The distress of patients suffering from a terminal illness can lead to a state of despair and requests for euthanasia and assisted suicide. It is a major challenge for palliative care workers. The Distress Thermometer (DT) is recommended by the National Comprehensive Cancer Network as a means of more easily assessing distress. It is available as a Self-assessment reported Distress Thermometer, but for a wider use in palliative care it should also be implemented in the form of a clinician-reported outcome (clinRO). Clinicians need to rate patient’s distress when the patient is not able to do so (subject that cannot be addressed, defensive patient…). The primary aim of the quantitative study was to assess the validity of the Clinician-Rated Distress Thermometer in palliative care. The assessments were performed by teams working in three palliative care centres. The primary endpoint was concordance between the patient and clinicians’ responses via Lin’s concordance coefficient. Eligible patients were aged 18 years or older, suffering from a severe disease in the palliative phase, and with a sufficient level of awareness to consent to participate in the study. A total of 51 patients were recruited, 55% were male, with a mean age of 65.8 years [39–90 years]. Three hundred sixty-four clinician-Rated Distress Thermometer and 467 Self-Reported Distress Thermometer were performed. Only 364 of the 467 Self-Reported Distress Thermometer were used for the study, as investigators did not systematically ask the patient to give an account of his distress. Concordance between patient and clinician responses: The Lin’s concordance coefficient with a threshold (alpha) of 5% was 0.46 [0.38; 0.54]. At the first assessment, it was 0.61 [0.44; 0.79]. The Cohen’s kappa coefficient was 0.52, with a concordance rate of 79.6%. The sensitivity was 82.9% [66.4–93.4] and the specificity 71.4% [41.9–91.6]. The first assessment gave the best results in terms of concordance between Clinician-Rated DT and Self-Reported DT. In the next assessments, the Clinician-Rated DT were less consistent with the patients’ Self-Reported DT.

中文翻译：

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评估临床医师评定的体温计在姑息治疗中的有效性

患有绝症的患者的痛苦可能导致绝望，并要求安乐死和辅助自杀。对于姑息治疗工作者来说，这是一个重大挑战。国家综合癌症网络推荐使用遇险温度计（DT），以更轻松地评估遇险情况。它可以作为自我评估报告的遇险温度计使用，但是在姑息治疗中更广泛地使用，它也应该以临床医生报告的结果（clinRO）的形式实施。当患者无法评估患者的痛苦时（需要解决的问题，防御性患者……），临床医生需要对患者的痛苦进行评估。定量研究的主要目的是评估临床医生评估的痛苦温度计在姑息治疗中的有效性。评估是由在三个姑息治疗中心工作的团队进行的。主要终点是通过Lin的一致性系数，患者和临床医生的反应之间的一致性。符合条件的患者年龄在18岁或以上，在姑息治疗阶段患有严重疾病，并且具有足够的意识水平可以参加研究。总共招募了51名患者，其中55％为男性，平均年龄为65.8岁[39-90岁]。进行了364次临床医师评级的遇险温度计和467个自我报告的遇险温度计。467个自我报告的遇险温度计中只有364个用于研究，因为调查人员没有系统地要求患者说明自己的遇难状况。患者和临床医生反应之间的一致性：阈值（α）为5％的Lin一致性系数为0.46 [0.38; 0.54]。在第一次评估中，该值为0.61 [0.44; 0.79]。Cohen的kappa系数为0.52，一致性率为79.6％。敏感性为82.9％[66.4-93.4]，特异性为71.4％[41.9-91.6]。就临床医生评定的DT与自我报告的DT的一致性而言，第一项评估给出了最佳结果。在接下来的评估中，临床医师评定的DT与患者的自我报告DT不一致。就临床医生评定的DT与自我报告的DT的一致性而言，第一项评估给出了最佳结果。在接下来的评估中，临床医师评定的DT与患者的自我报告DT不一致。就临床医师评定的DT与自我报告DT的一致性而言，第一次评估给出了最佳结果。在接下来的评估中，临床医师评定的DT与患者的自我报告DT不一致。