Development and Validation of the Symptom Assessment to Improve Symptom Control for Institutionalized Elderly Scale

doi:10.1016/j.jamda.2017.08.013

Journal of the American Medical Directors Association

Volume 19, Issue 2, February 2018, Pages 148-153.e5

https://doi.org/10.1016/j.jamda.2017.08.013 Get rights and content

Abstract

Objectives

To validate a newly developed multiple symptom self-assessment tool in nursing homes.

Design

Thirty prevalent symptoms identified in the literature were classified by a 2-round Delphi procedure to a top 10 of the most relevant, burdensome symptoms. Because no existing symptom scale fully covered this top 10, we developed a new scale, consisting of a horizontal numerical scale for the top 10 symptoms, with the possibility to add and rate 3 other symptoms. This scale was validated.

Setting and participants

Hundred seventy-four participants, mean age 85 (±5.94) years, were recruited from 7 nursing homes (86%) and 3 acute geriatric wards (14%).

Methods

To test the construct validity, participants with and without a palliative status were enrolled. Participants completed the Symptom Assessment to Improve Symptom Control for Institutionalized Elderly (SATISFIE) scale on day 0 and day 1 (intrarater reliability). Nurses completed the scale on day 0 (inter-rater reliability). Descriptive statistics described the characteristics of the study population and symptom scores. Differences in symptom scores between palliative and nonpalliative participants were analyzed with the Mann-Whitney U test. Intrarater and inter-rater reliability were calculated by means of an intraclass correlation coefficient. Factor analysis searched for possible symptom clusters. Feasibility was evaluated by measuring the assessment time and by providing a questionnaire for the nurses.

Results

In the nonpalliative group (n = 130), the highest self-rated median scores were pain on day 1 [median 3, interquartile range (IQR) 0–5] and pain on day 2. In the palliative group (n = 44), the highest median self-rated scores were fatigue on day 1 [median 5 (IQR 0–6)], lack of energy on day 1 and 2 [both median 5 (IQR 0–8)]; and depressed feeling on day 2 [median 3 (IQR 0–5)]. Nurse assessments median scores were the highest for depressed feeling [median 5 (IQR 1–7)], fatigue [median 4.5 (IQR 0–6.5)], and lack of energy, [median 3 (IQR 0–6)] in the palliative group. In the nonpalliative group, none of the median scores was 3 or more. Intraclass correlation coefficients for intrarater reliability varied between 0.65 and 0.89 and for inter-rater reliability (patients-nurses) between 0.18 and 0.63. Mean assessment time for nurses was 2.0 minutes [standard deviation (SD) = 1.01]. For participants, it decreased from 10.5 minutes (SD = 5.41) at the first assessment to 7.5 minutes (SD = 3.72) at the second assessment. Nurses determined the SATISFIE instrument to be useful, applicable in daily practice, and sufficiently comprehensible for the patients.

Conclusions

The SATISFIE scale is a valid and feasible instrument for regular, multiple symptom assessment in institutionalized older persons.

Section snippets

Development of a New Instrument

In the first step, a Medline-search, which searched for terms “symptom control, measuring symptoms, measuring tool, symptom scale,” combined with “end-of-life, palliative patient, palliative care, palliative elderly or geriatric patient” withheld 100 symptoms, prevalent in an older population. After removing overlapping and nonrelevant symptoms, a list of 30 symptoms remained, which was presented in alphabetical order to an expert panel, consisting of 7 physicians and 6 nurses who work in

Characteristics of the Validation Sample

A total of 174 participants were included in this study. Mean age of the total group was 85 years (SD = 5.94 years). The majority of the participants were female (69%). One hundred fifty participants resided in a long-term care facility (86%), and 24 participants were recruited from an acute geriatric ward in a hospital (14%). Mean Mini-Mental State Examination (MMSE) score was 23.8/30 (SD = 3.21). MMSE scores were only obtained in 111 out of 174 participants as some care facilities only

Discussion

This study describes the development and validation of the new SATISIFIE instrument. As research states that symptom prevalence and intensity increases near end-of-life,15, 16, 17 we hypothesized that overall symptom burden in the palliative population would exceed the symptom burden of the nonpalliative one in a group of communicative elders. The observed differences between these 2 groups support our hypothesis: the median symptoms scores appeared to be higher in the palliative group than in

Conclusions

Older patients are able to rate their symptoms with the help of the newly developed SATISFIE instrument. This is important because this study showed that nurses underestimate some of their patients’ symptoms.

Acknowledgments

The authors wish to thank the residents and nursing staff of the participating nursing homes; and Anne-Aurélie Uyttersprot, Els Steeman, and Julie Faes for the collecting of the data.

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Despite common use of palliative care screening tools in other settings, the performance of these tools in the nursing home has not been well established; therefore, the purpose of this review is to (1) identify palliative care screening tools validated for nursing home residents and (2) critically appraise, compare, and summarize the quality of measurement properties.
Systematic review of measurement properties consistent with Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines.
Embase (Ovid), MEDLINE (PubMed), CINAHL (EBSCO), and PsycINFO (Ovid) were searched from inception to May 2022. Studies that (1) reported the development or evaluation of a palliative care screening tool and (2) sampled older adults living in a nursing home were included.
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We identified only 1 palliative care screening tool meeting COSMIN criteria, the NECesidades Paliativas (NEC-PAL, equivalent to palliative needs in English), but evidence for use with nursing home residents was of low quality. The NEC-PAL lacked robust testing of measurement properties such as reliability, sensitivity, and specificity in the nursing home setting. Construct validity through hypothesis testing was adequate but only reported in 1 study. Consequently, there is insufficient evidence to guide practice. Broadening the criteria further, this review reports on 3 additional palliative care screening tools identified during the search and screening process but which were excluded during full-text review for various reasons.
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As far as the physical distress and dying symptoms are concerned, the research team believed that overestimation of symptom burden by family carers is the most probable. In studies comparing patient and staff symptom ratings, both overestimation15 and underestimation4,16 by staff has been described. However, Bahrami et al.17 established that agreement between patients and nurses was higher in describing the physical aspects of quality of life, in particular, in nurses who have greater clinical experience.
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: The PhD trajectory of Marc Tanghe is funded by the “PACE” project of the EU (Framework Program 7 Grant Agreement 603111).

: The authors declare no conflicts of interest.

View full text

Original StudyDevelopment and Validation of the Symptom Assessment to Improve Symptom Control for Institutionalized Elderly Scale

Abstract

Objectives

Design

Setting and participants

Methods

Results

Conclusions

Section snippets

Development of a New Instrument

Characteristics of the Validation Sample

Discussion

Conclusions

Acknowledgments

Lancet

Pain Manage Nurs

J Am Med Dir Assoc

J Am Med Dir Assoc

J Pain

Ageing characteristics the demographic perspectives of the European societies

Eurostat

Better Palliative Care for older people

Policies and managerial guidelines

Shorter symptom assessment instruments: The condensed Memorial Symptom Assessment Scale (CMSAS)

Cancer Invest

The Edmonton Symptom Assessment System: A 15-year retrospective review of validation studies (1991–2006)

Palliat Med

Feasibility and reliability of four pain self-assessment scales and correlation with an observational rating scale in hospitalized elderly demented patients

J Gerontol A Biol Sci Med Sci

Original Study
Development and Validation of the Symptom Assessment to Improve Symptom Control for Institutionalized Elderly Scale