Differences in the Intended Meaning of Congestion Between Patients and Clinicians

McCoul, Edward D.; Mohammed, Asmaa N.; Debbaneh, Peter; Carratola, Maria; Patel, Amit

doi:10.1001/jamaoto.2019.1023

Cited by 11 publications

(17 citation statements)

References 20 publications

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“…Because dizziness may represent different things to different people, use of the term without qualification also creates a barrier to effective communication. Investigation into the intended meaning of other common symptoms in otolaryngology (e.g., congestion) has demonstrated a large degree of variability between patients and providers 12 . The present study found that providers were more likely to ascribe dizziness to motion sensitivity, whereas patients tended to view dizziness as more closely related to lightheadedness, vision complaints, and pain.…”

Section: Discussioncontrasting

confidence: 44%

“…Recent work has demonstrated a disparity in the interpretation of “congestion” between patients and providers 12 . This study highlighted the fact that otolaryngologists have a tendency to interpret congestion as blockage of nasal breathing, whereas patients may in fact be referencing other symptoms such as facial pressure and excessive mucus.…”

Section: Introductionmentioning

confidence: 78%

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A Dizzying Complaint: Investigating the Intended Meaning of Dizziness Among Patients and Providers

et al. 2020

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Objective/Hypothesis To assess for semantic differences regarding the definition of dizziness among otolaryngology patients, otolaryngologists, and non‐otolaryngologist providers. Study Design Cross‐sectional survey. Methods Between March and May 2020, a survey consisting of 20 common descriptors for dizziness within five domains (lightheadedness, motion sensitivity, imbalance, vision complaints, and pain) was completed by patients at two outpatient otolaryngology clinics. Surveys were subsequently obtained from otolaryngology and non‐otolaryngology providers attending a multidisciplinary dizziness lecture. The primary outcome measure was to assess for differences in definition of dizziness between patients and providers. Secondary outcome measures included assessing differences between otolaryngologists and non‐otolaryngologists. Results About 221 patients and 100 providers participated. Patients selected a median of 7 terms compared to 8 for providers (P = .375), although providers had a larger overall distribution of number of terms selected (P = .038). Patients were more likely than providers to define dizziness according to the following domains: lightheadedness (difference 15.0%; 95% confidence interval [CI] 5.5%–25.3%), vision complaints (difference 21.6%, 95% CI 12.0%–29.6%), and pain (difference 11.5%, 95% CI 4.7%–17.1%). Providers were more likely to define dizziness according to the motion sensitivity domain (difference 13.8%, 95% CI 6.8%–19.6%). Otolaryngology and non‐otolaryngology providers defined dizziness similarly across symptom domains. Conclusion Although patients and providers both view dizziness as imbalance, patients more commonly describe dizziness in the context of lightheadedness, vision complaints, and pain, whereas providers more frequently define dizziness according to motion sensitivity. These semantic differences create an additional barrier to effective patient‐provider communication. Level of Evidence 4. Laryngoscope, 131:E1443–E1449, 2021

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Section: Discussioncontrasting

confidence: 44%

Section: Introductionmentioning

confidence: 78%

A Dizzying Complaint: Investigating the Intended Meaning of Dizziness Among Patients and Providers

et al. 2020

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“…Interestingly, many of these symptoms themselves are open to interpretation for their intended meaning. Semantic differences in the term congestion have been previously studied and shown to be highly variable and ambiguous for many patients, with significant differences between otolaryngologists and patients 9 . According to the American Academy of Otolaryngology‐Head and Neck Surgery clinical practice guideline for sinusitis, other cardinal symptoms experienced by patients with sinus infections include mucus, facial pain and pressure, sore throat, and loss of smell 16 .…”

Section: Discussionmentioning

confidence: 99%

“…However, semantic content in the interpretation and expectation of sinus infection symptoms may be variable. Previously, other common ear, nose, and throat complaints such as congestion 9 and dizziness 10 have shown significant differences between patients and providers, though these studies did not consider regional and geographic differences.…”

Section: Introductionmentioning

confidence: 97%

What do we mean when we have a “sinus infection?”

Riley

Navarro

Trinh

et al. 2022

Int Forum Allergy Rhinol

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Introduction Sinus infections are a common reason patients seek medical care. However, the intended meaning of the term sinus infection among patients and otolaryngologists is incompletely understood. Methods In this multi‐institutional cross‐sectional study, a semantics‐based questionnaire was provided to consecutive patients presenting to otolaryngology clinics at six academic centers from June 2020 until May 2021. The primary outcome was respondent definitions for sinus infection from a list of 28 proposed terms covering six general categories. Secondary outcome measures included differences between geographic regions. Results Responses were obtained from 560 patients (54% female, mean age 48.9 years) and 29 otolaryngologists (42% female, mean age 37.4 years). Patients and otolaryngologists selected a median of 10 and 11 terms, respectively, to define a sinus infection. Among patients the most frequently selected symptom categories were mucus (500, 89.3%), pressure/pain (480, 85.7%), and airflow (468, 83.6%). Compared to patients, clinicians selected with greater frequency the symptom categories of pressure/pain (14.3% difference; 95% CI, 7.6% to 22.5%), mucus (10.7% difference; 95% CI, 4.7% to 18.3%) and airflow (13.0% difference; 95% CI, 4.8% to 21.7%). Multiple categories were selected by 96% of patients and 100% of providers. Conclusion The definition of sinus infection appears variable for both patients and otolaryngologists, though patients appear to apply a broader range of symptoms to the term sinus infection. There were no pronounced geographic differences in the description of a sinus infection in this US sample population. Patients commonly described sinus infection in the context of pain‐related symptoms. Appreciation of these semantic differences may enable more effective patient‐clinician communication.

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“…All data were self-reported, and most symptoms were only reported as present or absent. Patient-reported symptoms can be very subjective [39]. Due to limitations in the available data, we had to make certain assumptions.…”

Section: Discussionmentioning

confidence: 99%

Virulence-mediated infectiousness and activity trade-offs and their impact on transmission potential of influenza patients

et al. 2020

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Communicable diseases are often virulent, i.e. they cause morbidity symptoms in those infected. While some symptoms may be transmission-enhancing, other symptoms are likely to reduce transmission potential. For human diseases, the reduction in transmission opportunities is commonly caused by reduced activity. There is limited data regarding the potential impact of virulence on transmission potential. We performed an exploratory data analysis of 324 influenza patients at a university health centre during the 2016/2017 influenza season. We classified symptoms as infectiousness-related or morbidity-related and calculated two scores. The scores were used to explore the relationship between infectiousness, morbidity (virulence), and activity level. We found a decrease in the activity level with increasing morbidity scores. There was no consistent pattern between an activity level and an infectiousness score. We also found a positive correlation between morbidity and infectiousness scores. Overall, we find that increasing virulence leads to increased infectiousness and reduced activity, suggesting a trade-off that can impact overall transmission potential. Our findings indicate that a reduction of systemic symptoms may increase host activity without reducing infectiousness. Therefore, interventions should target both systemic- and infectiousness-related symptoms to reduce overall transmission potential. Our findings can also inform simulation models that investigate the impact of different interventions on transmission.

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Differences in the Intended Meaning of Congestion Between Patients and Clinicians

Cited by 11 publications

References 20 publications

A Dizzying Complaint: Investigating the Intended Meaning of Dizziness Among Patients and Providers

A Dizzying Complaint: Investigating the Intended Meaning of Dizziness Among Patients and Providers

What do we mean when we have a “sinus infection?”

Virulence-mediated infectiousness and activity trade-offs and their impact on transmission potential of influenza patients

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