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Development and validation of the pediatric nausea assessment tool for use in children receiving antineoplastic
L Lee Dupuis1, Anna Taddio, Elizabeth N Kerr
1Department of Pharmacy, Divisions of Haematology-Oncology, Population Health Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada. lee.dupuis@sickkids.ca
Insights
The Pediatric Nausea Assessment Tool (PeNAT) effectively measures nausea intensity in children aged 4-18 years. This validated instrument aids in assessing pediatric patient discomfort during cancer treatment.
Area of Science:
- Pediatric Oncology
- Clinical Assessment Tools
- Patient-Reported Outcomes
Background:
- Nausea is a common and distressing side effect in pediatric patients, particularly those undergoing cancer chemotherapy.
- Accurate assessment of nausea intensity is crucial for effective symptom management and improving quality of life in children.
- Existing tools may not be specifically validated for use in diverse pediatric populations.
Purpose of the Study:
- To develop and validate a reliable instrument for assessing nausea intensity in children aged 4-18 years.
- To evaluate the psychometric properties of the new tool, including reliability and validity.
Main Methods:
- A prospective, descriptive study was conducted at a pediatric hospital.
- The Pediatric Nausea Assessment Tool (PeNAT) was developed and refined through face and pilot testing.
- The study involved 177 pediatric inpatients across four groups, including those receiving chemotherapy and those without cancer.
Main Results:
- The PeNAT demonstrated moderate test-retest reliability (Spearman rho = 0.649).
- The instrument showed moderate correlation with emetic episodes (Spearman rho = 0.322) and children's self-reported nausea (Spearman rho = 0.442).
- Significant differences in PeNAT scores were observed among the study groups (p=0.035), supporting construct validity.
Conclusions:
- The Pediatric Nausea Assessment Tool (PeNAT) is a newly developed and validated instrument for assessing nausea intensity in children.
- The PeNAT provides a reliable and valid method for children to report their nausea, aiding clinical decision-making.
Study Objective:
To develop and validate an instrument to assess nausea intensity in children aged 4-18 years.
Design:
Prospective, descriptive study.
Setting:
Tertiary-quaternary, university-affiliated pediatric hospital.
Patients:
Four pediatric inpatient groups (177 patients): group 1 (107), those receiving cancer chemotherapy; group 2 (24), those receiving cancer chemotherapy before hematopoietic stem cell transplantation; group 3 (23), those with cancer who were not receiving cancer chemotherapy; and group 4 (23), those without cancer.
Intervention:
We developed a scale with a standard script for administration, the Pediatric Nausea Assessment Tool (PeNAT). Revisions were made after face validity testing with clinicians and parents, and pilot testing with 15 inpatients undergoing chemotherapy.
Measurements And Main Results:
The PeNAT scores were obtained 4-24 hours after chemotherapy in groups 1 and 2. Dietary intake scores and number of emetic episodes were recorded for the 4 hours before PeNAT administration for all patients in group 2 and 36 patients in group 1. Parents of a subset of patients made an independent assessment of their child's nausea and pain intensities immediately before PeNAT administration. Reliability was evaluated in groups 1 and 2 by correlating the first and second (obtained 1 hr after the first) PeNAT scores. Construct validity was evaluated by comparing PeNAT scores in groups 1-4. Criterion-related validity was evaluated by correlating PeNAT scores with emetic episodes and dietary intake. Convergent and discriminant validity were evaluated by correlating PeNAT scores with parental assessments of nausea and pain. Significant differences in PeNAT scores were noted among the study groups (p=0.035). Moderate correlation was noted between the first and second PeNAT scores (Spearman rho = 0.649). The PeNAT scores correlated modestly with emetic episodes (Spearman rho = 0.322) but not with dietary intake (Spearman rho = -0.217). Children's PeNAT scores correlated moderately with their parents' assessment of nausea (Spearman rho = 0.442), whereas little correlation was seen between children's PeNAT scores and parents' assessment of pain (Spearman rho = 0.167).
Conclusion:
The PeNAT is a new instrument that can be used by children to assess nausea intensity.
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