RESUMEN
Many tools exist to assess the symptoms and needs of palliative care patients, but no tool has been validated to prioritise patients referred for specialist inpatient palliative care. The aim of this study was to produce and validate such a tool. A prospective pilot study produced a Support Team Assessment Schedule- (STAS-) based tool--the Admission Assessment Tool (AAT)--and compared this with the existing system of triage at the Marie Curie Hospice, Edinburgh. Validity of the tool was not confirmed and the tool was modified and re-evaluated. One hundred and twenty-seven consecutive patients referred to the hospice received three AAT scores: from the bed manager; the admitting doctor; and the admitting nurse. The hospice's multidisciplinary team assessed the urgency of each patient's admission. The overall correct classification rate was approximately two thirds, but false positive rates were high and there was poor inter-rate correlation. It is concluded the AAT has not been validated.
Asunto(s)
Evaluación en Enfermería/métodos , Cuidados Paliativos , Admisión del Paciente , Índice de Severidad de la Enfermedad , Triaje/métodos , Ansiedad/diagnóstico , Ansiedad/etiología , Urgencias Médicas , Familia/psicología , Grupos Focales , Ambiente de Instituciones de Salud , Humanos , Pacientes Internos , Evaluación de Necesidades , Evaluación en Enfermería/normas , Investigación en Evaluación de Enfermería , Variaciones Dependientes del Observador , Dolor/diagnóstico , Dolor/etiología , Cuidados Paliativos/organización & administración , Grupo de Atención al Paciente/organización & administración , Proyectos Piloto , Estudios Prospectivos , Psicometría , Derivación y Consulta , Escocia , Sensibilidad y Especificidad , Espiritualidad , Triaje/normasRESUMEN
This paper assesses different methods of evaluating pain management. We used the established methods of pain prevalence measurement and the Pain Management Index (PMI) to compare pain management between two groups who might be expected to have different outcomes. We also developed and used a method to assess how quickly pain was controlled for each group (time to pain control). We compared a group of cancer patients (n=712) managed by general practitioners in the community (Community Group) and a group of patients (n=152) treated in a Specialist Palliative Care Unit (Hospice Group) using all methods. The time to pain control method identified a significant difference between the two groups (P<0.01 log rank test), with the Hospice Group achieving pain control significantly faster. By contrast, neither the pain prevalence method nor the PMI could detect any difference (P=0.11 Wilcoxon test). The established methods of pain prevalence measurement and PMI are limited by their inability to measure pain over time and to assess prescribers' response to changing pain. Dynamic methods that evaluate changes in prescribing and pain levels over time must be developed in order to accurately assess pain management.