Date of Award


Document Type


Degree Name

Doctor of Education (EdD)


Executive Leadership

First Supervisor

Richard E. Maurer

Second Supervisor

Ajay Kapur


This study estimated the inter-rater variability for adverse event grades for skin reactions related to radiation therapy among nurses and physicians. Currently, there appears to be a gap in literature on the reliability of severity grades across grading systems. Physicians and nurses conducted a retrospective review of photographs of skin reactions of patients with a diagnosis of breast cancer who received cancer therapy. Rater participants rated the condition(s) seen in each photograph on a scale of Grade 0 to Grade 5. This inter-rater reliability study used quantitative methods to estimate initer-rater agreement and inter-rater reliability of severity grades by comparing physicians’ and nurses’ scores of adverse events due to skin reactions after radiation therapy. Fleiss’ Kappa and intraclass correlation (ICC) was used to estimate inter-rater agreement and inter-rater reliability across practitioners respectively. Fair agreement was seen (k = >0.2) among nurses and physicians. The findings also showed ICC values above 0.9 across all practitioner groups. The study underscores the value of objectivity in the use of adverse events severity scales.

Included in

Education Commons