Fatigue in Advanced Cancer Patients: Congruence Between Patients and Their Informal Caregivers About Patients' Fatigue Severity During Cancer Treatment With Palliative Intent and Predictors of Agreement
Fatigue in Advanced Cancer Patients: Congruence Between Patients and Their Informal Caregivers About Patients' Fatigue Severity During Cancer Treatment With Palliative Intent and Predictors of Agreement
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DOI：
10.1016/j.jpainsymman.2016.02.017
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发表时间：
2016-09-01
影响因子：
4.7
通讯作者：
Knoop, Hans
中科院分区：
文献类型：
--
作者：
Poort, Hanneke;Peters, Marlies E. W. J.;Knoop, Hans
上下文。非正式照顾者(IC)越来越多地参与晚期癌症患者姑息治疗期间的症状监测。在这个延长的治疗阶段，一个常见但主观的症状是疲劳。这项探索性的纵向研究旨在确定患者和ICS之间关于患者疲劳严重程度的一致性。此外，还研究了随时间推移一致性的预测因素。107名晚期癌症患者(预期寿命=6个月)和他们的IC患者的样本，根据患者在基线和6个月后的状态，完成了Checklist个体力量量表的疲劳严重程度子量表。这个由八个项目组成的子量表有一个有效的界值来确定是否存在临床相关的疲劳水平。ICS自身的疲劳程度、紧张感、自尊和关系满意度被作为一致性的预测因子。共有107个DYAD在基线时完成了测量，69个DYAD在6个月后完成了测量。在基线时，ICS显著高估了患者的疲劳严重程度(P<；0.001)，有适度的偏倚(Cohen‘s d=0.48)。在107个二联体中，有81个(76%)在存在或不存在严重疲劳方面存在一致性。在群体层面上，一致性并没有随着时间的推移而发生显著变化。在二元体水平上，有一种要么保持一致，要么达到一致的趋势。除了基线一致性外，ICs的疲劳严重程度和应变预测了ICs的疲劳等级(R2=0.22)。大多数ICs能准确预测患者是否存在临床相关程度的疲劳。应考虑ICS自身的疲劳严重程度和应变，因为它们会影响协议。(C)2016年美国临终关怀与姑息医学学会。爱思唯尔公司出版，版权所有。
Context. Informal caregivers (ICs) are increasingly involved in the monitoring of symptoms during advanced cancer patients' treatment with palliative intent. A common but subjective symptom during this extended treatment phase is fatigue.Objectives. This exploratory longitudinal study aimed to determine agreement between patients and ICs about patients' fatigue severity. In addition, predictors of agreement over time were studied.Methods. A sample of 107 patients with advanced cancer (life expectancy >= six months) and their ICs completed the subscale fatigue severity of the Checklist Individual Strength based on the patient's status at baseline and six months later. This eight-item subscale has a validated cutoff to determine the presence of clinically relevant levels of fatigue. ICs' own fatigue severity, strain, self-esteem, and relationship satisfaction were examined as predictors of agreement.Results. A total of 107 dyads completed measures at baseline and 69 dyads six months later. At baseline, ICs' significantly overestimated patients' fatigue severity (P < 0.001) with a moderate amount of bias (Cohen's d = 0.48). In 81 of the 107 dyads (76%), there was congruence about the presence or absence of severe fatigue. On a group level, congruence did not significantly change over time. On a dyad level, there was a tendency to either remain congruent or reach congruence. Next to baseline congruence, ICs' fatigue severity and strain predicted ICs' fatigue ratings (R-2 = 0.22).Conclusion. Most ICs accurately predict presence or absence of clinically relevant levels of patients' fatigue. ICs' own fatigue severity and strain should be taken into account as they influence agreement. (C) 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.