化疗患者症状自评与家庭主要照顾者评估的差异性分析

A comparative descriptive study examining the perceptions of symptom severity between cancer patients versus family caregivers during chemotherapy

目的探讨肿瘤化疗患者和家庭主要照顾者对患者化疗期间症状严重程度评估的差异性。方法采用便利抽样法选取2016年6月至2016年10月间在中国医学科学院肿瘤医院内科住院化疗的192例患者,采用汉化版埃德蒙顿症状评估量表(ESAS)对肿瘤患者及其家庭主要照顾者进行问卷调查,探讨肿瘤化疗患者和家庭主要照顾者对患者化疗期间症状严重程度评估的差异性。结果肿瘤化疗患者常见症状为食欲不振、疲倦、感觉生活质量差、恶心及瞌睡。家庭照顾者对患者焦虑的评分高于患者自评,差异有统计学意义(P<0.05),家庭照顾着与患者自评其余常见症状评估结果比较,差异均无统计学意义(均P>0.05)。使用ICC检验患者与家庭照顾者评估的一致性,恶心和瘙痒评估的一致程度高(ICC>0.75),其余症状评估一致性中等。结论肿瘤化疗患者的躯体症状自评结果与照顾者评估结果没有统计学差异,心理症状中的焦虑照顾者评估结果高于患者自评,在患者不知晓病情或无法表达时,可以由照顾者代替患者进行症状评估。

Objective To describe the symptom severity in with cancer patients receiving chemotherapy and to compare patient self-reports of symptom severity with inferences made by family caregivers.Methods The study was conducted on 192 patients undergoing chemotherapy that had a family caregiver at Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from June 2016 to October 2016 using convenience sampling. Symptom assessments were completed through questionnaire survey aimed at patients and their caregivers using the Chinese version of Edmonton symptom assessment system（ESAS）. The differences in the assessment of symptom severity between patients＇ self-report and family caregivers were discussed. Results The common symptoms in patients with cancer receiving chemotherapy included loss of appetite,tiredness,poor quality of life,nausea and drowsiness（P〈0. 05）. There was no significant difference in the assessment results on other common symptoms between patients＇ self-report and family caregivers（all P〉 0. 05）. When ICC was used to assess the consistency between patients＇ self-report and family caregivers＇ assessment,the consistency in nausea and drowsiness was higher than in other symptoms（ICC〉0. 75）. Consistency for other symptoms was moderate. Conclusion There was no significant difference in the assessment results on other common symptoms between patients＇ self-report and family caregivers. The assessment results on anxiety was higher by family caregivers than by patients＇ selfreport. Symptoms can be assessed by caregivers when patients have no idea about their disease or are unable to express themselves.