Development of a Symptom Assessment Instrument for Chronic Hemodialysis Patients: The Dialysis Symptom Index
|
|
- Jessica Stephens
- 6 years ago
- Views:
Transcription
1 226 Journal of Pain and Symptom Management Vol. 27 No. 3 March 2004 Original Article Development of a Symptom Assessment Instrument for Chronic Hemodialysis Patients: The Dialysis Symptom Index Steven D. Weisbord, MD, Linda F. Fried, MD, MPH, Robert M. Arnold, MD, Armando J. Rotondi, PhD, Michael J. Fine, MD, MSc, David J. Levenson, MD, and Galen E. Switzer, PhD Departments of Medicine (S.D.W., L.F.F., R.M.A., M.J.F., D.J.L., G.E.S.), Critical Care Medicine (A.J.R.), and Psychiatry (G.E.S.), University of Pittsburgh School of Medicine; Department of Medicine (L.F.F.), and Center for Health Equity Research and Promotion (M.J.F., G.E.S., L.F.F.), VA Pittsburgh Healthcare System; Center for Bioethics and Health Law (R.M.A.), Institute for Performance Improvement (R.M.A.), University of Pittsburgh Cancer Institute (R.M.A.), Department of Health Policy and Management (A.J.R.), and Center for Research on Health Care (G.E.S), University of Pittsburgh, Pittsburgh, Pennsylvania, USA Abstract Little is known about the prevalence, severity, or impact of symptoms in hemodialysis patients because of the lack of a validated symptom assessment instrument. We systematically developed an index to assess physical and emotional symptom burden in this patient population. We employed four steps in the generation of this index: a review of dialysis quality-of-life instruments, three focus groups, experts content validity assessment, and test retest reliability measurement. Seventy-five symptoms were identified. Of these, 46 appeared in 4 of the instruments/focus groups and were considered for inclusion. Twelve were grouped into other symptom constructs and experts judged four of the remaining items not to be pertinent, leaving 30 items in the new index. Overall kappa statistic was These steps allowed the systematic development of a 30-item symptom assessment index for hemodialysis patients. Additional reliability and validity testing is needed prior to its widespread use. J Pain Symptom Manage 2004;27: U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved. Key Words Symptom burden, hemodialysis, scale development Introduction The rapid growth in patients over 65 with end-stage renal disease (ESRD) has led to an Address reprint requests to: Steven D. Weisbord, MD, Renal-Electrolyte Division, University of Pittsburgh Medical Center, A919 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA USA. Accepted for publication: July 14, U.S. Cancer Pain Relief Committee Published by Elsevier Inc. All rights reserved. increased interest in the palliative care of dialysis patients. 1 3 The annual mortality rate of this population, 24%, is higher than many common cancers. 4,5 Moreover, the health-related quality of life (HRQOL) of dialysis patients is much lower than the general population. 6 8 Previous studies suggest this is a result of multiple comorbid illnesses, treatment-related side effects, lifestyle alteration, and the psychosocial impact of living with ESRD Less is known about /04/$ see front matter doi: /j.jpainsymman
2 Vol. 27 No. 3 March 2004 Assessment of Symptom Burden in Hemodialysis Patients 227 the prevalence, severity, and overall impact of physical and psychological symptoms in this population. 6,8,13 Chronic dialysis patients can suffer from a number of physical and emotional symptoms For example, fatigue, which commonly results from the anemia of renal failure, affects as many as 80% of patients on dialysis. 14 Human recombinant erythropoietin decreases this fatigue, and has been shown to have a beneficial effect on HRQOL. 19 Nonetheless, patients often report other symptoms including anorexia, pain, nausea, pruritis, shortness of breath, muscle cramps, paresthesias, feeling depressed, sexual difficulty, and sleep disturbance. 14,15,18,20,21 These symptoms may play an important role in the observed decrement in HRQOL of this patient population. In other areas, such as oncology and the acquired immune deficiency syndrome (AIDS), investigators have found a relationship between symptom burden and HRQOL Unfortunately, the prevalence, severity, and impact on HRQOL of symptoms in dialysis patients have not been well studied. Many instruments currently used to evaluate the HRQOL of dialysis patients have items pertaining to symptoms. However, a comprehensive and psychometrically tested questionnaire designed specifically for the assessment of physical and emotional symptoms in this population is lacking Such an instrument would be helpful both for research purposes and as a tool to improve care of patients dependent on dialysis. For example, symptom assessment instruments used in other fields have shown that providers frequently under-recognize and under-treat symptoms, that family members are moderately accurate surrogates in reporting patient symptoms, and that routine questioning about symptoms can result in improved treatment. 22,24,28 36 In a recent study conducted by our group on the potential value of palliative care to a highly ill segment of the hemodialysis population, we employed the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) to assess symptom burden. 1 The MSAS-SF was developed to assess the presence, severity, and frequency of 32 symptoms in patients with cancer, and it has since been used in patients with AIDS. 23,37 Using the MSAS-SF, we found several physical and emotional symptoms to be prevalent and severe in our study population, and to be associated with impairments in HRQOL. Moreover, we observed that nephrologists commonly failed to document in the medical record many of the symptoms reported by patients, raising the possibility that symptoms are under-recognized in patients on hemodialysis. However, because it was designed for cancer patients, the MSAS-SF contains many items of less relevance to those on dialysis and lacks certain items of potential importance to patients with ESRD dependent on this therapy. We believe that understanding physical and emotional symptom burden in patients on dialysis is essential if efforts to improve the HRQOL of this patient population are to be successful. For this reason, we sought to revise the MSAS- SF to generate an instrument that would allow for reliable and valid assessment of symptom prevalence and severity in patients on hemodialysis, the most common form of renal replacement therapy in this country. This report describes the preliminary steps taken to formulate this index. Methods Overview The institutional review boards at our institution and at the Dialysis Clinic Incorporated approved all study procedures. The Dialysis Symptom Index (DSI) was created in four phases using qualitative and quantitative research methods. First, we reviewed a convenience sample of four HRQOL questionnaires used in dialysis patients containing items on physical and emotional symptoms and one symptom assessment survey used in patients with chronic renal failure not yet dependent on dialysis. Second, we conducted three focus groups, two in dialysis patients and one in renal providers, to identify a wide range of symptoms experienced by the hemodialysis population. Using the information obtained from these two steps, we systematically selected items for potential inclusion on the new index. Third, to improve our content validity, we asked four experts in the field of HRQOL and ESRD, and four full-time clinical nephrologists to judge the clinical relevance and wording of each of the items. The data obtained from these three steps were used to modify the MSAS-SF and to formulate the new index. We emulated the format of
3 228 Weisbord et al. Vol. 27 No. 3 March 2004 the MSAS-SF to configure our new instrument for three main reasons. The instrument is bidimensional; it assesses both the presence and severity/frequency of physical and emotional symptoms. This format has been successfully used in other patient populations, particularly those with cancer. Lastly, in our previous study of dialysis patients, the MSAS-SF was easy to administer and patients had no trouble completing it. As a final step, we administered the index twice, 4 7 days apart, in 20 hemodialysis patients to obtain test retest reliability data. Detailed descriptions of these four steps are discussed below and are outlined in Figure 1. Health-Related Quality-of-Life Questionnaire Review We selected a convenience sample of four of the most widely recognized HRQOL questionnaires that have been developed for, and used in, patients with ESRD over the past five years as well as a symptom index designed for predialysis patients. From this review, we identified any item that asked either directly or indirectly about a physical or emotional symptom. Items that did not precisely match a symptom construct were recorded as the symptom they most closely matched as determined by one investigator (SDW). We added each new item to the symptoms noted in the MSAS-SF. Focus Groups Because of the unique experience of living on dialysis and of caring for those afflicted with ESRD, we chose to elicit the input of hemodialysis patients and renal care providers in the formulation of this index and to use a focus group format for this purpose. First, we conducted a group with renal providers including physicians, social workers, and dieticians to identify the symptoms seen by these individuals in chronic hemodialysis patients. We distributed a copy of the original MSAS-SF to each provider one week in advance of the meeting and asked him or her to review the scale. During the group, we asked the providers to discuss their experiences with symptoms, to comment on the items appearing on the MSAS-SF, and to identify items not present on the MSAS-SF that they believed should be included on a hemodialysisdirected symptom assessment instrument. The discussion was audiotaped and transcribed, and field notes were taken by the principal investigator (SDW). We then held two focus groups with hemodialysis patients. Patients participating in these groups were from two non-profit Dialysis Clinic Incorporated (DCI) clinics in the Pittsburgh area and were selected by nurse coordinators and nephrologists at these clinics based solely on willingness to participate. The first group was made up entirely of African American patients receiving their care at a clinic that treats a primarily urban, lower-middle class population. The second group was made up of Caucasian hemodialysis patients receiving dialysis at a clinic that cares for a middle class, suburban population. We opted to enroll patients from these two units because prior studies suggest that African Americans and Caucasian dialysis patients may experience different symptoms, and we wished to ensure that our sample would be demographically representative of the general dialysis population. 44 Discussions were aimed at the physical and emotional symptoms these patients had experienced since starting dialysis. Symptoms that were mentioned at least once in the focus groups were considered as potential items for the new index. These meetings were audiotaped and transcribed, and the principal investigator took field notes. One Caucasian moderator with prior experience in conducting focus groups ran all three sessions. One investigator reviewed the field notes and transcripts from all three focus groups. Fig. 1. Overview of item selection process. Item Selection These methods provided nine data sets, six questionnaires (4 HRQOL, 1 chronic kidney
4 Vol. 27 No. 3 March 2004 Assessment of Symptom Burden in Hemodialysis Patients 229 disease symptom index, and the MSAS-SF) and three focus groups, from which to identify symptoms for the new index. We quantified the number of times a specific symptom appeared in these nine data sources (maximum 9, minimum 1). We subjectively decided that only symptoms appearing in 4 or more of these 9 questionnaires/focus groups ( 44%) could be included on the DSI. Content Validity Four experts in the field of ESRD and qualityof-life assessment and four full-time clinical nephrologists were identified and asked to rate the relevance of each item (4-point Likert scale, 1 not relevant to 4 highly relevant) and the wording of each item (4-point Likert scale, 1 completely inappropriate wording to 4 completely appropriate wording). The experts, who were from four different medical centers, were chosen based on previous research and publication in the area of HRQOL and ESRD, while the four clinicians were a convenience sample based on their affiliation, direct or indirect, with our institution. Relevance was defined as the importance of the symptom to hemodialysis patients and renal providers. Appropriateness of wording was defined as how well the wording of the item captured the symptom it was intended to assess. Items that 6 or more of the 8 reviewers judged to be highly relevant (score of 4) were included on the new index, while items that 5 or fewer reviewers judged to be highly relevant were eliminated. We then reviewed the included items for appropriateness of wording. Items for which two or more of the 8 reviewers judged the wording to be less than completely appropriate (scores 4), were reviewed further for potential modification. The principal and senior investigator (GES), an expert in scale development and survey psychometrics, discussed these items, and wording was modified if both investigators agreed to a specific change. Test Retest Reliability Assessment As part of a larger study of symptoms in ESRD, we selected twenty hemodialysis patients and asked them to participate in test retest reliability assessment. This group of patients, all from the VA Pittsburgh Healthcare System dialysis unit, comprised 19 men and 1 woman and was 70% African American and 30% Caucasian. After providing informed consent, these patients were administered the new index by a trained interviewer during a routine dialysis session. Four to seven days later, the index was readministered by the same interviewer, also during a routine dialysis treatment. We chose to use a 4 7 day time frame in place of the standard one to two weeks for test retest reliability assessment because of the potentially transient nature of many of the symptoms experienced by this population. Kappa statistics were determined for each of the symptoms appearing in the index. Additionally, we identified the symptoms most commonly reported by these twenty patients on the first administration to begin to confirm the applicability of the new index. Results Health-Related Quality-of-Life Questionnaire Review We reviewed four HRQOL instruments. Two of the instruments, the Kidney Disease Quality of Life Questionnaire Short Form (KDQOL-SF) and the CHOICE Health Experience Questionnaire (CHEQ) are dialysis-specific instruments that have been used in large studies of the dialysis population. 27,38,39 The KDQOL-SF was developed by the RAND Corporation, uses the SF-36 as its core, and incorporates additional kidney disease targeted items. 7,25,38,39 Its internal consistency reliability and content and construct validity have been well established, and the development of the instrument involved the input of dialysis patients and renal providers. 7,25,38,39 The CHEQ, an instrument designed to assess HRQOL in both hemodialysis and peritoneal dialysis patients, contains 21 domains and several items pertaining to physical and emotional symptoms. 27 It too has good psychometric properties and was developed with the input of dialysis patients. 27 In addition to these questionnaires, we reviewed the HEMO study quality-of-life questionnaire and the Dartmouth COOP charts for ESRD, which have been developed for and used in dialysis patients. The HEMO Study Quality-of-Life Assessment questionnaire has as its core the KDQOL long form, an extended version of the KDQOL-SF. 40 It is supplemented with additional items, some of which deal with dialysis-related symptomatology. Although the KDQOL-LF, which makes up
5 230 Weisbord et al. Vol. 27 No. 3 March 2004 much of the HEMO study questionnaire, has good psychometric properties, reliability and validity data on the additional items are unknown The Dartmouth COOP charts questionnaire is a 36-item scale which contains several questions on symptoms. 26 Although, there are limited data on the psychometric properties of the Dartmouth COOP charts questionnaire for dialysis patients, it is a recently developed measure for quality-of-life assessment for this patient population and is known to the study investigators. It was selected for review in this study for these reasons. Also included in this review was the Patient Symptom Form used in the Modification of Diet in Renal Disease Study, a large study of patients with chronic renal failure not yet dependent on dialysis. 43 Because of the significant overlap of symptoms between these two populations, this instrument was included in our analysis. Symptoms appearing on these questionnaires and the MSAS-SF, and their frequency of appearance, are shown in Table 1. Focus Groups Provider Focus Group. Participants in the renal care provider group included two nephrologists, one renal social worker, and one dietician. The participating nephrologists, both of whom practiced in an academic setting, had a combined 41 years of experience treating patients receiving hemodialysis. The social worker had 16 years of experience caring for patients receiving chronic dialysis. The renal dietician had been working with this patient population for 16 years. From this group discussion, 27 symptoms that appear in hemodialysis patients were identified. Four items on the MSAS-SF were thought to be uncommon and not generally of significance in dialysis patients. These included sweats, hair loss, mouth sores, and dizziness. Two items present on the MSAS-SF were believed to be relevant, yet too general. Participants subdivided these two items, difficulty sleeping and problems with sexual interest or activity into two separate questions each. Results from this focus group are presented in Table 2. Patient Focus Groups. The second focus group was made up of 10 African American hemodialysis patients, 5 men and 5 women, with an average age of 52 (range 40 67). The mean number of years on dialysis for this group was 4.5 (range 1 13). Two patients had a history of a previous failed kidney transplant and seven suffered from diabetes mellitus. This group identified 36 symptoms. The third focus group was made up of three white hemodialysis patients, two women and one man, who had been on dialysis for a mean of 6 years (range 4 9). The average age of these patients was 51 (range Table 1 Symptom Appearance in Questionnaires Number of Questionnaires Containing Symptom Symptoms 6 Feeling sad, nausea, itching, feeling irritable, lack of energy, pain 5 Feeling nervous, weakness, lightheaded, difficulty sleeping, lack of appetite, numbness/tingling 4 Bodily pain, back pain, feeling bloated, difficulty concentrating, shortness of breath, dry skin, can t fall asleep, can t stay asleep, feeling anxious, dizziness, muscle cramps, problems with sex, changes in skin, don t look like myself 3 Constipation, cough, feeling drowsy, vomiting, loss of libido/decreased interest in sex, impotence, low exercise tolerance, worrying, chest pain, stomach cramps 2 Diarrhea, restless legs, dry mouth, swelling of arms or legs, muscle soreness, lack of strength, easy bruising, washed out/drained, blurred vision, joint stiffness 1 Cramps during dialysis, bone/joint pain, changes in skin color, cramps after dialysis, excessive thirst, headache, heartburn, pain in dialysis access, sweats, increased thirst, easy bleeding, change in taste, loss of taste, bad taste in mouth, weight gain, cold intolerance, chills, difficulty swallowing, hiccoughs, mouth sores, trouble seeing, foot problems, hives/rash, hot/cold spells, trouble hearing, trouble with memory, hair loss
6 Vol. 27 No. 3 March 2004 Assessment of Symptom Burden in Hemodialysis Patients 231 Table 2 Symptoms Reported by Focus Groups African Renal American White Symptom Providers Patients Patients Constipation Y Sweats Y Y Diarrhea Y Y Restless legs Y Y Bone/joint pain Y Y Y Feeling drowsy Y Y Swelling of arms/legs Y Y Y Feeling bloated Y Y Vomiting Y Y Y Decreased interest in sex Y Y Y Impotence Y Y Y Fatigue/lack of energy Y Y Y Difficulty concentrating Y Y Y Shortness of breath Y Y Y Dry skin Y Y Y Can t stay asleep Y Y Y Lightheaded Y Y Can t fall asleep Y Y Y Feeling sad Y Y Lack of appetite Y Y Nausea Y Y Y Itching Y Y Y Numbness/tingling Y Y Y Muscle soreness Y Y Worrying Y Y Feel anxious Y Dizziness Y Y Muscle cramps Y Y Y Problems with sex Y Y Y Changes in skin Y Y Y Pain Y Y Y Change in skin color Y Y Easy bruising Y Headaches Y Y Y Heartburn Y Y Thirst/dry mouth Y Y Y Easy bleeding Y Y Change in taste Y Y Loss of taste Y Y Cold intolerance Y Y Blurred vision Y Y Crying spells Y Y Cough Y Y Chest pain Y Y symptom reported; symptom not reported ), all three had a failed prior kidney transplant and none were diabetic. These three participants identified 41 individual symptoms. Results from these patient focus groups are also presented in Table 2. Item Selection From the questionnaire review and focus groups, a total of 75 separate symptoms were identified. Forty-seven symptoms appeared in 4 or more of these questionnaires/focus groups. Of these 47, 12 items were judged to overlap significantly with other symptoms and were compressed into these symptom constructs. For example, lack of strength, weakness, and low exercise tolerance were combined into fatigue or lack of energy. This process is detailed in Figure 2. One item, don t look like myself, was felt to represent a sign and not a symptom construct and was eliminated. This left 34 symptoms to be included in the analysis of relevance and wording in the next step of development. Content Validity Content validity surveys were received from all eight reviewers. Three or more reviewers judged four items to be less than highly relevant. These symptoms, which included blurred vision, back pain, feeling drowsy, and feeling bloated, were eliminated from consideration for inclusion in the index. Seven of the remaining 30 symptoms were identified by two or more reviewers as being less than completely appropriately worded. These included lack of appetite, swelling of arms or legs, restless legs, lack of energy, bone/joint pain, difficulty concentrating, and difficulty becoming sexually aroused. Consensus was reached to change the wording on four items. Lack of appetite was changed to decreased appetite; swelling of arms or legs was modified to read swelling in legs; lack of energy was changed to feeling tired or lack of energy; and restless legs was changed to restless legs or difficulty keeping legs still. These steps led to the formulation of a 30-item index, which, similar to the MSAS-SF, inquires about the presence of the symptom and the severity of that symptom based on a 5-point Likert scale. The final instrument is shown in the Appendix. Test Retest Reliability Assessment Twenty patients completed the index on two separate occasions. The percent total agreement was high (mean ). Kappa statistics range from 0.06 to 0.90 (mean ). Three values were below 0.2: diarrhea, lightheadedness/dizziness, and difficulty concentrating. Ten items demonstrated kappa values of An additional eight symptoms had kappa statistics Complete results of the test retest process are displayed in Table 3. The mean number of symptoms reported by the 20 patients was 9.8 with a range of Four
7 232 Weisbord et al. Vol. 27 No. 3 March 2004 Fig. 2. Grouping of symptoms. symptoms: feeling tired/lack of energy, dry mouth, dry skin, and itching were reported by more that 50% ofthese twenty patients;and an additional eleven symptoms were described by more than 33% of subjects. Discussion Past and current research has focused on ways to improve the substantial impairments in the HRQOL of chronic hemodialysis patients In the oncology and HIV-literature, there is a clear inverse relationship between symptoms and quality of life, leading investigators to focus on decreasing symptom burden as a way to improve patient well-being. 23,30,48 50 Similar work in nephrology is limited by the lack of a freestanding, comprehensive, and validated instrument for symptom assessment in dialysis patients. Nonetheless, it is well recognized that the rigors of the thrice weekly hemodialysis procedure, near universal cardiovascular and infectious comorbidity, metabolic derangements associated with ESRD, and psychological impact of living on dialysis contribute to the many symptoms that can plague this population. We believe that the accurate assessment and treatment of bothersome symptoms in dialysis patients is essential if efforts to improve the care of this patient population are to be successful. This belief, along with our recognition that dialysis patients can suffer from a constellation of symptoms unique to ESRD, served as the driving force behind the effort to develop the Dialysis Symptom Index. Most prior studies that have assessed dialysis patients symptoms have used ad hoc instruments. Parfrey and colleagues conducted a series of studies nearly 15 years ago to generate a symptom assessment index Although several steps including the incorporation of data pertaining to physical and emotional symptoms and preliminary evaluation of the scale s psychometric properties were completed, widespread testing and advanced scale development did not take place because of competing research interests of the investigators. 51 Moreover, over the past decade, the aging of the ESRD population and widespread use of erythropoietin have likely altered the symptom profile of patients on dialysis. 19,52 These factors also led us to pursue development of the DSI. The development of a valid scale is a complex process requiring several well-planned and wellexecuted steps. Issues that need to be considered include the survey construct, the target
8 Vol. 27 No. 3 March 2004 Assessment of Symptom Burden in Hemodialysis Patients 233 Table 3 Test-Retest Data Symptom % Endorsed Time 1 % Total Agreement % Negative % Positive Kappa Constipation Nausea Vomiting Diarrhea Decreased appetite Muscle cramps Swelling in legs Shortness of breath Lightheadedness Restless legs Numbness Feeling tired Cough Dry mouth Bone or joint pain Chest pain Headache Muscle soreness Difficulty concentrating Dry skin Itching Worrying Nervous Trouble falling asleep Trouble staying asleep Feeling irritable Feeling sad Feeling anxious Decreased interest in sex Difficulty becoming sexually aroused population, generation and formatting of questions, mode of administration, potential measurement error, and psychometric testing of the instrument. We carefully considered these factors during development of the DSI. First, we used a patient and provider centered approach to develop our new index Patients were chosen to ensure both ethnic and geographic diversity. Patients are likely to explore different symptoms with different health care providers, leading us to include a range of renal providers in our first focus group. Second, we employed both qualitative and quantitative research techniques to ensure both completeness and appropriateness of our data. Third, we asked experts in clinical care and research to review our first draft and provide feedback on the scale to collect preliminary validity data. Finally, we pilot tested the instrument in a group of patients to ensure that test retest reliability was acceptable. These methods and the final product, the Dialysis Symptom Index, highlight important points about symptom burden and symptom assessment in dialysis patients and the potential utility of this new index. First, there was great variability in the symptoms reported both in the literature and among our focus group respondents. The five questionnaires we reviewed contained different symptoms, variation which also existed in the responses of our focus group participants. Although the differences in responses from the two patient focus groups may be partially explained by differences in the experiences and demographic characteristics of the participants, the explanation for the variability in responses between the patient groups and the provider group is less clear. We believe that this points out that patients and providers may have very different perspectives on the symptoms that patients on hemodialysis experience, and that providers may under-appreciate the importance attached to specific symptoms by their patients. If so, this underscores the significance of finding ways to improve the dialysis patient renal provider interaction. The use of a symptom instrument such as the DSI may
9 234 Weisbord et al. Vol. 27 No. 3 March 2004 allow for the improved exchange of information between patients and providers. Second, there are a multitude of symptoms that can affect the dialysis population and could be considered for inclusion in an instrument to assess symptom burden. We identified a total of 75 unique symptoms from our instrument review and focus groups. This finding underscores the challenge of formulating an index that is comprehensive, yet concise and easy for patients to complete. Symptoms in these patients likely result from several processes. These include the physical demands of thrice weekly treatment, multiple comorbid conditions, metabolic derangements such as anemia, hyperphosphatemia, and hyperparathyroidism, and the psychological and social impact of being dependent on renal replacement therapy. Our aim was to configure a scale that would capture the most common and most bothersome symptoms and be viewed as useful from the perspective of a patient, a clinician, and the research community. Certain symptoms such as blurred vision that passed our preliminary criteria for inclusion and could be viewed as highly important by some, may not appear in our index. It is our belief that the symptoms that do appear are the physical and emotional symptoms that are most likely to afflict this patient group, and the brevity and potential ease of use of the index will increase its reliability, validity, responsiveness, and clinical utility. We did provide an open-ended question at the end of the index for patients to report on the presence of other symptoms not included on the scale. Future studies will determine if patients commonly report other symptoms. Certain methodological issues require further study. First, while our preliminary estimation of the index s reliability using test retest procedures was good, three items had very low kappa values ( 0.20). These included diarrhea, lightheadedness, and difficulty concentrating. We believe that both diarrhea and lightheadedness/dizziness are transient symptoms, which is the likely explanation for this finding. The DSI was administered while the subjects were receiving dialysis and the variability of dialysis treatment hypotension might have accounted for the differences in lightheadedness/dizziness. We are unsure why the reliability of difficulty concentrating was low. This finding, along with our preliminary results relating to diarrhea and lightheadedness/dizziness, need to be evaluated in greater detail. Second, this preliminary study did not include the administration of other instruments to test the construct validity of the DSI. We plan to replicate our results with a larger population of dialysis patients and assess the relationship between the DSI and validated measures of depression and HRQOL. Nonetheless, our results to date provide preliminary evidence that at this early stage of development, the Dialysis Symptom Index demonstrates good reliability characteristics when measured by test retest procedures. There are several limitations to the current study. First, we used investigator-defined criteria to eliminate items from the DSI rather than asking a larger cohort of patients to judge all the symptoms we identified from the questionnaires and focus groups. It is possible that this process resulted in the elimination of symptoms of importance to this patient population. However, we believe that the relative brevity of the scale will help to limit measurement error. Second, the smaller sizes of the provider and second patient focus group could have limited the breadth of data obtained in these two meetings. Moreover, sicker patients who may have had large symptom burdens may not have participated in the patient focus groups limiting the number of symptoms reported. We attempted to account for this by asking health care providers about the symptoms they commonly see. Third, we used a one-week time frame to conduct re-testing of the Dialysis Symptom Index. Although symptoms may be quite transient in dialysis patients as a result of the rigors of each dialysis session and the intermittent metabolic derangements of ESRD, the use of a shorter time frame would have raised the issue of recall bias, and the utility of a longer time frame would have been affected by the short-lived nature of certain symptoms. Further test retest and internal consistency testing are clearly needed to delineate the reliability of this scale. In summary, we have described the preliminary development of a freestanding, patientcentered instrument for the assessment of physical and emotional symptom burden in patients receiving hemodialysis. The specific steps we employed have allowed us to generate a concise, yet comprehensive and clinically relevant
10 Vol. 27 No. 3 March 2004 Assessment of Symptom Burden in Hemodialysis Patients 235 scale. Although additional psychometric testing is required, future studies on the morbidity associated with ESRD and the factors affecting the HRQOL of hemodialysis patients will be able to employ the DSI to further characterize the burden and impact of symptoms. This index also will help to improve communication between renal providers and dialysis patients. Furthermore, studies employing clinical interventions to improve the quality of life of patients with ESRD will now be better able to gauge the effect of such interventions on physical and emotional symptom burden. The Dialysis Symptom Index has the potential to become a highly useful tool to increase our understanding of the issues faced by patients dependent on hemodialysis. Acknowledgments Drs. Weisbord and Fried were supported by a grant from the Center for Health Equity Research and Promotion at the Pittsburgh and Philadelphia VA Healthcare Systems. Dr. Weisbord was also supported by NIH grant T32HL Dr. Arnold was supported by the Project on Death in America Faculty Scholars Program, the Greenwall Foundation, Ladies Hospital Aid Society of Western Pennsylvania, the International Union Against Cancer (UICC) Yamagiwa-Yoshida Memorial International Cancer Study Grant, and the LAS Trust Foundation. References 1. Weisbord SD, Carmody SS, Bruns FJ, et al. Symptom burden, quality of life, advance care planning, and the potential value of palliative care in severely ill hemodialysis patients. Nephrol Dial Transplant 2003;18: Cohen LM, Germain M, Poppel DM, et al. Dialysis discontinuation and palliative care. Am J Kidney Dis 2000;36(1): Cohen LM, McCue JD, Germain M, et al. Denying the dying. Advance directives and dialysis discontinuation. Psychosomatics 1997;38(1): US Renal Data System. USRDS 2001 Annual Data Report. Bethesda, MD. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases April Ries LAG EM, Kosary CL, et al. SEER Cancer Statistics Review, , National Cancer Institute, Bethesda MD. 6. Evans RW, Manninen DL, Garrison LP Jr, et al. The quality of life of patients with end-stage renal disease. N Engl J Med ;312(9): Kimmel PL. Just whose quality of life is it anyway? Controversies and consistencies in measurements of quality of life. Kidney International 2000;57(Suppl 74):S113 S Bremer BA, McCauley CR, Wrona RM, et al. Quality of life in end-stage renal disease: a reexamination. Am J Kidney Dis 1989;13(3): Kimmel PL. Psychosocial factors in dialysis patients. Kidney Int 2001;59(4): Kimmel PL. Psychosocial factors in adult endstage renal disease patients treated with hemodialysis: correlates and outcomes. Am J Kidney Dis 2000; 35(4 Suppl 1):S132 S Kutner NG, Jassal SV. Quality of life and rehabilitation of elderly dialysis patients. Semin Dial 2002; 15(2): Devins GM, Dion R, Pelletier LG, et al. Structure of lifestyle disruptions in chronic disease: a confirmatory factor analysis of the Illness Intrusiveness Ratings Scale. Med Care 2001;39(10): Patel SS, Shah VS, Peterson RA, et al. Psychosocial variables, quality of life, and religious beliefs in ESRD patients treated with hemodialysis. Am J Kidney Dis 2002;40(5): Merkus MP, Jager KJ, Dekker FW, et al. Physical symptoms and quality of life in patients on chronic dialysis: results of The Netherlands Cooperative Study on Adequacy of Dialysis (NECOSAD). Nephrol Dial Transplant 1999;14(5): Parfrey PS, Vavasour H, Bullock M, et al. Symptoms in end-stage renal disease: dialysis vs transplantation. Transplant Proc 1987;19(4): Parfrey PS, Vavasour HM, Henry S, et al. Clinical features and severity of nonspecific symptoms in dialysis patients. Nephron 1988;50(2): Parfrey PS, Vavasour H, Bullock M, et al. Development of a health questionnaire specific for endstage renal disease. Nephron 1989;52(1): Kimmel PL. Depression in patients with chronic renal disease: what we know and what we need to know. J Psychosom Res 2002;53(4): Levin NW, Lazarus JM, Nissenson AR. National Cooperative rhu Erythropoietin Study in patients with chronic renal failure an interim report. The National Cooperative rhu Erythropoietin Study Group. Am J Kidney Dis 1993;22(2 Suppl 1): Ring T, Merkus MP, Krediet RT. Physical symptoms and quality of life in patients on chronic dialysis: results of The Netherlands cooperative study
11 236 Weisbord et al. Vol. 27 No. 3 March 2004 on adequacy of dialysis (NECOSAD). Nephrol Dial Transplant 2000;15(2): Hui DS, Wong TY, Ko FW, et al. Prevalence of sleep disturbances in Chinese patients with end-stage renal failure on continuous ambulatory peritoneal dialysis. Am J Kidney Dis 2000;36(4): Breitbart W, Rosenfeld BD, Passik SD, et al. The undertreatment of pain in ambulatory AIDS patients. Pain 1996;65(2 3): Vogl D, Rosenfeld B, Breitbart W, et al. Symptom prevalence, characteristics, and distress in AIDS outpatients. J Pain Symptom Manage 1999;18(4): Justice AC, Rabeneck L, Hays RD, et al. Sensitivity, specificity, reliability, and clinical validity of provider-reported symptoms: a comparison with selfreported symptoms. Outcomes Committee of the AIDS Clinical Trials Group. J Acquir Immune Defic Syndr 1999;21(2): Korevaar JC, Merkus MP, Jansen MA, et al. Validation of the KDQOL-SF: a dialysis-targeted health measure. Qual Life Res 2002;11(5): Sadler JH, Blagg CR, Wasson JH. New dialysisspecific COOP charts may improve ESRD patient assessment. Nephrol News Issues 1998;12(9): Wu AW, Fink NE, Cagney KA, et al. Developing a health-related quality-of-life measure for end-stage renal disease: The CHOICE Health Experience Questionnaire. Am J Kidney Dis 2001;37(1): Du Pen SL, Du Pen AR, Polissar N, et al. Implementing guidelines for cancer pain management: results of a randomized controlled clinical trial. J Clin Oncol 1999;17(1): Chang VT, Hwang SS, Feuerman M, et al. Symptom and quality of life survey of medical oncology patients at a Veterans Affairs medical center: a role for symptom assessment. Cancer 2000;88(5): Chang VT, Hwang SS, Kasimis B. Longitudinal documentation of cancer pain management outcomes: a pilot study at a VA medical center. J Pain Symptom Manage 2002;24(5): Lobchuk MM, Degner LF. Symptom experiences: perceptual accuracy between advanced-stage cancer patients and family caregivers in the home care setting. J Clin Oncol 2002;20(16): Nekolaichuk CL, Maguire TO, Suarez-Almazor M, et al. Assessing the eliability of patient, nurse, and family caregiver symptom ratings in hospitalized advanced cancer patients. J Clin Oncol 1999;17(11): Stephens RJ, Hopwood P, Girling DJ, et al. Randomized trials with quality-of-life endpoints: are doctors ratings of patients physical symptoms interchangeable with patients self-ratings? Qual Life Res 1997;6(3): Stromgren AS, Groenvold M, Pedersen L, et al. Does the medical record cover the symptoms experienced by cancer patients receiving palliative care? A comparison of the record and patient selfrating. J Pain Symptom Manage 2001;21(3): Bernabei R, Gambassi G, Lapane K, et al. Management of pain in elderly patients with cancer. SAGE Study Group. Systematic Assessment of Geriatric Drug Use via Epidemiology. JAMA 1998;279(23): Cleeland CS, Gonin R, Hatfield AK, et al. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 1994;330(9): Portenoy RK, Thaler HT, Kornblith AB, et al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer 1994;30A(9): Edgell ET, Coons SJ, Carter WB, et al. A review of health-related quality-of-life measures used in endstage renal disease. Clin Ther 1996;18(5): Hays RD, Kallich JD, Mapes DL, et al. Development of the kidney disease quality-of-life (KDQOL) instrument. Qual Life Res 1994;3(5): Meyer KPL, Hays R, et al. Clinical correlates of baseline quality of life in the HEMO study: an interim report. [Abstract]. JASN 1997;8:204A. 41. Unruh M. Personal communication. 42. Meyer KPL, Hays R, et al. Quality of life in the hemo study: an interim report. JASN 1997;8:204A. 43. Rocco MV, Gassman JJ, Wang SR, et al. Crosssectional study of quality of life and symptoms in chronic renal disease patients: the Modification of Diet in Renal Disease Study. Am J Kidney Dis 1997; 29(6): Cooper L. USRDS 2001 Annual Data Report. Nephrol News Issues 2001;15(10):31, 34 35, 38 passim. 45. DePaul V, Moreland J, Eager T, et al. The effectiveness of aerobic and muscle strength training in patients receiving hemodialysis and EPO: a randomized controlled trial. Am J Kidney Dis 2002;40(6): Korevaar JC, Jansen MA, Dekker FW, et al. Evaluation of DOQI guidelines: early start of dialysis treatment is not associated with better health-related quality of life. National Kidney Foundation-Dialysis Outcomes Quality Initiative. Am J Kidney Dis 2002; 39(1): Goodkin DA, Mapes DL, Held PJ. The dialysis outcomes and practice patterns study (DOPPS): how can we improve the care of hemodialysis patients? Semin Dial 2001;14(3): Collins JJ, Byrnes ME, Dunkel IJ, et al. The measurement of symptoms in children with cancer. J Pain Symptom Manage 2000;19(5): Ingham JM, Portenoy RK. Symptom assessment. Hematol Oncol Clin North Am 1996; 10(1):21 39.
12 Vol. 27 No. 3 March 2004 Assessment of Symptom Burden in Hemodialysis Patients Chang VT, Thaler HT, Polyak TA, et al. Quality of life and survival: the role of multidimensional symptom assessment. Cancer 1998;83(1): Parfrey PS. Personal communication. 52. System. URD. USRDS 2001 Annual Data Report. Bethesda, MD: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, DeVellis RF. Scale development theory and applications. Newbury Park, CA: Sage Publications, Aday LA. Designing and conducting health surveys. San Francisco: Jossey-Bass Inc., Streiner DLaNGR. Health measurement scales a practical guide to their development and use. Oxford: Oxford University Press, 2000.
13 238 Weisbord et al. Vol. 27 No. 3 March 2004
14 Vol. 27 No. 3 March 2004 Assessment of Symptom Burden in Hemodialysis Patients 239
15 240 Weisbord et al. Vol. 27 No. 3 March 2004
Improvement in Pittsburgh Symptom Score Index After Initiation of Peritoneal Dialysis
Advances in Peritoneal Dialysis, Vol. 24, 2008 Matthew J. Novak, 1 Heena Sheth, 2 Filitsa H. Bender, 1 Linda Fried, 1,3 Beth Piraino 1 Improvement in Pittsburgh Symptom Score Index After Initiation of
More informationPatients with end-stage renal disease (ESRD) receiving
Symptom Burden, Depression, and Quality of Life in Chronic and End-Stage Kidney Disease Khaled Abdel-Kader,* Mark L. Unruh,* and Steven D. Weisbord* Renal Section and Center for Health Equity Research
More informationSymptom Experience of Adult Hospitalized Medical-Surgical Patients
Vol. 28 No. 5 November 2004 Journal of Pain and Symptom Management 451 Original Article Symptom Experience of Adult Hospitalized Medical-Surgical Patients Alison E. Kris, RN, PhD and Marylin J. Dodd, RN,
More informationPrevalence, Severity, and Importance of Physical and Emotional Symptoms in Chronic Hemodialysis Patients
Prevalence, Severity, and Importance of Physical and Emotional Symptoms in Chronic Hemodialysis Patients Steven D. Weisbord,* Linda F. Fried,* Robert M. Arnold, Michael J. Fine, David J. Levenson, Rolf
More informationDifferences in the symptom experience of older versus younger oncology outpatients: a cross-sectional study
Cataldo et al. BMC Cancer 2013, 13:6 RESEARCH ARTICLE Differences in the symptom experience of older versus younger oncology outpatients: a cross-sectional study Open Access Janine K Cataldo 1, Steven
More informationACTG Adherence Follow Up Questionnaire
ACTG Adherence Follow Up Questionnaire Date Self Interviewer Both Patient ID How Administered? 1 2 3 THIS PAGE IS TO BE COMPLETED BY THE PATIENT AND STUDY PERSONNEL TOGETHER. A. You are currently taking
More informationAuthor Block M. Fisch, J. W. Lee, J. Manola, L. Wagner, V. Chang, P. Gilman, K. Lear, L. Baez, C. Cleeland University of Texas M.D. Anderson Cancer Ce
Survey of disease and treatment-related t t related symptoms in outpatients with invasive i cancer of the breast, prostate, lung, or colon/rectum (E2Z02, the SOAPP study, Abst # 9619) Michael J. Fisch,
More informationValidity of the Memorial Symptom Assessment Scale-Short Form Psychological Subscales in Advanced Cancer Patients
Vol. 42 No. 5 November 2011 Journal of Pain and Symptom Management 761 Brief Methodological Report Validity of the Memorial Symptom Assessment Scale-Short Form Psychological Subscales in Advanced Cancer
More informationPATIENT SURVEY FOR ADMINISTRATIVE USE ONLY. TO BE COMPLETED BY STUDY COORDINATOR.
PATIENT SURVEY FOR ADMINISTRATIVE USE ONLY. TO BE COMPLETED BY STUDY COORDINATOR. DATE OF VISIT: / / PATIENT ID: REGULAR PROVIDER: SITE OF VISIT: Cleveland Houston Manhattan Pittsburgh Thank you for agreeing
More informationThe New Mexico Refugee Symptom Checklist-121 (NMRSCL-121)
The New Mexico Refugee Symptom Checklist-121 (NMRSCL-121) Michael Hollifield, MD 2007 New Mexico Refugee Symptom Checklist-121 Instructions: Using the scale beside each symptom, please indicate the degree
More informationDrug Resistant Tuberculosis Self-reporting of Drugrelated. During Treatment
Drug Resistant Tuberculosis Self-reporting of Drugrelated Adverse Events During Treatment Introduction This information has been prepared for people with tuberculosis (TB) that is resistant to the commonly
More informationDoes Hemodialysis or Peritoneal Dialysis Provide a Better Quality of Life for Those with Chronic Kidney Disease? University of New Hampshire
Running head: QUALITY OF LIFE AMONG CKD PATIENTS Does Hemodialysis or Peritoneal Dialysis Provide a Better Quality of Life for Those with Chronic Kidney Disease? University of New Hampshire QUALITY OF
More informationWebEx Quick Reference
Session 2 Drs. Alvin Moss & David Weissman WebEx Quick Reference Welcome to today s session! Please use Chat to All Raise your hand Participants for questions For technology issues only, please Chat to
More informationJoseph S. Weiner, MD, PC Patient History Form
Date: / / NAME: Last First M. I. Age: Sex: q F q M Birthdate: / / What specific questions or goals do you have for this appointment? Please list the names of other clinicians you have seen for this problem:
More information>6,600 Patients per day receiving care in one of these hospices. Symptom Experience. Symptom Management and Quality of Life at the End of Life
Symptom Management and Quality of Life at the End of Life Susan C. McMillan, PhD, ARNP, FAAN Professor, College of Nursing Center for Hospice, Palliative Care and End of Life Studies at USF A coalition
More informationIssues in Clinical Measurement
Issues in Clinical Measurement MERMAID Series January 15, 2016 Galen E. Switzer, PhD Clinical and Translational Science Institute University of Pittsburgh What is Measurement? observation of people, clinical
More informationGuidelines for the psychological management of chronic kidney disease patients (for the Psychologist)
Indian J Nephrol 2005;15, Supplement 1: S103-S108 S 103 Guidelines for the psychological management of chronic kidney disease patients (for the Psychologist) Introduction With increasing levels of sophistication
More informationMedical condition SELF Mother Father Sibling (list brother or sister) Anxiety Bipolar disorder Heart Disease Depression Diabetes High Cholesterol
PRE-EVALUATION FORM Medical condition SELF Mother Father Sibling (list brother or sister) Anxiety Bipolar disorder Heart Disease Depression Diabetes High Cholesterol High Blood Pressure Obesity Heart Defect
More informationVCU CENTER FOR SLEEP MEDICINE NEW PATIENT QUESTIONNAIRE
VCU CENTER FOR SLEEP MEDICINE NEW PATIENT QUESTIONNAIRE Name:_ DOB: MR#: Date: Sex: Age: Height: Referring physician: Primary care physician: What is your primary sleep problem? Please explain any strange
More informationSymptoms in the Month Before Death for Stage 5 Chronic Kidney Disease Patients Managed Without Dialysis
342 Journal of Pain and Symptom Management Vol. 40 No. 3 September 2010 Original Article Symptoms in the Month Before Death for Stage 5 Chronic Kidney Disease Patients Managed Without Dialysis Fliss E.
More informationYour Health Survey. Forename: Surname: Renal Unit: Type of treatment: If HD, are you: Date of birth: Home Post Code: Date completed: NHS number:
Your Health Survey Why this questionnaire You may already have heard about renal units introducing health questionnaires. The purpose of these questionnaires is to find out how your kidney disease affects
More information725 Jesse Jewell Pkwy, Suite 390 Gainesville, GA (770) (770) (facsimile)
Charles Nash, III, M.D., F.A.C.P. Richard J. LoCicero, M.D. Anup K. Lahiry, M.D. Timothy M. Carey, M.D. Andrew Johnson, M.D. 725 Jesse Jewell Pkwy, Suite 390 Gainesville, GA 30501 (770) 297-5700 (770)
More informationMethodological Considerations in Using Patient Reported Measures in Dialysis Clinics. Acknowledgements
Methodological Considerations in Using Patient Reported Measures in Dialysis Clinics John D Peipert Ron D Hays Acknowledgements Funding for this work provided by the Kidney Care Quality Alliance 1 Patient
More informationInitial assessment of patients without cognitive failure admitted to palliative care: a validation study
Original Article Initial assessment of patients without cognitive failure admitted to palliative care: a validation study José António Ferraz Gonçalves 1, Clara Castro 2, Paula Silva 1, Rui Carneiro 1,
More informationResearch Article Evaluation of Physical Symptoms in Patients on Peritoneal Dialysis
International Nephrology Volume 2012, Article ID 305424, 4 pages doi:10.1155/2012/305424 Research Article Evaluation of Physical Symptoms in Patients on Peritoneal Dialysis Ana Elizabeth Figueiredo, 1
More informationMeeting the Guidelines for End-of-Life Care
Advances in Peritoneal Dialysis, Vol. 22, 2006 Gillian Brunier, David M.J. Naimark, Michelle A. Hladunewich Meeting the Guidelines for End-of-Life Care The number of patients initiating dialysis in most
More informationNivolumab. Other Names: Opdivo. About this Drug. Possible Side Effects (More Common) Warnings and Precautions
Nivolumab Other Names: Opdivo About this Drug Nivolumab is used to treat cancer. It is given in the vein (IV). Possible Side Effects (More Common) Bone marrow depression. This is a decrease in the number
More informationOriginal Article. Keywords: Gastrointestinal cancer; symptoms; chemotherapy (CTX); targeted therapy (TT)
Original Article Differences in symptom occurrence, severity, and distress ratings between patients with gastrointestinal cancers who received chemotherapy alone or chemotherapy with targeted therapy Ilufredo
More informationProblem Summary. * 1. Name
Problem Summary This questionnaire is an important part of providing you with the best health care possible. Your answers will help in understanding problems that you may have. Please answer every question
More informationChapter 5: Acute Kidney Injury
Chapter 5: Acute Kidney Injury Introduction In recent years, acute kidney injury (AKI) has gained increasing recognition as a major risk factor for the development of chronic kidney disease (CKD). The
More informationAmarillo Surgical Group Doctor: Date:
Office Visit Information (General Surgery) Amarillo Surgical Group Doctor: Date: Patient s Information Name: Last First Middle Social Security #: Date of Birth: Age Gender: [ Male / Female ] Marital Status:
More informationIt may be g iven to you for other reasons. Talk with the doctor. What do I need to tell my doctor BEFORE I take this drug?
PATIENT & CAREGIVER EDUCATION Bendamustine Brand Names: US Bendeka; Treanda Brand Names: Canada Treanda What is this drug used for? It is used to treat a type of leukemia. It is used to treat a type of
More informationCenter for Advanced Wound Care New Patient Questionnaire Page 1 of 6
Center for Advanced Wound Care New Patient Questionnaire Page 1 of 6 These questions are general screening questions designed to identify areas where additional attention may be required. Please bring
More informationNew Patient Medical History and Intake Form Medical Marijuana ( MMJ ) Certification
Name Social Security Number Address: Street: _ New Patient Medical History and Intake Form Medical Marijuana ( MMJ ) Certification Date of Birth Gender: Male Female City: State Zip Code E-mail: Home Phone:
More informationQuestionnaire for Lipedema Patients
Questionnaire for Lipedema Patients Name Date of diagnosis Date Name of physician making diagnosis Do you also have lymphedema? What areas of the body are affected? Outside of thighs Inner thighs Knees
More informationScottsdale Family Health
Please list pharmacy you would like us to use for your medications. Pharmacy Phone Number Fax Number Since your last visit: 1. Have you been diagnosed with any new medical conditions? Yes No If Yes (give
More informationExperience of Care and Quality of Life Quality of Life and Satisfaction with Care in Chronic Kidney Disease Focus on End-Stage Renal Disease
Experience of Care and Quality of Life Quality of Life and Satisfaction with Care in Chronic Kidney Disease Focus on End-Stage Renal Disease Paul L. Kimmel, MD Professor of Medicine Division of Renal Diseases
More informationMEDICAL QUESTIONNAIRE (male)
MEDICAL QUESTIONNAIRE (male) Slievemore Clinic, Old Dublin Road, Stillorgan, Co. Dublin. Tel 01-2000501/502 Fax: 01 2780248 The appointment comprises of a discussion about this questionnaire and a subsequent
More informationRHEUMATOLOGY PATIENT HISTORY FORM
!! RAMOS RHEUMATOLOGY, PC RHEUMATOLOGY PATIENT HISTORY FORM Date: / / NAME: Birthdate: / / Last First M. I. Age: Sex: F M Marital status: Never married Married Divorced Separated Widowed Partnered/significant
More informationAbstract. Introduction. Volume 54 Number 4 Oct. - Dec., Philippine Journal of Internal Medicine. Original Paper
Philippine Journal of Internal Medicine Original Paper A Comparison Between Dialysis Versus Conservative Management as Modes of Treatment in the Management of Elderly Patients with End Stage Renal Disease:
More informationHealth History. Tests and Procedures: Test: Date: Location: Provider: Abnormal: Results/Notes: Monthly self breast exam. Last mammogram (female)
Comprehensive Cancer Center A Cancer Center Designated by the National Cancer Institute Please answer the following questions and bring this form to your first appointment at Rutgers Cancer Institute of
More informationNew Patient Medical History Intake Form
New Patient Medical History Intake Form Name: Todays Date: / / Date of Birth: / / Age: Gender: M / F Marital Status: S M D W Address: City: State: Zip Code Primary Ph.# (cell, hm, wk) Email Address 2nd
More informationThe Limits of Harm Reduction? Neil McKeganey Centre for Substance Use Research West of Scotland Science Park Glasgow Scotland
The Limits of Harm Reduction? Neil McKeganey Centre for Substance Use Research West of Scotland Science Park Glasgow Scotland Principle of Harm Reduction First Do No Harm Hippocratic Oath I will use treatment
More informationA need for a palliative care program among hospitalized patients in the departments of internal medicine
בית הספר לרפואה של האוניברסיטה העברית והדסה בירושלים A need for a palliative care program among hospitalized patients in the departments of internal medicine Abstract Rinat Stern January, 2007 Background:
More informationPlease complete this questionnaire and bring it to your first appointment.
Please complete this questionnaire and bring it to your first appointment. Name: Date: DOB: Age: Legal Guardian if other than self Name of Person filling out form (if different than patient): What brought
More informationConservative Care Pathway: A Client-Centred Approach
2016 Conservative Care Pathway: A Client-Centred Approach Abbotsford Kidney Care Clinic October 7, 2016 Bobbi Preston, MSW, RCSW Jane Valcourt, RN Susan Cooper, MD, FRCP Goals of Session 1. Introduce the
More informationFor the Patient: Fludarabine injection Other names: FLUDARA
For the Patient: Fludarabine injection Other names: FLUDARA Fludarabine (floo-dare-a-been) is a drug that is used to treat many types of cancer. It is a clear liquid that is injected into a vein. Tell
More informationThe Rehabilitation Institute Cancer Rehabilitation
DO NOT DRILL The Rehabilitation Institute Cancer Rehabilitation STAR Patient Intake Form Your Name: Date: Your date of birth: Age: Who referred you (if a healthcare provider, please provide address)? Doctors
More informationSummary of the Risk Management Plan (RMP) V. 1.6, July 2017 for BAVENCIO. Avelumab 200 mg/10 ml. Concentrate for Solution for Infusion
Summary of the Risk Management Plan (RMP) V. 1.6, July 2017 for BAVENCIO Avelumab 200 mg/10 ml Concentrate for Solution for Infusion Marketing Authorisation Number 66380 Marketing Authorisation Holder:
More informationMEDICAL QUESTIONNAIRE (female)
MEDICAL QUESTIONNAIRE (female) Slievemore Clinic, Old Dublin Road, Stillorgan, Co. Dublin. Tel 01-2000501 The appointment comprises of a discussion about this questionnaire and a subsequent medical examination.
More informationPATIENT AGREEMENT TO SYSTEMIC ANTI- CANCER THERAPY:
PATIENT AGREEMENT TO SYSTEMIC ANTI- CANCER THERAPY: Cisplatin- Capecitabine- Trastuzumab PATIENT DETAILS PATIENT S SURNAME/FAMILY NAME: PATIENT S FIRST NAME(S): DATE OF BIRTH: NHS NUMBER: (or other identifier)
More informationDexamethasone is used to treat cancer. This drug can be given in the vein (IV), by mouth, or as an eye drop.
Dexamethasone Other Names: Decadron About This Drug Dexamethasone is used to treat cancer. This drug can be given in the vein (IV), by mouth, or as an eye drop. Possible Side Effects (More Common) Increased
More informationWELCOME TO THE NORTHSHORE UNIVERSITY HEALTHSYSTEM SLEEP CENTERS
WELCOME TO THE NORTHSHORE UNIVERSITY HEALTHSYSTEM SLEEP CENTERS Prior to your office visit, we request that you complete this questionnaire. It asks questions not only about your sleeping habits and behavior
More informationSymptom Questionnaire
Symptom Questionnaire The following questionnaire is a general assessment of your health developed by Dr Royal Lee D.D.S. Each grouping represents a particular area of your body that may be causing you
More informationEastern Shore MediCann Clinic, LLC
Eastern Shore MediCann Clinic, LLC New Patient Medical History and Intake Form Medical Marijuana Certification Name Date of Birth Social Security Number Gender: Male Female Address: Street: City: State
More informationVanderbilt University Autonomic Dysfunction Center Autonomic Dysfunction Questionnaire
Vanderbilt University Autonomic Dysfunction Center Autonomic Dysfunction Questionnaire Name: Date: Address: Phone number:( ) E-mail address: Birth date: / / Age: Sex: M F Height Weight Ethnic group: a.
More informationEmotional Relationships Social Life Sexually Recreation
Name Date Address City State Zip Married Single Partner Divorced Widowed Date of Birth SS# Email Work Phone Home Phone Cell Phone Occupation Referred by Emergency Contact Family Physician Contact May we
More informationHong Kong J Nephrol 1999;1(1): KL TONG, et al!"#$%&'()*+,-./ :;<qtkp!"#$%&'()!"#$%&'()*+,-./0
Self-care Hong Kong hemodialysis Journal of Nephrology program 1999;1(1):30-34. ORIGINAL A R T I C L E A pilot self-care hemodialysis program in a satellite dialysis center Kwok-Lung TONG 1, Lim-Lim KONG
More informationComparisons between hemodialysis (HD) and peritoneal
Hemodialysis and Peritoneal Dialysis: Patients Assessment of Their Satisfaction with Therapy and the Impact of the Therapy on Their Lives Erika Juergensen, Diane Wuerth, Susan H. Finkelstein, Peter H.
More information+ Color Change - + Hearing Loss - + Apnea - + Enuresis (urine - + Tremors - + Rash -
Review of Systems: 0-1 year old Constitution neg Eyes neg GI neg Neurological neg + Activity Change - + Eye Discharge - + Reflux - + Facial Asymmetry - + Appetite Change - + Eye Redness - + Vomiting -
More informationPatient History Form
Patient History Form Advanced Directive Care Plan? Yes No Name: Birth date: / / Address: Age: Sex: F M STREET DAY YEAR Telephone: Home ( ) CITY STATE DAY YEAR MARITAL STATUS: Divorced Separated Alive/Age
More informationPatient Education Kidney Early Education Program (KEEP) Chapter 2 bjectives: Overview 1. Understand what kidneys do. 2. Understand symptoms
Patient Education (KEEP) Chapter 2 What Your Kidneys Do And what happens when they fail Objectives: 1. Understand what kidneys do. 2. Understand symptoms of uremia and some ways to treat it. 3. Know the
More informationAddress Street Address City State Zip Code. Address Street Address City State Zip Code
Male Initial Visit Intake Form PATIENT INFORMATION Today s Date Last Name Mid Initial First Name Date of Birth Address Home Phone Social Security Number Street Address City State Zip Code Cell Phone E-mail
More informationPATIENT AGREEMENT TO SYSTEMIC ANTI- CANCER THERAPY:
PATIENT AGREEMENT TO SYSTEMIC ANTI- CANCER THERAPY: Axitinib PATIENT DETAILS PATIENT S SURNAME/FAMILY NAME: PATIENT S FIRST NAME(S): DATE OF BIRTH: NHS NUMBER: (or other identifier) HOSPITAL NAME/STAMP:
More informationTranslation and Psychometric Properties of the Persian Version of the Dialysis Symptom Index in Hemodialysis Patients
Nephro Urol Mon. 2015 January; 7(1): e23152. Published online 2014 December 15. DOI: 10.5812/numonthly.23152 Research Article Translation and Psychometric Properties of the Persian Version of the Dialysis
More informationPlease have your health insurance card(s), a valid picture ID, and any applicable copayment ready when you check-in.
Please have your health insurance card(s), a valid picture ID, and any applicable copayment ready when you check-in. We have enclosed a questionnaire for you to complete and bring to the visit. Please
More informationPATIENT AGREEMENT TO SYSTEMIC ANTI- CANCER THERAPY:
PATIENT AGREEMENT TO SYSTEMIC ANTI- CANCER THERAPY: Pazopanib PATIENT DETAILS PATIENT S SURNAME/FAMILY NAME: PATIENT S FIRST NAME(S): DATE OF BIRTH: NHS NUMBER: (or other identifier) HOSPITAL NAME/STAMP:
More informationClinical Trial Results with OROS Ò Hydromorphone
Vol. 33 No. 2S February 2007 Journal of Pain and Symptom Management S25 Advances in the Long-Term Management of Chronic Pain: Recent Evidence with OROS Ò Hydromorphone, a Novel, Once-Daily, Long-Acting
More informationPreparing for Your Immune Checkpoint Inhibitor (CPI) Treatment
Preparing for Your Immune Checkpoint Inhibitor (CPI) Treatment Overview What is the immune system? What are immune checkpoint inhibitors? What are the side effects to look out for? How are side effects
More informationEMORY SLEEP CENTER Sleep and Health Questionnaire
EMORY SLEEP CENTER Sleep and Health Questionnaire Demographics Today s Date: / / Name: Date of Birth: / / Address: Sex: Male Female City/State/Zip: Preferred Contact Number: Work Home Cell Occupation:
More informationConceptual and Practical Issues in Measurement Validity
Conceptual and Practical Issues in Measurement Validity MERMAID Series, December 10, 2010 Galen E. Switzer, PhD Clinical and Translational Science Institute VA Center for Health Equity Research and Promotion
More informationNovember Webinar Journal Club Aims. Session 2: Spiritual Screening - Using Just One Question
Session 2: Spiritual Screening - Using Just One Question APC Webinar Journal Club http://www.professionalchaplains.org/apcstore/productdetails.aspx?productid=apcwebwjc Webinar Journal Club Aims Substantive
More informationPatient Name: DOB: Age: Sex: Male Female Height: Weight: Dominant Hand: Right Left HISTORY OF PRESENT ILLNESS
CAPS PAINCARE Page 1 of 5 Today s : / / SSN (last 4 digits): xxx-xx - Patient Name: DOB: Age: Sex: Male Female Height: Weight: Dominant Hand: Right Left Type of Accident/Injury: Auto Work Personal Injury
More informationFor the Patient: Trastuzumab emtansine Other names: KADCYLA
For the Patient: Trastuzumab emtansine Other names: KADCYLA Trastuzumab emtansine (tras tooz' ue mab em tan' seen) is a drug that is used to treat some types of cancer. Trastuzumab emtansine is a clear
More informationOnly 50 years ago, patients diagnosed
The Multidimensional Characteristics of Symptoms Reported by Patients on Hemodialysis Continuing Nursing Education Anita Jablonski Only 50 years ago, patients diagnosed with irreversible renal disease
More informationFor the Patient: Bendamustine Other names: TREANDA
For the Patient: Bendamustine Other names: TREANDA Bendamustine (ben'' da mus' teen) is a drug that is used to treat some types of cancer (lymphoma). It is a clear liquid that is injected into a vein.
More informationTEXAS VASCULAR ASSOCIATES, P.A. PATIENT CLINICAL INTAKE FORM
TEXAS VASCULAR ASSOCIATES, P.A. PATIENT CLINICAL INTAKE FORM PATIENT NAME: DATE OF BIRTH: TVA Physician being seen: Date of Visit: PAST MEDICAL HISTORY HEART PROBLEMS NEUROLOGICAL Congestive Heart Failure
More informationINFORMATION ABOUT THE FATIGUE SYMPTOM INVENTORY (FSI) AND THE MULTIDIMENSIONAL FATIGUE SYMPTOM INVENTORY (MFSI)
INFORMATION ABOUT THE FATIGUE SYMPTOM INVENTORY (FSI) AND THE MULTIDIMENSIONAL FATIGUE SYMPTOM INVENTORY (MFSI) Prepared by Kevin D. Stein, Ph.D., and Paul B. Jacobsen, Ph.D. Moffitt Cancer Center and
More informationWhat You Need to Know About LEMTRADA (alemtuzumab) Treatment: A Patient Guide
For Patients What You Need to Know About LEMTRADA (alemtuzumab) Treatment: A Patient Guide Patients: Your doctor or nurse will go over this patient guide with you. It is important to ask any questions
More informationChanges Over Time in Occurrence, Severity, and Distress of Common Symptoms During and After Radiation Therapy for Breast Cancer
98 Journal of Pain and Symptom Management Vol. 45 No. June Original Article Changes Over Time in Occurrence, Severity, and Distress of Common Symptoms During and After Radiation Therapy for Breast Cancer
More informationFor the Patient: Olaparib tablets Other names: LYNPARZA
For the Patient: Olaparib tablets Other names: LYNPARZA Olaparib (oh lap' a rib) is a drug that is used to treat some types of cancer. It is a tablet that you take by mouth. Tell your doctor if you have
More informationPRODUCT MONOGRAPH. FLOCTAFENINE Floctafenine Tablets 200 mg and 400 mg THERAPEUTIC CLASSIFICATION. Anti-inflammatory, Analgesic
0 PRODUCT MONOGRAPH FLOCTAFENINE Floctafenine Tablets 200 mg and 400 mg THERAPEUTIC CLASSIFICATION Anti-inflammatory, Analgesic INFORMATION FOR THE PATIENT FLOCTAFENINE, which has been prescribed to you
More informationHeadache Follow-up Visit Form
!1 Headache Follow-up Visit Form We will be unable to see you unless this form is completely filled out. We appreciate your thoroughness. Name DOB Age Today s Date Referring doctor: Primary doctor: Neurologist:
More informationWhat Your Kidneys Do and What Happens When They Fail
Patient Education Chapter 2 Page 1 What Your Kidneys Do and What Happens When They Fail Objectives: 1. Understand basic kidney functions. 2. Understand symptoms of uremia and some treatments used for it.
More informationClient Name: Date: Birthdate: Age: Gender: F M Address: City State Zipcode phone # home: cell: work:
Client Name: : Birthdate: Age: Gender: F M Address: City State Zipcode e-mail: phone # home: cell: work: Thermogram Hx: type: initial ROI scan follow-up ROI scan initial fullbody scan follow-up fullbody
More informationPlease answer all questions in blue or black ink by filling in the blank or circling. SOCIAL HISTORY
PATIENT QUESTIONNAIRE / ASSESSMENT Endocrinology Form Please answer all questions in blue or black ink by filling in the blank or circling. SOCIAL HISTORY Date Phone (H) (W) (C) Age Male Female Marital
More informationREAD THIS FOR SAFE AND EFFECTIVE USE OF YOUR MEDICINE PATIENT MEDICATION INFORMATION. SYLVANT pronounced SILL-vant siltuximab for injection
READ THIS FOR SAFE AND EFFECTIVE USE OF YOUR MEDICINE PATIENT MEDICATION INFORMATION Pr SYLVANT pronounced SILL-vant siltuximab for injection Read this carefully before you start taking SYLVANT and each
More informationWhat is the most important information I should know about bortezomib? What should I discuss with my healthcare provider before receiving bortezomib?
1 of 5 6/10/2016 3:46 PM Generic Name: bortezomib (bor TEZ oh mib) Brand Name: Velcade What is bortezomib? Bortezomib interferes with the growth of some cancer cells and keeps them from spreading in your
More informationPATIENT AGREEMENT TO SYSTEMIC ANTI- CANCER THERAPY:
PATIENT AGREEMENT TO SYSTEMIC ANTI- CANCER THERAPY: Everolimus PATIENT DETAILS PATIENT S SURNAME/FAMILY NAME: PATIENT S FIRST NAME(S): DATE OF BIRTH: NHS NUMBER: (or other identifier) HOSPITAL NAME/STAMP:
More informationPATIENT MEDICAL HISTORY INTAKE FORM
Northgate Professional Center 1985 Main Street, Suite 209 Springfield, Massachusetts 01103 Tel; 413-455-1081 Fax; 413-391-7489 www.marimedconsults.com PATIENT MEDICAL HISTORY INTAKE FORM Patient Information:
More informationYOUR CABOMETYX HANDBOOK
YOUR CABOMETYX HANDBOOK AN OVERVIEW FOR PATIENTS AND CAREGIVERS in the full Prescribing Information. Table of Contents What s included in this handbook... 3 A kidney cancer overview...4 About CABOMETYX...4
More informationHeart failure (HF) patients are a rapidly emerging. Symptoms Experienced by Heart Failure Patients in Hospice Care. Symptom Management Series METHODS
Symptoms Experienced by Heart Failure Patients in Hospice Care Johanna Wilson, MSN ƒ Susan McMillan, PhD, ARNP, FAAN End-stage heart failure patients are a prevalent hospice population with unique symptoms.
More informationJ Am Soc Nephrol 14: , 2003
J Am Soc Nephrol 14: 2132 2141, 2003 Bias in Assessment of Health-Related Quality of Life in a Hemodialysis Population: A Comparison of Self-Administered and Interviewer-Administered Surveys in the HEMO
More informationSANTA MONICA BREAST CENTER INTAKE FORM
SANTA MONICA BREAST CENTER Who referred you to see us today? Who is your primary care physician? Are there any other MDs who you would like to receive today s visit information? No Yes MD contact info
More informationSoutheastern Rehabilitation Medicine Initial (New) Outpatient Information Questionnaire
Southeastern Rehabilitation Medicine Initial (New) Outpatient Information Questionnaire Name: MR#:_ Date: Date of Injury: Referred By: Age: Date of Birth: Handed: R L Ambidextrous Male Female **** Mark
More informationCOUPLE & FAMILY INSTITUTE OF TRI-CITIES AMEN ADULT GENERAL SYMPTOM CHECKLIST
COUPLE & FAMILY INSTITUTE OF TRI-CITIES AMEN ADULT GENERAL SYMPTOM CHECKLIST Please rate yourself on each symptom listed below. Please use the following scale: 0--------------------------1---------------------------2--------------------------3--------------------------4
More informationPATIENT INFORMATION Last Name: First Name: Middle: Date of Birth: EMERGENCY CONTACT INFORMATION PRIMARY INSURANCE INFORMATION
PATIENT INFORMATION Last Name: First Name: Middle: Date of Birth: Gender: SSN: Race: Marital Status: Address Line: City: State: Zip Code: Home Phone: Work Phone: Email Address: Cell Phone: Primary Care
More informationMultiple studies of prevalent patients who receive
Race, Gender, and Incident Dialysis Patients Reported Health Status and Quality of Life Nancy G. Kutner, Rebecca Zhang, and Donna Brogan Rehabilitation/Quality of Life Special Studies Center, United States
More informationPreventing Traumatic Brain Injury in Older Adults. U.S. Department of Health and Human Services Centers for Disease Control and Prevention
Preventing Traumatic Brain Injury in Older Adults U.S. Department of Health and Human Services Centers for Disease Control and Prevention Most of us worry about staying safe, healthy, and independent as
More informationSilver Child Development Center New Patient Questionnaire. Relation (circle) Biological Mother Stepmother Adoptive Mother
Silver Child Development Center New Patient Questionnaire Today s Date Mother s Name First Last Date of Birth Relation (circle) Biological Mother Stepmother Adoptive Mother Foster Mother Other Father s
More information