MEASURING ONCOLOGY NURSING-SENSITIVE PATIENT OUTCOMES:
EVIDENCE-BASED SUMMARY
1. Outcome: Return to Usual Function
2. Cate...
5. Guidelines and standards:
The National Guideline Clearinghouse, the Nursing Outcomes Classification labels
and definiti...
3
6. Table(s) of tools to measure oncology nursing-sensitive patient outcome: Return to Usual Function
Table A:
No literat...
4
Name of tool Author/year Domains of factors # of
Items
Scaling Scoring Language
Barthel Index (Mahoney &
Barthel,
1965)
...
5
Name of tool Author/year Domains of factors # of
Items
Scaling Scoring Language
Erdman
(modified)
(Scranton,
Fogel, &
Er...
6
Table B:
Name of tool Populations* Reliability Validity Sensitivity Clinical Utility Comment
Brief Pain
Inventory (BPI)
...
7
Name of tool Populations* Reliability Validity Sensitivity Clinical Utility Comment
Sickness Impact
Profile
26 patients ...
8
Name of tool Populations* Reliability Validity Sensitivity Clinical Utility Comment
against the appropriate
therapist’s....
7. References related to instruments to measure outcome (as noted in 4 and 5
above)
Brief Pain Inventory:
http://www.stat....
Barthel Index:
http://www.neuro.mcg.edu/mcgstrok/Indices/Barthel_Ind.htm
Mahoney, F. I., & Barthel, D. W. (1965). Function...
8. Summary of key evidence and gaps in current evidence-base
A. Summary of key evidence that nursing interventions influen...
• Research is needed to evaluate the effect of oncology nursing
interventions aimed at maintaining, improving or restoring...
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DRAFT TEMPLATE AND INSTRUCTION: 8/11/03

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DRAFT TEMPLATE AND INSTRUCTION: 8/11/03

  1. 1. MEASURING ONCOLOGY NURSING-SENSITIVE PATIENT OUTCOMES: EVIDENCE-BASED SUMMARY 1. Outcome: Return to Usual Function 2. Category: Functional Status 3. Definition: Function is a complex concept that requires at least a dual approach to measurement (Richmond, Tang, Tulman, Fawcett, & McCorkle, 2004). Two dimensions should include functional ability and functional status. Functional ability is defined as the “actual or potential capacity to perform the activities and tasks normally expected of individuals” (p. 84). Functional status is defined as “an individual’s performance of activities and tasks associated with life roles” (p. 84). Further, function integrates biological, psychological and social domains (World Health Organization, 1998). Return to usual function implies that the patient with cancer demonstrates changes in functional ability and status during his or her experiences with the cancer trajectory, which he or she desires to regain. World Health Organization. (1998). The role of physical activity in healthy aging. Retrieved October 24, 2003, from The Role of Physical Activity in Healthy Aging Richmond, T., Tang, S. T., Tulman, L., Fawcett, J., & McCorkle, R. (2004). Measuring function. In M. Frank-Stromborg & S. J. Olsen (Eds.), Instruments for clinical health-care research (3rd ed., pp. 83–99). Boston: Jones and Bartlett. 4. Integrative reviews and meta-analyses: A literature search restricted to dates between 1/1/94–02/15/04 and to integrative review or meta-analysis and using the terms return to usual function, functional status, physical status, function, disability, activities of daily living, instrumental activities of daily living, or social reintegration in combination with the terms nursing or nursing outcomes, and cancer yielded no integrative reviews or meta-analyses. When terms related to nurses or nursing were removed, one article addressing functional outcomes for a cancer population and reporting itself to be a meta-analysis was identified. This article is more similar to an integrative review. It did not address return to usual function or oncology nurse contributions to this outcome. Davis, A. M. (1999). Functional outcome in extremity soft tissue sarcoma. Seminars in Radiation Oncology, 9, 360–368. PubMed Abstract 1
  2. 2. 5. Guidelines and standards: The National Guideline Clearinghouse, the Nursing Outcomes Classification labels and definitions, and the Nursing Intervention Classification labels and definitions databases were searched. There are no specific guidelines available that address returning patients with cancer to usual function. http://www.guideline.gov http://www.nursing.uiowa.edu/centers/cncce/noc/index.htm http://www.nursing.uiowa.edu/centers/cncce/nic/index.htm 2
  3. 3. 3 6. Table(s) of tools to measure oncology nursing-sensitive patient outcome: Return to Usual Function Table A: No literature was identified that directly defined or measured this outcome or included oncology nursing or nursing interventions. For the purposes of this project, instruments cited in Davis (1999) above were included. Name of tool Author/year Domains of factors # of Items Scaling Scoring Language Brief Pain Inventory (BPI) (Serlin, 1995) 1. Severity of pain 2. Impact of pain on physical and social function (activity, mood, leep)s 11 0–10 11-point numeric rating scale Pain score obtained by averaging all the items on the BPI Severity of pain: sum of four items Impact of pain: sum of seven items English, French, Philippine, Chinese Musculoskeletal Tumor Society Rating Scale (MSTS) (Enneking et al., 1987, 1993) Combines seven parameters to evaluate patient functioning after treatment: pain, range of motion, strength, joint stability, joint deformity, overall function, emotional acceptance of treatment 36 The score ratings range from 0–35. Can generate category ratings of poor, fair, good, or excellent The score is based on impairment ratings English Sickness Impact Profile (Bergner, Bobbit, & Pollard, 1976) Generic measure used to evaluate the impact of disease on physical and emotional functioning. Two domains containing 12 categories. 1. Physical: ambulation, mobility, body care, movement 2. Psychosocial: social interaction, communication, alertness, behavior, emotional behavior, sleep and rest, eating, home management, recreation and pastimes, employment 136 Yes/No Overall score, two domain scores, 12 category scores. Items are weighted according to a standardized weighting scheme. English, Arabic, Chinese (Hong Kong), Danish, Finnish, French, Dutch, German, Italian, Norwegian, Portuguese, Russian, Spanish, Swedish, Tamil, Thai Guidelines for translation are available from the Medical Outcomes Trust.
  4. 4. 4 Name of tool Author/year Domains of factors # of Items Scaling Scoring Language Barthel Index (Mahoney & Barthel, 1965) Categories of: feeding, transfers, grooming, toilet use, bathing, mobility, stairs, dressing, bowel control, and bladder control 10 0 or 5 points per item for bathing and grooming; 0, 5, or 10 points per item for feeding, dressing, bowel control, bladder control, toilet use, and stairs; 0, 5, 10, or 15 points per item for transfers and mobility. Scores obtained by direct observation, self-, family- or nurse reports English Katz Activities of Daily Living (Katz, Ford, Moskowitz, Jackson, & Jaffe, 1963) Bathing, dressing, toileting, transferring, continence, and feeding 6 0–1 0 = dependence (needs supervision, direction, personal assistance or total care) in the specified activity 1=independence (needs no supervision, direction or personal assistance) in the specified activity Score based on aggregate summary score. 6 = high (patient independent). 0 = low (patient very dependent) English Convery (Convery, Minteer, Amiel, & Connett, 1977) 1. Daily Living Skills: feeding, dress upper body, dress lower body, grooming, care of perineum, wash or bathe, and vocational activities 2. Mobility: supine to sitting, sitting to standing, transfer-toilet, transfer- tub, transfer-automobile, walk on level 50 yards, walk outdoors, up and down stairs, and wheelchair 10 yards 16 Items are scored as either 7, 4, 2, or 0 for all categories except for vocational, which is yes/no and scores are assigned either 2 or 0. Patient self-report of performance in the previous seven days. Summary scores can range from 0–100. Subscores can be obtained the two domains. Four classes of disability are created by summary scores: I = no, II = mild, III = moderate, and IV = severe English
  5. 5. 5 Name of tool Author/year Domains of factors # of Items Scaling Scoring Language Erdman (modified) (Scranton, Fogel, & Erdman, 1970) 1. Physical Factors: locomotion, transfer, elevation, feeding, dressing, grooming, bathing, bladder control, hand use, skin condition, medical and nursing requirements, and communication 2. Psychosocial Factors: degree of initiative, decision-making ability, acceptance of disability, social and avocational status, vocational status, family relationships, physical environment of the home, and degree of financial independence 27 Rating scale from best (I) to poorest (VII) level. Individual scores on 27 items. English Wexler (survey is unnamed) (Wexler, Eilber, & Miller, 1988) Functional abilities: pain, work and household duties, dressing, carrying objects, writing (if affected hand was writing hand), meal preparation, and satisfaction with postoperative course. Dominant hand changes, occupation pre- and post- treatment, reasons if any change in occupation, new problems/disease recurrence. 7 items Nine short answer or open- ended questions. Excellent, good, fair, or poor Qualitative reports No scoring. English
  6. 6. 6 Table B: Name of tool Populations* Reliability Validity Sensitivity Clinical Utility Comment Brief Pain Inventory (BPI) Adult patients with metastatic cancer and pain from the U. S. (n = 1,106 inpatient and outpatient), France (n = 324 cancer treatment sites), China (n = 200 cancer treatment hospitals), and the Philippines (n = 267 no site provided) No demographic information provided (Serlin, 1995) Internal consistency of interference items across three levels of pain for each country. Coefficient ranges: Mild = 0.8694–0.9139 Moderate = 0.8368– 0.8789 Severe = 0.7953– 0.8910 Criterion validity for cut points in pain severity F-Ratios were highest for boundaries of 1–4 mild, 5–6 moderate, and 7–10 severe. No data available Evaluated “Pain Worst” because it is used in clinical situations to determine types of treatment. Illuminates how pain interferes with function. The use of a numerical rating scale reduced the need for translation. Musculoskeletal Tumor Society Rating Scale (MSTS) 1987 version 97 adult patients treated for lower extremity sarcoma (surgery alone or in combination with adjuvant therapy (Davis et al., 1999) Internal consistency: Chronbach’s alpha = 0.81 Ability to detect change Effect size range = 0.09–0.52 No data provided Poor choice for monitoring patients in practice or research settings because there is no conceptual basis for the definition of function it purports to measure and reflects the clinicians’ perceptions rather than the patients’. Musculoskeletal Tumor Society Rating Scale (MSTS) 1993 version 97 adult patients treated for lower extremity sarcoma (surgery alone or in combination with adjuvant therapy (Davis et al., 1999b) Internal consistency: Chronbach’s alpha = 0.91 Ability to detect change Effect size range = 0.29–0.52 No data provided Poor choice for monitoring patients in practice or research settings because there is no conceptual basis for the definition of function it purports to measure and reflects the clinicians’ perceptions rather than the patients’.
  7. 7. 7 Name of tool Populations* Reliability Validity Sensitivity Clinical Utility Comment Sickness Impact Profile 26 patients undergoing limb preservation surgery for soft tissue sarcoma (Sugarbaker, Barofsky, Rosenberg, & Gianola, 1982) Test-retest r = 0.938 No data available No data available Complex scoring Barthel Index 26 patients undergoing limb preservation surgery for soft tissue sarcoma (Sugarbaker, Barofsky, Rosenberg, & Gianola, 1982) Test-retest r = 0.938 No data available No data available Katz Activities of Daily Living 26 patients undergoing limb preservation surgery for soft tissue sarcoma (Sugarbaker, Barofsky, Rosenberg, & Gianola, 1982) Test-retest r = 0.938 No data available No data available Convery 40 patients who underwent limb preservation surgery for soft tissue sarcoma two years prior to the study (Lampert, Gerber, Glatstein, Rosenberg, & Danoff, 1984) No data available No data available No data available Erdman (modified) 54 adult patients following conservation treatment of soft tissue sarcoma (Robinson, Spruce, Eeles, Fryatt, Harmer, Thomas, & Westbury, 1991), 186 patients discharged from a rehabilitation hospital. Patients had a variety of diagnoses (Scranton, Fogel, & Erdman, 1970) Not tested for reliability Not tested for reliability Not tested for validity The validity of the senior author’s judgment on each variable was checked Not tested for sensitivity Not tested for sensitivity
  8. 8. 8 Name of tool Populations* Reliability Validity Sensitivity Clinical Utility Comment against the appropriate therapist’s. Close agreement was found in most cases. Wexler 26 patients, aged 15-74 years, treated for soft tissue sarcoma and treated with limb salvaging protocols (Wexler, Eilber, & Miller, 1988). Not tested for reliability Not tested for validity Not tested for sensitivity Authors felt that only patients’ subjective responses were appropriate measures of final functional result. **Note: Literature searches were conducted using PubMed, OVID, CancerLit, CINAHL, and Cochrane Library. The basic search terms (functional status, physical status, function, disability, activities of daily living, instrumental activities of daily living, social reintegration) mainly produced literature related to quality of life, symptom management, and self-care.
  9. 9. 7. References related to instruments to measure outcome (as noted in 4 and 5 above) Brief Pain Inventory: http://www.stat.washington.edu/TALARIA/attachb1.html Cleeland, C., & Ryan, K. (1994). Pain assessment: Global use of the Brief Pain Inventory. Annals of Academic Medicine Singapore, 23, 129–138. Daut, R., Cleeland, C., & Flanery, R. (1983). Development of the Wisconsin brief pain questionnaire to assess pain in cancer and other diseases. Pain, 17, 197–210. Serlin, R. C, Mendoza, T. R., Nakamura, Y., Edwards, K. R, & Cleeland, C. S. (1995). When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain, 61(2), 277–284. Musculoskeletal Tumor Society Rating Scale: Not available online. Davis, A. M., Bell, R. S., Badley, E. M., Yoshida, K., & Williams, J. I. (1999). Evaluating functional outcome in patients with lower extremitysarcoma. Clinical Orthopaedics and Related Research, 1(358), 90–100. Enneking, W. (1987). Modification of the system for functional evaluation in the surgical management of musculoskeletal tumors. In W. Enneking (Ed.), Limb Salvage in Musculoskeletal Oncology (pp. 626–639). New York: Churchill Livingstone. Enneking, W. F., Dunham, W., Gebhardt, M. C., Malawar, M., & Pritchard, D. J. (1993). A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clinical Orthopaedics, 286, 241–246. Sickness Impact Profile: http://www.qolid.org/public/SIP.html http://www.atsqol.org/sick.asp Bergner, M., Bobbit, R. A., Kressel, S., Pollard, W., Gilson, B., & Morris, J. (1976). The Sickness Impact Profile: Conceptual formulation andmethodology for the development of a health status measure. International Journal of Health Services, 6, 393–415. Bergner, M., Bobbit, R. A., & Pollard, W. (1976). The Sickness Impact Profile: Validation of a health status measure. Medical Care, 14, 57–67. Bergner, M., Bobbitt, R. A., Carter, W. B., & Gilson, B. S. (1981). The Sickness Impact Profile: Development and final revision of a health status measure. Medical Care, 19, 787–805. Sugarbaker, P. H., Barofsky, I., Rosenberg, S. A., & Gianola, F. J. (1982). Quality of life assessment of patients in extremity sarcoma clinical trials. Surgery, 91(1), 17–2 9
  10. 10. Barthel Index: http://www.neuro.mcg.edu/mcgstrok/Indices/Barthel_Ind.htm Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14, 61–65. Sugarbaker, P. H., Barofsky, I., Rosenberg, S. A., & Gianola, F. J. (1982). Quality of life assessment of patients in extremity sarcoma clinical trials. Surgery, 91(1), 17–23 Katz Activities of Daily Living: http://www.hartfordign.org/publications/trythis/issue02.pdf Katz, S., Ford, A., Moskowitz, R., Jackson, B., & Jaffe, M. (1963). Studies of illness in the aged. The Index of ADL: A standardized measure of biological and psychosocial function. Journal of the American Medical Association, 185, 914–919. Katz, S., & Akpom, C. A. (1976). A measure of primary sociobiological functions. International Journal of Health Services, 6, 493–507. Sugarbaker, P. H., Barofsky, I., Rosenberg, S. A., & Gianola, F. J. (1982). Quality of life assessment of patients in extremity sarcoma clinical trials. Surgery, 91(1), 17–23 Convery: Not available online. Convery, F., Minteer, M., Amiel, D., & Connett, K. (1977). Polyarticular disability: A functional assessment. Archives of Physical Medicine and Rehabilitation, 58, 494–499. Lampert, M. H., Gerber, L. H., Glatstein, E., Rosenberg, S. A., & Danoff, J. V. (1984). Soft tissue sarcoma: Functional outcome after wide local excision and radiation therapy. Archives of Physical Medicine and Rehabilitation, 65, 477–480. Erdman (modified): Not available online. Robinson, M. H., Spruce, L., Eeles, R., Fryatt, I., Harmer, C. L., Thomas, J. M., & Westbury, G. (1991). Limb function following conservation treatment of adult soft tissue sarcoma. European Journal of Cancer, 27, 1567–1574. Scranton, J., Fogel, M., & Erdman, W. (1970). Evaluation of functional levels of patients during and following rehabilitation. Archives of Physical Medicine and Rehabilitation, 51, 1–21. Wexler (unnamed instrument) Wexler, A. M., Eilber, F. R., & Miller, T. A. (1988). Therapeutic and functional results of limb salvage to treat sarcomas of the forearm and hand. Journal of Hand Surgery, 13A, 292–296. 10
  11. 11. 8. Summary of key evidence and gaps in current evidence-base A. Summary of key evidence that nursing interventions influence return to usual function • Research has identified function as an important area in the outcomes of patients with cancer. • Return to usual function is conceptually unclear and may be embedded in research related to the quality of life, symptom management, or self- care of patients with cancer. • Research has identified that function is related to symptom management. • Return to usual function has largely been ignored in cancer research, although function is clinically important and possibly directly related to nursing care via symptom management. • No meta-analyses or integrative reviews of cancer nursing interventions to promote return to usual function were identified. • No single studies of cancer nursing interventions designed to influence the return to usual function of patients with cancer were identified. B. Gaps in current evidence base No studies were identified that evaluated oncology nurse interventions targeted at returning patients with cancer to usual function. 1. Prevalence and patterns 2. Assessment/measurement 3. Mechanisms/etiology 4. Correlates 5. Management/nursing interventions 6. Diverse populations 9. Recommendations 1. Practice • No practice recommendations can be made because of lack of evidence. 2. Education • No educational recommendations can be made because of lack of evidence. 3. Research • Research is needed to develop the concept of return to usual function 11
  12. 12. • Research is needed to evaluate the effect of oncology nursing interventions aimed at maintaining, improving or restoring usual function among cancer patients. 10. Links No links are available. 11. Current research related to return to usual function ONS Foundation-funded research http://www.ons.org/research/funding/Projects/index.shtml “Physical Activity in Young Adult Survivors of Childhood Cancer”, Lorna Finnegan, PhD, RN, St. Xavier University “Sleep, Fatigue, and Enhanced Activity in Children with Cancer”, Pamela S. Hinds, PhD, RN, CS, St. Jude Children’s Research Hospital National Institutes of Health-funded research http://crisp.cit.nih.gov/ Authors: Meg Bourbonniere, PhD, RN, Assistant Professor of Community Health (Research), Center for Gerontology and Health Care Research, Brown University Nina Sutherland, RN, MS, Research Assistant, Center for Gerontology and Health Care Research, Brown University Last updated: May 13, 2004 12

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