Nurse-reported vs. Patient-reported Symptom Occurrence, Severity, And Agreement Using The Therapy-related Symptoms Checklist (TRSC) In Cancer Patients

Abstract

PURPOSE: Developments in cancer treatments have resulted in increased survival of patients, but side effects/symptoms continue to be a concern. The Therapy-Related Symptoms Checklist (TRSC) has been used with adults undergoing cancer treatments. Study purposes were to examine among patients who completed the TRSC: (a) patient-reported symptom occurrence and severity; (b) nurse-reported symptom occurrence and severity; and (c) inter-rater agreement between patient-reported and nurse-reported symptoms. No study on this last question has been reported. Theoretical Framework: Orem’s Self-Care Deficit Theory focuses on individuals unable to meet their own self-care requirements. The TRSC is a tool that assists nurses in identifying these deficits, better facilitates supportive interventions to alleviate the symptoms, and promotes the patient’s/caregiver’s ability to enhance self-care. DESIGN: This is a cross-sectional study using primary data collection and analysis. Setting: The study was conducted on patients at a single outpatient cancer center in a rural community of the Midwestern United States. Participants: A convenience sample (N=22) of adult outpatients undergoing cancer therapy. METHODS: All patients and their nurse completed the TRSC, a 25-item checklist, with response choices ranging from “0” (none) to “4” (very severe). Descriptive statistics were used to address Purposes A and B, and a Pearson product-moment correlation analysis for Purpose C. RESULTS: All symptoms on the TRSC were reported in varying degrees. Regarding Purpose A, 40% or more of the patients reported 14 symptoms. Regarding Purpose B, 40% or more of nurse respondents reported 8 symptoms. In addition to higher symptom occurrence, greater symptom severity also was reported by patients compared to nurses. Regarding Purpose C, the percentage agreement between patient-reported and nurse identified symptoms was 77%, and the Pearson product-moment correlation coefficient was r =.77, indicating moderate agreement. CONCLUSIONS: Use of patient self-report of symptoms is a preferred approach. A standardized tool (the TRSC) can guide nurses in providing a more complete, symptom-focused care. This may then enhance treatment compliance and improved outcomes.