Self-report measurement of pain & symptoms in palliative care patients: a comparison of verbal, visual and hand scoring methods in Sub-Saharan Africa.

Abstract

BACKGROUND:

Despite a high incidence of life-limiting disease, there is a deficit of palliative care outcome evidence in sub-Saharan Africa. Providers of end of life care call for appropriate measurement tools. The objective is to compare four approaches to self-report pain and symptom measurement among African palliative care patients completing the African Palliative Care Association African Palliative Outcome Scale (APCA African POS).

METHODS:

Patients were recruited from five services (4 in South Africa and 1 in Uganda). Research nurses cross-sectionally administered POS pain and symptom items in local languages. Both questions were scored from 0 to 5 using 4 methods: verbal rating, demonstrating the score using the hand (H), selecting a face on a visual scale (F), and indicating a point on the Jerrycan visual scale (J). H, F and J scores were correlated with verbal scores as reference using Spearman's rank and weighted Kappa. A Receiver Operating Characteristic (ROC) analysis was performed.

RESULTS:

315 patients participated (mean age 43.5 years, 69.8% female), 71.1% were HIV positive and 35.6% had cancer, 49.2% lived in rural areas. Spearman's rank correlations for pain scores were: H: 0.879, F: 0.823, J: 0.728 (all p < 0.001); for symptoms H: 0.876, F: 0.808, J: 0.721 (all p < 0.001). Weighted Kappa for pain was H: 0.798, F: 0.719 J: 0.548 and for symptoms: H: 0.818, F: 0.718, J: 0.571. There was lower agreement between verbal and both hand and face scoring methods in the Ugandan sample. Compared to the verbal scale the accuracy of predicting high pain/symptoms was H > F > J (0.96-0.89) in ROC analysis.

CONCLUSIONS:

Hands and faces scoring methods correlate highly with verbal scoring. The Jerrycan method had only moderate weighted Kappa. POS scores can be reliably measured using hand or face score.

• Authors: David Blum, Lucy E Selman, Godfrey Agupio, Thandi Mashao, Keletso Mmoledi, Tony Moll, Natalya Dinat, Liz Gwyther, Lydia Mpanga Sebuyira, Barbara Ikin, Julia Downing, Stein Kaasa, Irene J Higginson, Richard Harding
• Journal: Health and quality of life outcomes (Health Qual Life Outcomes) Vol. 12 Pg. 118 (Aug 02 2014) ISSN: 1477-7525 [Electronic] England
• PMID: 25085579 (Publication Type: Comparative Study, Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Aged, 80 and over
• Cross-Sectional Studies
• Female
• HIV Infections (therapy)
• Health Status Indicators
• Humans
• Logistic Models
• Male
• Middle Aged
• Neoplasms (therapy)
• Pain Measurement (methods)
• Palliative Care
• Patient Outcome Assessment
• Quality of Life
• ROC Curve
• Self Report
• South Africa
• Uganda