Lack of Patient-Clinician Concordance in Cancer Patients: Its Relation With Patient Variables

被引:30
作者
Chandwani, Kavita D. [1 ]
Zhao, Fengmin [2 ]
Morrow, Gary R. [6 ]
Deshields, Teresa L. [3 ]
Minasian, Lori M. [4 ]
Manola, Judith [2 ]
Fisch, Michael J. [5 ]
机构
[1] Univ Texas Hlth Sci Ctr Houston, McGovern Med Sch, Houston, TX 77030 USA
[2] Dana Farber Canc Inst, Boston, MA 02115 USA
[3] Siteman Canc Ctr, St Louis, MO USA
[4] NCI, Bethesda, MD 20892 USA
[5] AIM Specialty Hlth, Chicago, IL USA
[6] Univ Rochester, Med Ctr, Rochester, NY 14642 USA
基金
美国国家卫生研究院;
关键词
Lack of concordance; bother; distress; treatment compliance; QOL; cancer; QUALITY-OF-LIFE; PHYSICIAN DISCORDANCE; SYMPTOMS; DISTRESS; CHEMOTHERAPY; OUTPATIENTS; PARTNERS; ACCURATE; BREAST; BOTHER;
D O I
10.1016/j.jpainsymman.2016.12.347
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Context. Patients with cancer are bothered by its diagnosis, treatment, and associated uncertainty. Lack of concordance (LOC) of patients' reporting of their symptoms and quality of life (QOL) with that of their clinicians has been observed in cancer care. However, information regarding the reporting of patients' bother due to aspects of cancer experience and their clinicians' assessment is lacking. Objectives. The objective was to describe cancer patients' bother due to aspects of their disease experience and explore the concordance (LOC) or a lack thereof between patients' and clinicians' reporting of patients' bother and factors associated with it. Methods. Data from a prospective study of cancer patients' symptoms were analyzed. LOC was defined as any discrepancy between patient-clinician pairs in reporting patients' bother due to disease, cancer treatment, comorbidity, and side effects of symptom management. The relation of LOC to patients' QOL and distress was also explored. Results. Of the 2597 patients analyzed, a perfect concordance was observed in 37%-42%. Clinicians underestimated the severity of bother in 62%-76% of discordant cases. LOC was significantly associated with patient-reported distress and poor QOL. Referral for symptom management was associated with the clinician's rating of patients' bother, and LOC was associated with likelihood of poor compliance with recommendations for symptom management. Conclusion. Majority of clinicians tended to underestimate cancer patients' bother, and this was associated with poor QOL of cancer patients and their distress. Future studies should examine the LOC and its correlates to confirm the results of this study. (C) 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:988 / 998
页数:11
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