Symptom Assessment Scale Retrospective Case Review
University of Western Australia
Duration: August 2017 – June 2018
The Symptom Assessment Scale (SAS) is a validated tool used by palliative care services in Australia which aims to enable patients to self-report on the distress they experience, measuring seven common physical symptoms – sleep, appetite, nausea, bowels, breathing, fatigue and pain. Assessment of symptoms by direct patient self-reporting is regarded as the ‘gold standard’ to ensure effective assessment and control of symptoms. Patient symptom assessment by proxy may be indicated however, when patients are unable to directly report on symptoms due to a decline in cognitive or physical functioning.
The first phase of this multi-stage project investigating patient / proxy rating of the SAS involves undertaking a retrospective case audit.
This retrospective case review will build on the evidence base by:
- Ascertaining the percentage of patient/proxy rating across the country and by state;
- Ascertaining differences in the percentage of patient / proxy rating between service settings
- Ascertaining relationships between Australia-modified Karnofsky Performance Scale (AKPS), language and patient/proxy ratings;
- Exploring the association between patient outcome measures and proxy versus patient symptom assessment.
The findings from this study will assist in the understanding of the incidence of proxy rating, inform training and the relationship of proxy rating to language, diagnosis and functional performance (AKPS).
What we did
Using a purposive sampling framework, invitations to participate in the study were distributed to services from different palliative care settings in August 2017. Seventeen services who routinely collect demographic, clinical assessment (SAS, AKPS, and RUG-ADL) and rater (patient or proxy) data for the whole of each episode were recruited. Data collection was completed late in 2017.
Data analysis will be undertaken by experienced statisticians in early 2018. Cohort characteristics will be reported using descriptive statistics, with comparisons made to broader population statistics already produced by PCOC, in order to assess representativeness of the study sample. Percentages and 95% confidence intervals will be used to summarise the percentage of SAS assessments that were proxy completed, both overall and for each participating service (anonymised) in order to determine the variability of practice across services. Repeated measures logistic regression models will be used to analyse the relationship between proxy rating and level of symptom, function and preferred language over time, controlling for other patient characteristics.
Following completion of the retrospective case review, other phases of the study will be progressed, including testing of a revised SAS tool and an exploration of the disparity between patient and clinician rated scores.
Project team: Darcy Morris, Sabina Clapham, Sam Allingham