Journal of Hospice and Palliative Care

  • 제12권4호
  • /
  • Pages.177-193
  • /
  • 2009
  • /
  • 2765-3072(pISSN)
  • /
  • 2765-3080(eISSN)
한국호스피스완화의료학회 (Korean Society for Hospice and Palliative Care)
권호 표지

완화 의학에서의 평가도구

The Assessment Tools in Palliative Medicine

  • 곽정임 (성균관대학교 의과대학 삼성서울병원 가정의학과) ;
  • 서상연 (동국대학교 의과대학 일산병원 가정의학과)
  • Gwak, Jung-Im (Department of Family Medicine, Samsung Medical Center) ;
  • Suh, Sang-Yeon (Department of Family Medicine, Dongguk University Ilsan Hospital)
  • 발행 : 2009.12.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

완화의학에서 환자의 평가는 치료의 의사결정과 그 결과에 이르기까지 중요한 역할을 한다. 평가도구의 사용 목적은 이를 환자 진료에 반영하여 개개인 환자와 가족들에 대한 돌봄의 질을 높이는 데 있다. 환자의 기능 상태와 통증 및 비 통증 증상을 평가하는 다양한 단일 영역 및 다차원 평가 척도들이 사용 가능하며, 삶의 질을 측정하는 다양한 도구들이 존재한다. 삶의 질이나 증상 측정에서 우월하다고 추천되는 단일 도구는 없는 실정이다. 도구마다 측정하는 시간의 틀이 다르고, 특성이 다르므로 사용 목적과 상황에 따라 적절한 도구를 선택하여야 한다. 여명 예측을 위해서는 예후 지수의 병용이 권고되는 추세이고, 웹을 기반으로 하는 예측 프로그램들도 등장하였다. 예후지수로는 최근 우리나라에서 다기관 연구를 통해 개발한 객관적 예후지수가 임상적인 여명 예측을 포함하지 않으면서 새로운 객관적인 예후 요인을 반영하여, 누구나 쉽게 사용이 가능하다. 완화의학 입문자의 경우 상대적으로 사용이 용이한 도구가 좋다. 따라서 기능의 평가에는 Eastern Cooperative Oncology Group 기능지수를 사용하고, 통증에서는 10점만점의 숫자 통증 등급(Numeric Rating Scale) 도구를 활용하면서 초기 통증 평가로는 간이 통증 조사지를 추천한다. 여러 가지 증상을 한꺼번에 측정하기 위해서는 숫자 등급으로 직접 물어보거나 혹은 M.D. Anderson 증상조사지(the Korean version of MD Anderson Symptom Inventory) 설문지를 사용하기 바란다. 삶의 질을 평가하는데에는 European Organization Research and Treatment Quality of Life Questionnaire Core 15 for Palliative Care, 예후 지수로는 객관적 예후 지수(Objective Prognostic Score)를 사용하기를 권한다. 향후 완화의학에서 평가도구의 발전방향은 국제 공동 연구의 활성화와 디지털 기기를 통한환자 보고의 전산화이고, 머지않은 앞날에 우리나라에도 이러한 경향이 도입될 것이다.

The assessment of patient status in palliative medicine is essential for determining treatments and for clinical outcomes. The objective of assessment tools is to raise the quality of care for individual patients and their families. There are a number of tools available to assess pain, non-pain symptoms and quality of life. The tools are either uni-dimensional or multi-dimensional measures. Unfortunately, however, no single tool is recommended to be a superior to others in symptoms or quality of life assessment. Therefore, to select an appropriate assessment tool, one should consider the time frame and unique characteristics of tools depending on purpose and setting. The combination of prognostic index is highly recommended in prognostication, and web-based prognostic tools are available. Recently, a new objective prognostic score has been constructed through multicenter study in Korea. It does not include clinicalestimates of survival, but includes new objective prognostic factors, therefore, anyone can easily use it. For beginners in palliative medicine, relatively easy-to-use tools would be convenient. We recommend Eastern Cooperative Oncology Group performance status to assess functional status, numeric rating scale for pain assessment and the Korean version of brief pain inventory for initial pain assessment. Asking directly with numeric rating scale or the Korean version of MD Anderson Symptom Inventory would be desirable to assess various symptoms together. We think that European Organization Research and Treatment Quality of Life Questionnaire Core 15 for Palliative Care is good to assess the quality of life, while Objective Prognostic Score is convenient as prognostic index for beginners.

키워드

참고문헌

  1. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5(6):649-55. https://doi.org/10.1097/00000421-198212000-00014
  2. Glare P, Christakis N. Predicting survival in patients with advanced disease. In: Doyle D, Hanks GW, Cherny N, Calman K, eds. Oxford textbook of palliative medicine. 3rd ed. New York: Oxford University Press;2004. p. 32-4.
  3. Anderson F, Downing GM, Hill J, Casorso L, Lerch N. Palliative performance scale (PPS): a new tool. J Palliat Care 1996;12(1): 5-11.
  4. Davis MP, Walsh D. Cancer pain: how to measure the fifth vital sign. Cleve Clin J Med 2004;71(8):625-32. https://doi.org/10.3949/ccjm.71.8.625
  5. McCarberg B, Stanos S. Key patient assessment tools and treatment strategies for pain management. Pain Pract 2008;8(6):423-32. https://doi.org/10.1111/j.1533-2500.2008.00223.x
  6. von Baeyer CL. Children's self-reports of pain intensity: scale selection, limitations and interpretation. Pain Res Manag 2006;11(3): 157-62. https://doi.org/10.1155/2006/197616
  7. Lee JY, Ahn JS. Progress of cancer pain management in Korea. Oncology 2008;74 Suppl 1:4-6. https://doi.org/10.1159/000143211
  8. Yun YH, Mendoza TR, Heo DS, Yoo T, Heo BY, Park HA, et al. Development of a cancer pain assessment tool in Korea: a validation study of a Korean version of the brief pain inventory. Oncology 2004;66(6):439-44. https://doi.org/10.1159/000079497
  9. Choi YS, Kim SH, Kim JS, Lee J, Kang JH, Kim SY, et al. Change in patients' satisfaction with pain control after using the Korean cancer pain assessment tool in Korea. J Pain Symptom Manage 2006;31(6):553-62. https://doi.org/10.1016/j.jpainsymman.2005.10.008
  10. Choi YS, Lee JY, Park JN, Lee MA, Yeom CH, Jang SK. Reliability and Validity of the Evaluation of Korean Cancer Pain Assessment Tool (K-CPAT). Korean J Hosp Palliat Care 2003; 6(2):152-63.
  11. Jacobsen PB. Assessment of fatigue in cancer patients. J Natl Cancer Inst Monogr 2004;(32):93-7.
  12. Yun YH, Wang XS, Lee JS, Roh JW, Lee CG, Lee WS, et al. Validation study of the Korean version of the brief fatigue inventory. J Pain Symptom Manage 2005;29(2):165-72. https://doi.org/10.1016/j.jpainsymman.2004.04.013
  13. McMillan SC, Williams FA. Validity and reliability of the Constipation Assessment Scale. Cancer Nurs 1989;12(3):183-8. https://doi.org/10.1097/00002820-198906000-00012
  14. Bruera E, Suarez-Almazor M, Velasco A, Bertolino M, MacDonald SM, Hanson J. The assessment of constipation in terminal cancer patients admitted to a palliative care unit: a retrospective review. J Pain Symptom Manage 1994;9(8):515-9. https://doi.org/10.1016/0885-3924(94)90113-9
  15. Bausewein C, Booth S, Higginson IJ. Measurement of dyspnoea in the clinical rather than the research setting. Curr Opin Support Palliat Care 2008;2(2):95-9. https://doi.org/10.1097/SPC.0b013e3282ffafe8
  16. Lee YK, Yoon HS. Usefulness of modified borg scale in assessing dyspnea. Clinical Nursing Research 2004;10(2):173-85.
  17. Tanaka K, Akechi T, Okuyama T, Nishiwaki Y, Uchitomi Y. Development and validation of the Cancer Dyspnoea Scale: a multidimensional, brief, self-rating scale. Br J Cancer 2000;82(4): 800-5. https://doi.org/10.1054/bjoc.1999.1002
  18. Saxby C, Ackroyd R, Callin S, Mayland C, Kite S. How should we measure emesis in palliative care- Palliat Med 2007;21(5): 369-83. https://doi.org/10.1177/0269216307080173
  19. Kim YJ, Kim JY, Choi IR, Kim MW, Rhodes V. The index of nausea, vomiting, and retching (Korean Translation). J Korean Acad Adult Nurs 2000;12(2):278-85.
  20. Yun YH, Park YS, Lee ES, Bang SM, Heo DS, Park SY, et al. Validation of the Korean version of the EORTC QLQ-C30. Qual Life Res 2004;13(4):863-8. https://doi.org/10.1023/B:QURE.0000021692.81214.70
  21. Yun YH, Mendoza TR, Kang IO, You CH, Roh JW, Lee CG, et al. Validation study of the Korean version of the M. D. Anderson symptom inventory. J Pain Symptom Manage 2006;31(4):345-52. https://doi.org/10.1016/j.jpainsymman.2005.07.013
  22. Strasser F. Diagnostic criteria of cachexia and their assessment: decreased muscle strength and fatigue. Curr Opin Clin Nutr Metab Care 2008;11(4):417-21. https://doi.org/10.1097/MCO.0b013e3283025e27
  23. Frances A, First MB, Pincus HA, Widiger TA. DSM-IV: Diagnostic and statistical manual of mental disorders, Korean translation. 4th ed. Seoul:Hana Medical Publishing Co.;1995. p. 178-9.
  24. Lim KO, Kim SY, Lee YH, Lee SW, Kim JL. A validation study for the Korean version of delirium rating scale-revised-98 (KDRS- 98). J Korean Neuropsychiatr Assoc 2006;45(6):518-26.
  25. Kelly B, McClement S, Chochinov HM. Measurement of psychological distress in palliative care. Palliat Med 2006;20(8): 779-89. https://doi.org/10.1177/0269216306072347
  26. Shim EJ, Shin YW, Jeon HJ, Hahm BJ. Distress and its correlates in Korean cancer patients: pilot use of the distress thermometer and the problem list. Psychooncology 2008;17(6): 548-55. https://doi.org/10.1002/pon.1275
  27. Noorani NH, Montagnini M. Recognizing depression in palliative care patients. J Palliat Med 2007;10(2):458-64. https://doi.org/10.1089/jpm.2006.0099
  28. Oh SM, Min KJ, Park DB. A study on the standardization of the hospital anxiety and depression scale for Koreans: a comparison of normal, depressed and anxious groups. J Korean Neuropsychiatr Assoc 1999;38(2):289-96.
  29. Lee JH, Kim TS, Ko YH, Yoon SJ, Lyoo IK, Jun TY, et al. The standardization of the Korean version of brief edinburgh depression scale as a screening tool for depression in cancer patients. J Korean Soc Biol Psychiatry 2009;16(2):112-20.
  30. Kirkova J, Davis MP, Walsh D, Tiernan E, O'Leary N, LeGrand SB, et al. Cancer symptom assessment instruments: a systematic review. J Clin Oncol 2006;24(9):1459-73. https://doi.org/10.1200/JCO.2005.02.8332
  31. Granda-Cameron C, Viola SR, Lynch MP, Polomano RC. Measuring patient-oriented outcomes in palliative care: functionality and quality of life. Clin J Oncol Nurs 2008;12(1):65-77. https://doi.org/10.1188/08.CJON.65-77
  32. Mularski RA, Rosenfeld K, Coons SJ, Dueck A, Cella D, Feuer DJ, et al. Measuring outcomes in randomized prospective trials in palliative care. J Pain Symptom Manage 2007;34 Suppl 1:7-19. https://doi.org/10.1016/j.jpainsymman.2007.01.003
  33. Lua PL, Salek S, Finlay I, Lloyd-Richards C. The feasibility, reliability and validity of the McGill Quality of Life Questionnaire- Cardiff Short Form (MQOL-CSF) in palliative care population. Qual Life Res 2005;14(7):1669-81. https://doi.org/10.1007/s11136-005-2817-8
  34. Kyriaki M, Eleni T, Efi P, Ourania K, Vassilios S, Lambros V. The EORTC core quality of life questionnaire (QLQ-C30, version 3.0) in terminally ill cancer patients under palliative care: validity and reliability in a Hellenic sample. Int J Cancer 2001;94(1): 135-9. https://doi.org/10.1002/ijc.1439
  35. Park KU. Assessment of change of quality of life in terminally ill patients under cancer pain management using the EORTC Core Quality of Life Questionnaire (QLQ-C30) in a Korean sample. Oncology 2008;74 Suppl 1:7-12.
  36. Kim KU, Yoon SJ, Lee JL, Ahn HS, Park HJ, Lee SI, et al. Validation of the Korean version of the McMaster Quality of Life Scale in terminal cancer patients. J Palliat Care 2006;22(1):40-5.
  37. Kim SH, Choi YS, Lee J, Oh SC, Yeom CH, Lee MA, et al. Reliability and validity of the hospice quality of life scale for Korean cancer patients. J Pain Symptom Manage 2009;37(2):156- 67. https://doi.org/10.1016/j.jpainsymman.2008.02.008
  38. Kim SH, Gu SK, Yun YH, Lee CG, Choi YS, Lee WS, et al. Validation study of the Korean version of the McGill Quality of Life Questionnaire. Palliat Med 2007;21(5):441-7. https://doi.org/10.1177/0269216307079816
  39. Glare P, Virik K, Jones M, Hudson M, Eychmuller S, Simes J, et al. A systematic review of physicians' survival predictions in terminally ill cancer patients. BMJ 2003;327(7408):195-8. https://doi.org/10.1136/bmj.327.7408.195
  40. Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, et al. Prognostic factors in advanced cancer patients: evidence-based clinical recommendations-a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 2005;23(25):6240-8. https://doi.org/10.1200/JCO.2005.06.866
  41. Pirovano M, Maltoni M, Nanni O, Marinari M, Indelli M, Zaninetta G, et al. A new palliative prognostic score: a first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care. J Pain Symptom Manage 1999;17(4):231-9. https://doi.org/10.1016/S0885-3924(98)00145-6
  42. Glare P, Virik K. Independent prospective validation of the PaP score in terminally ill patients referred to a hospital-based palliative medicine consultation service. J Pain Symptom Manage 2001; 22(5):891-8. https://doi.org/10.1016/S0885-3924(01)00341-4
  43. Glare PA, Eychmueller S, McMahon P. Diagnostic accuracy of the palliative prognostic score in hospitalized patients with advanced cancer. J Clin Oncol 2004;22(5):4823-8. https://doi.org/10.1200/JCO.2004.12.056
  44. Maltoni M, Nanni O, Pirovano M, Scarpi E, Indelli M, Martini C, et al. Successful validation of the palliative prognostic score in terminally ill cancer patients. Italian Multicenter Study Group on Palliative Care. J Pain Symptom Manage 1999;17(4):240-7. https://doi.org/10.1016/S0885-3924(98)00146-8
  45. Morita T, Tsunoda J, Inoue S, Chihara S. The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients. Support Care Cancer 1999;7(3):128-33. https://doi.org/10.1007/s005200050242
  46. Lee IC, Kim CK, Suh SY, Kim YS, Cho KH, Kang HC, et al. Validation of scoring system for survival prediction in terminal cancer patients in Korea. J Korean Acad Fam Med 2007;28(9): 682-9.
  47. Suh SY, Choi YS, Shim JY, Kim YS, Yeom CH, Kim D, et al. Construction of a new, objective prognostic score for terminally ill cancer patients: a multicenter study. Support Care Cancer 2009. Epub 2009 Apr 21.
  48. Lau F, Downing GM, Lesperance M, Shaw J, Kuziemsky C. Use of Palliative Performance Scale in end-of-life prognostication. J Palliat Med 2006;9(5):1066-75. https://doi.org/10.1089/jpm.2006.9.1066
  49. Olajide O, Hanson L, Usher BM, Qaqish BF, Schwartz R, Bernard S. Validation of the palliative performance scale in the acute tertiary care hospital setting. J Palliat Med 2007;10(11): 111-7. https://doi.org/10.1089/jpm.2006.0125
  50. Downing M, Lau F, Lesperance M, Karlson N, Shaw J, Kuziemsky C, et al. Meta-analysis of survival prediction with Palliative Performance Scale. J Palliat Care 2007;23(4):245-52; discussion 252-4.