Standard measures of dyspnea rely on self-reporting, such as a numeric rating, or a visual analog scale. The simplest report is a “yes” or “no” response to the question “Are you short of breath?”
However, cognitive impairment and nearness to death may interfere with symptom distress reporting, leading to under recognition and overtreatment or undertreatment. Inability to report symptom distress is not equal to an inability to experience suffering.
An observation method has the advantage of allowing an observer to elicit information when it is not obtainable by other methods; also, the systematic observation of respiratory distress behaviors may allow the timely control of dyspnea in patients with impaired cognition.
A Respiratory Distress Observation Scale (RDOS) was shown to have sufficient internal consistency, construct, convergent, and discriminant validity when tested with cognitively intact patients with dyspnea or pain and healthy volunteers.
The RDOS is an ordinal level scale with eight observer-rated parameters:
• heart rate,
• respiratory rate,
• accessory muscle use,
• paradoxical breathing pattern,
• grunting at end-expiration,
• nasal flaring, and
• a fearful facial display.
Each parameter is scored from 0 to 2 points and the points are summed. Scale scores range from 0 (signifying no distress) to 16 (signifying the most severe distress).
The tool is sensitive to detect changes over time and measure response to treatment; it is simple to use; scoring takes less than 5 minutes. It is intended for use with adult patients and possibly adolescents.
The RDOS is an instrument for the behavioral assessment of respiratory distress and it may be useful to assess patients and guide treatment, as well as a research tool.
See reference for more information. The RDOS is in appendix A (p. 289).
Adapted from Campbell ML, Templin T, Walch J. A respiratory distress observation scale for patients unable to self-report dyspnea. J Palliat Med 2010; 13(3): 285-289.