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Palliative sedation: reliability and validity of sedation scales.

Abstract：

CONTEXT:Observer-based sedation scales have been used to provide a measurable estimate of the comfort of nonalert patients in palliative sedation. However, their usefulness and appropriateness in this setting has not been demonstrated. OBJECTIVES:To study the reliability and validity of observer-based sedation scales in palliative sedation. METHODS:A prospective evaluation of 54 patients under intermittent or continuous sedation with four sedation scales was performed by 52 nurses. Included scales were the Minnesota Sedation Assessment Tool (MSAT), Richmond Agitation-Sedation Scale (RASS), Vancouver Interaction and Calmness Scale (VICS), and a sedation score proposed in the Guideline for Palliative Sedation of the Royal Dutch Medical Association (KNMG). Inter-rater reliability was tested with the intraclass correlation coefficient (ICC) and Cohen's kappa coefficient. Correlations between the scales using Spearman's rho tested concurrent validity. We also examined construct, discriminative, and evaluative validity. In addition, nurses completed a user-friendliness survey. RESULTS:Overall moderate to high inter-rater reliability was found for the VICS interaction subscale (ICC = 0.85), RASS (ICC = 0.73), and KNMG (ICC = 0.71). The largest correlation between scales was found for the RASS and KNMG (rho = 0.836). All scales showed discriminative and evaluative validity, except for the MSAT motor subscale and VICS calmness subscale. Finally, the RASS was less time consuming, clearer, and easier to use than the MSAT and VICS. CONCLUSION:The RASS and KNMG scales stand as the most reliable and valid among the evaluated scales. In addition, the RASS was less time consuming, clearer, and easier to use than the MSAT and VICS. Further research is needed to evaluate the impact of the scales on better symptom control and patient comfort.

journal_name

J Pain Symptom Manage

journal_title

Journal of pain and symptom management

authors

Arevalo JJ,Brinkkemper T,van der Heide A,Rietjens JA,Ribbe M,Deliens L,Loer SA,Zuurmond WW,Perez RS,AMROSE Site Study Group.

doi

10.1016/j.jpainsymman.2011.11.010

subject

Has Abstract

pub_date

2012-11-01 00:00:00

pages

704-14

issue

5

eissn

0885-3924

issn

1873-6513

pii

S0885-3924(12)00245-X

journal_volume

44

pub_type

杂志文章

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