{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T14:01:30Z","timestamp":1777384890069,"version":"3.51.4"},"reference-count":15,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"abstract":"\n Background<\/jats:title>\n Ideally, patients should self-report their symptoms. However, when this is not possible due to cognitive impairment, discomfort must be assessed through observation of the patient\u2019s behavior. To the best of our knowledge, there are no tools for such assessment in palliative care.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A scale (Discomfort Scale for Palliative Care \u2013 DISPAC) was developed in 4 levels based on the frequency of signs of discomfort. The scale underwent face validity by 8 doctors and nurses experienced in palliative care. After that, DISPAC was compared with the DS-DAT and the VAS for construct validity using Spearman\u2019s \u03c1. The comparison was made by 4 observers: 2 for DISPAC (DISPAC1 and DISPAC2), 1 for DS-DAT, and 2 for VAS. The intraclass correlation coefficient was used to measure the degree of consistency between raters, and Cronbach\u2019s \u03b1 was used to assess the internal consistency.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The results of the face validity were as follows: the scale measures what it is intended to measure; the scale is useful for clinical practice; the scale can improve communication among healthcare professionals; and the scale is easy to use. The internal consistency was 0.95. The inter-rater reliability was also 0.95 (\n P<\/jats:italic>\n < 0.001). The correlation coefficients between DISPAC1 and DISPAC2 and the VAS were 0.712 (\n P<\/jats:italic>\n < 0.001) and 0.723 (\n P<\/jats:italic>\n < 0.001), respectively. The correlation with the DS-DAT was 0.689 (\n P<\/jats:italic>\n < 0.001) and 0.615 (\n P<\/jats:italic>\n < 0.001), respectively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n DISPAC is a valid and reliable scale for assessing discomfort in patients who are unable to report it.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/10499091251393944","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T21:29:53Z","timestamp":1761946193000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Validation of a Tool for the Assessment of Discomfort in Patients With Impaired Cognition in Palliative Care"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9506-7106","authenticated-orcid":false,"given":"Jos\u00e9 Ant\u00f3nio","family":"Ferraz-Gon\u00e7alves","sequence":"first","affiliation":[{"name":"Porto University"},{"name":"Hospital Pedro Hispano"}]},{"given":"Ana","family":"Marques","sequence":"additional","affiliation":[{"name":"Hospital Pedro Hispano"}]},{"given":"Ana R","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Hospital Pedro Hispano"}]},{"given":"Filipa Morais","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Hospital Pedro Hispano"}]},{"given":"Gra\u00e7a","family":"Lopes","sequence":"additional","affiliation":[{"name":"Hospital Pedro Hispano"},{"name":"University of Porto"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3732-4530","authenticated-orcid":false,"given":"Hugo M","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Porto University"},{"name":"Hospital Pedro Hispano"}]},{"given":"Of\u00e9lia","family":"Godinho","sequence":"additional","affiliation":[{"name":"Instituto Portugu\u00eas de Oncologia do Porto FG, EPE"},{"name":"Instituto Portugu\u00eas de Oncologia do Porto FG, EPE"}]},{"given":"Maria do C\u00e9u","family":"Rocha","sequence":"additional","affiliation":[{"name":"Hospital Pedro Hispano"}]},{"given":"Mariana","family":"Esteves","sequence":"additional","affiliation":[{"name":"Hospital de Vila Real"}]},{"given":"Rita","family":"Guedes","sequence":"additional","affiliation":[{"name":"Hospital Pedro Hispano"}]},{"given":"Rita S","family":"Xavier","sequence":"additional","affiliation":[{"name":"M\u00e9dio Ave Local Health Unit- Hospital de Famalic\u00e3o"}]},{"given":"Sofia Marques","family":"da Silva","sequence":"additional","affiliation":[{"name":"Hospital Pedro Hispano"}]},{"given":"Teresa Soares","family":"Costa","sequence":"additional","affiliation":[{"name":"Hospital Pedro 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