An instrument to collect data on frequency and intensity of symptoms in older palliative cancer patients: A development and validation study

Xerostomia in patients with advanced cancer: a scoping review of clinical features and complications

BACKGROUND

The aim of this project was to review the literature on dry mouth / xerostomia in patients with advanced cancer, with the objectives being to determine its prevalence, clinical features, and complications.

METHODS

Standard methodology was used to conduct this scoping review. Detailed searches of the Medline, Embase, CINAHL, and PsycInfo databases were conducted to identify relevant studies: eligible studies had to include patients with advanced cancer, and to contain details of clinical features and/or complications of xerostomia. Commercial bibliographic / systematic review software was used to support the process.

RESULTS

Forty-three studies were discovered from the database and hand searches. The studies included 23 generic symptom studies, eight "symptom cluster" studies, nine oral symptom / problem studies, and three xerostomia-specific studies. In depth data is described on the clinical features and complications of xerostomia, and on the "symptom clusters" including xerostomia, in this cohort of patients.

CONCLUSION

This review discovered a relatively small number of focused studies (involving a similarly small number of patients). Nonetheless, it demonstrates that xerostomia is a very common problem in patients with advanced cancer and is often associated with significant morbidity (and impairment of quality of life).

Taste disturbance in patients with advanced cancer: a scoping review of clinical features and complications

PURPOSE

The purpose of this scoping review is to appraise the published literature on taste disturbance in patients with advanced cancer, with the specific objectives being to determine its prevalence, clinical features and complications.

METHODS

This scoping review was conducted using the recommended methodological framework. A detailed search of databases (Medline, Embase, CINAHL and PsycInfo) was conducted to identify eligible studies: eligible studies needed to include patients with advanced cancer and needed to include details of clinical features and/or complications of taste disturbance. Standard bibliographic/systematic review software was used to store the records and manage the review process, respectively.

RESULTS

Twenty-five studies were identified from the database searches. The studies identified included eight physical and/or psychological symptom studies, six symptom cluster studies, five oral symptom studies and six taste and/or smell specific studies. Detailed data is presented on the clinical features and complications of taste disturbance and on the symptom clusters involving taste disturbance in this cohort of patients.

CONCLUSION

This scoping review identified a relatively small number of relevant studies involving a relatively small number of participants. Nevertheless, it confirms that taste disturbance is a common problem in patients with advanced cancer and is associated with significant morbidity because of the primary condition and the associated complications.

To Leave is to Die a Little: Assessing the Symptom Structure of Separation Anxiety Disorder in Left-Behind Emerging Adults

The literature on separation anxiety disorder (SAD) presented two contentious issues relating to its assessment. First, studies are scarce in assessing the symptom structure of DSM-5 SAD among the adult population. Second, the accuracy in assessing the severity of SAD through measuring the intensity of disturbance and the frequency of occurrence of symptoms is yet to be studied. To address these limitations, the present study aimed to: (1) examine the latent factor structure of the newly developed separation anxiety disorder symptom severity inventory (SADSSI); (2) evaluate the necessity of using frequency or intensity formats through comparison of differences in the latent level; and (3) investigate SAD latent class analysis. Utilizing 425 left-behind emerging adults (LBA), the findings showed that a general factor with two dimensions (i.e., response formats) measuring frequency and intensity symptom severity separately has excellent fit and good reliability. Finally, the latent class analysis yielded a three-class solution best fitting to the data. Overall, the data provided evidence for the psychometric soundness of SADSSI as an assessment tool for separation anxiety symptoms among LBA.

Examining the Latent Dimensions of Social Anxiety Disorder

While the body of literature has investigated the latent dimensions of Social Anxiety Disorder (SAD), only few have directly anchored in the DSM-5 SAD symptoms. Similarly, a continuing issue on measuring mental health disorders pertains to whether a symptom's frequency, intensity, or both, are appropriate and sufficient indicators of severity. To address this gap, the present study developed and validated a DSM-5-based measurement tool, the Social Anxiety Symptom Severity Inventory (SASSI), which assesses both the intensity (intensity of disturbance) and frequency (frequency of occurrence) of SAD symptoms. In study 1 (n = 6458, college students), the results revealed a two-factor structure using exploratory structural equation modeling. In study 2 (n = 425, left-behind emerging adults), confirmatory factor analysis, measurement invariance testing, and latent class analysis were used. Findings demonstrated the importance of using both frequency and intensity of symptoms in assessing SAD severity. Moreover, a five-class solution best fitted the sample. Studies 1 and 2 demonstrated the good psychometric properties of SASSI and filled an important gap among available measures in assessing SAD severity through symptom frequency and intensity.

A Short Performance Anxiety Scale for Musicians

Given the prevalence of debilitating anxiety associated with music performance, there is a need for rapid, pinpointed assessment of the extent to which an individual experiences music performance anxiety (MPA). A short, five item scale, the Mazzarolo Music Performance Anxiety Scale (M-MPAS), was developed to capture retrospective self-reported estimates of the frequency, intensity and aversion tendency associated with performing music. 102 musicians completed the scale, as well as an established MPA inventory. The M-MPAS was found to be internally reliable (Cronbach's alpha = 0.894) with all items being statistically relevant to the overall scale. Furthermore, the M-MPAS was correlated with the relevant factors of an established MPA measure (r = 0.791), suggesting that the new scale exhibited good construct validity. M-MPAS is easy to score, with a scale range of 0-30. A score of 11 or above is suggested as the range in which a diagnosis of potential high MPA can be made, but more research into this and the psychometric robustness of the scale is called for. Nevertheless, the reliability and validity demonstrated in the present study, along with the brevity of the M-MPAS suggest that the newly proposed scale may offer considerable triaging benefits for pinpointed assessment of the extent to which an individual experiences MPA.

Palliative Care and the Management of Common Distressing Symptoms in Advanced Cancer: Pain, Breathlessness, Nausea and Vomiting, and Fatigue

Good symptom management in oncology is associated with improved patient and family quality of life, greater treatment compliance, and may even offer survival advantages. With population growth and aging, the proportion of patients with multiple symptoms—both related and unrelated to their cancer—is anticipated to increase, supporting calls for a more routine and integrated approach to symptom management. This article presents a summary of the literature for the use of symptom assessment tools and reviews the management of four common and distressing symptoms commonly experienced by people with advanced cancer: pain, breathlessness, nausea and vomiting, and fatigue. We also discuss the role of palliative care in supporting a holistic approach to symptom management throughout the cancer trajectory.

Construction and validation of an instrument for nursing consultation in outpatient chemotherapy

OBJECTIVE

Construct and validate instrument content for nursing consultation in an adult chemotherapy outpatient clinic.

METHOD

Methodological study composed of two stages: elaboration of the instrument and validation of content. A literary review of the dimensions of customer care was carried out in the light of Theory of Basic Human Needs Theory, culminating in two instruments: one for admission consultation and other for follow-up. The content was validated by the evaluation of listed experts based on the adapted Fehring's Validation Model.

RESULTS

In the first round, two items of the admission instrument and three items of follow-up required reformulation. In the second round, there was an increase in agreement rate: 11% in the instrument of admission and 10% in follow-up.

FINAL CONSIDERATION

The instrument represents a guideline for the Nursing Process and future research, but it cannot be seen as a substitute for nurses' knowledge and clinical reasoning.

Instruments for the functional assessment of elderly persons in palliative care: an integrative review

Abstract Objective: to identify validated instruments that can be used for the functional assessment of elderly persons in Palliative Care. Method: an integrative review focused on identifying instruments for the functional assessment of elderly persons in palliative care was carried out by searching publications in periodicals indexed in seven electronic databases. Descriptors, keywords and Boolean operators were used for a cross-database search in November 2017. A total of 357 abstracts were identified, from which 53 articles were selected for reading, of which 21 met the inclusion criteria. Results: this strategy allowed the identification of eight scales and one test for the functional assessment of elderly persons in palliative care. Conclusion: eight scales and a functional test which also provide guidelines for improving the quality of life of elderly people in palliative care were identified, demonstrating that it is practically impossible to disassociate physical functional performance from social and psychological aspects.

A comparison of symptoms in older hospitalised cancer and non-cancer patients in need of palliative care: a secondary analysis of two cross-sectional studies

Background

Evidence on the differences in symptom patterns between older palliative cancer and non-cancer patients is lacking. The purpose of the study was to determine the differences in symptoms between older hospitalised palliative cancer and non-cancer patients.

Methods

A secondary analysis of two multi-centre cross-sectional studies was performed. A validated instrument was used to assess the frequency and intensity of 40 symptoms in older hospitalised palliative cancer patients (n = 100) and older palliative non-cancer patients (n = 100). The data were collected between March 2013 and June 2015. Differences between groups were measured statistically.

Results

Overall, similarities in symptom patterns were observed between cancer and non-cancer patients. Some minor differences were detected between the groups. Non-cancer patients experienced significantly more physical symptoms and functional dependence than cancer patients. Patients with cancer experienced higher levels of frequency and intensity of psychological symptoms compared to non-cancer patients.

Conclusions

Healthcare professionals should be aware of the high occurrence of symptoms in both cancer and non-cancer patients, and they should be educated about the systematic assessment of symptoms in multiple domains by accounting for the occurrence of generic symptoms and disease-specific symptoms.

Symptom clustering in hospitalised older palliative cancer patients: A cross-sectional study

BACKGROUND

Accurate detection of symptoms is essential in palliative care. Identification of clustering of symptom is valuable to develop target interventions. This area is largely understudied in older palliative cancer patients.

OBJECTIVES

To identify symptom clustering in older palliative cancer patients, and patient groups based on the clustering of symptoms, and to evaluate the difference in functional dependence and experiencing life as not meaningful between the identified patient groups.

DESIGN

A cross-sectional study.

SETTING

Geriatric and non-geriatric wards of seven acute care hospitals.

PARTICIPANTS

400 palliative cancer patients aged 65 years and older.

METHODS

Symptoms were collected using a validated instrument which assesses physical, psychological, functional, social, and existential symptoms by means of a structured interview with a researcher. An agglomerative hierarchical clustering analysis was used to analyse the data.

RESULTS

The cluster analysis revealed five groups of symptoms: (1) urological and gastrointestinal symptoms, and their treatment complications, (2) psychological and existential symptoms, (3) pain, constipation, sleeplessness and airway problems, (4) functionality problems, and (5) fatigue-related symptoms. Three patient groups were identified: (1) symptom-free group, (2) physical discomfort group, and (3) physical and psychological discomfort group. In the last group, significant more patients had a geriatric risk profile and less of them received chemotherapy. Patients in this group were more often functionally dependent and experienced their life as not meaningful.

CONCLUSION

Five groups of symptoms were identified. Three patient groups were identified which reported different levels of functionality and experiencing life as meaningful. Healthcare professionals should be triggered to detect symptom clusters and be alert to the presence of the other symptoms in the cluster when identifying one symptom. They should also be alert to patients with a geriatric risk profile because of their higher risk of experiencing physical and psychological symptoms and the influence these symptoms have on being functionally dependent and experiencing life as not meaningful.