Symptoms are important patient-reported outcomes (PRO), which help to evaluate the impact of diseases and treatments and assess quality of care. Thorough symptom assessment is a challenge, as patients in palliative settings are often polysymptomatic and easily fatigued. There is no consensus about standardization of symptom assessment in palliative medicine. The available research provides some methodological guidance, but the psychometric properties of structured multisymptom assessments are largely understudied. New approaches may improve the efficacy of clinical assessment and create instruments with greater clinical utility. In this article, we discuss current methodological concepts of symptom assessment in clinical practice, specifically with reference to symptom questionnaires appropriate for palliative medicine.
Cleeland CSSymptom burden: multiple symptoms and their impact as patient-reported outcomes . J Natl Cancer Inst Monogr. 2007 :37):16-21.
2.
Ingham J., Portenoy RKThe measurement of pain and other symptoms. In: Doyle D, Hanks GWC , MacDonald N, eds. Oxford Textbook of Palliative Medicine. 2nd ed. Oxford, New York, Tokyo: Oxford University Press; 1998:203-219.
3.
Boyle DADelirium in older patients with cancer- implications for practice and research . Oncol Nurs Forum. 2006;33(1):71-78.
4.
Clinical skills. Chapter 1. The practice of medicine. In: Harrison’s Internal Medicine, Part 1. Introduction to clinical medicine . http://www.accessmedicine.com/content.aspx?aID=50029&searchStr=clinicalexamination#50029. Accessed on September 17, 2006.
5.
Stromgren AS , Groenvold M., Pedersen L., Olsen AK, Sjogren P.Symptomatology of cancer patients in palliative care: content validation of self-assessment questionnaires against medical records. Eur J Cancer. 2002;38(6):788-794.
6.
Skinner KM, Miller DR, Lincoln E., Lee A., Kazis LEConcordance between respondent self-reports and medical records for chronic conditions: experience from the Veterans Health Study. J Ambul Care Manage. 2005;28(2):102-110.
7.
Stromgren AS , Groenvold M., Sorensen A., Andersen L.Symptom recognition in advanced cancer. A comparison of nursing records against patient self-rating . Acta Anaesthesiol Scand. 2001;45(9):1080-1085.
8.
Walsh D., Donnelly S., Rybicki L.The symptoms of advanced cancer: relationship to age, gender, and performance status in 1,000 patients. Support Care Cancer.2000;8(3):175-179.
9.
Keller M., Sommerfeldt, Fischer C, et al. Recognition of distress and psychiatric morbidity in cancer patients: a multi-method approach. Ann Oncol.2004;15(8): 1243-1249.
10.
Ingham JM, Portenoy RKSymptom assessment. Hematol Oncol Clin North Am.1996;10(1):21-39.
11.
Cleeland CS , Ryan KMPain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23(2):129-138.
12.
Twycross R. , Harcourt J., Bergl S.A survey of pain in patients with advanced cancer. J Pain Symptom Manage. 1996;12(5):273-282.
13.
Munch TN, Strömgren AS, Pedersen L., Petersen MA, Hoermann L., Groenvold M.Multidimensional measurement of fatigue in advanced cancer patients in palliative care: an application of the multidimensional fatigue inventory . J Pain Symptom Manage. 2006;31(6):533-541.
14.
Maunsell E. , Allard P., Dorval M., Labbé J.A brief pain diary for ambulatory patients with advanced cancer: acceptability and validity. Cancer. 2000;88(10): 2387-2397.
15.
Ewing G., Todd C., Rogers M., Barclay S., McCabe J., Martin A.Validation of a symptom measure suitable for use among palliative care patients in the community: CAMPAS-R. J Pain Symptom Manage . 2004;27(4): 287-299.
16.
Bruera E., Kuehn N., Miller MJ, Selmser P., Macmillan K.The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliative Care . 1991;7(2):6-9.
17.
Hoekstra J. , Bindels PJE, van Duijn NP, Shade E.The symptom monitor. A diary for monitoring physical symptoms for cancer patients in palliative care: feasibility, reliability and compliance. J Pain Symptom Manage. 2004 ;27(1):24-35.
18.
Hjermstad M. , Loge JH, Kaasa S.Methods for assessment of cognitive failure and delirium in palliative care patients: implications for practice and research . Palliat Med. 2004;18(6):494-506.
19.
Higginson I. , Donaldson D.Relationship between three palliative care outcome scales. Health Qual Life Outcomes. 2004;2:68.
20.
Higginson IJ , McCarthy M.Validity of the Support Team Assessment Schedule: do staffs’ ratings reflect those made by patients or their families ? Palliat Med. 1993;7(3):219-228.
21.
Jenkinson C. , Fitzpatrick R., Brennan C., Bromberg M., Swash M.Development and validation of a short measure of health status for individuals with amyotrophic lateral sclerosis/ motorneurone disease: the ALSAQ-40. J Neurol.1999;246(suppl 3):11116-11121.
22.
Lutz ST, Huang DT, Ferguson CL, Kavanagh BD, Tercilla OF, Lu J.A retrospective quality of life analysis using the Lung Cancer Symptom Scale in patients treated with palliative radiotherapy for advanced non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 1997;37(1):117-122.
23.
Barresi MJ, Shadbolt B., Byrne D., Stuart-Harris R.The development of the Canberra symptom score cared: a tool to monitor the physical symptoms of patients with advanced tumours. BMC Cancer . 2003;3:32.
24.
Holen JC, Saltvedt I., Fayers PM, et al. The Norwegian Doloplus-2, a tool for behavioural pain assessment: translation and pilot-validation in nursing home patients with cognitive impairment . Palliat Med. 2005;19(5):411-417.
25.
Peruselli C. , Camporesi E., Colombo AM, Cucci M., Mazzoni G., Paci E.Quality-of-life assessment in a home care program for advanced cancer patients: A study using the Symptom Distress Scale . J Pain Symptom Manage . 1993;8(5):306-311.
26.
Kaasa S., Loge JHQuality of life assessment in palliative care. Lancet Oncol . 2002;3(3):175-182.
27.
Sharpe L., Butow P., Smith C.Changes in quality of life in patients with advanced cancer: evidence of response shift and response restriction. J Psychosom Res . 2005; 58(6):497-504.
28.
Visser MR, Smets EM, Sprangers MA, de Haes HJHow response shift may affect the measurement of change in fatigue . J Pain Symptom Manage. 2000;20(1):12-18.
29.
Homsi J., Walsh D., Rivera N., et al. Symptom evaluation in palliative medicine: patient report vs. systematic assessment. Support Care Cancer.2006;14(5):444-453.
30.
Groenvold M. , Petersen MA, Aaronson NK. The development of the EORTC QLQ-C15-PAL: a shortened questionnaire for cancer patients in palliative care . Eur J Cancer. 2006;42(1):55-64.
31.
Fortner B., Okon T., Schwartzberg L., Tauer K., Houts ACThe cancer care monitor: Psychometric content evaluation and pilot testing of a computer administered system for symptom screening and quality of life in adult cancer patients. J Pain Symptom Manage. 2003;26(6):1077-1092.
32.
Pijls-Johannesma MCG , Pijpe A., Kempen G., Lambin P., Dagnelie PCHealth related quality of life assessment instruments: a prospective study on preference and acceptability among cancer patients referred for radiotherapy. Eur J Cancer. 2005;41(15):2250-2256.
33.
Closs SJ, Barr B., Briggs M., Cash K., Seers K.A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairment. J Pain Symptom Manage . 2004;27(3):196-205.
34.
Hauser K., Walsh D., Davis MP, Lagman RL, LeGrand SBThe pitfalls of visual analogue scales in palliative medicine. Eur J Cancer. 2007;14(3):99-102.
35.
Kirkova J., Davis MP, Walsh D., et al. Symptom assessment instruments-a systematic review. J Clin Oncol. 2006;24(9):1459-1473.
36.
Nekolaichuk CL, Maguire TO, Suarez-Almazor M., Rogers WT, Bruera E.Assessing the reliability of patient, nurse and family caregiver symptom ratings in hospitalized advanced cancer patients. J Clin Oncol. 1999;17(11):3621-3630.
37.
Strömgren AS, Sjogren P., Goldschmidt D., Petersen MA, Pedersen L., Groenvold M.Symptom priority and course of symptomatology in specialized palliative care. J Pain Symptom Manage. 2006;31(3):199-206.
38.
Chang VT, Hwang SS, Feuerman M., Kasimis BSSymptom and quality of life survey of medical oncology patients at a veterans affairs medical center: a role for symptom assessment. Cancer . 2000;88(5):1175-1183.
39.
Portenoy RK , Thaler HT, Kornblith AB, et al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer. 1994;30A(9):1326-1336.
40.
Bausewein C. , Farquhar M., Booth S., Gysels M., Higginson IJMeasurement of breathlessness in advanced disease: a systematic review. Respir Med. 2007;101(3):399-410.
