Objective: For patients who are terminally ill, the
efficiency of symptom management is dependent, among other factors, on an
accurate assessment by proxy raters. The aim of this prospective study is
to describe differences in symptom severity ratings between patients and
their nurses, physicians, and family members during their stay in
different departments with acute care, and to identify variables
associated with the accuracy of the ratings by others.
Methods: Physical, psychological, social, and functional
disorders were assessed for 41 in-patients with a standardized 13-item
Symptom List for Quality Assurance in Palliative Care drafted by the
Working Group on the Core Documentation for Palliative Care Units in
Germany. Symptom assessment was completed by different raters (patient,
nurse, physician, family member) within the first four days after
admission. Socio-demographic, disease-related, and hospitalization data
were taken from patient charts.
Results: Reliability of the symptom list was computed with
Cronbach's alpha measures for the present sample.
Between-group-comparisons on the individual items and on the sum-score
level were analyzed separately for the different rater-pairs:
patients-nurses (n = 41), patients-physicians (n = 39),
patients-family members (n = 12). Multiple regression analyses
calculated predictive variables of the staff's deviation scores.
Significance of results: Significant differences for nurses
and physicians were found on the sum-score level for psychological and
social symptoms, but not for physical and functional symptoms. Family
members rated the intensities of the symptoms generally higher than the
patients. Suggestions for further analyses are presented and