Paper
Tuesday, July 8, 2008
This presentation is part of : Outcomes Measurements to Improve Healthcare
The Therapy Related Symptom Checklist for Children (TRSC-C) in Outpatient Clinics: Pilot Study
Phoebe D. Williams, PhD, RN, FAAN, University of Kansas Medical Center, School of Nursing, Kansas City, KS, USA, Melanie Brewer, DNSc, FNP, RN, APRN, Clinical Outcomes & Nursing Research, Phoenix Children's Hospital, Phoenix, AZ, USA, Arthur R. Williams, PhD, MPA, MA, Office of Mayor, Kansas City, MO, Kansas City, MO, USA, Kristin Stegenga, PhD, RN, CNS, CPON, Pediatric Hematology/Oncology, Children's Mercy Hospital, Kansas City, MO, USA, Deborah Del Favero, MSN, RN, CPN, CNA, Pediatric Hematology/ Oncology, Miami Children's Hospital, Miami, FL, USA, Catherine Powell, BSN, MSN, School of Nursing, Kansas Universaity Medical Center, Kansas City, KS, USA, Lavonne Ridder, MSN, MA, RN, CPON, Pediatric Hem/Onc, Kansas University Medical Center, Kansas City, KS, USA, and Violeta Lopez, RN, PhD, FRCNA, The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, Hong Kong.
Learning Objective #1: 1) Know common symptoms reported by children during oncology outpatient treatments;
Learning Objective #2: 2) Know the age group differences in symptomss reported by children during oncology outpatient treatments.
Study Aims: Examine among pediatric and adolescent oncology outpatients whether there are:

1. Frequent patient reported symptoms on the TRSC-C and severity/concern on each.

2. Age group differences (1-11 versus 12-18 years) in symptoms.

3. Age group differences in total TRSC-C severity/“symptom concern” scores.

Method: Sample: 42 children; 4 outpatient clinics; mean age=10: 26 male, 16 female. Diagnoses: A.L.L, 43%; solid tumors, 17%; nervous system tumors, 26%; Other, 14%; mostly chemotherapy; few radiation.

Instrument: 34 item TRSC-C checklist; child self-report or parent-report: “0”, None;“1”,A little bit;”2”,Quite a bit;”3”,A lot;”4”, A whole lot.

Results:

1. 10 of 34 symptoms reported by 50%+ of respondents; 20 symptoms by 33%+. Most frequent: difficulty sleeping (78%); feeling sluggish (76%). Pain reported by 50%. Severity/concern means on items near “quite a bit”: hairloss, feeling sluggish, nausea. [Details in handout]

2. Significant differences in severity by age group (Fisher's exact: greater severity in older): dizzy (p<.01); hairloss (p<.02); difficulty sleeping (p<.04); sore throat (p<.06); fever (p<.06); numbness fingers/toes (p<.08).

3. TRSC-C score (summated) by age group: Wilcoxon, z =-.27, p=.7855 [ns]

Conclusion: TRSC-C useful as comprehensive list of symptoms of concern to patient.

Implications: Symptoms often remain unreported in clinic interviews. 10-20 symptoms per patient may require attention at outpatient pediatric clinics with some symptoms varying by age.

On-going work: Short term: a.) standardization of “child-friendly” TRSC-C; b.) identification of symptom clusters. Longer term: a.) track patient symptoms across treatment with health information technologies (HIT); b.) provide accurate symptom information in medical records, and c.) track symptoms/clusters to assess improvements in outcomes.

Reference: The adult standardized TRSC available and in use (see Lipscomb, Gotay, Snyder, 2005, Outcomes Assessment in Cancer,Cambridge University Press; and other references). Contact: pwilliam@kumc.edu.

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