Development and validation of a medical chart review checklist for symptom management performance of oncologists in the routine care of patients with advanced cancer

David Blum; Daniel Rosa; Susanne deWolf-Linder; Stefanie Hayoz; Karin Ribi; Dieter Koeberle; Florian Strasser

doi:10.1016/j.jpainsymman.2014.04.009

Development and validation of a medical chart review checklist for symptom management performance of oncologists in the routine care of patients with advanced cancer

J Pain Symptom Manage. 2014 Dec;48(6):1160-7. doi: 10.1016/j.jpainsymman.2014.04.009. Epub 2014 May 23.

Authors

David Blum¹, Daniel Rosa², Susanne deWolf-Linder², Stefanie Hayoz³, Karin Ribi⁴, Dieter Koeberle⁵, Florian Strasser²

Affiliations

¹ Oncological Palliative Medicine, Section Oncology, Department of Internal Medicine and Palliative Care Centre, Cantonal Hospital, St. Gallen, Switzerland; European Palliative Care Research Center, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: david.blum@ntnu.no.
² Oncological Palliative Medicine, Section Oncology, Department of Internal Medicine and Palliative Care Centre, Cantonal Hospital, St. Gallen, Switzerland.
³ Coordinating Center, Swiss Group for Clinical Cancer Research, Bern, Switzerland.
⁴ Quality of Life Office, International Breast Cancer Study Group Coordinating Center, Bern, Switzerland.
⁵ Section Oncology, Department of Internal Medicine, Cantonal Hospital, St. Gallen, Switzerland.

PMID: 24863153
DOI: 10.1016/j.jpainsymman.2014.04.009

Abstract

Context: Oncologists perform a range of pharmacological and nonpharmacological interventions to manage the symptoms of outpatients with advanced cancer.

Objectives: The aim of this study was to develop and test a symptom management performance checklist (SyMPeC) to review medical charts.

Methods: First, the content of the checklist was determined by consensus of an interprofessional team. The SyMPeC was tested using the data set of the SAKK 96/06 E-MOSAIC (Electronical Monitoring of Symptoms and Syndromes Associated with Cancer) trial, which included six consecutive visits from 247 patients. In a test data set (half of the data) of medical charts, two people extracted and quantified the definitions of the parameters (content validity). To assess the inter-rater reliability, three independent researchers used the SyMPeC on a random sample (10% of the test data set), and Fleiss's kappa was calculated. To test external validity, the interventions retrieved by the SyMPeC chart review were compared with nurse-led assessment of patient-perceived oncologists' palliative interventions.

Results: Five categories of symptoms were included: pain, fatigue, anorexia/nausea, dyspnea, and depression/anxiety. Interventions were categorized as symptom specific or symptom unspecific. In the test data set of 123 patients, 402 unspecific and 299 symptom-specific pharmacological interventions were detected. Nonpharmacological interventions (n = 242) were mostly symptom unspecific. Fleiss's kappa for symptom and intervention detections was K = 0.7 and K = 0.86, respectively. In 1003 of 1167 visits (86%), there was a match between SyMPeC and nurse-led assessment. Seventy-nine percent (195 of 247) of patients had no or one mismatch.

Conclusion: Chart review by SyMPeC seems reliable to detect symptom management interventions by oncologists in outpatient clinics. Nonpharmacological interventions were less symptom specific. A template for documentation is needed for standardization.

Keywords: Chart review; oncology; symptom management; validation.

Publication types

Research Support, Non-U.S. Gov't
Validation Study

MeSH terms

Checklist*
Disease Management*
Humans
Medical Oncology / methods*
Medical Records*
Neoplasms / therapy*
Palliative Care / methods
Reproducibility of Results
Retrospective Studies