通过多中心实地测试,研究筛查成年癌症患者严重健康相关痛苦的 SHS 工具的有效性和可行性。

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES
Indian Journal of Palliative Care Pub Date : 2024-07-01 Epub Date: 2024-08-23 DOI:10.25259/IJPC_13_2024
Nandini Vallath, Aneka Paul, Arunangshu Ghoshal, Jenifer Jeba Sundararaj, Kalpana Balakrishnan
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引用次数: 0

摘要

目标:2017 年柳叶刀委员会报告称,"严重健康相关痛苦"(SHS)是医疗保健服务的深渊。该报告列出了 20 种常见健康状况和 15 种症状,它们通常与 SHS 相关。2015 年,80%(约 6100 万人)的 SHS 患病率来自中低收入国家。印度国家癌症网格认识到 SHS 在癌症患者中的高流行率,并与全球应对和减轻痛苦的努力保持一致,因此开发并评估了 SHS 筛查工具(SHS-tool)。在研究的第 1 阶段,通过系统的建立共识方法开发了 SHS 工具。在第 2 阶段,通过多中心实地测试完成了 SHS 工具的有效性和可行性研究:第 1 阶段开发的 SHS 工具在印度不同医疗保健部门和地区的九个三级癌症护理中心(TCC 地点)进行了实地测试。该研究有目的性地抽取了 254 名癌症患者,以评估 SHS 筛选工具在选定地点的有效性,此外还记录了可行性、相关性、可接受性以及来自患者(n = 121)、研究助理(n = 11)和主要研究人员(PI)(n = 9)的反馈意见。由首席研究员选定的经验丰富的人员在同一时间内对患者进行记录访谈作为标准:实地测试 TCC 站点代表了政府学术机构、非政府组织和私营部门。这些地点利用病人候诊区和住院/日间护理病房进行实地测试。SHS工具问卷的Cronbach's alpha内部一致性为0.728。该工具检测出 137/254 名患者患有 SHS,而通过访谈法检测出的患者人数为 116/254。64.17%的结果与访谈结果一致。该工具的灵敏度为 70%,特异度为 59%。如果没有实地测试过程,66.67% 的患者可能无法接触到访谈人员。患者(n = 121)对可行性问卷的答复显示,该工具易于理解(91.74%)、易于使用(92.56%)和相关性(89.26%)。96.69%的人认为所选设置合适。研究人员的反馈意见显示,易于管理(10/11)和相关性(8/11),没有发现妨碍使用的原因(8/11)。研究人员对相关人员的反馈意见进行了专题分组,以便深入了解:结论:SHS 工具经过验证可用于筛查不存在的 SHS。结论:SHS 工具已通过验证,可用于筛查无 SHS 的地区,它是一种可行、相关且可接受的工具,适用于印度各地 TCC 的成年癌症患者。对利益相关者反馈意见进行分析后得出的见解已被纳入 "使用指南",以便更好地实施 SHS 工具。正如柳叶刀委员会所建议的那样,SHS 工具可用于识别和触发深入评估,并加快获得必要的姑息关怀套餐,以缓解姑息关怀。未来在其他SHS负担较重的疾病中使用SHS工具的研究可以评估其更广泛的适用性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Multicentric Field Test to Study the Validity and Feasibility of the SHS-tool to Screen for Serious Health-related Suffering in Adult Patients with Cancer.

Objectives: The 2017 Lancet Commission reports 'Serious Health-related Suffering' (SHS) as an abyss in healthcare services. It lists 20 common health conditions and 15 symptoms as commonly associated with SHS. In 2015, 80% of SHS prevalence, an estimated 61 million, was noted as from low-middle-income countries. Acknowledging the high prevalence of SHS in cancer patients and aligning with global efforts to address and alleviate the suffering, the National Cancer Grid of India developed and evaluated the SHS screening tool (SHS-tool). The SHS tool was developed during phase 1 of the study through a systematic consensus-building methodology. During phase 2, the validity and feasibility study of the SHS tool was completed through a multicentric field test, which is described here.

Materials and methods: The SHS tool developed during phase 1 was field-tested across nine tertiary cancer care centres (TCC sites) selected from different healthcare sectors and regions of India. The study utilised a purposive sample of 254 cancer patients to evaluate the validity of the SHS screening tool at selected sites and additionally recorded the feasibility, relevance, acceptability and feedback comments from patients (n = 121), research associates (n = 11) and principal investigators (PIs) (n = 9). A documented interview of the patient within the same timeframe by experienced personnel selected by the PI served as the standard.

Results: The field-test TCC-sites represented government academic institutions, non-government and private sectors. The sites used patient waiting areas and inpatient/daycare wards for conducting field tests. The Cronbach's alpha of the SHS-tool questionnaire showed an internal consistency of 0.728. The tool detected SHS in 137/254 patients, compared to 116/254 through the interview method. The outcomes concurred with that of the interview in 64.17% of instances. The tool exhibited a sensitivity of 70% and specificity of 59%. 66.67% of patients might not have reached the interviewers if not for the field test processes. The feasibility questionnaire responses from patients (n = 121) indicated ease of understanding (91.74%), ease of use (92.56%) and relevance (89.26%). The selected settings were found suitable by 96.69%. Feedback responses from research associates indicated ease of administration (10/11) and relevance (8/11) and found no reasons preventing its use (8/11). The feedback comments from the stakeholders were thematically grouped for insights.

Conclusion: The SHS tool is validated for screening SHS where none exists. It has been found to be a feasible, relevant and acceptable tool for use in adult cancer patients attending TCCs across India. Insights from analysing the feedback comments from the stakeholders have been integrated as 'instruction for use' for refined implementation of the SHS tool. The SHS tool may be utilised to recognise and trigger an in-depth evaluation and expedited access to essential palliative care packages towards alleviating it, as recommended by the Lancet Commission. Future studies using the SHS tool in other disease conditions with a high burden of SHS can assess its wider applicability.

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来源期刊
Indian Journal of Palliative Care
Indian Journal of Palliative Care HEALTH CARE SCIENCES & SERVICES-
CiteScore
2.30
自引率
0.00%
发文量
57
期刊介绍: Welcome to the website of the Indian Journal of Palliative Care. You have free full text access to recent issues of the journal. The links connect you to •guidelines and systematic reviews in palliative care and oncology •a directory of palliative care programmes in India and IAPC membership •Palliative Care Formulary, book reviews and other educational material •guidance on statistical tests and medical writing.
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