Assessment tools

Question 1

Symptoms defining

Answer 1

• lack of consistent terminology
• subjective
• variation in meaning with culture, education, symptom experience

Question 2

Measuring symptoms

Answer 2

• self report is gold standard
• poor correlation between observer and patient assessment

Question 3

How to measure symptoms

Answer 3

• frequency
• severity
• distress
• impact on function
• family, social, financial, spiritual impact
• health related quality of life

Question 4

Symptom management assessment tools

Answer 4

• ESAS
• standardized approach with validated tool
• repeated at intervals
• evidence for improved outcome when routine symptom measures are paired with clinical pathways and consultation

Question 5

Methodological considerations for symptom measurement in clinical research

Answer 5

• ability to provide consent
• willingness to participate
• study aims and methods
• data management
• validity of sx assessment tool
• minimal important difference in scores
• clinical utility

Question 6

ESAS

Answer 6

• Edmonton Symptom Assessment System
• validated, well used
• 9 common symptoms on Visual analogue scale 0-10
• patient rating or proxy rating
• Pain, fatigue, nausea, depression, drowsy, anxious, appetite, feeling of wellbeing, shortness of breath

Question 7

Memorial Symptom Assessment Scale

Answer 7

• validated
• patient related measure of 26 symptoms
• language translation
• better for research, global symptom distress

Question 8

Visual Analogue Scale

Answer 8

• Dypsnea
• Pain
• can be used in cognitive impairment or limited language

Question 9

Modified Borg Scale

Answer 9

• Dyspnea measurement 0-10
• Chronic pulmonary disease

Question 10

Medical research council dyspnea scale (MRC)

Answer 10

• assessess functional limitations of dyspnea
• grade 0-4
• Grade 0 - breathless only with exercise
• GRade 4- breathless at rest

Question 11

Cancer Dyspnea Scale

Answer 11

• rates effort, anxiety, discomfort
• Likert scale

Question 12

MMSE

Answer 12

• Mini mental status exam
• cognitive impairment, sensitive
• not specific for delirium
• LEAST useful for delirium

Question 13

Confusion Assessment Method

Answer 13

• CAM for delirium:
  1. acute onset and fluctuating course
  2. inattention
  3. disorganized thinking or altered LOC

Question 14

Challenges to applying symptom tools in PC settings

Answer 14

• hcp scepticism
• lack of familiarity
• workload burden
• lack of standardization in geographic areas
• ease of use- paper charts vs electronic
• patient barriers, reluctance

Question 15

BOMC

Answer 15

• Blessed orientation, memory and concentration test
• validated tool in cognitive impairment but not specific for delirium or dementia
• condensed form of IMCMST test
• Score above 10 = abnormal
• Higher the score, more cognitive impairment

Question 16

NUDESC

Answer 16

• 5 item instrument based on observation of a patient by nurses
• not burdensome for patient
• documents hypoactive behaviour
  
  • Disorientation
  • Inapproriate behaviour
  • Inappropriate communication
  • Hallucinations
  • Psychomotor retardation

Question 17

Palliative Performance Scale

Answer 17

• communicates patient functional levels
• 0-100% (0= death)
  
  • Ambulation
  • Activity and Evidence of disease
  • Self care
  • Intake
  • Conscious level
• PPS 30% = totally bed bound, unable to do any activyt, extensive disease, total care, minimal to sips oral intake, full/drosy/confusion
• PPS 30%= prognosis < 3 months

Question 18

PPI

palliative prognostic index

Answer 18

• PPS
  
  • 10-20
  • 30-50
  • >60
• Oral intake
  
  • mouthfuls
  • reduced
  • normal
• Edema
  
  • present
  • absent
• Dyspnea at rest
  
  • present
  • absent
• Delirium
  
  • Present
  • absent

PPI >6 = prognosis < 3 weeks

PPI >4 = prognosis < 6 weeks

PPI <4 = prognosis > 6 weeks