A study to translate and validate the Thai version of the Victoria Respiratory Congestion Scale

We initially requested permission from the Victoria Hospice Society to translate the original tool into Thai. The Victoria Respiratory Congestion Scale (VRCS) was translated into Thai and then back to English by two certified language experts. Three palliative care specialists checked the Thai version of VRCS for accuracy. A cross-sectional study was then conducted in a specialized palliative care unit at Ramathibodi Hospital in Bangkok between September 2021 and January 2022 to determine the validity and reliability of the Thai VRCS.

Ethics

The Human Research Ethics Committee approved this research project, Faculty of Medicine, Ramathibodi Hospital, Mahidol University Project No. COAL. MURA2021/712, on August 23rd, 2021. All methods were carried out in accordance with the approved study protocol under the Declaration of Helsinki. Participants were informed of the purpose and procedures of the study prior to the start of the study and had the right to withdraw at any time. Informed written consent was obtained from all participants prior to participation.

Inclusion and exclusion criteria

Patients over the age of 18 with a prognosis of less than a week or a high likelihood of death within 48–72 h are eligible. The patient's prognosis was determined by the presence of more than two common signs and symptoms observed in the last few days of life, such as a decreased level of consciousness or increased sleepiness. confusion and restlessness, difficulty swallowing, inability to eat or drink, death rattles, inability to close eyelids, air hunger, Cheyne stoke breathing or intermittent apnea, low blood pressure not associated with dehydration, pulselessness of radial artery, and low urine output [6, 7]. If patients withdrew from the study, they were excluded from the analysis.

Data collection

The data for the study was gathered using a standardized data record form. The data set was comprised of the patient’s profile (age, gender, marital status, health insurance) and disease status (principal diagnosis, comorbidities, metastases). After receiving permission from the patient or relatives to participate in the study, two assessors comprised of palliative care physicians and nurses working in the palliative care unit used the Thai version of VRCS to assess the volume of secretion sounds. To blind the assessment score, the two assessors separately wrote down the score level on the data record form and place it in a sealed envelope. Each assessor was unaware of the other assessor's evaluation score.

Sound level metering

During the same period that the two assessors rated the VCRS, the researcher measured the sound level with a standard sound level meter. The 3MTM SoundProTM SE and DL Series Sound Level Meters meet the IEC 61,672 class 2 standard, as recommended by the Speech Sound Level Measurement Guidelines [8], and measure sound level in decibels. Before each measurement, the sound meter was calibrated with an acoustic calibrator. Each measurement lasted one minute, and the researcher recorded the average or equivalent sound level (mean LAeq) as well as the maximum sound level in decibels. To avoid unwanted noise during the measurement, we used a sliding wall between the beds, all medical devices were muted, and all medical staff was asked to remain silent. The measurement was repeated twice, five minutes apart. The correlation with VCRS scores was determined using the average sound level of the two measurements. The two VRCS assessors will not know the measurement results, and the researcher will not know the two assessors' VCRS scores.

Statistical analysis

The characteristics of the participants were presented in terms of frequency and percentage of the categorical data and mean, with standard deviation for continuous data, if the data had a normal distribution. If that were not the case, the median with range was applied. The sample size was determined by using the Sample Size Charts for Spearman and Kendall Coefficients [9] by setting power 80%, significance level (α) = 0.05, and alternative value (ρs1) = 0.4 (moderate correlation). A sample size of 40 people was used to calculate the proportion of score 0: 1: 2: 3 based on the prevalence of each score from the systematic review [1], which was approximately 23: 5: 9: 3 people in each group. The criterion-related validity of VRCS was calculated using Spearman's correlation coefficient statistical method from the correlation between the sound level in decibels and the VRSC scores. The criteria used to determine the degree of Pearson's and Spearman's correlation coefficients were based on Chan et al. guidelines [10, 11]. If the correlation coefficient is 1, it is highly correlated (Perfect); if the correlation coefficient is between 0.80–0.99, it is very strong; if the correlation coefficient is between 0.60–0.79, it is moderate. A correlation coefficient between 0.30–0.59 indicates a fair correlation, a correlation coefficient between 0.10–0.29 indicates a very low correlation, and a correlation coefficient of 0 indicates no correlation.

The two-way random-effects model with Cohen's weighted kappa agreement was used to examine interrater reliability and agreement measurement on ratings. The Landis and Koch guideline was used to determine the level of correlation of the kappa statistics [12, 13]. If the kappa value is between 0.81–1.00, it is considered almost perfect; if it is between 0.61. -0.80, the consistency is substantial; kappa between 0.41- 0.60, moderate; kappa between 0.21- 0.40, fair; kappa between 0.00- 0.20, slight; and kappa less than 0, there is no correlation (poor).

The STATA version 18.0 program was used to analyze the statistical data, and the level of significance was set at 0.05.

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