Validation of a Tool for the Assessment of Discomfort in Patients With Impaired Cognition in Palliative Care

BackgroundIdeally, patients should self-report their symptoms. However, when this is not possible due to cognitive impairment, discomfort must be assessed through observation of the patient's behavior. To the best of our knowledge, there are no tools for such assessment in palliative care.MethodsA scale (Discomfort Scale for Palliative Care - DISPAC) was developed in 4 levels based on the frequency of signs of discomfort. The scale underwent face validity by 8 doctors and nurses experienced in palliative care. After that, DISPAC was compared with the DS-DAT and the VAS for construct validity using Spearman's ρ. The comparison was made by 4 observers: 2 for DISPAC (DISPAC1 and DISPAC2), 1 for DS-DAT, and 2 for VAS. The intraclass correlation coefficient was used to measure the degree of consistency between raters, and Cronbach's α was used to assess the internal consistency.ResultsThe results of the face validity were as follows: the scale measures what it is intended to measure; the scale is useful for clinical practice; the scale can improve communication among healthcare professionals; and the scale is easy to use. The internal consistency was 0.95. The inter-rater reliability was also 0.95 (<i>P</i> < 0.001). The correlation coefficients between DISPAC1 and DISPAC2 and the VAS were 0.712 (<i>P</i> < 0.001) and 0.723 (<i>P</i> < 0.001), respectively. The correlation with the DS-DAT was 0.689 (<i>P</i> < 0.001) and 0.615 (<i>P</i> < 0.001), respectively.ConclusionDISPAC is a valid and reliable scale for assessing discomfort in patients who are unable to report it.