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Health care providers underestimate symptom intensities of cancer patients: A multicenter European study

Laugsand, Eivor Alette; Sprangers, Mirjam A. G.; Bjordal, Kristin; Skorpen, Frank; Kaasa, Stein; Klepstad, Pål
Journal article, Peer reviewed
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URI
http://hdl.handle.net/11250/2357737
Date
2010
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  • Institutt for klinisk og molekylær medisin [2117]
  • Institutt for sirkulasjon og bildediagnostikk [1084]
  • Publikasjoner fra CRIStin - NTNU [21863]
Original version
Health and Quality of Life Outcomes 2010, 8(1):104   10.1186/1477-7525-8-104
Abstract
Background: Many patients with advanced cancer depend upon health care providers for symptom assessment.

The extent of agreement between patient and provider symptom assessments and the association of agreement

with demographic- and disease-related factors was examined.

Methods: This cross-sectional study included 1933 patient-health care provider dyads, from 11 European countries.

Patients reported symptoms by using the four-point scales of the European Organization of Research and

Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) version 3, and providers used

corresponding four-point categorical scales. Level of agreement was addressed at the group level (Wilcoxon

Signed-Rank test), by difference scores (provider score minus patient score), at the individual level (Intraclass

Correlation Coefficients, ICCs) and visually by Bland-Altman plots. Absolute numbers and chi-square tests were used

to investigate the relationship between agreement and demographic-, as well as disease-related factors.

Results: The prevalence of symptoms assessed as moderate or severe by patients and providers, respectively, were

for pain (67 vs.47%), fatigue (71 vs. 54%), generalized weakness (65 vs. 47%), anorexia (47 vs. 25%), depression

(31 vs. 17%), constipation (45 vs. 30%), poor sleep (32 vs. 21%), dyspnea (30 vs. 16%), nausea (27 vs. 14%), vomiting

(14 vs. 6%) and diarrhea (14 vs. 6%). Symptom scores were identical or differed by only one response category in

the majority of patient-provider assessment pairs (79-93%). Providers underestimated the symptom in

approximately one of ten patients and overestimated in 1% of patients. Agreement at the individual level was

moderate (ICC 0.38 to 0.59). Patients with low Karnofsky Performance Status, high Mini Mental State-score,

hospitalized, recently diagnosed or undergoing opioid titration were at increased risk of symptom underestimation

by providers (all p < 0.001). Also, the agreement was significantly associated with drug abuse (p = 0.024), provider

profession (p < 0.001), cancer diagnosis (p < 0.001) and country (p < 0.001).

Conclusions: Considerable numbers of health care providers underestimated symptom intensities. Clinicians in

cancer care should be aware of the factors characterizing patients at risk of symptom underestimation.
Publisher
BioMed Central
Journal
Health and Quality of Life Outcomes

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