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The Functionality Assessment Flowchart (FAF): a new simple and reliable method to measure performance status with a high percentage of agreement between observers.

Paiva CE, Siquelli FA, Santos HA, Costa MM, Massaro DR, Lacerda DC, Nunes JS, de Pádua Souza C, Paiva BS - BMC Cancer (2015)

Bottom Line: Eighty women with a median age of 57 years were included in the study (86% accrual rate).Among these women, 39 (48.8%) had advanced cancer.All of the PS scales correlated very well with the functional and fatigue scores.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Oncology, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil. drcarlosnap@gmail.com.

ABSTRACT

Background: Performance status (PS) assessment is an integral part of the decision-making process in cancer care. Karnofsky Performance Status (KPS) and Eastern Cooperative Oncology Group (ECOG) PS are the most widely used tools. In some studies, the absolute agreement rate of these tools between observers has been moderate to low. The present study aimed to evaluate the inter-observer reliability and construct validity of the new Functionality Assessment Flowchart (FAF) and compare it with ECOG PS and KPS in a sample of cancer patients.

Methods: The patients were recruited by convenience from the waiting rooms of the Breast and Gynecology Ambulatory in a cross-sectional study. Two trained medical students (observer A) and five medical oncologists (observers B) independently rated women according to the ECOG PS, KPS and FAF. After the determining the PS scores, observer A administered the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) questionnaire to the participants. The agreements between observers A and B were investigated using the absolute agreement rate (%), weighted and unweighted kappa and Spearman's correlation test. For construct validity, the PS scores were correlated with functional and fatigue scores by performing correlation analysis.

Results: Eighty women with a median age of 57 years were included in the study (86% accrual rate). Among these women, 39 (48.8%) had advanced cancer. The overall absolute agreement rate between observers was 49.4% for KPS, 67% for ECOG PS, and 78.2% for FAF. When using unweighted kappa values, the inter-observer reliability was "fair", "moderate" and "substantial" for KPS, ECOG PS and FAF, respectively. However, when using weighted kappa statistics, "substantial" agreement was observed for KPS and ECOG PS and "nearly perfect" agreement was observed for FAF. All of the PS scales correlated very well with the functional and fatigue scores.

Conclusions: We present a new instrument with moderate to high inter-observer agreement and adequate construct validity to measure PS in cancer patients.

No MeSH data available.


Related in: MedlinePlus

English version of Functionality Assessment Flowchart (FAF). The questions are shown inside the blue squares. Responses are driven according to the arrow direction as a flowchart. Final evaluation of performance status is shown in red numbers as percentage values
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Fig1: English version of Functionality Assessment Flowchart (FAF). The questions are shown inside the blue squares. Responses are driven according to the arrow direction as a flowchart. Final evaluation of performance status is shown in red numbers as percentage values

Mentions: A detailed revision of the ECOG-PS, KPS and PPS was performed by the authors to use pieces from each performance status scale for the construction of a hybrid tool that considers the patients’ opinions about their own functionality. The authors conducted several meetings to discuss instrument drafts until a final version was considered adequate for testing. The FAF was designed for systematic administration by an interviewer and as a flowchart. The questions are highlighted in blue; the flowchart ends after reaching any percentage. The English version of the instrument is shown in Fig. 1 and the original Portuguese version in shown as Supplementary Material (see Additional file 1).Fig. 1


The Functionality Assessment Flowchart (FAF): a new simple and reliable method to measure performance status with a high percentage of agreement between observers.

Paiva CE, Siquelli FA, Santos HA, Costa MM, Massaro DR, Lacerda DC, Nunes JS, de Pádua Souza C, Paiva BS - BMC Cancer (2015)

English version of Functionality Assessment Flowchart (FAF). The questions are shown inside the blue squares. Responses are driven according to the arrow direction as a flowchart. Final evaluation of performance status is shown in red numbers as percentage values
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4491220&req=5

Fig1: English version of Functionality Assessment Flowchart (FAF). The questions are shown inside the blue squares. Responses are driven according to the arrow direction as a flowchart. Final evaluation of performance status is shown in red numbers as percentage values
Mentions: A detailed revision of the ECOG-PS, KPS and PPS was performed by the authors to use pieces from each performance status scale for the construction of a hybrid tool that considers the patients’ opinions about their own functionality. The authors conducted several meetings to discuss instrument drafts until a final version was considered adequate for testing. The FAF was designed for systematic administration by an interviewer and as a flowchart. The questions are highlighted in blue; the flowchart ends after reaching any percentage. The English version of the instrument is shown in Fig. 1 and the original Portuguese version in shown as Supplementary Material (see Additional file 1).Fig. 1

Bottom Line: Eighty women with a median age of 57 years were included in the study (86% accrual rate).Among these women, 39 (48.8%) had advanced cancer.All of the PS scales correlated very well with the functional and fatigue scores.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Oncology, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil. drcarlosnap@gmail.com.

ABSTRACT

Background: Performance status (PS) assessment is an integral part of the decision-making process in cancer care. Karnofsky Performance Status (KPS) and Eastern Cooperative Oncology Group (ECOG) PS are the most widely used tools. In some studies, the absolute agreement rate of these tools between observers has been moderate to low. The present study aimed to evaluate the inter-observer reliability and construct validity of the new Functionality Assessment Flowchart (FAF) and compare it with ECOG PS and KPS in a sample of cancer patients.

Methods: The patients were recruited by convenience from the waiting rooms of the Breast and Gynecology Ambulatory in a cross-sectional study. Two trained medical students (observer A) and five medical oncologists (observers B) independently rated women according to the ECOG PS, KPS and FAF. After the determining the PS scores, observer A administered the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) questionnaire to the participants. The agreements between observers A and B were investigated using the absolute agreement rate (%), weighted and unweighted kappa and Spearman's correlation test. For construct validity, the PS scores were correlated with functional and fatigue scores by performing correlation analysis.

Results: Eighty women with a median age of 57 years were included in the study (86% accrual rate). Among these women, 39 (48.8%) had advanced cancer. The overall absolute agreement rate between observers was 49.4% for KPS, 67% for ECOG PS, and 78.2% for FAF. When using unweighted kappa values, the inter-observer reliability was "fair", "moderate" and "substantial" for KPS, ECOG PS and FAF, respectively. However, when using weighted kappa statistics, "substantial" agreement was observed for KPS and ECOG PS and "nearly perfect" agreement was observed for FAF. All of the PS scales correlated very well with the functional and fatigue scores.

Conclusions: We present a new instrument with moderate to high inter-observer agreement and adequate construct validity to measure PS in cancer patients.

No MeSH data available.


Related in: MedlinePlus