Evaluation of an educational program for the caregivers of persons diagnosed with a malignant glioma.

BACKGROUND: Caring for a loved one with a malignant glioma can be a formidable responsibility. The guarded prognosis, side effects of treatments, and changes in brain function, personality and behaviour pose unique challenges in care provision by family members. It is rare that institutions provide educational programs for caregivers. PURPOSE: To evaluate the impact of providing information in an educational program to caregivers of patients diagnosed with a malignant glioma. METHODS: A structured educational program for caregivers of brain tumour patients was developed based upon multidisciplinary expert opinion and caregiver feedback. Twenty-four caregiver participants were enrolled in the program. Knowledge was assessed before, immediately following, and four to six weeks following the program. Open-ended questions were used to explore the caregivers' experiences, as well as additional benefits derived from the program. RESULTS: Knowledge scores on testing immediately after the program and four to six weeks following the program were statistically significantly improved from baseline testing, although there was a decline in scores four to six weeks after the program. These findings demonstrate effective knowledge transfer (recall of the information) immediately after the education program and four to six weeks later. Specific qualitative and quantitative data serve as a basis for understanding caregivers' needs and experiences.

Level of Concordance Between Proxy and Cancer Patient Ratings in Brief PainInventory.

BACKGROUND: The objective of this study was to assess whether caregivers serve as valid and reliable proxies for the assessment of a patient's pain level using the Brief Pain Inventory (BPI) assessment tool. PATIENTS AND METHODS: Twenty-seven patients with cancer with pain, referred for health care management to the Toronto Sunnybrook Regional Cancer Centre and the Sunnybrook and Women's College Health Sciences Centre, and their proxies participated in this study. Patient and proxy completed the BPI independently, with proxies given explicit instructions to rate and answer the questions from the perspective of the patient. Patient and proxy also completed a data extraction form to obtain patient/proxy characteristics such as sex, age, primary cancer site, and relationship. An intraclass correlation coefficient (ICC) was performed for each question of the BPI. RESULTS: In this study, we found poor to good agreement for questions that are subjective (eg, average pain), whereas the highest agreement was for worst pain scoring (ICC = 0.72). Poor to moderate agreement was found for questions that are objective (eg, walking ability), suggesting that the functional interference questions of the BPI may be too vague for proxies to respond reliably. CONCLUSION: The findings indicate that proxies and patients agree well on worst pain levels but agree much less on the effectiveness of pain medications and patients' average level of pain. Further investigations should examine other tools for pain assessment that may be more reliably used by a proxy.

The correlation among patients and health care professionals in assessing functional status using the karnofsky and eastern cooperative oncology group performance status scales.

This study evaluated the correlation between Karnofsky performance status (KPS) and Eastern Cooperative Oncology Group (ECOG) performance status (PS) scores assigned by doctors (MDs), nurses (RNs), radiation therapist (RTT), radiation therapy student (RTS), and patients (PTs) in assessing functional status of patients with cancer. Patients admitted to the general oncology and palliative care wards at our institution participated in the study. Data were gathered from survey forms completed by MDs, RNs, RTT, RTS, and PTs. The Spearman rank correlation coefficient was used to determine the extent of correlation between paired assessments. Thirty-six patients were enrolled in the study, 27 of whom were evaluable (17 men and 10 women), with a mean age of 57.7 years (range, 32-76 years). The correlation for ECOG PS scores were MD/RTS = 0.81; MD/RN = 0.77; MD/RTT = 0.57; MD/PT = 0.64; PT/RN = 0.51; PT/RTT = 0.60; and PT/RTS = 0.64. The correlations for KPS scores were MD/RTS = 0.81; MD/RN = 0.74; MD/RTT = 0.67; MD/PT = 0.70; PT/RN = 0.60; PT/RTT = 0.79; and PT/RTS = 0.60. The findings demonstrate that patients can make valuable and reliable self-assessments as evidenced from the moderate to good degree of correlation of patient-assigned scores with those of health care professionals.