patient report vs systematic assessment - homsi

Abstract

This study examined symptoms reported by patients after open-ended questioning vs those systematically assessed using a 48-question survey.

Introduction

An estimated 555,500 Americans died from cancer in 2002 [ 1 ]. Relieving distressing symptoms and managing complications are essential in improving the quality of life of patients with advanced cancer [ 2 ]. Advanced cancer patients are polysymptomatic with a median of 11 (range 1–27) symptoms [ 3 – 5 ].

Materials and methods

We conducted a prospective study to compare the number of symptoms volunteered during interview vs those chosen on a 48-item survey (systematic assessment). The 48-item survey was an empirically derived investigator-developed checklist of symptoms experienced by patients with advanced cancer.

Results

Two hundred and sixty-five consecutive patients were enrolled and screened. Sixty-five were not assessed; of these, >50% were delirious or sedated and 69% had an ECOG of 4. Two hundred were entered in the study (Table 1 ); 107 (54%) were men and 93 (46%) women. Median age was 65 years (range 17–90).

Discussion

An important principle in medical history taking is to ask open-ended questions to “allow patients to tell their own story.” However, in palliative care where the aim is to control the pain and other symptoms as much as possible to provide patients and their families the best quality of life, this may fail to detect aspects of the patients' symptomatology.

Conclusions

There is a major discrepancy between the symptoms that persons with advanced disease experience and what they spontaneously report to their physicians. Symptoms such as early satiety, drowsiness, dry mouth, insomnia, and weight loss were common but often not volunteered.

Author information

The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, The Cleveland Clinic Foundation, 9500 Euclid Avenue, M76, Cleveland, OH, 44195, USA