Symptom assessment in hospitalized older palliative patients with cancer: agreement among patients, nurses, and proxies.

PURPOSE/OBJECTIVES To evaluate the level of agreement of symptom assessment among older adult palliative patients with cancer, nurses, and patients' proxies.
 DESIGN A cross-sectional study.
 SETTING Two general hospitals in Flanders, Belgium.
 SAMPLE 120 palliative patients with cancer, aged 65 years and older.
 METHODS A validated 36-item instrument developed to assess physical, psychological, functional, social, and existential symptoms in older palliative patients with cancer was independently completed by patients, the nurses, and proxies.
 MAIN RESEARCH VARIABLES Frequency and intensity of 36 symptoms.
 FINDINGS The study indicates that nurses and proxies tend to underestimate physical and social symptoms and overestimate psychological, functional, and existential symptoms. Agreement scores between patients and nurses and patients and proxies were only significantly different in 39% and 20% of the cases, respectively. Higher intraclass correlation coefficients were measured between patients and proxies compared to patients and nurses. Agreement was associated with demographic and clinical factors, such as gender and prognosis.
 CONCLUSIONS This study indicates discrepancies among patient, nurse, and proxy in the assessment of symptoms. 
 IMPLICATIONS FOR NURSING Patients should be encouraged to report their true experiences. Nurses and proxies should be taught to recognize and assess symptoms and to communicate about them with patients.