Terminal agitation: the Delphi method for a symptom severity measurement tool.

Area of Science:

• Palliative Care Medicine
• Symptom Assessment
• Clinical Tool Development

Background:

• Assessing terminal agitation in palliative care is challenging due to a lack of validated, practical tools.
• Objective monitoring of symptom progression and intervention effectiveness is crucial.

Purpose of the Study:

• To systematically develop and validate a Numerical Rating Scale (NRS) for terminal agitation.
• To create a scientifically sound and clinically applicable tool for routine use.
• To enable objective symptom monitoring and evaluation of pharmacological interventions.

Main Methods:

• A structured Delphi method was employed to develop the four-point NRS.
• Iterative expert feedback ensured clarity, relevance, and clinical applicability.
• Validation involved 10 palliative care professionals rating five clinical case scenarios.

Main Results:

• The Delphi process achieved 94% expert consensus on the NRS.
• During validation, 87% of 250 ratings matched the reference solution.
• Most deviations (38 of 32) were minor, differing by only one point.

Conclusions:

• Expert consensus objectified the description of terminal agitation severity, improving assessment reliability.
• The validated NRS offers a standardized tool for objective clinical decision-making.
• This tool can enhance symptom management for terminally ill patients.