Rater and Intensity Psychometrics of the Respiratory Distress Observation Scale

描述（由申请人提供）：呼吸困难的治疗必须通过评估指导;然而，呼吸困难的标准测量依赖于自我报告。认知障碍和濒临死亡可能会干扰症状困扰报告，导致识别不足和过度或治疗不足。以前的心理测试的唯一已知的行为工具，呼吸窘迫观察量表（RDOS），表现出内部一致性，结构效度与低氧血症，收敛效度与呼吸困难自我报告和判别效度与疼痛和无呼吸困难。RDOS在有呼吸窘迫风险的绝症患者中进行测试时表现良好，其中大多数患者不能自我报告呼吸困难。该工具对检测随时间的变化和测量对治疗的反应很敏感。我们不知道RDOS是否可以由家庭护理人员准确评分;需要建立可能使用RDOS的临床团队成员（包括家庭护理人员）的评分员间可靠性。还需要确定表示轻度、中度或重度痛苦的分界点。在为期2年的研究间隔期间，我们计划寻找病情严重且有呼吸困难风险的患者，并在经过培训的研究RN和家庭护理人员之间进行评估者间可靠性测试。此外，在研究入组时，将要求患者回答关于呼吸短促的询问，在数字评定量表（NRS）上指出严重程度，并从无、轻度、中度或重度痛苦中分配描述符。对评估者之间RDOS评分一致性的分析将建立家庭照顾者评分者间的信度和测量不变性。分析患者描述与NRS，口头描述和RDOS将确定痛苦强度的临界点。该项目的结果将提供使用RDOS作为主要结局，以确定在未来研究中濒临死亡且无法提供呼吸困难自我报告的患者的护理环境中患者的痛苦或舒适度。 公共卫生相关性：当患者不能自我报告呼吸困难时，拟议的研究将增加唯一已知的测量呼吸窘迫工具的实用性。呼吸窘迫观察量表（RDOS）的评定者可靠性将与家庭护理人员一起测量;我们还将从患者描述符中确定窘迫强度临界点。拟议的研究与公共卫生有关，因为一个可靠和有效的工具允许跨环境和照顾者评估认知障碍患者，从而确保对痛苦的全面治疗。

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. PUBLIC HEALTH RELEVANCE: The proposed study will increase the utility of the only known tool for measuring respiratory distress when the patient cannot self-report dyspnea. The rater reliability of the Respiratory Distress Observation Scale (RDOS) will be measured with family caregivers; we will also ascertain distress intensity cut points from patient descriptors. The proposed research has relevance to public health because a reliable and valid instrument permits assessment of cognitively impaired patients across settings and caregivers, thus, ensuring comprehensive treatment of distress.