Patient Self-report Of Symptoms Research Articles

2020 Improving pain management in non-verbal patients

Abstract Introduction Identification of pain generally relies on patient self-reporting of symptoms. Patients with limited communication, advanced dementia or learning disabilities are unable to self-report pain. This results in pain being under-recognised and under-treated. Consequences of this are serious and include physical and psychological distress, longer length of stay and worse outcomes.1 Methods Abbey Pain Score (APS) [Figure 1] was introduced on a single Healthcare of the Older Person ward.2,3 It was used as the primary means of assessing pain in non-verbal patients (NVP) in place of the usual verbal pain scale (scored 0-10). [Figures 2 and 3] Ward-based teaching for all doctors, nurses and healthcare assistants was conducted before introduction of the APS. Data was collected for 20 consecutive NVP. Figure 1: Abbey Pain Score (Six items observed & Score) Vocalisation: 0-3; Facial expression: 0-3; Change in body language: 0-3; Behavioural change: 0-3; Physiological change: 0-3; Physical changes: 0-3. Scoring scale: No Pain (0-2); Mild Pain (3-7); Moderate Pain (8-13); Severe (14+). Results At baseline we identified that pain as a symptom was missed in 54 % of NVP using the verbal pain score. With introduction of APS this dropped only slightly at 3 months but there was an increased uptake in scoring NVP on APS. With persistent engagement there was a significant decline in number of patients with un-managed pain needs. Figure 3: Abbey pain score (All patients with any pain) Baseline Pre-intervention: 21 / 39 (54 %); Post-intervention (3 months): 10 / 20 (50 % Post-intervention (12 months): 1 / 19 (5 %) Conclusion ABP is an effective means of addressing pain in NVP. It is simple to implement and can lead to significant improvements in patient care.

The relationship between response style and symptom reporting in cancer patients

Patient-reported outcomes are considered the gold standard for documenting treatment-related toxicities and cancer-related symptoms in the management of oncology patients. Poor concordance between patients and health care professionals (HCPs) on patients' symptoms has been documented. The purpose of this study is to examine the association between social desirability, a response style, and symptom reporting in a colorectal cancer clinic. Patients being treated for colorectal cancer completed a social desirability measure and a symptom measure before their appointment in the oncology clinic. The HCP who saw the patient completed a symptom measure for the patient after the clinic visit. One hundred sixty-nine patients consented to participate in the study. The majority of the patients had stage 4 disease. There was a statistically significant positive correlation between social desirability and overall reported symptom burden. There was a statistically significant negative correlation between social desirability and concordance between the patient and the HCP on the patient's symptoms. Social desirability scores were stable over the course of 1year. Sensitivity to social desirability effects seems to play an important role in patient self-report of symptoms. As social desirability is a stable quality, patients sensitive to it may be persistently at risk for undertreatment of symptoms due to limited symptom reporting.

Patient Self-Report Superior to Electronic Medical Record Abstraction for Identifying Positive COVID-19 Symptoms at Illness Onset

IntroductionMost initial COVID-19 research focused on hospitalized patients. Presenting symptomatology in the outpatient setting was poorly characterized, making it difficult for primary care physicians to predict which patients would require hospitalization. The purpose of this study was to characterize the presenting symptoms of COVID-19 infection and baseline patient characteristics and evaluate for correlation with disease severity, duration, and chronicity in the outpatient setting.MethodsA total of 107 adult, English-speaking patients with suspected and confirmed COVID-19 cases at the 3 primary care practices of Stony Brook University Hospital were studied between March and December 2020. Survey data were collected from patient telephone interviews and electronic medical record abstraction. The potential risk factors assessed included participant demographics, medical comorbidities, and the number and type of symptoms at illness onset. Outcome measures included symptom duration, hospitalizations, and persistence of symptoms at 12 weeks from study enrollment.ResultsPatient self-report survey elicited nearly twice as many symptoms described at illness onset as those recorded in the electronic medical record (p<0.0001). A higher number of symptoms at illness onset was positively associated with symptom duration and chronicity. The presence of fever and hypoxia at the onset of illness were each positively associated with eventual hospitalization for COVID-19 disease.ConclusionsEarly in the setting of newly emerging infectious diseases, particularly those such as COVID-19 that involve multiple organ systems, patient self-report of symptoms using a complete review of systems rather than electronic medical record abstraction alone may be key for accurate disease identification and characterization as well as prediction of eventual disease severity, duration, and chronicity.

Patient survey superior to EMR extraction for eliciting positive symptoms at COVID-19 illness onset.

Context: COVID-19 has ravaged nations around the world, with New York City (NYC) and the NYC suburbs being particular epicenters of COVID-19 infection. Suffolk County, NY, has reported over 200,000 cases and 3,000 deaths to date. Most initial COVID-19 research concerned hospitalized patients. Presenting symptomology in the outpatient setting was poorly characterized, as were the implications of specific presenting symptoms, beyond respiratory distress or hypoxia, for eventual disease severity. This made it difficult for primary care physicians to predict which patients would require hospitalization for COVID-19 disease or decompensate while being managed at home during a time when hospital and ICU beds were limited. Objective: To characterize presenting symptoms of COVID-19 infection in the outpatient setting and evaluate for correlation with severity, duration, and chronicity of disease. Study Design and Analysis: We collected survey data from both patient telephone interviews and electronic medical record (EMR) extraction. Patient characteristics were described using means and percentages when appropriate. Percentage of symptoms by severity level, symptom duration, COVID-19 testing and escalating medical care were calculated. To evaluate association of risk factors with positive testing, severity, duration and chronicity of symptoms, logistic regression was used. Patient characteristics, medications and repeat measures were evaluated as risk factors in logistic regression. Setting or Dataset: 107 patients with suspected and confirmed COVID-19 cases at the 3 primary care practices of Stony Brook University Hospital between March and December, 2020. Population Studied: adult, English speaking primary care patients with suspected or confirmed COVID-19 Intervention/Instrument: patient self report telephone survey, EMR data extraction survey Outcome Measures: symptom duration, symptom severity, persistence of symptoms at 3 month time point Significant Results: Patient self-report survey elicited nearly twice as many symptoms described at illness onset vs. those recorded in the EMR. Conclusions: Early in the setting of newly emerging infectious diseases, particularly those such as COVID-19 which involve multiple organ systems, patient self report of symptoms of illness rather than EMR extraction alone may be crucial both for identifying cases and in order to characterize pathophysiology of disease in real time.

P12.03 A Delphi survey to inform core ‘red flag’ symptoms for an electronic patient reported outcome system in glioblastoma follow up

Abstract BACKGROUND Glioblastoma is a common and aggressive primary malignant brain tumour in adults associated with a poor prognosis and considerable symptom burden. Clinical review and serial neuroimaging remain the primary monitoring tools to assess for disease status. However, the evidence base for the existing surveillance imaging schedule is yet to be established. New models of follow up care are needed to demonstrate better patient outcomes in this patient cohort. There are indications that patient-reported outcome measures (PROMs) can contribute to improved survival and maintaining an optimal quality of life in other oncology populations. MATERIALS AND METHODS There are no standardised PROMs for the priority symptoms in glioblastoma patients, which can be used for evaluation in clinical care as a surrogate marker for disease progression. A broad set of symptoms were therefore initially identified in a targeted literature search and were further refined via Delphi methodology, with the aim to obtain consensus amongst a small expert panel involved in the care of glioblastoma patients. A three round Delphi email survey was conducted. Consensus was defined as 70% agreement. RESULTS Symptom and function constructs were assessed for relevance, relationship to disease and treatment, sensitivity to change, psychometric properties and patient acceptability. Consensus was reached on the red flag symptoms and symptom clusters to monitor, as well as the minimum severity thresholds needed to trigger an alert on an electronic symptom reporting system, which has been developed to allow patient self-reporting of symptoms during treatment. CONCLUSION The red flag symptoms to monitor, along with the symptom severity thresholds, informed an app-based symptom reporting system, which is currently being piloted in a feasibility study exploring triggered imaging using ePROMs. This has the potential to inform future clinical practice through development of patient reported biomarkers.

Analysis of Central and Peripheral Vision Reaction Times in Patients With Postconcussion Visual Dysfunction.

To determine whether central and peripheral vision reaction times (PVRTs) are prolonged in patients with visual dysfunction after sustaining a concussion. Comparison of Dynavision D2 central and PVRTs in patients with postconcussion visual dysfunction were compared with control data from a normative patient database. Concussion patients without visual dysfunction were not included in this study. National Collegiate Athletic Association Division 1 college training room and university based, academic health center. Patients were selected for inclusion based on diagnosis of new visual dysfunction as indicated either by physical examination of the team physician or by patient self-report of symptoms. Patients included college athletes, college students, and concussion patient's presenting to a university based, academic health center. Measurement of central and PVRTs using a Dynavision D2 reaction time program were used as the dependent variables. Evaluations were conducted from 3 days to 11 months postconcussion, depending on the temporal development of visual symptoms after the concussion. No intervention was used. Average central and PVRTs for patients with postconcussion visual symptoms were compared with an asymptomatic control group with no history of concussion. Both central and PVRTs were significantly prolonged in patients with postconcussion visual symptoms compared with patients with no history of concussion. Central and PVRTs are both prolonged in patients with postconcussion visual dysfunction with PVRT being disproportionately prolonged. The percent change from central to PVRT was also increased in patients with postconcussion visual dysfunction.

Relation Between Subjective And Objective Activity In Patients With Knee Osteoarthritis

Knee osteoarthritis (OA) is a leading cause of disability in the United States, impairing mobility and decreasing physical activity. Clinicians rely on patient self-reports of symptoms and physical activity to evaluate functional status, especially in this population. Considering the importance of maintaining a physically active lifestyle in preventing chronic disease, it is imperative to understand how accurately patients perceive their own impairments to determine if more objective measures of function are needed to properly evaluate physical activity in patients with knee OA. PURPOSE: Determine the relation between symptoms and physical activity in patients with knee OA. METHODS: A case series of eight females with physician diagnosed knee OA (age: 56.5±5.7years; body mass index: 28.4±2.5kg/m2) participated in a single testing session as part of an ongoing study. Symptoms were assessed via self-report knee pain, UCLA activity scale and WOMAC questionnaire. The WOMAC disability subscale was extracted to quantify self-reported disability. To determine physical activity levels, patients wore Actigraph GT3X activity monitors for 7 days. Physical activity levels (sedentary, light and moderate) were extracted and associations between symptoms and physical activity were calculated via Pearson product moment correlations (P<0.05). RESULTS: Knee pain was positively correlated with WOMAC (r=0.859, P=0.01). Time spent sedentary was negatively correlated with knee pain (r=-0.736, P=0.04) and WOMAC (r=-0.778, P=0.02). Time spent in moderate activity was positively correlated with UCLA score and (r=0.723, P=0.04). UCLA score was positively correlated with average steps/day (r=0.763, P=0.03). CONCLUSION: Knee OA patients who report higher UCLA scores take more steps per day and spend more time performing moderate intensity activities, suggesting these patients may accurately perceive their own physical activity levels. Additionally, patients with knee OA report knee pain is associated with self-reported disability during daily tasks. Importantly, patients who spend less time in sedentary activities report greater pain and disability during daily tasks. This study is one important step in optimizing interventions to relieve symptoms and keep these patients physically active across the lifespan.

Radiological changes among artistic gymnasts in Gauteng Province

Background. The skeletal immaturity of competitive female gymnasts allows for a unique physiological predisposition to injuries as a result of the spine, limbs, ankles and wrists still growing. Studies have shown that lower back (spinal) injuries account for approximately 12% of injuries in female gymnasts.Objectives. The primary objective of the study was to determine the prevalence of radiological changes in female artistic gymnasts in South Africa. A further objective was to determine whether these radiological changes were associated with symptoms and with the amount of time spent training.Methods. A sample of 40 female artistic gymnasts with a mean of age 15.2 years (range 10 - 31) was included in the study. Thirty-one were active gymnasts and nine were retired at the time of the current study. Measuring instruments included questionnaires and X-rays.Results. X-ray analysis of symptomatic versus asymptomatic gymnasts showed no significant differences. Of the 18 gymnasts training &lt;25 h/week, 13 (72%) had degenerative changes detectable by X-ray. Of the 22 gymnasts training &gt;25 h/week, 15 (68%) had degenerative changes detected by X-ray. Radiological changes were higher than those in other studies.Conclusion. The prevalence of radiological changes was higher than international norms, however there was little difference between symptomatic and asymptomatic gymnasts. Patient self-reports of symptoms had little value in diagnosing change in the lumbar spine. Training duration affected the prevalence of changes in the lumbar spine and could be related to conditioning and experience.

Radiological changes among artistic gymnasts in Gauteng Province

Background. The skeletal immaturity of competitive female gymnasts allows for a unique physiological predisposition to injuries as a result of the spine, limbs, ankles and wrists still growing. Studies have shown that lower back (spinal) injuries account for approximately 12% of injuries in female gymnasts.Objectives. The primary objective of the study was to determine the prevalence of radiological changes in female artistic gymnasts in South Africa. A further objective was to determine whether these radiological changes were associated with symptoms and with the amount of time spent training.Methods. A sample of 40 female artistic gymnasts with a mean of age 15.2 years (range 10 - 31) was included in the study. Thirty-one were active gymnasts and nine were retired at the time of the current study. Measuring instruments included questionnaires and X-rays.Results. X-ray analysis of symptomatic versus asymptomatic gymnasts showed no significant differences. Of the 18 gymnasts training &lt;25 h/week, 13 (72%) had degenerative changes detectable by X-ray. Of the 22 gymnasts training &gt;25 h/week, 15 (68%) had degenerative changes detected by X-ray. Radiological changes were higher than those in other studies.Conclusion. The prevalence of radiological changes was higher than international norms, however there was little difference between symptomatic and asymptomatic gymnasts. Patient self-reports of symptoms had little value in diagnosing change in the lumbar spine. Training duration affected the prevalence of changes in the lumbar spine and could be related to conditioning and experience.

Conversion to tacrolimus once-daily from ciclosporin in stable kidney transplant recipients: a multicenter study

This 24-week, open, single-arm, prospective, multicenter study evaluated the effects of conversion from ciclosporin to Tacrolimus QD in adult kidney transplant patients. Stable patients receiving ciclosporin were converted to Tacrolimus QD at 0.1mg/kg/day. Relative change in renal function (primary endpoint) was assessed using estimated creatinine clearance (eCrCl) with a noninferiority margin set at -10%. A total of 346 patients were enrolled; and 301 patients were treated per protocol (PPS) in the hyperlipidemia (n=42), hypertrichosis (n=106), hypertension (n=77) and gingival hyperplasia (n=76) groups. Relative change in eCrCl was -0.6% in all PPS patients (95% CI, -2.2; 0.9) and -5.3% in the hyperlipidemia (CI, -9.59; -0.97), 0.9% in the hypertrichosis (CI, -2.59; 4.45), -0.1% in the hypertension (CI, -3.8; 3.68), and -1% in the gingival hyperplasia groups (CI, -4.63; 2.65) (PPS), meeting noninferiority criteria. There was no acute rejection. Decreases in serum lipids and blood pressure were moderate but without meaningful change in the number of treatment medications. Substantial decreases in severity of ciclosporin-related cosmetic side effects were evident from investigator and patient self-report of symptoms. Renal function remained stable after conversion to Tacrolimus QD. The effect of conversion on cardiovascular parameters was not clinically meaningful, however, marked improvement in ciclosporin-related cosmetic side effects was observed. (ClinicalTrials.gov number: NCT00481481).

Patient Self-Reports of Symptoms and Clinician Ratings as Predictors of Overall Cancer Survival

The National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE) reporting system is widely used by clinicians to measure patient symptoms in clinical trials. The European Organization for Research and Treatment of Cancer's Quality of Life core questionnaire (EORTC QLQ-C30) enables cancer patients to rate their symptoms related to their quality of life. We examined the extent to which patient and clinician symptom scoring and their agreement could contribute to the estimation of overall survival among cancer patients. We analyzed baseline data regarding six cancer symptoms (pain, fatigue, vomiting, nausea, diarrhea, and constipation) from a total of 2279 cancer patients from 14 closed EORTC randomized controlled trials. In each trial that was selected for retrospective pooled analysis, both clinician and patient symptom scoring were reported simultaneously at study entry. We assessed the extent of agreement between clinician vs patient symptom scoring using the Spearman and kappa correlation statistics. After adjusting for age, sex, performance status, cancer severity, and cancer site, we used Harrell concordance index (C-index) to compare the potential for clinician-reported and/or patient-reported symptom scores to improve the accuracy of Cox models to predict overall survival. All P values are from two-sided tests. Patient-reported scores for some symptoms, particularly fatigue, did differ from clinician-reported scores. For each of the six symptoms that we assessed at baseline, both clinician and patient scorings contributed independently and positively to the predictive accuracy of survival prognostication. Cox models of overall survival that considered both patient and clinician scores gained more predictive accuracy than models that considered clinician scores alone for each of four symptoms: fatigue (C-index = .67 with both patient and clinician data vs C-index = .63 with clinician data only; P <.001), vomiting (C-index = .64 vs .62; P = .01), nausea (C-index = .65 vs .62; P < .001), and constipation (C-index = .62 vs .61; P = .01). Patients provide a subjective measure of symptom severity that complements clinician scoring in predicting overall survival.

Issues in online patient self-reporting of health status.

Patient self-reporting of symptoms and quality of life following surgical interventions is generally delivered in the form of paper-based questionnaires to be completed in the outpatient clinic or at home. A commonly used tool for patient self-reporting of quality of life is the EQ5D health status questionnaire which, while limited in scope, has general applicability across a range of health interventions. In this article we examine the issues relating to online patient self-reporting using this questionnaire and the wider implications for the online reporting of health status.

Supporting Clinical Practice Decisions With Real-Time Patient-Reported Outcomes

Supporting Clinical Practice Decisions With Real-Time Patient-Reported Outcomes

Patient Self-Reports of Symptoms and Clinician Ratings as Predictors of Overall Cancer Survival

Patient Self-Reports of Symptoms and Clinician Ratings as Predictors of Overall Cancer Survival

Is patient self-reporting more accurate than clinician reporting of symptoms for predicting survival in patients with cancer? Meta-analysis of 30 closed EORTC randomized controlled trials

9597 Background: This study investigated whether patient self-reporting of symptoms improved prediction of survival as compared to clinician reporting or whether it provided an additive value when taken together with clinician assessment of the same symptoms. Methods: Patients with advanced cancer from 30 European Organisation for Research and Treatment of Cancer (EORTC) Randomized Controlled Trials were included in this retrospective pooled analysis. Clinician [Common Toxicity Criteria (CTC)] and patient (EORTC QLQ-C30) symptom assessment were reported at entry into the study. Data were obtained for six symptoms: pain, fatigue, vomiting, nausea, diarrhea and constipation. The prognostic accuracy for survival was assessed by modeling the contrast in reporting using the Harrell's discrimination c-index (c). Results: Data were available from patient and clinician assessment for pain [number of trials (t) =8, number of patients (n) =1214], fatigue [t=5, n=1237], vomiting [t=5, n=824], nausea [t=6, n=1393], diarrhea [t=6, n=815] and constipation [t=4, n=751]. Fatigue (c=0.59 vs 0.55, p&lt;.01) and constipation (c=0.57 vs 0.52, p=0.03) as reported by patients (vs clinicians) were significantly higher in predicting survival. Patient reported pain (c=0.59 vs 0.58, p=0.17), nausea (c=0.54 vs 0.52, p=0.51), vomiting (c=0.55 vs 0.52, p=0.21) and diarrhea (c=0.51 vs 0.52, p=0.49) did not predict survival any more accurately than clinician assessment. Patient and clinician assessment combined (vs clinicians alone) improved the prognostic accuracy for fatigue (c=0.61 vs 0.55, p=0.01), pain (c=0.60 vs 0.58, p&lt;0.01), nausea (c=0.54 vs 0.52, p=0.04), vomiting (c=0.56 vs 0.52, p=0.04) and constipation (c=0.5 vs 0.52, p=0.01), but not for diarrhea (c=0.52 vs 0.52, p=0.44). Conclusions: Our results suggest that patients’ ratings of their own fatigue and constipation have more prognostic value than clinicians’ ratings of these symptoms. Further, the prognostic value of clinicians's ratings can be improved by combining them with patients’ assessments for the symptoms pain, fatigue, constipation, nausea and vomiting. No significant financial relationships to disclose.

546Comparison of patient self-report of symptoms to medical professional report during 3-D-planned radiotherapy of prostate cancer

546Comparison of patient self-report of symptoms to medical professional report during 3-D-planned radiotherapy of prostate cancer