Rater and Intensity Psychometrics of the Respiratory Disease Observation Scale

描述(由申请人提供)：呼吸困难的治疗必须通过评估来指导；然而，呼吸困难的标准测量依赖于自我报告。认知障碍和接近死亡可能会干扰症状痛苦的报告，导致识别不足和治疗过度或不足。此前对唯一已知的行为工具-呼吸窘迫观察量表(RDOS)进行的心理测量测试显示，内部一致性、与低氧血症的结构效度、与呼吸困难自我报告的收敛效度以及与疼痛和无呼吸困难的区分效度。当对有呼吸窘迫风险的绝症患者进行测试时，RDOS表现良好，他们中的大多数人无法自我报告呼吸困难。该工具敏感地检测随时间的变化并测量对治疗的反应。我们不知道家庭照顾者是否可以准确地对RDO进行评分；需要建立临床团队成员(包括可能使用RDO的家庭照顾者)的评分员之间的可靠性。还需要确定表示轻度、中度或重度痛苦的临界点。在为期两年的研究间隔期间，我们计划寻找有呼吸困难风险的重病患者，并在训练有素的研究RN和家庭照顾者之间进行评分员之间的可靠性测试。此外，在研究登记时，患者将被要求回答有关呼吸短促的询问，在数字分级量表(NRS)上指示严重程度，并从无、轻度、中度或严重痛苦中分配一个描述符。分析主考者对RDOS评分的一致性将建立家庭照顾者与评分者之间的信度和测量不变性。对患者描述与NRS、言语描述和RDO的分析将确定痛苦强度的分界点。该项目的结果将提供使用RDOS作为主要结果，以确定患者的痛苦或舒适的护理环境，在未来的研究中，患者濒临死亡，无法提供呼吸困难自我报告。

DESCRIPTION (provided by applicant): Treatment of dyspnea must be guided by assessment; however standard measures of dyspnea rely on self-report. Cognitive impairment and nearness to death may interfere with symptom distress reporting leading to under-recognition and over or under-treatment. Previous psychometric testing of the only known behavioral tool, the Respiratory Distress Observation Scale (RDOS), demonstrated internal consistency, construct validity with hypoxemia, convergent validity with dyspnea self-report and discriminant validity with pain and no dyspnea. The RDOS performed well when tested with terminally ill patients who were at risk for respiratory distress, most of whom could not self-report dyspnea. The tool is sensitive to detect changes over time and measure response to treatment. We do not know if the RDOS can be accurately scored by family caregivers; inter-rater reliability across members of the clinical team, including family caregivers, who may use the RDOS needs to be established. The cut-points to signify mild, moderate or severe distress also need to be determined. During a 2-year study interval we plan to seek patients who are seriously ill and at risk for dyspnea and conduct inter-rater reliability testing between a trained research RN and family caregivers. Additionally, at study enrollment, the patient will be asked to respond to a query about shortness of breath, indicate severity on a numeric rating scale (NRS) and assign a descriptor from among none, mild, moderate, or severe distress. Analysis of agreement on RDOS scoring among examiners will establish family caregiver inter-rater reliability and measurement invariance. Analysis of patient descriptors with NRS, verbal descriptors and RDOS will determine distress intensity cut-points. The results of this project will afford use of the RDOS as the major outcome to ascertain patient distress or comfort across care settings in future studies of patients who are near death and unable to provide a dyspnea self-report.