Clinical decision support system to optimise symptom management in palliative medicine: focus group study

Stap, Lotte van der; Heij, Albert H de; Heide, Agnes van der; Reyners, Anna K.L.; Linden, Yvette M. van der

doi:10.1136/bmjspcare-2021-002940

Cited by 5 publications

(1 citation statement)

References 42 publications

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“…For example, co-occurring fatigue and insomnia (cluster 3) require a different treatment approach than fatigue without co-occurring insomnia (cluster 2). So, to effectively treat co-occurring symptoms, health care professionals must perform comprehensive symptom assessment, including physical as well as psychological symptoms (34).…”

Section: Methodological Considerations and Recommendationsmentioning

confidence: 99%

Symptom burden and its associations with clinical characteristics in patients with COPD: a clustering approach

Houben-Wilke,

Deng,

Janssen

et al. 2024

ERJ Open Res

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BackgroundSymptom burden in people with COPD is often under-recognized. In this cross-sectional analysis, we aimed to study the severity of a variety of (non-)respiratory symptoms in people with COPD and non-COPD subjects and to explore the associations between clusters based on symptom severity and other clinical characteristics.MethodsCharacteristics were assessed in 538 people with COPD from primary, secondary, tertiary care and 116 non-COPD subjects. Severity of 20 symptoms was measured using a Visual Analogue Scale (VAS), ranging from 0 (no symptom) to 100 mm (maximum severity). K-means cluster analysis was applied on symptoms’ severity in the patient sample only.ResultsPatients were comparable with non-COPD subjects in terms of gender (58% vs. 55% male, p=0.132) and age (64 [9]versus63 [6] years, p=0.552) and had a reduced FEV1(57 [23]%versus111 [17]% pred, p<0.001). Patients had higher VAS scores for most symptoms (p<0.05). Most severe symptoms in patients with COPD were dyspnea, fatigue, and muscle weakness while non-COPD subjects mainly experienced insomnia and micturition. Three clusters were identified in the patient sample. Health status and care dependency differed between all clusters, while functional mobility, exacerbation history and lung function differed between clusters 1 and the other two clusters (p<0.05).ConclusionsPeople with COPD report a high burden of respiratory as well as non-respiratory symptoms. Cluster analysis demonstrated a co-occurrence of different levels of symptom severity highlighting the heterogeneity of symptoms experience. Identifying clusters of patients with shared symptom experiences can help to understand the impact of the disease and define integrated, multidimensional treatment strategies.

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Section: Methodological Considerations and Recommendationsmentioning

confidence: 99%

Symptom burden and its associations with clinical characteristics in patients with COPD: a clustering approach

Houben-Wilke,

Deng,

Janssen

et al. 2024

ERJ Open Res

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Barriers and facilitators to multidimensional symptom management in palliative care: A focus group study among patient representatives and clinicians

et al. 2022

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Objectives It is widely acknowledged that co-occurring symptoms in patients with a psychosocial and spiritual aspects should also be considered. However, this multidimensional approach is difficult to integrate into daily practice, especially for generalist clinicians not specialized in palliative care. We aimed to identify the barriers and facilitators to multidimensional symptom management. Methods Focus group meetings were conducted with the following stakeholders: (1) patient representatives, (2) generalist community nurses, (3) generalist hospital nurses, (4) general practitioners, (5) generalist hospital physicians, and (6) palliative care specialists. Audiotapes were transcribed verbatim and thematically analyzed. Results Fifty-one participants (6–12 per group) reported barriers and facilitators with 3 main themes: multidimensional symptom assessment, initiating management of nonphysical problems, and multidisciplinary collaboration. As barriers, generalist clinicians and palliative care specialists reported that generalist clinicians often lack the communication skills to address nonphysical problems and are unaware of available resources for multidimensional symptom management. Palliative care specialists felt that generalist clinicians may be unaware that assessing nonphysical problems is important and focus on pharmacological interventions. Generalist nurses and palliative care specialists indicated that hierarchical difficulties between them and generalist physicians are barriers to multidisciplinary collaboration. Reported facilitators included using symptom assessment scales and standardized questions on nonphysical problems. Significance of results Generalist clinicians can be supported by improving their communication skills, increasing their awareness of available resources for multidimensional symptom management, and by using a standardized approach to assess all 4 dimensions of palliative care.

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The feasibility of a Bayesian network model to assess the probability of simultaneous symptoms in patients with advanced cancer

Stap

Haaften

Marrewijk

et al. 2022

Sci Rep

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Although patients with advanced cancer often experience multiple symptoms simultaneously, clinicians usually focus on symptoms that are volunteered by patients during regular history-taking. We aimed to evaluate the feasibility of a Bayesian network (BN) model to predict the presence of simultaneous symptoms, based on the presence of other symptoms. Our goal is to help clinicians prioritize which symptoms to assess. Patient-reported severity of 11 symptoms (scale 0–10) was measured using an adapted Edmonton Symptom Assessment Scale (ESAS) in a national cross-sectional survey among advanced cancer patients. Scores were dichotomized (< 4 and ≥ 4). Using fourfold cross validation, the prediction error of 9 BN algorithms was estimated (Akaike information criterion (AIC). The model with the highest AIC was evaluated. Model predictive performance was assessed per symptom; an area under curve (AUC) of ≥ 0.65 was considered satisfactory. Model calibration compared predicted and observed probabilities; > 10% difference was considered inaccurate. Symptom scores of 532 patients were collected. A symptom score ≥ 4 was most prevalent for fatigue (64.7%). AUCs varied between 0.60 and 0.78, with satisfactory AUCs for 8/11 symptoms. Calibration was accurate for 101/110 predicted conditional probabilities. Whether a patient experienced fatigue was directly associated with experiencing 7 other symptoms. For example, in the absence or presence of fatigue, the model predicted a 8.6% and 33.1% probability of experiencing anxiety, respectively. It is feasible to use BN development for prioritizing symptom assessment. Fatigue seems most eligble to serve as a starting symptom for predicting the probability of experiencing simultaneous symptoms.

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Clinical decision support system to optimise symptom management in palliative medicine: focus group study

Cited by 5 publications

References 42 publications

Symptom burden and its associations with clinical characteristics in patients with COPD: a clustering approach

Symptom burden and its associations with clinical characteristics in patients with COPD: a clustering approach

Barriers and facilitators to multidimensional symptom management in palliative care: A focus group study among patient representatives and clinicians

The feasibility of a Bayesian network model to assess the probability of simultaneous symptoms in patients with advanced cancer

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