Finalising the administration of co-SSPedi, a dyad approach to symptom screening for paediatric patients receiving cancer treatments

ObjectivesSymptom Screening in Pediatrics Tool (SSPedi) is a validated self-report symptom screening tool for patients with cancer 8–18 years of age. Co-SSPedi is a novel dyad approach in which both child and parent complete SSPedi together. The objective was to finalise the approach to co-SSPedi administration with instruction that is easy to understand, resulting in dyads completing co-SSPedi correctly.MethodWe enrolled child and parent dyads, who understood English and where children (4–18 years) had cancer or were hematopoietic stem cell transplantation recipients. We provided each dyad with instruction on how to complete co-SSPedi together. Mixed methods were used to determine how easy or hard the instruction was to understand. Two raters adjudicated if co-SSPedi was completed correctly. Dyads were enrolled in cohorts of 12 evenly divided by age (4–7, 8–10, 11–14 and 15–18 years).ResultsWe enrolled 5 cohorts of 12 dyads, resulting in 60 dyads. Following verbal instruction provided in the first cohort, we identified the need for written instruction emphasising children should wait for parent response prior to entering scores. The instruction was iteratively refined based on qualitative feedback until the fifth cohort, where all 12 dyads found the instruction easy to understand and completed co-SSPedi correctly.ConclusionsWe developed a standard approach to dyad symptom screening named co-SSPedi with instruction that is easy to understand, resulting in correct co-SSPedi completion. Future efforts should focus on co-SSPedi validation and understanding how co-SSPedi scores compare to self- or proxy-reported symptom reporting.

Evaluation of Health Care Professional Response To Patient-Reported Distress In Gynecologic Oncology Clinics At An Academic Cancer Centre

Objective: To evaluate health care professional (HCP) documentation of elevated patient-reported symptoms and subsequent intervention in gynecologic oncology clinics. Methods: This was a retrospective chart review of gynecologic oncology patients within a single institution. Prior to their clinical encounter, patients complete the validated Edmonton Symptom Assessment System revised (ESAS-r) questionnaire. Patients with any ESAS-r symptom score ≥4 (moderate-severe) were eligible for analysis. A stratified sampling method was used: 100 patients were randomly selected with 20 patients per year from 2012 to 2016. Patient, tumor and treatment characteristics were extracted from medical records. Health care provider (HCP) documentation of elevated symptoms and subsequent intervention were evaluated. Descriptive statistics were used to report symptom prevalence, HCP documentation and intervention. Fisher’s exact test evaluated documentation and intervention rates according to symptom severity and total ESAS-r score. Results: Between January 2012 and December 2016, 5849 patients completed the ESAS-r. Symptoms scores were ≥ 4 in 3216 patients (55%). In our sample of 100, ovarian (42%) and endometrial (34%) malignancies were most common. Median age was 55 years (range 47-63). Median ESAS-r score was 24 (range: 5-84), with tiredness being the most prevalent symptom reported by patients. HCP documented at least one elevated symptom in 50 patients (50%), most commonly for pain (71%) and least commonly for nausea (4%). Subsequent interventions were offered to only 32 patients (32%), most commonly for pain (56%). Higher median total ESAS-r score was associated with higher rate of documentation (p=0.004) and higher rate of intervention (p<0.001). Conclusions: A significant proportion of gynecologic oncology patients report symptom that should prompt an intervention. However, HCPs documented symptoms in only half of patients and reported interventions in only one third. These results highlight gaps and opportunities for improving symptom screening and response in the “real-world” setting.

Symptom Burden of Patients with Advanced Pancreas Cancer (APC): A Provincial Cancer Institute Observational Study

Patients with advanced pancreatic cancer (APC) experience many disease-related symptoms. ESAS-r measures the severity of 9 symptom domains and has been validated for use in the ambulatory oncology setting. We aimed to describe symptom burden at baseline for patients with APC treated with modern chemotherapy (CT), and to determine whether symptom burden at baseline is prognostic. Patients diagnosed with APC between 2012–2016, treated with ≥1 cycle of CT, who completed ≥1 ESAS-r were identified. Descriptive statistics were used to report symptom burden and common moderate-to-severe symptoms. A joint model was used to describe the trajectory of ESAS-r during follow-up while controlling for death. Multivariable Cox regression was used to identify independent predictors of death. Of 123 patients identified, the median age was 65 and 61% had metastatic disease. The median baseline ESAS-r total symptom distress score (TSDS) was 24. A total of 86% of patients had at least one symptom score of ≥4 at baseline, with the most common being: fatigue, nausea, anxiety, and shortness of breath. Median overall survival was 10.2 months. Baseline TSDS was not predictive for worse survival in the era of modern CT. Patients with APC have a high burden of cancer-associated symptoms and a high prevalence of moderate-to-severe symptoms. Early intervention has the potential to improve quality of life in this group of patients and should be investigated.

DIVERGENT INTERPRETATION OF POST-CONCUSSIVE SYMPTOMS BETWEEN PARENT AND CHILD

Background: Self-report symptom scales are often given to both parents and the injured child to rate a child’s symptoms following concussion. Previous research has shown that individual symptom reporting may not reflect agreement between parent and child. While total calculated scores may reflect agreement, looking at the total number of items reported may provide more insight into consistency between parent and child symptom rating following concussion. Purpose/Hypothesis: To evaluate the degree of divergence in post-concussive symptom reporting between parent and child. It was hypothesized the parent would endorse their child as having more symptoms following their concussion than self-reported by the child. Methods: The concussed child and their parent completed the Post-Concussion Symptom Inventory (PCSI), a self-reported concussion symptom scale to document symptoms related to the injury. The concussed child completed the age-appropriate version (8-12 years-old or 13-18 years-old) of the PCSI while the parent reported their perception of symptoms experienced by the child. The parent version of PCSI has 26 items, the adolescent version has 25 items, and the child version has 23 items. The total number of symptoms endorsed were calculated by recoding each symptom as a 0 or 1 variable to account for the item differences on the scales. A difference in total items reported, between parent and child as well as parent and adolescent PCSI, were calculated. Results: A total of 36 patients, 15 males and 21 females aged 8-18 (13.8±12.1 years), filled out the PCSI with 10 patients filling out the 8-12 years-old version and 26 filling out the 13-18 years-old version. The 10 parents of children ages 8-12, endorsed 2.9±2.7 more concussion symptoms. Of the 26 parents to adolescents ages 13-18, 1.08±6.28 more concussion symptoms were reported. Conclusion: Current results suggest the parents endorse their child experiencing more symptoms following their concussion than what is self-reported by the child. A future study to investigate the impact of parents’ elevated PCSI score(s) (i.e. total score or endorsed items) when compared to patient’s duration of recovery is recommended. This research would provide more comprehensive guidelines for recovery by means of patient and parent education.

How Plausible Is the Implausible? Students’ Plausibility and Prevalence Ratings of the Self-Report Symptom Inventory

Some self-report symptom validity tests, such as the Self-Report Symptom Inventory (SRSI), rely on a detection strategy that uses bizarre, extreme, or very rare symptoms. Thus, items are constructed to invite respondents with an invalid response style to affirm pseudosymptoms that are usually not experienced by genuine patients. However, these pseudosymptoms should not be easily recognizable, because otherwise sophisticated over-reporters could strategically avoid them and go undetected. Therefore, we tested how well future psychology professionals were able to differentiate between genuine complaints and pseudosymptoms in terms of their plausibility and prevalence.Psychology students (N = 87) received the items of the SRSI online and were given the task to rate each item as to its plausibility and prevalence in the community.Students evaluated genuine symptoms as significantly more plausible and more prevalent than pseudosymptoms. However, 56% of students rated pseudosymptoms as moderately plausible, whereas 17% rated them as moderately prevalent in the general public.Overall, it appears that psychology students are successful in distinguishing bizarre, unusual, or rare symptoms from genuine complaints. Yet, the majority of students still attributed relatively high prima facie plausibility to pseudosymptoms. We contend that if such a trusting attitude is true for psychology students, it may also be the case for young psychology practitioners, which, consequently, may diminish the probability of employing self-report validity measures in psychological assessments.

COVID-19 symptom frequency comparison: non-hospitalised positively and negatively tested persons with flu-like symptoms in Austria

Background A large number of studies report COVID-19 symptom frequencies but most studies focus on hospitalized patients. Therefore reported symptom frequencies vary and their applicability to the general population is limited. Here we report COVID-19 symptom frequencies for the general population of a central European country. Methods In a collaboration between the Vienna Social Fund (FSW) and the AI-biotech company Symptoma we report symptom frequencies based on the COVID-19 chatbot of the city government of Vienna and corresponding PCR-test results. Chatbot users answered 13 yes/no questions about symptoms and provided information about age and sex. Subsequently a medically trained professional came to their address to take a sample and PCR results were obtained. Findings Between November 2 and January 5, a total of 3011 persons experiencing flu-like symptoms had a PCR-test by a medical professional at home and completed the chatbot session prior to the test, 816 (27.1%) of them were COVID-19 positive. We compared the symptom frequencies between COVID-19 positive and negative users, and between male and female users. The symptoms (sorted by frequency) of users with positive PCR-test are malaise (81.1%), fatigue (72.9%), headache (64.1%), cough (57.7%), fever (50.7%), sore throat (40.7%), close contact with COVID-19 cases (34.9%), rhinorrhea (31.0%), sneezing (28.4%), dysgeusia (27.1%), hyposmia (26.5%), dyspnea (11.4%) and diarrhea (10.9%). Among these, cough, fever, hyposmia, dysgeusia, malaise, headache, close contact with COVID-19 case and fatigue are significantly (P < 0.01) increased in COVID-19 positive persons while dyspnea, diarrhea and sore throat are significantly (P < 0.01) decreased in COVID-19 positive persons. There was no significant difference for rhinorrhea and sneezing.

Testing of Journal Writing for Symptom Concordance in Adults with Multiple Sclerosis

Background: Adults with multiple sclerosis (MS) experience many complex symptoms. However, research is lacking on the best method to record their symptom experience. The primary goal of this study was to test the feasibility of journal writing to capture the description of core symptoms experienced by adults with MS. A secondary goal was to collect self-report symptom data to assess concordance between the journal entries and MS-Related Symptom Checklist (MS-RS) scores. Methods: A pre-selected group of participants (n = 5) from the total sample of 16 participants with MS were asked to complete the revised MS-RS and Web-based journal writing for 20 minutes per day for 4 consecutive days over a 4-week period. Feasibility was evaluated by journal completion rates. Results: Most participants found journal writing acceptable as a method for writing about symptoms. Participants were able to write about symptoms that formed clusters: unpredictable physical alterations and unpredictable sensory and emotional changes. Likewise, participants reported frequent fatigue, difficulty sleeping, heat intolerance, and difficulty concentrating/cognitive problems from the revised MS-RS. Disconcordance between revised MS-RS data and journal entries included lack of disclosure of difficulty sleeping and “pins and needles” in the journals. Conclusions: Preliminary findings from this study provide the personal perspectives of core symptoms experienced by adults with MS. These results provide preliminary evidence of the feasibility of journal writing, along with self-report survey, to describe symptoms in adults with MS.

The Symptom Structure of Postdisaster Major Depression: Convergence of Evidence from 11 Disaster Studies Using Consistent Methods

Agreement has not been achieved across symptom factor studies of major depressive disorder, and no studies have identified characteristic postdisaster depressive symptom structures. This study examined the symptom structure of major depression across two databases of 1181 survivors of 11 disasters studied using consistent research methods and full diagnostic assessment, addressing limitations of prior self-report symptom-scale studies. The sample included 808 directly-exposed survivors of 10 disasters assessed 1–6 months post disaster and 373 employees of 8 organizations affected by the September 11, 2001 terrorist attacks assessed nearly 3 years after the attacks. Consistent symptom patterns identifying postdisaster major depression were not found across the 2 databases, and database factor analyses suggested a cohesive grouping of depression symptoms. In conclusion, this study did not find symptom clusters identifying postdisaster major depression to guide the construction and validation of screeners for this disorder. A full diagnostic assessment for identification of postdisaster major depressive disorder remains necessary.

The Self-Report Symptom Inventory as an Instrument for Detecting Symptom Over-Reporting

The recently developed Self-Report Symptom Inventory (SRSI) intends to provide an alternative approach to the detection of symptom over-reporting. Unlike other measures, the SRSI includes both non-existent symptoms (i.e., pseudosymptoms) and genuine symptoms. Previous research using the German SRSI showed that people who exaggerate their complaints over-endorse both types of symptoms. In the current simulation experiment, we tested whether the Dutch and English SRSI are effective in identifying over-reporting by comparing SRSI scores of an honest group ( n = 51) with those of two experimental simulator groups (pain, n = 54; anxiety, n = 53). The pain and anxiety simulators endorsed significantly more genuine symptoms and pseudosymptoms than honest participants (ηp2 = .50 and ηp2 = .30, respectively). Furthermore, pain and anxiety over-reporters specifically over-endorsed symptoms corresponding to their simulation instructions (Cohen’s ds > 0.77). Using the recommended cut-off score, the SRSI detected 48% of pain over-reporters and 73% of anxiety over-reporters, with areas under the curve (AUC) ranging from .88 to .91. These results indicate that the SRSI is a promising tool for identifying over-reporting, but further research with clinical samples is needed.