Carla Ripamonti1, Rita Leporati2, Giulia De Feo3, Patricia Di Pede3, Luisa Toffolatti3, Mauro Guglielmo3, Domenico La Carpia4, Guido Miccinesi5, Francesca Chiesi6. 1. Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy. carla.ripamonti@istitutotumori.mi.it. 2. Medical Oncology Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy. 3. Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy. 4. Azienda USL Toscana Centro, UDS Cure Palliative Prato Pistoia, Firenze, Italy. 5. Epidemiologia Clinica e Di Supporto Al Governo Clinico, Istituto Per lo Studio, la Prevenzione e la Rete Oncologica-ISPRO, Firenze, Italy. 6. Department of Neuroscience and Child's Health (NEUROFARBA), University of Florence, Florence, Italy.
Abstract
INTRODUCTION: The routine use of patient-reported outcomes (PROs) in clinical practice improves quality of care, it helps in reducing the access to emergency services and unscheduled visits, and it can improve cancer patients' time survival. The Edmonton Symptom Assessment System (ESAS) is a PRO largely used in different care settings to monitor physical and psychological symptoms. Nonetheless, along with these symptoms, literature also highlighted the presence and effect of spiritual pain, financial distress, and social isolation on quality of care, treatment effectiveness, and survival. AIM: The aims of the current study were (a) to complete the Italian version of the ESAS validation process by adding the missing symptom "insomnia" and (b) to develop and validate the ESAS-Total Care (ESAS-TC) that is intended to evaluate and screen not only physical and psychological symptoms but also spiritual pain, discomfort deriving from financial problems associated with illness, and suffering related to social isolation. METHODS: A sample of Italian native outpatients, who referred to the dedicated Supportive Care Unit of the Fondazione IRCCS, Istituto Nazionale deiTumori (INT), Milano, were asked to fill the ESAS-TC to assess item properties, factorial structure, internal consistency, test-retest reliability (patients were asked to retake the scale after 2-6 weeks), and external validity. Concerning the latter, other self-administered scales were employed to assess perceived stress (Perceived Stress Scale), unmet needs (using theNeed Evaluation Questionnaire that describes informative, assistance/care, relational, needs for psycho-emotional support, material needs), and perceived social support (administering the Multidimensional Scale of Perceived Social Support that evaluates perceived support of family, friends, and significant others in the wider social field). RESULTS: The scales were administered to 243 patients with solid (90%) and hematologic (10%) cancers, mean age 62.6, female 76.5%. Analysis suggested that a single factor better represents the structure of the ESAS scales, their internal consistency and test-retest reliability were good, and evidence of construct and criterion validity were provided. Additionally, incremental validity of the ESAS-TC was proved showing that the added items offer a unique contribution in predicting the patient's stress. Finally, known groups validity was confirmed testing the differences in the ESAS scores due to the Karnofsky Performance Status. CONCLUSIONS: The current study allowed to complete the validation of the Italian version of the ESAS and to develop a psychometrically sound scale, the ESAS-Total Care, that potentially helps in moving cancer research toward personalized total cancer care.
INTRODUCTION: The routine use of patient-reported outcomes (PROs) in clinical practice improves quality of care, it helps in reducing the access to emergency services and unscheduled visits, and it can improve cancer patients' time survival. The Edmonton Symptom Assessment System (ESAS) is a PRO largely used in different care settings to monitor physical and psychological symptoms. Nonetheless, along with these symptoms, literature also highlighted the presence and effect of spiritual pain, financial distress, and social isolation on quality of care, treatment effectiveness, and survival. AIM: The aims of the current study were (a) to complete the Italian version of the ESAS validation process by adding the missing symptom "insomnia" and (b) to develop and validate the ESAS-Total Care (ESAS-TC) that is intended to evaluate and screen not only physical and psychological symptoms but also spiritual pain, discomfort deriving from financial problems associated with illness, and suffering related to social isolation. METHODS: A sample of Italian native outpatients, who referred to the dedicated Supportive Care Unit of the Fondazione IRCCS, Istituto Nazionale deiTumori (INT), Milano, were asked to fill the ESAS-TC to assess item properties, factorial structure, internal consistency, test-retest reliability (patients were asked to retake the scale after 2-6 weeks), and external validity. Concerning the latter, other self-administered scales were employed to assess perceived stress (Perceived Stress Scale), unmet needs (using theNeed Evaluation Questionnaire that describes informative, assistance/care, relational, needs for psycho-emotional support, material needs), and perceived social support (administering the Multidimensional Scale of Perceived Social Support that evaluates perceived support of family, friends, and significant others in the wider social field). RESULTS: The scales were administered to 243 patients with solid (90%) and hematologic (10%) cancers, mean age 62.6, female 76.5%. Analysis suggested that a single factor better represents the structure of the ESAS scales, their internal consistency and test-retest reliability were good, and evidence of construct and criterion validity were provided. Additionally, incremental validity of the ESAS-TC was proved showing that the added items offer a unique contribution in predicting the patient's stress. Finally, known groups validity was confirmed testing the differences in the ESAS scores due to the Karnofsky Performance Status. CONCLUSIONS: The current study allowed to complete the validation of the Italian version of the ESAS and to develop a psychometrically sound scale, the ESAS-Total Care, that potentially helps in moving cancer research toward personalized total cancer care.
Authors: Neal J Meropol; Deborah Schrag; Thomas J Smith; Therese M Mulvey; Robert M Langdon; Diane Blum; Peter A Ubel; Lowell E Schnipper Journal: J Clin Oncol Date: 2009-07-06 Impact factor: 44.544
Authors: Christina M Puchalski; Andrea Sbrana; Betty Ferrell; Najmeh Jafari; Stephen King; Tracy Balboni; Guido Miccinesi; Anna Vandenhoeck; Michael Silbermann; Lodovico Balducci; Julianna Yong; Andrea Antonuzzo; Alfredo Falcone; Carla Ida Ripamonti Journal: ESMO Open Date: 2019-02-16