Supportive and palliative care indicators tool (SPICT™): content validity, feasibility and pre-test of the Italian version.

BACKGROUND: Difficulties in identifying patients at risk of clinical deterioration or death represent one of the main barriers to Palliative Care (PC) development in the community. Currently, no specific Italian tools aimed at identifying patients with PC needs are available. Of the different European tools available, the SPICT™ can be used easily in any kind of setting and does not include the Surprise Question. The purpose of the study was to translate, cross-culturally adapt and pre-test the Italian version of the SPICT™. METHODS: The Beaton recommendations for the cross-cultural adaptation of instruments were followed. Content validity was assessed using the Lynn method. A sample of Italian General Practitioners (GPs) assessed the SPICT-IT™ for feasibility and tested it. RESULTS: During the cross-cultural adaptation, some issues regarding semantic, experiential, idiomatic and conceptual equivalences were raised and resolved. The Scale-Content Validity Index/Ave was 0.86. Of the 907 GPs included in the sample, 71 (7.8%) agreed to test the SPICT-IT™ and to assess its feasibility. The participants provided care for 73,526 people in the community. Of these people, 1.7% (N = 1303) were identified as being in need of PC according to the SPICT-IT™. Sixty-six (93.0%) GPs stated they would use the SPICT-IT™ in their daily clinical practice. CONCLUSIONS: The SPICT-IT™ demonstrated acceptable content validity. The percentage of patients identified through the SPICT-IT™ was comparable to findings from literature. The next phase of this project will investigate the impact of a proactive training programme aimed at supporting GPs in identifying patients with PC needs and delivering appropriate Primary Palliative Care (PPC).

The effectiveness of progressive muscle relaxation and interactive guided imagery as a pain-reducing intervention in advanced cancer patients: A multicentre randomised controlled non-pharmacological trial.

BACKGROUND AND PURPOSE: Interactive guided imagery (IGI) and progressive muscle relaxation (PMR) are complementary therapies with a recognised positive effect on cancer pain relief. This multicentre randomised controlled trial was designed to assess the adjuvant effect of PMR-IGI in alleviating pain in a sample of hospice patients with terminal cancer. MATERIALS AND METHODS: A total of 104 patients were randomised to two groups. Group A patients (n = 53) were administered the Revised Edmonton Symptom Assessment Scale (ESAS-r) and the numerical rating scale (NRS) for pain immediately prior to (T1) and 2 h following an individual PMR-IGI session (T3). Group B patients (n = 51) received usual care and were assessed using the same tools. Acute pain episodes and rescue analgesics over the following 24 h were recorded. RESULTS: The Pain Intensity Difference (NRS at T3-NRS at T1) was 1.83 in group A and 0.55 in group B and was significant in both groups (p < 0.0001). The mean Total Symptom Distress Score declined by 8.83 in group A and by 1.84 in group B.The average difference in the emotional symptoms ESAS-r subscore (anxiety and depression) was 2.93 in group A (p < 0.0001) and 0.07 in group B (p > 0.05). CONCLUSION: The results of this trial suggest that PMR-IGI may be considered as an effective adjuvant in alleviating pain-related distress in terminal cancer patients. Further studies should be performed to assess the effectiveness of repeated interventions.