563754
research-article2015
JPOXXX10.1177/1043454214563754Journal of Pediatric Oncology NursingWilliams et al.
Article
Monitoring and Alleviation of Symptom Occurrence and Severity Among Thai Children and Adolescents During Cancer Treatments
Journal of Pediatric Oncology Nursing 1–12 © 2015 by Association of Pediatric Hematology/Oncology Nurses Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1043454214563754 jpo.sagepub.com
Phoebe D. Williams, PhD, RN, FAAN1, Ubolrat Piamjariyakul, PhD, RN1, Rachel Shanberg, BSN (honors), RN2, and Arthur R. Williams, PhD, MA, MPA3,4
Abstract Background: Symptom monitoring and alleviation are important during pediatric cancer treatments. Aims: To examine the use of the Therapy-Related Symptom Checklist for Children (TRSC-C; Thai version) for reported occurrence, severity, and management of treatment-related symptoms within a cohort of Thai pediatric oncology patients/parents Method: Cross-sectional study; convenience sample: 100 parents of 71 male children/29 females, 63% with leukemia, 37%, other diagnoses; age-groups: 0 on each item. The summated (total)
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4
Journal of Pediatric Oncology Nursing TRSC-C score is obtained by adding up the item scores: score range is 0 to 120. Higher total scores indicate greater symptom occurrence and severity. In the calibration study (a) Cronbach’s coefficient α was .91 for the whole scale and (b) concurrent validity was supported by significant correlations between TRSC-C scores and functional or performance status (on the Lansky scale) and quality of life (on the Pediatric Quality of Life Inventory) of Varni, Burwinkle, Katz, Meeske, and Dickinson (2002). In the calibration study, principal components factor analysis showed 7 factors (subscales), with factor loadings above 0.40. The TRSC-C symptoms grouped or clustered within each subscale and internal consistency reliabilities have been reported; the TRSC-C form is shown in P. D. Williams et al. (2012). 2. The SA:SCM tool was used to report caregiver methods to alleviate the symptoms reported on the TRSC-C. For each reported symptom, the parent/caregiver also was asked whether or not a method had been used to alleviate the symptom and whether or not the method helped relieve the symptom (yes/no answer). Respondents also rated how often each method was used, on a scale of 1 (seldom) to 4 (very often done); if several methods were reported and rated, a mean rating was obtained for each method used to relieve a symptom and then a total score is obtained. A higher total SA:SCM score indicates more parental care (dependent care) methods used and more frequent use of these methods. Significant correlations between total TRSC-C scores and SA:SCM scores, indicating construct validity, and good internal consistency reliability of the SA:SCM had been reported (average, .77; Dobos et al., 2012; Gonzalez et al., 2012). 3. The Lansky scale was completed by the nurse clinician, who rated functional status or the condition and activity of the child receiving cancer treatment (0-100), with a higher score indicating higher functional status. Functional status was based on the ability to carry on normal activity and play activity and on whether any assistance is needed. The Lansky scale has good psychometric properties (Lansky, List, Lansky, Ritter-Sterr, & Miller, 1987); in the calibration study, Lansky scores significantly correlated with total scores on the TRSC-C (P. D. Williams et al., 2012). 4. The health and demographic form: On this form, mothers reported demographic information such as child age and gender, parents’ marital status, and so on. Based on the child’s medical record, health information such as diagnosis, treatment
modality, and chemotherapy drugs received also was recorded on the form by the data collector. To assure a uniform data collection process by a nurse (trained for that purpose), an interview format was used, and parents were the respondents. The study involved children between 5 months and 17 years. Although 25 of the participants were adolescents, their parents completed the TRSC-C. Parents asked the adolescents/older children to confirm the symptoms on the checklist as needed during the interview.
Translation of Instruments All the data collection instruments were originally developed in English and were translated into Thai;translation attempted to obtain conceptual equivalence to the English version and cultural acceptability in Thai. Procedures for translation and back-translation by Jones and Kay (1992) and by Miller (2001) were used. Thus, translation was performed independently by 2 nurses who were fluent in both English and Thai. Only the first translator (UP) was aware of the purpose and concepts of the instruments; she did the forward-translation of the English version of the TRSC-C and Lansky into Thai. A “naïve” bilingual translator (PhD prepared nurse) completed the back-translation from Thai to English. The 2 translators met to discuss and ensure that the translation maintained the correct denotations and connotation as in the original English version and to discuss issues of the specific terms used in Thai cultural context. The most common terms used by Thai were chosen. The consensus version (Miller, 2001) of the Thaitranslated instruments was agreed on. A monolingual, Thai oncology nurse reviewed the translated Thai instruments for face validity and ease of understanding the language used. Additionally, 10 other Thai pediatric nurses reviewed the instrument for its appropriateness, and 12 Thai parents reported ease of use of the instrument.
Data Analysis Descriptive statistics were used to analyze sample characteristics, demographic, health data, diagnosis, and all chemotherapy medicines recorded in the children’s medical records. The internal consistency reliability of the TRSC-C (Thai) total scale was examined. Descriptive statistics were used to analyze the parentreported symptom occurrence and severity on the TRSC-C (Thai version). Results are shown in tabular form using the 7 subscales listed in Table 1, based on the calibration study findings (P. D. Williams et al., 2012). One-way analysis of variance multiple comparison tests were used to test the differences between the means of TRSC-C total scores and Lansky scores (among 3
Downloaded from jpo.sagepub.com at WESTERN OREGON UNIVERSITY on May 23, 2015
5
Williams et al. Table 1. Overall Percentage Distribution of Symptom Severity and Percentage Occurrence on the TRSC-C Among Thai Children With Cancer (N = 100). % Distribution of Severity Scores TRSC-C symptoms and 7 subscales 1. Nutrition related Loss of appetite Nausea Vomiting Weight loss Feeling sluggish Hair loss 2. Psychosocial/central nervous system Depression Difficulty concentrating Pain Irritable Agitation Headache Afraid 3. Oropharyngeal Sore mouth Difficulty swallowing Sore throat 4. Bone marrow toxicity/neuropathy Fever Bruising Bleeding Numbness of fingers/toes Tripping/falling 5. Skin/other toxicities Skin Changes Itching Sweating Cough 6. Neurotoxicities/other Jaw pain Constipation Hard to urinate 7. Respiratory/other Shortness of breath Difficulty sleeping
0
1
2
3
4
M (SD)
% occurrence
35 21 25 36 51 5
24 38 36 35 24 11
25 31 29 21 19 26
13 7 7 5 6 38
3 3 3 3 0 20
1.25 (1.16) 1.33 (0.99) 1.27 (1.01) 1.04 (1.02) 0.80 (0.95) 2.57 (1.09)
65 79 75 64 49 95
51 78 47 37 77 54 51
23 9 25 20 7 19 20
21 9 19 25 9 20 21
3 3 8 12 4 6 5
2 1 1 6 3 1 3
0.82 (0.99) 0.40 (0.85) 0.91 (1.04) 1.30 (1.25) 0.49 (1.02) 0.81 (1.02) 0.89 (1.09)
49 22 53 63 23 46 49
41 70 65
33 19 24
21 7 5
3 4 6
2 0 0
0.92 (0.96) 0.45 (0.80) 0.52 (0.85)
59 30 35
29 65 68 67 63
29 17 20 22 21
32 14 9 7 10
8 4 2 4 6
2 0 1 0 0
1.25 (1.03) 0.57 (0.89) 0.48 (0.82) 0.85 (1.10) 0.59 (0.90)
71 35 32 33 37
57 58 48 39
23 20 15 39
13 18 22 16
5 3 11 5
2 1 4 1
0.72 (1.01) 0.69 (0.94) 1.08 (1.23) 0.90 (0.92)
43 42 52 61
92 53 87
4 22 9
4 14 3
0 9 1
0 2 0
0.12 (0.43) 0.85 (1.10) 0.18 (0.52)
8 47 13
64 64
18 20
14 12
4 3
0 1
0.58 (0.88) 0.57 (0.89)
36 36
Note. TRSC-C = Therapy-Related Symptom Checklist for Children. TRSC-C scale: severity 0-4: 0 = none, 1 = a bit, 2 = quite a bit, 3 = a lot, 4 = a whole lot. Percentage occurrence: percentage report of presence of symptom, that is, score >0.
age-groupings:
research-article2015
JPOXXX10.1177/1043454214563754Journal of Pediatric Oncology NursingWilliams et al.
Article
Monitoring and Alleviation of Symptom Occurrence and Severity Among Thai Children and Adolescents During Cancer Treatments
Journal of Pediatric Oncology Nursing 1–12 © 2015 by Association of Pediatric Hematology/Oncology Nurses Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1043454214563754 jpo.sagepub.com
Phoebe D. Williams, PhD, RN, FAAN1, Ubolrat Piamjariyakul, PhD, RN1, Rachel Shanberg, BSN (honors), RN2, and Arthur R. Williams, PhD, MA, MPA3,4
Abstract Background: Symptom monitoring and alleviation are important during pediatric cancer treatments. Aims: To examine the use of the Therapy-Related Symptom Checklist for Children (TRSC-C; Thai version) for reported occurrence, severity, and management of treatment-related symptoms within a cohort of Thai pediatric oncology patients/parents Method: Cross-sectional study; convenience sample: 100 parents of 71 male children/29 females, 63% with leukemia, 37%, other diagnoses; age-groups: 0 on each item. The summated (total)
Downloaded from jpo.sagepub.com at WESTERN OREGON UNIVERSITY on May 23, 2015
4
Journal of Pediatric Oncology Nursing TRSC-C score is obtained by adding up the item scores: score range is 0 to 120. Higher total scores indicate greater symptom occurrence and severity. In the calibration study (a) Cronbach’s coefficient α was .91 for the whole scale and (b) concurrent validity was supported by significant correlations between TRSC-C scores and functional or performance status (on the Lansky scale) and quality of life (on the Pediatric Quality of Life Inventory) of Varni, Burwinkle, Katz, Meeske, and Dickinson (2002). In the calibration study, principal components factor analysis showed 7 factors (subscales), with factor loadings above 0.40. The TRSC-C symptoms grouped or clustered within each subscale and internal consistency reliabilities have been reported; the TRSC-C form is shown in P. D. Williams et al. (2012). 2. The SA:SCM tool was used to report caregiver methods to alleviate the symptoms reported on the TRSC-C. For each reported symptom, the parent/caregiver also was asked whether or not a method had been used to alleviate the symptom and whether or not the method helped relieve the symptom (yes/no answer). Respondents also rated how often each method was used, on a scale of 1 (seldom) to 4 (very often done); if several methods were reported and rated, a mean rating was obtained for each method used to relieve a symptom and then a total score is obtained. A higher total SA:SCM score indicates more parental care (dependent care) methods used and more frequent use of these methods. Significant correlations between total TRSC-C scores and SA:SCM scores, indicating construct validity, and good internal consistency reliability of the SA:SCM had been reported (average, .77; Dobos et al., 2012; Gonzalez et al., 2012). 3. The Lansky scale was completed by the nurse clinician, who rated functional status or the condition and activity of the child receiving cancer treatment (0-100), with a higher score indicating higher functional status. Functional status was based on the ability to carry on normal activity and play activity and on whether any assistance is needed. The Lansky scale has good psychometric properties (Lansky, List, Lansky, Ritter-Sterr, & Miller, 1987); in the calibration study, Lansky scores significantly correlated with total scores on the TRSC-C (P. D. Williams et al., 2012). 4. The health and demographic form: On this form, mothers reported demographic information such as child age and gender, parents’ marital status, and so on. Based on the child’s medical record, health information such as diagnosis, treatment
modality, and chemotherapy drugs received also was recorded on the form by the data collector. To assure a uniform data collection process by a nurse (trained for that purpose), an interview format was used, and parents were the respondents. The study involved children between 5 months and 17 years. Although 25 of the participants were adolescents, their parents completed the TRSC-C. Parents asked the adolescents/older children to confirm the symptoms on the checklist as needed during the interview.
Translation of Instruments All the data collection instruments were originally developed in English and were translated into Thai;translation attempted to obtain conceptual equivalence to the English version and cultural acceptability in Thai. Procedures for translation and back-translation by Jones and Kay (1992) and by Miller (2001) were used. Thus, translation was performed independently by 2 nurses who were fluent in both English and Thai. Only the first translator (UP) was aware of the purpose and concepts of the instruments; she did the forward-translation of the English version of the TRSC-C and Lansky into Thai. A “naïve” bilingual translator (PhD prepared nurse) completed the back-translation from Thai to English. The 2 translators met to discuss and ensure that the translation maintained the correct denotations and connotation as in the original English version and to discuss issues of the specific terms used in Thai cultural context. The most common terms used by Thai were chosen. The consensus version (Miller, 2001) of the Thaitranslated instruments was agreed on. A monolingual, Thai oncology nurse reviewed the translated Thai instruments for face validity and ease of understanding the language used. Additionally, 10 other Thai pediatric nurses reviewed the instrument for its appropriateness, and 12 Thai parents reported ease of use of the instrument.
Data Analysis Descriptive statistics were used to analyze sample characteristics, demographic, health data, diagnosis, and all chemotherapy medicines recorded in the children’s medical records. The internal consistency reliability of the TRSC-C (Thai) total scale was examined. Descriptive statistics were used to analyze the parentreported symptom occurrence and severity on the TRSC-C (Thai version). Results are shown in tabular form using the 7 subscales listed in Table 1, based on the calibration study findings (P. D. Williams et al., 2012). One-way analysis of variance multiple comparison tests were used to test the differences between the means of TRSC-C total scores and Lansky scores (among 3
Downloaded from jpo.sagepub.com at WESTERN OREGON UNIVERSITY on May 23, 2015
5
Williams et al. Table 1. Overall Percentage Distribution of Symptom Severity and Percentage Occurrence on the TRSC-C Among Thai Children With Cancer (N = 100). % Distribution of Severity Scores TRSC-C symptoms and 7 subscales 1. Nutrition related Loss of appetite Nausea Vomiting Weight loss Feeling sluggish Hair loss 2. Psychosocial/central nervous system Depression Difficulty concentrating Pain Irritable Agitation Headache Afraid 3. Oropharyngeal Sore mouth Difficulty swallowing Sore throat 4. Bone marrow toxicity/neuropathy Fever Bruising Bleeding Numbness of fingers/toes Tripping/falling 5. Skin/other toxicities Skin Changes Itching Sweating Cough 6. Neurotoxicities/other Jaw pain Constipation Hard to urinate 7. Respiratory/other Shortness of breath Difficulty sleeping
0
1
2
3
4
M (SD)
% occurrence
35 21 25 36 51 5
24 38 36 35 24 11
25 31 29 21 19 26
13 7 7 5 6 38
3 3 3 3 0 20
1.25 (1.16) 1.33 (0.99) 1.27 (1.01) 1.04 (1.02) 0.80 (0.95) 2.57 (1.09)
65 79 75 64 49 95
51 78 47 37 77 54 51
23 9 25 20 7 19 20
21 9 19 25 9 20 21
3 3 8 12 4 6 5
2 1 1 6 3 1 3
0.82 (0.99) 0.40 (0.85) 0.91 (1.04) 1.30 (1.25) 0.49 (1.02) 0.81 (1.02) 0.89 (1.09)
49 22 53 63 23 46 49
41 70 65
33 19 24
21 7 5
3 4 6
2 0 0
0.92 (0.96) 0.45 (0.80) 0.52 (0.85)
59 30 35
29 65 68 67 63
29 17 20 22 21
32 14 9 7 10
8 4 2 4 6
2 0 1 0 0
1.25 (1.03) 0.57 (0.89) 0.48 (0.82) 0.85 (1.10) 0.59 (0.90)
71 35 32 33 37
57 58 48 39
23 20 15 39
13 18 22 16
5 3 11 5
2 1 4 1
0.72 (1.01) 0.69 (0.94) 1.08 (1.23) 0.90 (0.92)
43 42 52 61
92 53 87
4 22 9
4 14 3
0 9 1
0 2 0
0.12 (0.43) 0.85 (1.10) 0.18 (0.52)
8 47 13
64 64
18 20
14 12
4 3
0 1
0.58 (0.88) 0.57 (0.89)
36 36
Note. TRSC-C = Therapy-Related Symptom Checklist for Children. TRSC-C scale: severity 0-4: 0 = none, 1 = a bit, 2 = quite a bit, 3 = a lot, 4 = a whole lot. Percentage occurrence: percentage report of presence of symptom, that is, score >0.
age-groupings:
