation, tachypnea, depressed LOC, and agitated delirium. Results: A total of 259 patients with data from visits 1 and 2 were included in the analysis. On visit 1, 46% (61/133) of PR patients were male, 70% (94/134) were ≥60yrs and 73% (98/134) were Caucasian. Symptom distress scores varied by rater and visit (Table). Conclusions: There is a need for proxy symptom distress measurement in the palliative care patient population as LOC fluctuates. Variability in symptom distress ratings between the SR and PR groups, with a trend toward lower scores in PR patients, is in accordance with the current literature. Of note, there was a consistent improvement in scores, regardless of rater, when visit 2 was compared to visit 1. We plan a prospective study of inter-rater reliability and validity of this novel symptom scoring system. [Table: see text] No significant financial relationships to disclose.