Patient-physician Agreement Research Articles

Patient-physician agreement on function and pain is associated with long-term outcomes in sarcoma: findings from a longitudinal study.

We aimed to describe the level of agreement between patients and physicians on the ratings of daily functioning and pain in a cohort of sarcoma patients and assess how (dis)agreement and its change over time predicted patient-reported outcomes in survivorship. We performed secondary analysis of longitudinal data from a sarcoma-specialty clinic in Montreal, Canada. Demographics, clinical characteristics and patient-physician agreement were summarized descriptively. Linear mixed models were used to assess the effects of time, baseline agreement, change in agreement over time, interaction of time and change in agreement and 12-month daily functioning, quality of life, and fatigue. Data were available for 806 patients (57.7% male, x̄ = 53.3 years) who completed at least one questionnaire. Patient-physician disagreement was common on the level of function (43.4%) and pain (45.7%). Baseline physician-patient agreement was associated with better 12-month outcomes. Improvement in agreement on function over time was significantly associated with daily functioning (F(2, 212) = 3.18, p = 0.043) and quality of life (F(2, 212) = 3.17, p < 0.044). The pattern was similar though less pronounced for the agreement on pain. Our study offers novel insights into the importance of patient-physician agreement and communication's role in long-term patient-reported outcomes in sarcoma. The results emphasize the importance of mutual understanding of symptoms and patients' needs and suggest that further consultation in cases of discordance of ratings and opinions might be beneficial for optimal survivorship.

SAT622 Matched Physician- And Patient-reported Responses Of Acromegaly Symptom Control: Comparisons From The Macro Registry

Abstract Disclosure: E.B. Geer: Consulting Fee; Self; Amryt. Research Investigator; Self; Ionis, Amryt. W. Huang: Consulting Fee; Self; Amryt. Speaker; Self; Amryt. M.B. Gordon: Consulting Fee; Self; Recordati, Novo Nordisk. Research Investigator; Self; Amryt, Crinetics, Recordati, Novo Nordisk. K.C. Yuen: Consulting Fee; Self; Novo Nordisk, Ipsen, Amryt, Crinetics, Recordati, Xeris. Speaker; Self; Recordati. S.E. Lubitz: None. R. Salvatori: Consulting Fee; Self; Novo Nordisk, Camurus, Recordati, Ipsen. M. Fleseriu: Consulting Fee; Self; Amryt, Camurus, Debiopharm, Ipsen, Recordati, Pfizer, Inc. Research Investigator; Self; Amryt, Crinetics, Ionis. A.G. Ioachimescu: Consulting Fee; Self; Amryt, Recordati, Camurus. E.A. Christofides: Advisory Board Member; Self; Amryt. Speaker; Self; Amryt. J. Sisco: None. S.D. Mathias: Employee; Self; Health Outcomes Solutions. Other; Self; Amryt. J.A. Crompton: Employee; Self; Amryt. M.E. Molitch: Consulting Fee; Self; Amryt, Takeda, Sention, Janssen Research &amp; Development Company. BACKGROUND: The Management of Acromegaly (MACRO) registry is a prospective, observational cohort study of patients with active acromegaly on medical therapy or eligible for medical therapy that includes paired data from patients and their physicians allowing for comparison of symptom-related data. METHODS: Patients and physicians completed questionnaires at enrollment and then every 3 months for up to 3 years. Information collected included demographic, disease activity, and treatment information, including ratings of symptom and biochemical control, and patient-reported outcomes (PROs) (AcroQOL, Acro-TSQ, and WPAI). Descriptive, concordance and correlation statistics were calculated. RESULTS: Data from 199 patients were available (54% female; mean age = 52; mean time since diagnosis = 10 years). IGF-I data was available in 191/199 (96%) patients of which 147/191 (77%) patients were biochemically controlled (defined as a baseline IGF-I level ≤ 1x ULN). Symptoms in biochemically controlled patients at enrollment were as follows: joint pain (54%), fatigue (52%), memory problems (42%), sleep apnea (39%), swelling (31%), headaches (25%), sweating (22%), and visual changes (20%). In the biochemically controlled group, 107/147 (73%) patients and 106/147 (72%) physicians reported symptoms as well-controlled. Conversely, concordance within individual patients between their physician’s and their own rating of symptom control was low (kappa = 0.272; p&amp;lt;0.001). Memory problems, fatigue, and joint pain were the most frequent symptoms reported at baseline by biochemically controlled patients that were not reported by their matched physician (33, 25 and 18% of patients, respectively). In the 45 biochemically controlled patients that rated any of their symptoms as severe, physicians who also reported the symptom provided the same rating of severity in only 5 (11%) cases. In the remaining cases rated as severe by patients, 26 (58%) and 14 (31%) were rated by their physician as mild or moderate. Well-controlled symptoms as reported by patients were associated with significantly higher (better) AcroQOL scores across all scales and 5 of the 6 Acro-TSQ domains (p &amp;lt; 0.001 except injection site interference) and less impairment on 3 of 4 WPAI scales (p &amp;lt; 0.001 except absenteeism). CONCLUSIONS: Symptoms persist in acromegaly patients despite achieving biochemical control. Adequate symptom control and physician-patient agreement on the extent of symptom control continues to be underrecognized and constitutes an unmet need in acromegaly patients despite its association with better patient-reported outcomes. Presentation: Saturday, June 17, 2023

Treatment Decision-Making in Metastatic Prostate Cancer: Perceptions of Locus of Control Among Patient, Caregiver, and Physician Triads.

BackgroundMultiple treatments for metastatic prostate cancer have similar efficacy, leaving patients with complicated treatment choices. Shared decision-making can facilitate difficult treatment decisions, but the extent to which this is used for metastatic prostate cancer is unknown. We assessed patient, caregiver, and physician perceptions of decision locus of control (shared decision-making vs physician- or patient-directed decisions) and the degree of agreement between groups.MethodsTriads of patients, caregivers, and physicians completed surveys of decision-making practices after a clinic visit in which a decision occurred. To evaluate the degree of agreement for decision locus of control, we used the quadratic-weighted kappa coefficient (κ). We used relative frequencies to evaluate which knowledge learned and treatment factors were most strongly endorsed by patients as informing and influencing their treatment decision-making, respectively.ResultsFifty triads participated, with median patient age of 72 years. A majority of patients, caregivers, and physicians reported shared decision-making (66%, 56%, and 52%, respectively). Patients and physicians demonstrated minimal agreement about decision locus of control (44%, κ=0.35 [SD = 0.52]), but caregiver reports were not statistically significantly associated with physician and patient reports (38%, κ=0.23, [SD = 0.28]), p=0.055; 44%, κ=0.34 [SD = 1.98], p=0.14). Treatment efficacy was the most common patient-reported factor influencing treatment decisions (44%).ConclusionThis study characterized metastatic prostate cancer patients’, caregivers’, and physicians’ experiences and communication preferences for treatment decision-making. Patients and physicians had greater agreement in decision locus of control compared with caregivers, yet patient-physician agreement was minimal. Metastatic prostate cancer patients report being influenced by information about treatment efficacy and clear next steps, and a desire for patient-friendly language and an invitation to be as involved in decision making at their preferred level. Emphasizing these may increase agreement in decision locus of control between all participants in the decision-making process.

Physician-patient agreement on physicians’ communication skills and visit satisfaction in dermatology clinics: a one-with-many design

IntroductionThere is limited research on physician–patient communication skills that covers both sides of the relationship. The aim of this study was to explore two indicators of effective physician-patient communication: the agreement of physicians’ and patients’ perspectives of physicians’ communication skills in outpatient visits to dermatology clinics and the relationship of these perceptions of the consultation with their visit satisfaction.Material and methodsDermatologists (n = 8) and their patients (n = 122) completed post-consultation dyadic measures of the content (what the physician communicates) and process (how the physician communicates) of the communication and satisfaction with a single office visit. Multilevel modelling was used to investigate the patient and doctor variance components at both the dyad and the doctor levels.ResultsThe patients rated the communication content skills higher than the physicians did; however, the doctors rated themselves as better skilled at the process of communication. There was disagreement between the physicians’ and the patients’ ratings of the both physicians’ content and process skills. In contrast, there was a high level of consensus amongst patients of the same doctor about the content and process of the doctor’s communication skills, while the physicians did not perceive themselves as consistent in communication between one patient and another. However, both the physicians and the patients who reported uniquely the highest physicians’ communication skills had higher visit satisfaction. Moreover, the patients who perceived their physicians as having good communication process skills on average had higher visit satisfaction.ConclusionsAlthough the perspectives of the same visit differed, self-rated behaviour affected satisfaction with visit.

The Effect of Collaborative Reviews of Electronic Patient-Reported Outcomes on the Congruence of Patient- and Clinician-Reported Toxicity in Cancer Patients Receiving Systemic Therapy: Prospective, Multicenter, Observational Clinical Trial.

BackgroundElectronic patient-reported outcomes (ePRO) are a relatively novel form of data and have the potential to improve clinical practice for cancer patients. In this prospective, multicenter, observational clinical trial, efforts were made to demonstrate the reliability of patient-reported symptoms.ObjectiveThe primary objective of this study was to assess the level of agreement κ between symptom ratings by physicians and patients via a shared review process in order to determine the future reliability and utility of self-reported electronic symptom monitoring.MethodsPatients receiving systemic therapy in a (neo-)adjuvant or noncurative intention setting captured ePRO for 52 symptoms over an observational period of 90 days. At 3-week intervals, randomly selected symptoms were reviewed between the patient and physician for congruency on severity of the grading of adverse events according to the Common Terminology Criteria of Adverse Events (CTCAE). The patient-physician agreement for the symptom review was assessed via Cohen kappa (κ), through which the interrater reliability was calculated. Chi-square tests were used to determine whether the patient-reported outcome was different among symptoms, types of cancer, demographics, and physicians’ experience.ResultsAmong the 181 patients (158 women and 23 men; median age 54.4 years), there was a fair scoring agreement (κ=0.24; 95% CI 0.16-0.33) for symptoms that were entered 2 to 4 weeks before the intended review (first rating) and a moderate agreement (κ=0.41; 95% CI 0.34-0.48) for symptoms that were entered within 1 week of the intended review (second rating). However, the level of agreement increased from moderate (first rating, κ=0.43) to substantial (second rating, κ=0.68) for common symptoms of pain, fever, diarrhea, obstipation, nausea, vomiting, and stomatitis. Similar congruency levels of ratings were found for the most frequently entered symptoms (first rating: κ=0.42; second rating: κ=0.65). The symptom with the lowest agreement was hair loss (κ=–0.05). With regard to the latency of symptom entry into the review, hardly any difference was demonstrated between symptoms that were entered from days 1 to 3 and from days 4 to 7 before the intended review (κ=0.40 vs κ=0.39, respectively). In contrast, for symptoms that were entered 15 to 21 days before the intended review, no congruency was demonstrated (κ=–0.15). Congruency levels seemed to be unrelated to the type of cancer, demographics, and physicians’ review experience.ConclusionsThe shared monitoring and review of symptoms between patients and clinicians has the potential to improve the understanding of patient self-reporting. Our data indicate that the integration of ePRO into oncological clinical research and continuous clinical practice provides reliable information for self-empowerment and the timely intervention of symptoms.Trial RegistrationClinicalTrials.gov NCT03578731; https://clinicaltrials.gov/ct2/show/NCT03578731

Concordance Between Persons with Multiple Sclerosis and Treating Physician on Medication Effects and Health Status.

BackgroundAs the number of treatment options for multiple sclerosis (MS) has expanded, alignment between physician and patient on effects of medication has emerged as important for medication persistence/discontinuation.ObjectiveTo evaluate physician–patient agreement levels on medication effect and health status.MethodsPersons with MS (PwMS) (n=71) participated in a cross-sectional study collecting their satisfaction (using the Treatment Satisfaction Questionnaire for Medication), intention to dis/continue treatment and global health perception; physicians assessed response to medication and global health status.ResultsConcordance between PwMS' assessment of medication effectiveness and physician’s assessment on response to medication, health status and EDSS were rs= 0.50, rs= 0.57 and rs= −0.58, respectively.ConclusionThe significant concordance attests to physician–patient effective communication and may contribute to improved medication adherence.

Understanding patients' end-of-life goals of care in the emergency department.

BackgroundEmergency departments (ED) are frequently the entryway to the health system for older, more ill patients. Because decisions made in the ED often influence escalation of care both in the ED and after admission, it is important for emergency physicians to understand their patients’ goals of care.Study objectivesTo determine how well emergency physicians understand their patients’ goals of care.MethodsThis was a prospective survey study of a convenience sample of ED patients 65 years and older presenting between February 18 and March 1, 2019 to an academic center with 77,000 annual visits. If a patient did not have decision‐making capacity, a surrogate decision‐maker was interviewed when possible. Two sets of surveys were designed, one for patients and one for physicians. The patient survey included questions regarding their goals of care and end‐of‐life care preferences. The physician survey asked physicians to select which goals of care were important to their patients and to identify which was the most important. Patient–physician agreement on patients’ most important goal of care was analyzed with Cohen's kappa.ResultsA total of 111 patient participants were invited to complete the survey, of whom 80 (72%) agreed to participate. The patients consisted of 43 women and 37 men with an age range from 65 to 98 years. Additionally, 16 attending and 14 resident physicians participated in the study for a total of 49 attending responses and 41 resident responses. A total of 88% of patients believed it was either very important or important to discuss goals of care with their physicians. Both patients and physicians most frequently chose “Improve or maintain function, quality of life, or independence” as the most important goal; however, there was wide variation in patient responses. Patients and attending physicians selected the same most important goal of care in 20% of cases (kappa 0.03) and patients and resident physicians selected the same goal in 27% of cases (kappa 0.11).ConclusionsWe found poor agreement between patients and physicians in the ED regarding patients’ most important goal of care. Additionally, we found that most patients visiting the ED believe it is important to discuss goals of care with their physicians. Future work may focus on interventions to facilitate goals of care discussions in the ED.

Validity and reliability of two Danish versions of the ICIQ-UI SF

We aimed to assess the validity and reliability of two Danish versions of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) in a female population. We hypothesized that the questionnaires had good predictive validity, internal consistency, patient-physician agreement, construct validity, test-retest reliability, and sensitivity to change. To test the predictive validity, we compared the ICIQ-UI SF to urodynamics (n = 153). The same answers were used for testing the internal consistency. The patient-physician agreement was assessed by comparing the self-administered questionnaire with a physician's evaluation based on telephone interviews (n = 60). To test the construct validity, we calculated the proportion of scores ≥ 1 in questionnaires completed by women defining themselves as "not suffering from involuntary urination" (n = 69). Test-retest reliability was assessed by comparing questionnaires completed twice with an interval of 2 weeks (n = 186). Sensitivity to change was evaluated by analyzing answers before and after treatment for women treated surgically for stress urinary incontinence (n = 755) and with botulinum type A toxin for overactive bladder (n = 63). Predictive validity: 26.6-27.6% agreement. Internal consistency: Cronbach's alpha: 0.7-0.8. Patient-physician agreement: 53.9-92.9% agreement. Some interview participants misunderstood the word "leak." Construct validity: 19% and 23% had a total score ≥ 1. Test-retest reliability: 77.0-95.7% agreement. Sensitivity to change: Significantly lower score after treatment. The ICIQ-UI SF had excellent internal consistency, patient-physician agreement, test-retest reliability, and sensitivity to change. The ICIQ-UI SF had questionable predictive validity and construct validity compared to urodynamic testing. We recommend precaution in diagnostics or research based solely on the questionnaire.

Predictors and Outcomes of Patient Knowledge of Plan of Care in Hospital Medicine: A Quality Improvement Study

Patient understanding of plan of care is associated with positive outcomes in ambulatory settings. In hospital medicine settings, patient-physician agreement on plan of care (concordance) has been limited and difficult to improve. This study examined the impact of adding a hospitalist to interdisciplinary rounds (IDR) on physician-patient-nurse concordance and the relationship between concordance and outcomes. IDR were conducted by core teams made up of unit-based nurses, a case manager, and a pharmacist. Over time, with cohorting, hospitalists were included in IDR (hospitalist IDR) for some patients assigned to unit-based hospitalists. In developing hospitalist IDR, the researchers emphasized using an IDR checklist, including a patient communication plan. Patient-nurse-physician interviews were used to assess concordance in the domains of diagnosis, tests and procedures, and expected discharge date. Using two-hospitalist review, agreement was rated as none, partial, or complete, and a total concordance score was calculated for each patient in both IDR groups. Multivariate analysis was used to examine the relationship between concordance, IDR type, patient factors, and utilization outcomes. For 658 patients, the mean concordance score was 11.71 out of a possible 18. There was no difference in concordance between hospitalist and core IDR groups (11.68 vs. 11.84, p = 0.7). Higher total concordance score was associated with lower lengths of stay (p < 0.001) and readmission rates (p = 0.001). Total concordance had a negative association with patient age (p = 0.04). Concordance did not change with IDR type. Higher concordance appears to be related to positive utilization outcomes. Future studies are needed to evaluate potential interventions to improve concordance.

Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts

ObjectiveWe aimed to compare patient’s and physician’s ratings of inhaled medication adherence and to identify predictors of patient-physician discordance.DesignBaseline data from two prospective multicentre observational studies.Setting29 allergy, pulmonology and paediatric...

175 Understanding Patients’ End-of-Life Goals of Care in the Emergency Department

Emergency departments (ED) are frequently the entryway to the health system for older, ill patients. Since decisions made in the ED often influence escalation of care both in the ED and intensive care unit, it is important for emergency physicians to understand their patients’ goals of care. We aim to determine how well emergency physicians understand their patients’ goals of care, and better understand patient perspectives and attitudes on end-of-life care.

Patient-Physician Agreement in Reporting and Prioritizing Existing Chronic Conditions.

In this study, we aimed to assess (1) the agreement between patient self-reports and general practitioner (GP) reports of the chronic conditions affecting the patients and (2) the agreement between patients and GPs on health priorities in a primary care setting. Patients were recruited in the Parisian area of France by a convenience sample of GPs; eligibility criteria required that the GP was the patient's listed primary care provider for at least 12 months. Participants were asked to report all the patient's current chronic conditions by using a previously developed list of 124 chronic conditions and write a list of up to 3 priority conditions. From April to May 2017, 233 patients were recruited from 16 GP practices. Agreement between the number of conditions reported by patients and by GPs was moderate (intraclass correlation coefficient 0.59, 95% CI, 0.50 to 0.69). Agreement between patient self-reports and GP reports of each chronic condition ranged from very good (eg, κ = 0.85 for hypothyroidism) to poor (eg, κ = 0.12 for chronic anxiety disorder). Among the 153 patient-GP pairs for which both the patient and GP wrote a priority list, 45 (29.4%) of patients' first priorities did not appear anywhere on the corresponding GPs' lists, and 19 (12.4%) pairs had no matching priority condition. Agreement between patients and their GPs varied widely depending on the diseases reported. Low agreement on health priorities suggests a need for improvement to ensure better alignment between patient and physician perspectives.

Prospective Blinded Evaluation of Patient-Physician Agreement Using the Summary Outcome Determination (SOD) Score

ObjectiveTo determine whether the Summary Outcome Determination (SOD) score demonstrates a high level of physician-patient agreement in a prospective setting with multiple raters. Patients and MethodsFor this study, 100 patients who were being evaluated at various intervals following shoulder or elbow surgery were prospectively enrolled from May 30, 2017, through August 31, 2017. The patients’ attending physicians and a member of their team (physician assistant, resident, fellow, medical student) assigned categorical and numerical SOD scores while blinded to the scores given by each other. All scores were analyzed among raters, assessing internal consistencies, agreement, and reliability. ResultsThe mean follow-up (interval between surgery and completion of the survey) was 31 months, with a range of 1 to 220 months. The intraclass correlation coefficient for patient and physician numerical scores was excellent at 0.82. The weighted κ value for categorical scores was 0.64. Bland-Altman analysis revealed low average discrepancy at 0.6 with a 95% CI of −3.3 to 4.5. The Cronbach α value was 0.94, indicating strong internal validity. The categorical physician-patient agreement occurred within one category 96% of the time. ConclusionThis study found that the SOD score has strong agreement with excellent intraclass correlation coefficient and weighted κ values, indicating substantial agreement, reproducibility (shown by low average error), and strong internal validity. With promising results in the prospective setting, the SOD score was found to be an easy to use outcome measure with reliable agreement between patient and physician. This score has potential to be a metric revealing the “value” of a specific surgical intervention.

Impact of Symptom Reporting Agreement on Interdisciplinary Pain Program Participation.

To investigate whether physician-patient agreement of potential patient problem areas impacts subsequent patient enrollment in an interdisciplinary pain management program. Retrospective chart review of 544 patients who underwent evaluation of their chronic pain. Physicians and their patients endorsed perceived patient problems during the evaluation. The potential problems included 7 clinical domains: pain, sleep, mood, physical functioning, ability to cope with pain, ability to manage pain flare-ups, and pain medication effectiveness. Results indicated statistically significant levels of agreement among the physicians and their patients (free-marginal kappa range, 0.19 to 0.94, P's<0.001). The highest agreement occurred for pain and the lowest for pain medication effectiveness. Patients who enrolled in a recommended program did not differ from those who did not enroll based on either levels of agreement or average number of physician-patient agreements for the 7 clinical domains (P's>0.05). Patients recommended for higher-intensity programs were perceived by their evaluating physician to have a significantly greater number of problematic clinical domains than those recommended for less intense pain programs. The level of physician-patient agreement regarding the patients' current difficulties did not appear to influence patients' decisions to participate in interdisciplinary pain management. Extraneous, nonclinical factors may have had a greater impact on participation in interdisciplinary pain management than physician-patient agreement. Future research should focus on identifying these factors and their impact. Also, studying the impact of physician-patient agreement beyond enrollment status (eg, on successful program completion) may be helpful in potentially enhancing patient outcomes.

(375) An Analysis of Physician and Patient Reporting of Treatable Targets in an Interdisciplinary Pain Management Program

Interdisciplinary pain management programs (IPMP) provide low-risk, cost-effective treatment for patients with “high-impact chronic pain”. Patient participation is important for successful outcomes and may be influenced by patient and physician perceptions of treatment targets. The purpose of this study was to determine the presence of difficulty with 7 key clinical domains and the level of agreement between patients and physicians identifying these. It was hypothesized that more impaired patients would be recommended for more intense treatment and that higher levels of physician-patient agreement would predict higher levels of enrollment in treatment. A retrospective chart review was performed of 544 patients evaluated in an outpatient academic pain clinic. Patient characteristics; patient and physician reported presence of difficulty with 7 clinical domains (pain, sleep, mood, physical functioning, ability to cope with pain, ability to manage pain flare-ups and medication effectiveness); treatment recommendation (>80 h total treatment in an IPMP vs 80h of treatment had significantly more physician-identified problem domains. Levels of physician-patient agreement did not vary by treatment recommendation or treatment enrollment status (P's >.05). Despite agreement between patients and physicians, only 57.4% of patients began treatment. As hypothesized, more impaired patients were recommended for more treatment. However, patient-physician agreement did not appear to affect the treatment recommendation or enrollment status. Further studies are needed to identify other barriers to treatment.

Perspectives on End-of-Life Treatment among Patients with COPD: A Multicenter, Cross-sectional Study in Japan

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality. Since patients with severe COPD may experience exacerbations and eventually face mortality, advanced care planning (ACP) has been increasingly emphasized in the recent COPD guidelines. We conducted a multicenter, cross-sectional study to survey the current perspectives of Japanese COPD patients toward ACP. “High-risk” COPD patients and their attending physicians were consecutively recruited. The patients’ family configurations, understanding of COPD pathophysiology, current end-of-life care communication with physicians and family members, and preferences for invasive life-sustaining treatments including mechanical ventilation (MV) and cardiopulmonary resuscitation (CPR) were evaluated using a custom-made, structured, self-administered questionnaire. Attending physicians were also interviewed, and we evaluated the patient–physician agreement. Among the 224 eligible “high-risk” patients, 162 participated. Half of the physicians (54.4%) thought they had communicated detailed information; however, only 19.4% of the COPD patients thought the physicians did so (κ score = 0.16). Less than 10% of patients wanted to receive invasive treatment (MV, 6.3% and CPR, 9.4%); interestingly, more than half marked their decision as “refer to the physician” (MV 42.5% and CPR 44.4%) or “refer to family” (MV, 13.8% and CPR, 14.4%). Patients with less knowledge of COPD were less likely to indicate that they had already made a decision. Although ACP is necessary to cope with severe COPD, Japanese “high-risk” COPD patients were unable to make a decision on their preferences for invasive treatments. Lack of disease knowledge and communication gaps between patients and physicians should be addressed as part of these patients’ care.

The Shoulder Self-Administered Motion Evaluation Has Excellent Patient Reliability and Reproducibility on Both Physician and Repeat Follow-up Testing.

Long-term clinical evaluation is becoming more important, yet difficulties exist because there are substantial patient costs for extended follow-up. The goal of this study was to validate whether a new shoulder motion evaluation is reproducible and reliable with physician examination. Consecutive patients were administered a shoulder motion assessment during their clinic visit. Patients completed the same evaluation 2 weeks after their visit to determine test-retest reliability. Exact and approximate (within 20° or 4 spinal levels) agreements between patient and physician measurements were calculated. A total of 112 patients (224 shoulders) with an average age of 56.7 years were evaluated. The most common diagnoses were osteoarthritis (33.0%) and rotator cuff tear (32.1%). All motion questions had greater than 50% exact patient-physician agreement and greater than 70% approximate agreement. When agreement was off, patients more often underestimated their motion. There was substantial clinician-patient agreement for all questions and almost perfect agreement for forward elevation (intraclass correlation coefficient, 0.78) and internal rotation (intraclass correlation coefficient, 0.77). On test-retest reliability testing, patient-patient agreement was substantial for external rotation at the side (intraclass correlation coefficient, 0.71). There was near perfect agreement for internal rotation (intraclass correlation coefficient, 0.83) and abduction (intraclass correlation coefficient, 0.81) testing. This shoulder assessment tool had both good agreement to physician examination and substantial agreement on correlation testing. There was substantial agreement between follow-up visits, suggesting excellent reproducibility. This motion assessment shows effectiveness with most shoulder pathologies. It is recommended as a good screening tool for both clinical and research purposes requiring long-term follow-up in which in-person clinical examinations may be costly and time consuming. [Orthopedics. 2018; 41(6):e820-e826.].

Patient-Physician Agreement Using Summary Outcome Determination Scores

ObjectiveTo determine whether the Summary Outcome Determination (SOD) score had exhibited a high level of physician-patient agreement in surgical patients. Patients and MethodsThe medical records of 320 postoperative patients were reviewed, of whom 164 patients were included in the study. Patients were included if both physician-assigned and patient-assigned SOD scores had been recorded. The SOD is administered as follows: the patient is asked “Compared to before surgery, is your elbow/shoulder better, worse or no different?” If better: “Is it improved, greatly improved, almost normal or normal?” If worse: “Is it worse or profoundly worse, or as bad as dying?” Each category is associated with a numerical value and definition for further clarification. The patient is asked to assign a category and a numerical value after the physician has already done so. These categories and values were evaluated between raters (ie, physician and patient) to assess reliability. ResultsThe intraclass correlation coefficient of physician-patient numerical ratings was “excellent” (0.93). The Bland-Altman 95% limits of agreement on the differences between the physician and the patient ranged from −1.3 to 1.3. The physician and patient numerical rankings matched exactly in 118 patients (72%) or differed by a factor of no more than 1 (26%) in 161 (98%) patients. ConclusionThe SOD score can be used as both a surgeon-based and a patient-based outcome score, given the high level of agreement. Given its brevity, ease of understanding, and high interrater reliability, the SOD has the potential to be used across multiple specialties to rate outcomes.

Goals of Chronic Pain Management: Do Patients and Primary Care Physicians Agree and Does it Matter?

Assess patient-physician agreement on management goals for chronic musculoskeletal pain and its associations with patient and physician visit experiences. Pre-visit and post-visit questionnaires for 87 primary care visits that involved patients taking opioids for chronic musculoskeletal pain and primary care resident physicians. After each visit, patients and physicians independently ranked 5 pain treatment goals from most to least important. In total, 48% of patients ranked reducing pain intensity as their top priority, whereas 22% ranked finding a diagnosis as most important. Physicians ranked improving function as the top priority for 41% of patients, and ranked reducing medication side effects as most important for 26%. The greatest difference between patient and physician rankings was for reducing pain intensity. In regression analyses, neither overall agreement on goals (ie, the physician's first or second priority included the patient's top priority) nor difference in patient versus physician ranking of pain intensity was significantly associated with patient-reported visit experience (β for overall agreement, -0.08; 95% confidence interval [CI], -0.45 to 0.30; P=0.69; β for intensity, -0.06; 95% CI, -0.17 to 0.04; P=0.24) or physician-reported visit difficulty (β for overall agreement, 1.92; 95% CI, -2.70 to 6.55; P=0.41; β for intensity, 0.42; 95% CI, -0.87 to 1.71; P=0.53). Patients and physicians prioritize substantially different goals for chronic pain management, but there is no evidence that agreement predicts patient experience or physician-reported visit difficulty. Primary care physicians may have adapted to new recommendations that emphasize functional goals and avoidance of long-term opioid therapy, whereas patients continue to focus on reducing pain intensity.

Satisfaction with control of systemic lupus erythematosus and lupus nephritis: physician and patient perspectives.

PurposePatient satisfaction with disease control of systemic lupus erythematosus (SLE) is an important component of medical management. This analysis evaluated patient and physician satisfaction with disease control of SLE, factors associated with satisfaction/dissatisfaction, and the degree of physician–patient concordance of these parameters.Patients and methodsData were extracted from the US Adelphi Real World Lupus Disease Specific Programme®, a cross-sectional survey of 50 rheumatologists, 25 nephrologists, and their patients with non-nephritis SLE (NNSLE) or lupus nephritis (LN).ResultsPhysicians reported moderate or severe disease activity in 25.0% of patients with NNSLE and in 50.5% of patients with LN, and were satisfied with disease control in 78.6% (132/168) and 73.8% (152/206) of patients, respectively. For patients, 75.8% (75/99) with NNSLE were satisfied with their current treatment, compared with 65.5% (74/113) with LN. Physician–patient agreement (70.7%) on the level of satisfaction was “slight” (kappa =0.1445) for NNSLE; patients were more frequently dissatisfied than physicians with regard to joint tenderness, fatigue, anxiety, pain on movement, malar rash, and photosensitivity. Physician–patient agreement (71.4%) on the level of satisfaction was “fair” (kappa =0.3695) for LN; patients expressed greater dissatisfaction than physicians for headache, photosensitivity, and anxiety, whereas physicians were more dissatisfied with regard to joint swelling, kidney function, and blood pressure control. In general, patients with NNSLE or LN who were dissatisfied (or whose physicians were dissatisfied) were more likely to have joint swelling, joint stiffness, malar rash, hair loss, depression, and fatigue, have moderate or severe disease, or to be currently experiencing disease flare.ConclusionThese data highlight the patient and physician dissatisfaction with real-world disease control of SLE.