Inter-rater reliability in performance status assessment among health care professionals: a systematic review

Chow, Ronald; Chiu, Nicholas; Bruera, Éduardo; Krishnan, Monica; Chiu, Leonard; Lam, Henry; DeAngelis, Carlo; Pulenzas, Natalie; Vuong, Sherlyn; Chow, Edward

doi:10.21037/apm.2016.03.02

Cited by 84 publications

(69 citation statements)

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“…Correlation of PS with survival has been well documented for different types of malignancies [3][4][5], and considering that overall survival is the most reliable and preferred cancer endpoint [6], accurate assessment of PS is a powerful tool for appropriate selection of study subjects. Besides not unanimous agreement on the general results of PS scales with variable inter-expert agreement in a wide range from kappa=0.19 to kappa=0.92 [2], the methodology of assessment does not suggest well-defined criteria and is based on the ability to perform working and self-service activities [7]. The rationale is to assess the influence of the main oncology disease on these parameters, but in the absence of a clear and widely-recognized guideline, there is the potential to perform such assessment irrespective of cancer pathology, mixing up consequences of cancer and other concomitant conditions.…”

Section: Discussionmentioning

confidence: 92%

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Implication of Murphy's Law in Clinical Trials

Kosov¹,

Kolesnik²,

Riefler³

et al. 2017

J Neoplasm

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Assessment of performance status (PS) is an essential part of inclusion criteria in oncology clinical trials. It correlates with the major study outcomes. Among limitations of PS assessment is lack of well-defined criteria which may lead to difference in interpretation. We present 3 cases of misinterpretation of patients' clinical condition that lead to different PS assessment. In 2 cases activity of patients was limited due to factors other than oncology disease, recent surgery and concomitant medical condition (obesity). Such situations as presence of concomitant factors that have a potential to limit patient's ability to perform working or daily living activities, should be carefully considered while assessing PS.

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Section: Discussionmentioning

confidence: 92%

“…Reliability of every method that requires a subjective judgment is determined by concordance rate between observers or reviewers. Opinions differ on PS scales' reliability, ranging from good concordance between observers to significant differences in opinion [2].…”

Section: Introductionmentioning

confidence: 99%

Implication of Murphy's Law in Clinical Trials

Kosov¹,

Kolesnik²,

Riefler³

et al. 2017

J Neoplasm

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show abstract

“…Both scores are prone to inter-observer variability. [36][37][38] There is only moderate correlation between physician and patient reported performance status, with patients scoring themselves more pessimistically than their physicians. [39][40][41] In cancer patients, discordance between physician assessed and patient assessed performance status is associated with worse survival.…”

Section: Frailty Syndrome In Hsct Recipientsmentioning

confidence: 99%

Frailty: the missing piece of the pre- hematopoietic cell transplantation assessment?

Hegde

Murthy

2017

Bone Marrow Transplant

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Hematopoietic stem cell transplantation (HSCT) represents a curative option for those afflicted with numerous hematologic malignancies and bone marrow failure syndromes. Advances and refinement of the HSCT process have resulted in increasing number of transplants performed on older patients in the recent years. Pre-transplant assessments (PTA) function to risk stratify patients prior to undergoing HSCT in an effort to predict those at higher risk of treatment-related toxicity, to inform risk/benefit assessments and to aid clinical decision making. Traditionally used risk stratification parameters such as chronologic age, comorbidity and performance status may not fully capture physical function, physiologic fitness, highlighting a need for improvement in PTA. Incorporation of frailty measurements in pre-HSCT assessments, particularly in elderly transplant candidates, may result in improving predictive ability of existing tools such as the Hematopoietic Cell Transplantation Comorbidity Index and Karnofsky performance status. Here, we review existing pre-HSCT assessment tools, measures of frailty that may aid in risk stratification for patients undergoing HSCT and directions for future research using frailty in the pre-HSCT setting.

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“…Multiple studies have assessed the inter‐rater agreement between physicians, nurses, and other health care professionals in scoring performance status of patients with cancer. Surprisingly, physician and nurse inter‐rater agreement in KPS and ECOG‐PS scores is not always robust and has been shown to vary significantly across the reported literature (Cohen's κ coefficient ranging between 0.23 and 0.77) . The majority of studies suggest that physicians tend to report “healthier” ECOG‐PS or KPS scores than nurses .…”

Section: Introductionmentioning

confidence: 97%

Comparing Physician and Nurse Eastern Cooperative Oncology Group Performance Status (ECOG-PS) Ratings as Predictors of Clinical Outcomes in Patients with Cancer

et al. 2019

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Background. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scale is commonly used by physicians and nurses in oncology, as it correlates with cancer morbidity, mortality, and complications from chemotherapy and can help direct clinical decisions and prognostication. This retrospective cohort study aimed to identify whether ECOG-PS scores rated by oncologist versus nurses differ in their ability to predict clinical outcomes. Materials and Methods. Over 19 months, 32 oncologists and 41 chemotherapy nurses from a single academic comprehensive cancer center independently scored ECOG-PS (range: 0-5) for a random sample of 311 patients with cancer receiving chemotherapy. Logistic regression models were fit to evaluate the ability of nurse and physician ECOG-PS scores, as well as the nursephysician ECOG-PS score difference (nurse minus physician), to predict the occurrence of chemotherapy toxicity (CTCAE v4, grade ≥3) and hospitalizations within 1 month from ECOG-PS ratings, as well as 6-month mortality or hospice referrals.

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Inter-rater reliability in performance status assessment among health care professionals: a systematic review

Abstract: The existing literature cites both good and bad inter-rater reliability of PS scores. It is difficult to conclude which HCPs' PS assessments are more accurate.

Cited by 84 publications

References 0 publications

Implication of Murphy's Law in Clinical Trials

Implication of Murphy's Law in Clinical Trials

Frailty: the missing piece of the pre- hematopoietic cell transplantation assessment?

Comparing Physician and Nurse Eastern Cooperative Oncology Group Performance Status (ECOG-PS) Ratings as Predictors of Clinical Outcomes in Patients with Cancer

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