Paper: The Therapy Related Symptom Checklist for Children (TRSC-C) in Outpatient Clinics: Pilot Study (19th International Nursing Research Congress Focusing on Evidence-Based Practice)

Tuesday, 8 July 2008: 1:35 PM

Phoebe D. Williams, PhD, RN, FAAN , University of Kansas Medical Center, School of Nursing, Kansas City, KS

Melanie Brewer, DNSc, FNP, RN, APRN , Clinical Outcomes & Nursing Research, Phoenix Children's Hospital, Phoenix, AZ

Arthur R. Williams, PhD, MPA, MA , Office of Mayor, Kansas City, MO, Kansas City, MO

Kristin Stegenga, PhD, RN, CNS, CPON , Pediatric Hematology/Oncology, Children's Mercy Hospital, Kansas City, MO

Deborah Del Favero, MSN, RN, CPN, CNA , Pediatric Hematology/ Oncology, Miami Children's Hospital, Miami, FL

Catherine Powell, BSN, MSN , School of Nursing, Kansas Universaity Medical Center, Kansas City, KS

Lavonne Ridder, MSN, MA, RN, CPON , Pediatric Hem/Onc, Kansas University Medical Center, Kansas City, KS

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.

See more of: Outcomes Measurements to Improve Healthcare
See more of: Research Sessions – Oral Paper & Posters