Proxy Assessment Of Symptoms In Patients With Hepatocellular Carcinoma

China has large number of patients with hepatocellular carcinoma. Relievingsymptoms becomes the important method of softening suffering of patients, when thetherapeutics of anticancer was no longer benefit for curing. For symptom management,assessment is the first and capital step. And symptom intervention depended on accuratesymptom assessment. Generally, researchers and clinicians often accepted patient ratingsas the gold standard of symptom assessment. However, due to disease deterioration, a lotof advanced cancer patients cannot provide completed symptom assessment. At this time,the assessment of symptoms was mainly depended on the information from caregivers ornurses of patients. Accordingly, exploring the feasibility of proxy assessment of symptomsmay provide evidence for symptom management of patients with heptatocellularcarcinoma. In order to improve the accurate of symptom assessment of patients with selfassessment absence, and to increase the level of proxy assessment on symptoms, this studyaimed to measure the agreement in symptom assessments between patients withhepatocellular carcinoma and their primary family caregivers (FCs) and nurses, and todetermine whether the agreement was influenced by patient’s, caregiver’s and nurse’sfactors.There are two parts in this study.The first part is an investigation of the agreement on symptom assessment betweenheptacellular carcinoma patients and family caregivers. Objectives: to explore theagreement in symptom evaluation between patients and their family caregivers, and to findthe possible factors which influence the accuracy of agreement. Methods: A conveniencesample of280dyads consisting of hepatocellular carcinoma patients and their familycaregivers participated in this study. Both completed the symptom checklist of Chineseversion of the M. D. Anderson Symptom Inventory (MDASI-C) and the evaluations of theSymptom Module Specific to Primary Liver Cancer (TSM-PLC). Results: Fatigue, sleepdisturbance, distress and pain are the symptoms with the most prevalence and highest meanscore rated by patients. The levels of agreement ranged from moderate to substantial.Caregiver reaction and depression influenced level of agreement. Meanwhile, a number offactors associated with caregivers (male, not living with patients, short duration of caring,distant relationship with patients, no religion, lower level of education and family income) and patients (Patient knows the exact diagnosis, receiving not expectant treatment, surgery,radio frequency current ablation and traditional Chinese medicine, Hepatitis B infected,lower KPS score, higher stage of TNM and lower education level) were also correlatedwith levels of disparity on some symptoms. Conclusions: The study illustrates that familycaregivers of cancer patients can provide reasonable reports on symptoms of hepatocellularcarcinoma patients. Healthcare providers need to pay special and enough attention to thecaregivers’ burden and depression when using this result.The second part is an exploration of the agreement on symptom assessment betweenheptacellular carcinoma patients and their nurses. Objectives: to explore the agreement insymptom evaluation between patients and their nurses, and to find out the possible factorswhich influence the accuracy of agreement. Methods:81pairs of heptacellular carcinomapatients and their nurses were surveyed by questionnaires. And then10nurses wereinterviewed by semi-structure interviews to discover the possible factors which influencedthe agreement. Results: The agreements of pain and fever were good, rsof which were0.539and0.476, separately. The other17symptoms’ agreements were poor. Semi-structureinterviews resulted that three aspects such as nursing supervision, nurses, patients’ bias onnurses. Conclusions: The levels of agreement of pain and fever were moderate. Otherswere poor. Consummating the nursing regulations and human resources, improving nurses’level of symptom management and communication abilities may increase the accurate ofnurse’s assessment on symptoms of hepatocellular carcinoma patients.