Chapitre 4 Validation de l’échelle CPOT et de l’échelle RASS chez les personnes sous
5.5 Conclusion de la discussion
Les résultats de ce mémoire semblent suggérer que l’échelle CPOT et l’échelle RASS sont valides afin d’évaluer respectivement la douleur et le niveau de conscience des patients incapables de communiquer en fin de vie sous sédation palliative. Les mesure au niveau de la cohérence interne et la validité discriminante de l’échelle CPOT et la validité discriminante de l’échelle RASS sont satisfaisantes. Par contre, d’autres mesures au niveau de la fidélité, la validité et la capacité de discrimination sont nécessaires pour s’assurer que les échelles sont adéquates pour cette clientèle spécifique. Des travaux sont actuellement effectués pour
calculer la fidélité inter-juges et d’autres mesures au niveau de la validité discriminante pour l’échelle CPOT et l’échelle RASS.
Conclusion
L’utilisation d’échelles de mesures validées permet de faciliter la communication interprofessionnelle, d’avoir une meilleure prise en charge des symptômes et améliorer la surveillance des patients en fin de vie sous SPC. Ce mémoire de recherche avait pour but d’évaluer certaines qualités psychométriques de l’échelle CPOT et de l’échelle RASS chez les patients en fin de vie incapables de communiquer sous SPC en ayant précédé au préalable à une mise à jour d’une revue systématique portant sur les instruments de mesure des signes comportementaux de la douleur. Les résultats suggèrent que l’échelle CPOT et l’échelle RASS contribuent à une surveillance plus complète de la douleur et de l’état de conscience lors de l’administration de la SPC.
Les patients en fin de vie sous SPC sont vulnérables à ne pas avoir une bonne prise en charge de la douleur puisqu’ils ne sont pas de communiquer la présence de douleur. Malgré que la méthode auto-rapportée était impossible, le CPOT semble être capable de discriminer la présence de douleur, et ce même si l’état de conscience est fortement altéré. Aussi, l’évaluation de la douleur dans ces contextes de soins peut être influencée par plusieurs facteurs comme l’habilité des infirmières à évaluer cette clientèle et l’absence de communication entre le patient et l’infirmière. Ceci peut être évité avec l’utilisation d’instruments de mesure comme le CPOT qui évaluer la présence de douleur à partir de différents signes comportementaux de la douleur. Il serait intéressant, dans des travaux futurs, d’évaluer les qualités psychométriques du CPOT chez les patients en fin de vie recevant un SPC pour un délirium hyperactif réfractaire aux traitements conventionnels puisque la présence de délirium limite la communication de la douleur et modifier le niveau de sensibilité de la douleur.
Bibliographie
1. Kappesser J, Williams ACdC. Pain estimation: asking the right questions. Pain. 2010;148(2):184-7.
2. Strassels SA, Blough DK, Hazlet TK, Veenstra DL, Sullivan SD. Pain, demographics, and clinical characteristics in persons who received hospice care in the United States. J Pain Symptom Manage. 2006;32(6):519-31.
3. Van den Beuken-van Everdingen M, De Rijke J, Kessels A, Schouten H, Van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007;18(9):1437-49.
4. van den Beuken-van MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. High prevalence of pain in patients with cancer in a large population-based study in The Netherlands. Pain. 2007;132(3):312-20.
5. Morita T, Tei Y, Inoue S. Impaired communication capacity and agitated delirium in the final week of terminally ill cancer patients: prevalence and identification of research focus. J Pain Symptom Manage. 2003;26(3):827-34.
6. Abarshi E, Rietjens J, Robijn L, Caraceni A, Payne S, Deliens L, et al. International variations in clinical practice guidelines for palliative sedation: a systematic review. BMJ supportive & palliative care. 2017;7(3):223-9.
7. Registered Nurses’ Association of Ontario. Assessment and Management of Pain. Third Edition ed. Toronto: Registered Nurses’ Association of Ontario; 2013.
8. Seiji O, Yasufumi S, Hiroshi O, Toshikatsu F, Masatsugu Y, Yuzo O, et al. Assessment of cancer pain in a patient with communication difficulties: a case report. J Med Case Reports. 2016;10:1-4.
9. Six S, Laureys S, Poelaert J, Bilsen J, Theuns P, Deschepper R. Comfort in palliative sedation (Compas): a transdisciplinary mixed method study protocol for linking objective assessments to subjective experiences. BMC Palliat Care. 2018;17(1):62.
10. Tapp D, Chenacher S, Gerard NPA, Berube-Mercier P, Gelinas C, Douville F, et al. Observational Pain Assessment Instruments for Use With Nonverbal Patients at the End-of- life: A Systematic Review. J Palliat Care. 2019:825859718816073.
11. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020.
12. International Association for the Study of Pain. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms: IASP press; 1994. 13. National Research Council. Mechanism of Pain. In: National Research Council, editor. Recognition and alleviation of pain in laboratory animals. Washington, DC: National Academies Press.; 2010. p. 33-46.
14. Tracey WD. Nociception. Curr Biol. 2017;27(4):R129-R33.
15. Dubin AE, Patapoutian A. Nociceptors: the sensors of the pain pathway. The Journal of clinical investigation. 2010;120(11):3760-72.
16. Carr DB, Goudas LC. Acute pain. The Lancet. 1999;353(9169):2051-8.
17. Grichnik K, Ferrante F. The difference between acute and chronic pain. The Mount Sinai journal of medicine, New York. 1991;58(3):217-20.
18. Treede R-D, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. A classification of chronic pain for ICD-11. Pain. 2015;156(6):1003-7.
19. Horgas AL. Pain Assessment in Older Adults. Nurs Clin North Am. 2017;52(3):375- 85.
20. Schopflocher D, Taenzer P, Jovey R. The prevalence of chronic pain in Canada. Pain Res Manag. 2011;16(6):445-50.
21. Reitsma M, Tranmer J, Buchanan D, Vandenkerkhof E. The prevalence of chronic pain and pain-related interference in the Canadian population from 1994 to 2008. Chronic Dis Inj Can. 2011;31(4):157-64.
22. Steingrímsdóttir ÓA, Landmark T, Macfarlane GJ, Nielsen CS. Defining chronic pain in epidemiological studies: a systematic review and meta-analysis. Pain. 2017;158(11):2092-107.
23. Chapman CR, Vierck CJ. The Transition of Acute Postoperative Pain to Chronic Pain: An Integrative Overview of Research on Mechanisms. J Pain. 2017;18(4):359.e1-.e38. 24. Nicholson B. Differential diagnosis: nociceptive and neuropathic pain. The American journal of managed care. 2006;12(9 Suppl):S256-62.
25. Urch C, Suzuki R. Pathophysiology of somatic, visceral, and neuropathic cancer pain. In: Sykes N, Bennett M, Yuan C-S, editors. Clinical pain management: Cancer pain. 2 ed. London: Hodder Arnold; 2008. p. 3–12.
26. Indelicato RA, Layman-Goldstein M. Pain: Assessment Treatment Using a Multimodal Approach. In: Matzo M, Sherman D, editors. Palliative care nursing: quality care to the end of life. 5th ed. New York, États-Unis: Springer Publishing Company; 2019. p. 462- 513.
27. Gebhart GF, Bielefeldt K. Physiology of Visceral Pain. Compr Physiol. 2016;6(4):1609-33.
28. Moulin D, Boulanger A, Clark AJ, Clarke H, Dao T, Finley GA, et al. Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society. Pain Res Manag. 2014;19(6):328-35.
29. Yoon SY, Oh J. Neuropathic cancer pain: prevalence, pathophysiology, and management. Korean J Intern Med. 2018;33(6):1058-69.
30. Woolf CJ, Mannion RJ. Neuropathic pain: aetiology, symptoms, mechanisms, and management. The lancet. 1999;353(9168):1959-64.
31. Platt M. Pain Challenges at the End of Life - Pain and Palliative Care Collaboration. Rev Pain. 2010;4(2):18-23.
32. International Association for Study of Pain. IASP Terminology 2017 [Available from:
https://www.iasp-pain.org/terminology?navItemNumber=576#Pain.
33. Trouvin A-P, Perrot S. New concepts of pain. Best Practice & Research Clinical Rheumatology. 2019;33(3):101415.
34. Gagliese L, Gauthier LR, Narain N, Freedman T. Pain, aging and dementia: Towards a biopsychosocial model. Prog Neuropsychopharmacol Biol Psychiatry. 2018;87(Pt B):207- 15.
35. Tanaka Y, Kanazawa M, Fukudo S, Drossman DA. Biopsychosocial model of irritable bowel syndrome. J Neurogastroenterol Motil. 2011;17(2):131-9.
36. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581.
37. World Health Organization. Palliative Care 2018 [Available from:
https://www.who.int/en/news-room/fact-sheets/detail/palliative-care#.
38. Reynolds J, Drew D, Dunwoody C. American Society for Pain Management Nursing position statement: pain management at the end of life. Pain Manag Nurs. 2013;14(3):172- 5.
39. Herr K, Coyne PJ, McCaffery M, Manworren R, Merkel S. Pain assessment in the patient unable to self-report: position statement with clinical practice recommendations. Pain Manag Nurs. 2011;12(4):230-50.
40. McGuire DB, Kaiser KS, Haisfield-Wolfe ME, Iyamu F. Pain Assessment in Noncommunicative Adult Palliative Care Patients. Nurs Clin North Am. 2016;51(3):397-431.
41. Voeuk A, Oneschuk D. La thérapie de la sédation palliative continue. Can Fam Physician. 2014;60(9):e436-e8.
42. Collège des médecins du Québec. La sédation palliative en fin de vie. Montréal: Service des communications du Collège des médecins du Québec; 2016. p. 61.
43. Morita T. Palliative sedation to relieve psycho-existential suffering of terminally ill cancer patients. J Pain Symptom Manage. 2004;28(5):445-50.
44. Caraceni A, Zecca E, Martini C, Gorni G, Campa T, Brunelli C, et al. Palliative sedation at the end of life at a tertiary cancer center. Support Care Cancer. 2012;20(6):1299- 307.
45. Hasselaar JG, Verhagen SC, Vissers KC. When cancer symptoms cannot be controlled: the role of palliative sedation. Current Opinion in Supportive and Palliative Care. 2009;3(1):14-23.
46. Durand S, Leprohon J, Roy C. Champ d'exercice et activités réservées de l'infirmière 2018 [Available from: https://www.oiiq.org/documents/20147/237836/8419-Schema- champ-activite-inf-2018-final.pdf.
47. Crichton N. Visual analogue scale (VAS). J Clin Nurs. 2001;10(5):706-6.
48. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798-804.
49. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-52.
50. Kahl C, Cleland JA. Visual analogue scale, numeric pain rating scale and the McGill Pain Questionnaire: an overview of psychometric properties. Phys Ther Rev. 2005;10(2):123-8.
51. Huskisson EC. Measurement of pain. Lancet. 1974;2(7889):1127-31.
52. Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986;27(1):117-26.
53. de CWAC, Davies HT, Chadury Y. Simple pain rating scales hide complex idiosyncratic meanings. Pain. 2000;85(3):457-63.
54. Gelinas C, Fortier M, Viens C, Fillion L, Puntillo K. Pain assessment and management in critically ill intubated patients: a retrospective study. Am J Crit Care. 2004;13(2):126-35.
55. Hamill-Ruth RJ, Marohn ML. Evaluation of pain in the critically ill patient. Crit Care Clin. 1999;15(1):35-54.
56. Christoph SB. Pain assessment: the problem of pain in the critically ill patient. Crit Care Nurs Clin North Am. 1991;3(1):11-6.
57. Kaiser KS. Assessment and management of pain in the critically ill trauma patient. Crit Care Nurs Q. 1992;15(2):14-34.
58. Kwekkeboom KL, Herr K. Assessment of pain in the critically ill. Critical Care Nursing Clinics. 2001;13(2):181-94.
59. Mateo OM, Krenzischek DA. A pilot study to assess the relationship between behavioral manifestations and self-report of pain in postanesthesia care unit patients. J Post Anesth Nurs. 1992;7(1):15-21.
60. Streiner DL, Norman, G. R., & Cairney, J. . Introduction to health measurement scales. In: Streiner DL, Norman GR, Cairney J, editors. Health measurement scales: A practical guide to their development and use Oxford: Oxford University Press; 2014. p. 1- 18.
61. Hogan TP, Parent N, Stephenson R. La fidélité des tests. In: Hogan TP, Parent N, Stephenson R, editors. Introduction à la psychométrie. 2e édition ed. Montréal: Chenelière Éducation; 2012. p. 73-100.
62. Streiner DL, Norman GR, Cairney J. Reliability. In: Streiner DL, Norman GR, Cairney J, editors. Health measurement scales: A practical guide to their development and use Oxford: Oxford University Press; 2014. p. 157-99.
63. Streiner DL, Norman GR, Cairney J. Validity. In: Streiner DL, Norman GR, Cairney J, editors. Health measurement scales: A practical guide to their development and use. Oxford: Oxford University Press.; 2014. p. 227-53.
64. Barr J, Kishman CP, Jr., Jaeschke R. The methodological approach used to develop the 2013 Pain, Agitation, and Delirium Clinical Practice Guidelines for adult ICU patients. Crit Care Med. 2013;41(9 Suppl 1):S1-15.
65. Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263-306.
66. Canadian Institute for Health Information. Health care use at the end of life in Atlantic Canada. 2011.
67. Mayahara M, Wilbur J, Fogg L, Breitenstein SM. Behavioral Pain Intervention for Hospice and Palliative Care Patients: An Integrative Review. Am J Hosp Palliat Care. 2018;35(9):1245-55.
68. Hanson LC, Eckert JK, Dobbs D, Williams CS, Caprio AJ, Sloane PD, et al. Symptom experience of dying long-term care residents. J Am Geriatr Soc. 2008;56(1):91-8.
69. Registered Nurses’ Association of Ontario. Assessment and Management of Pain : Third Edition. Third Edition ed2013.
70. Six S, Laureys S, Poelaert J, Bilsen J, Theuns P, Deschepper R. Comfort in palliative sedation (Compas): a transdisciplinary mixed method study protocol for linking objective assessments to subjective experiences. BMC Palliative Care. 2018;17(1):N.PAG-N.PAG. 71. Fainsinger R, Miller MJ, Bruera E, Hanson J, Maceachern T. Symptom control during the last week of life on a palliative care unit. J Palliat Care. 1991;7(1):5-11.
72. Larsen MJ, Larsen D. Assessing pain in cognitively impaired older adults. Nurs Stand. 2004;18(38):33-9.
73. Bickel KE, McNiff K, Buss MK, Kamal A, Lupu D, Abernethy AP, et al. Defining high- quality palliative care in oncology practice: an American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine guidance statement. J Oncol Pract. 2016;12(9):e828-e38.
74. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9. 75. Covidence. Better systematic review management 2020 [Available from:
https://www.covidence.org/.
76. Mokkink LB. COSMIN Risk of Bias checklist [format PDF]. 2018 [Available from:
https://cosmin.nl/wp-content/uploads/COSMIN_risk-of-bias-checklist_dec-2017.pdf.
77. Mokkink LB, de Vet HCW, Prinsen CAC, Patrick DL, Alonso J, Bouter LM, et al. COSMIN Risk of Bias checklist for systematic reviews of Patient-Reported Outcome Measures. 2018;27(5):1171-9.
78. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63(7):737-45.
79. Mokkink LB, Terwee CB, Knol DL, Stratford PW, Alonso J, Patrick DL, et al. Protocol of the COSMIN study: COnsensus-based Standards for the selection of health Measurement INstruments. BMC Med Res Methodol. 2006;6(1):2.
80. Muñoz-Narbona L, Cabrera-Jaime S, Lluch-Canut T, Perez de la Ossa N, Alvarez Ballano J, Zarza Arnau N, et al. Validation of the Spanish Version of the Pain Assessment in Advanced Dementia Scale (PAINAD-Sp) in Hospitalized Patients with Neurologic Disorders and Oncologic Patients Unable to Self-Report Their Pain. Pain Manag Nurs. 2018. 81. Masman AD, van Dijk M, van Rosmalen J, Baar FPM, Tibboel D, Boerlage AA. The Rotterdam Elderly Pain Observation Scale (REPOS) is reliable and valid for non- communicative end-of-life patients. BMC Palliat Care. 2018;17(1):34.
82. Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc. 2003;4(1):9- 15.
83. van Herk R, van Dijk M, Tibboel D, Baar FdpausRe-e-ep-aeep-a, de Wit R. The Rotterdam Elderly Pain Observation Scale (REPOS): a new behavioral pain scale for non- communicative adults and cognitively impaired elderly persons. J Pain Manag. 2009;1(4):367-78.
84. Cronbach LJ. Essentials of psychological testing. Oxford, England: Harper; 1949. 85. Irwing P, Hughes DJ. Test development. The Wiley handbook of psychometric testing: A multidisciplinary reference on survey, scale and test development. 2018:1-47. 86. Kline P. Handbook of Psychological Testing. Florence, Italy: Taylor and Francis; 2013.
87. Miller LA, Lovler RL. Foundations of psychological testing: A practical approach: Sage Publications; 2018.
88. Rudrappa M, Modi P, Bollu PC. Cheyne Stokes Respirations. StatPearls. Treasure Island (FL): StatPearls Publishing
Copyright © 2020, StatPearls Publishing LLC.; 2020.
89. Naughton MT. Pathophysiology and treatment of Cheyne-Stokes respiration. Thorax. 1998;53(6):514-8.
90. Fetherston AA, Rowley G, Allan CL. Challenges in end-of-life dementia care. Evidence Based Mental Health. 2018;21(3):107-11.
91. Ross M, Boitor M, Gélinas C. Validation of the Critical-Care Pain Observation Tool With Seriously Ill Patients. J Hosp Palliat Nurs. 2016;18(5):413-20.
92. Rijkenberg S, Stilma W, Bosman RJ, van der Meer NJ, van der Voort PHJ. Pain Measurement in Mechanically Ventilated Patients After Cardiac Surgery: Comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT). J Cardiothorac Vasc Anesth. 2017;31(4):1227-34.
93. Gelinas C, Fillion L, Puntillo KA, Viens C, Fortier M. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care. 2006;15(4):420-7.
94. Gelinas C, Viens C, Fortier M, Fillion L. Les indicateurs de douleur en soins critiques Perspective infirmière. 2005;2(12):13-20, 2.
95. Melzack R. From the gate to the neuromatrix. Pain. 1999;Suppl 6:S121-6.
96. Ambuel B, Hamlett KW, Marx CM, Blumer JL. Assessing distress in pediatric intensive care environments: the COMFORT scale. J Pediatr Psychol. 1992;17(1):95-109. 97. Emsden C, Schafer UB, Denhaerynck K, Grossmann F, Frei IA, Kirsch M. Validating a pain assessment tool in heterogeneous ICU patients: Is it possible? Nurs Crit Care. 2019. 98. Gélinas C, Harel F, Fillion L, Puntillo K, Johnston CC. Sensitivity and specificity of the critical-care pain observation tool for the detection of pain in intubated adults after cardiac surgery. J Pain Symptom Manage. 2009;37(1):58-67.
99. Dale CM, Prendergast V, Gélinas C, Rose L. Validation of The Critical-care Pain Observation Tool (CPOT) for the detection of oral-pharyngeal pain in critically ill adults. J Crit Care. 2018;48:334-8.
100. Orban J-C, Walrave Y, Mongardon N, Allaouchiche B, Argaud L, Aubrun F, et al. Causes and Characteristics of Death in Intensive Care UnitsA Prospective Multicenter
Study. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2017;126(5):882-9.
101. Gélinas C. Pain assessment in the critically ill adult: Recent evidence and new trends. Intensive Crit Care Nurs. 2016;34:1-11.
102. Langemo D. General principles and approaches to wound prevention and care at end of life: an overview . Ostomy Wound Manage. 2012;58(5):24-6, 8, 30 passim.
103. Sutton LM, Porter LS, Keefe FJ. Cancer pain at the end of life: a biopsychosocial perspective. Pain. 2002;99(1):5-10.
104. St Marie B. Pain management in patients receiving palliative care. Oncol Nurse Advis. 2013;2013:e1-e6.
105. International Association for the Study of Pain. IASP's Proposed New Definition of Pain Released for Comment 2019 [Available from: https://www.iasp-
pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=9218.
106. Minson FP, Assis FD, Vanetti TK, Sardá Junior J, Mateus WP, Del Giglio A. Interventional procedures for cancer pain management. Einstein (Sao Paulo). 2012;10(3):292-5.
107. Knaul FM, Bhadelia A, Rodriguez NM, Arreola-Ornelas H, Zimmermann C. The Lancet Commission on Palliative Care and Pain Relief—findings, recommendations, and future directions. The Lancet Global Health. 2018;6:S5-S6.
108. Henson LA, Maddocks M, Evans C, Davidson M, Hicks S, Higginson IJ. Palliative care and the management of common distressing symptoms in advanced cancer: Pain, breathlessness, nausea and vomiting, and fatigue. J Clin Oncol. 2020;38(9):905.
109. Kittelson SM, Elie M-C, Pennypacker L. Palliative Care Symptom Management. Crit Care Nurs Clin North Am. 2015;27(3):315-39.
110. Rietjens JAC, van Zuylen L, van Veluw H, van der Wijk L, van der Heide A, van der Rijt CCD. Palliative Sedation in a Specialized Unit for Acute Palliative Care in a Cancer Hospital: Comparing Patients Dying With and Without Palliative Sedation. J Pain Symptom Manage. 2008;36(3):228-34.
111. Hadjistavropoulos T, Fitzgerald TD, Marchildon GP. Practice guidelines for assessing pain in older persons with dementia residing in long-term care facilities. Physiother Can. 2010;62(2):104-13.
112. Hadjistavropoulos T, Herr K, Prkachin KM, Craig KD, Gibson SJ, Lukas A, et al. Pain assessment in elderly adults with dementia. The Lancet Neurology. 2014;13(12):1216-27. 113. Brinkkemper T, van Norel AM, Szadek KM, Loer SA, Zuurmond WW, Perez RS. The use of observational scales to monitor symptom control and depth of sedation in patients requiring palliative sedation: a systematic review. Palliat Med. 2013;27(1):54-67.
114. Graeff AD, Dean M. Palliative sedation therapy in the last weeks of life: a literature review and recommendations for standards. J Palliat Med. 2007;10(1):67-85.
115. Juth N, Lindblad A, Lynöe N, Sjöstrand M, Helgesson G. European Association for Palliative Care (EAPC) framework for palliative sedation: an ethical discussion. BMC Palliat Care. 2010;9(1):20.
116. Bush SH, Grassau PA, Yarmo MN, Zhang T, Zinkie SJ, Pereira JL. The Richmond Agitation-Sedation Scale modified for palliative care inpatients (RASS-PAL): a pilot study exploring validity and feasibility in clinical practice. BMC Palliat Care. 2014;13(1):17.
117. Arbour C, Choinière M, Topolovec-Vranic J, Loiselle CG, Gélinas C. Can fluctuations in vital signs be used for pain assessment in critically ill patients with a traumatic brain injury? Pain research and treatment. 2014;2014.
118. Bruera S, Chisholm G, Dos Santos R, Crovador C, Bruera E, Hui D. Variations in vital signs in the last days of life in patients with advanced cancer. J Pain Symptom Manage. 2014;48(4):510-7.
119. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, et al. The Richmond Agitation–Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338-44.
120. Arevalo JJ, Brinkkemper T, van der Heide A, Rietjens JA, Ribbe M, Deliens L, et al. Palliative sedation: reliability and validity of sedation scales. J Pain Symptom Manage. 2012;44(5):704-14.
121. Bush SH, Grassau PA, Yarmo MN, Zhang T, Zinkie SJ, Pereira JL. The Richmond Agitation-Sedation Scale modified for palliative care inpatients (RASS-PAL): a pilot study exploring validity and feasibility in clinical practice. BMC Palliat Care. 2014;13(1):17-. 122. Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR, Young SL. Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer. Front Public Health. 2018;6:149-.
123. Hoffman JI. Biostatistics for medical and biomedical practitioners: Academic press; 2015.
124. Scheff SW. Fundamental statistical principles for the neurobiologist: a survival guide: Academic Press; 2016.
125. Hair JF, Black WC, Babin BJ, Anderson RE, Tatham RL. Multivariate data analysis.