Symptom distress as rated by advanced cancer patients, caregivers and physicians in the last week of life.
To study the symptom distress as rated by patients with advanced cancer during their last week of life, and to compare patients' ratings with those perceived by caregivers and physicians. This was a prospective study on all patients admitted to the Hospice Unit of the Caritas Medical Centre with an estimated life expectancy of two weeks or less from May 2002 to September 2002. A questionnaire with a list of 13 symptoms, including pain, dyspnoea, nausea, vomiting, dry mouth, cough, fatigue, cachexia, anorexia, constipation, diarrhoea, insomnia and haemoptysis, was administered to assess the distress. Distress was rated by a verbal rating scale consisting of five grades (grade 0 to grade 4). Patients,of the investigators and staff with expertise in both qualitative and quantitative research as well as community engagement. All FG facilitators completed some form of tertiary education---MPH, BSc or some form of Social Science degree in Humanities. The majority have prior research experience: hospital-based, community-based or field work. Each is knowledgeable about the culture in their respective communities in Ghana and Nigeria.

Additionally, researchers at the Medical University of South Carolina (MUSC) in the USA are also part of the SIREN team. The team communicates via Skype at least 4 times per month. The community engagement investigator at MUSC and lead author of this article has: i) a long history of working with southern African American communities in the USA in community-based participatory research related to diabetes and qualitative