Failure of Physicians To Recognize Functional Disability in Ambulatory Patients

Calkins, David R.; Rubenstein, Lisa V.; Cleary, Paul D.; Davies, Allyson Ross; Jette, Alan M.; Fink, Arlène; Kosecoff, Jacqueline; Young, Roy T.; Brook, Robert H.; Delbanco, Thomas L.

doi:10.7326/0003-4819-114-6-451

Cited by 268 publications

(134 citation statements)

References 14 publications

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“…Therefore, the proportion of patients who would deserve operative treatment could even be underestimated. Years ago it was already shown that doctors have difficulty in recognising functional disability in patients -not so much the symptoms themselves-and one could speculate this is even more true for emotional impairment [16]. Although we are unable to draw any conclusions based on the results of the current study, one could hypothesise that underestimating the impact of symptoms represents another cause of underestimating the need for treatment.…”

Section: Interpretation and Discussion Of Main Resultscontrasting

confidence: 52%

“…It does not take social and emotional aspects into account and only roughly reflects one's current health status but certainly not one's desired health status or disease burden. Furthermore, physicians sometimes fail to recognise the functional disability of their patients [16]. An underestimation by the treating physician of the impact of symptoms on a patient's QoL might be one of the reasons why so many symptomatic patients with severe aortic stenosis are not referred for surgery.…”

Section: Introductionmentioning

confidence: 99%

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Quality of life among patients with severe aortic stenosis

et al. 2012

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Background The disease burden of patients with severe aortic stenosis is not often explored, while the incidence is increasing and many patients who have an indication for aortic valve replacement are not referred for surgery. We studied the quality of life of 191 patients with severe aortic stenosis, hypothesising that symptomatic patients have a far worse quality of life than the general population, which could enforce the indication for surgery. Methods The SF-36v2 Health Survey was completed by 191 consecutive patients with symptomatic or asymptomatic severe aortic stenosis.

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Section: Interpretation and Discussion Of Main Resultscontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Quality of life among patients with severe aortic stenosis

et al. 2012

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“…Many survivor outcomes of interest may be systematically underdiagnosed in routine practice (47,65,66). As such, an intervention to improve such an outcome after critical illness might yield a positive trial, even if the critical illness does not cause the outcome-but instead because critical illness serves as a marker for a large burden of an underdiagnosed problem or propensity to develop that problem.…”

Section: Proportion Of Geriatric Conditions After Sepsis Compared To mentioning

confidence: 99%

Spurious Inferences about Long-Term Outcomes

Iwashyna

Netzer

Langa

et al. 2012

Am J Respir Crit Care Med

113

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Rationale: Survivors of critical illness suffer significant limitations and disabilities. Objectives: Ascertain whether severe sepsis is associated with increased risk of so-called geriatric conditions (injurious falls, low body mass index [BMI], incontinence, vision loss, hearing loss, and chronic pain) and whether this association is measured consistently across three different study designs. Methods: Patients with severe sepsis were identified in the Health and Retirement Study, a nationally representative cohort interviewed every 2 years, 1998 to 2006, and in linked Medicare claims. Three comparators were used to assess an association of severe sepsis with geriatric conditions in survivors: the prevalence in the United States population aged 65 years and older, survivors' own pre-sepsis levels assessed before hospitalization, or survivors' own pre-sepsis trajectory. Measurements and Main Results: Six hundred twenty-three severe sepsis hospitalizations were followed a median of 0.92 years. When compared with the 65 years and older population, surviving severe sepsis was associated with increased rates of low BMI, injurious falls, incontinence, and vision loss. Results were similar when comparing survivors to their own pre-sepsis levels. The association of low BMI and severe sepsis persisted when controlling for patients' pre-sepsis trajectories, but there was no association of severe sepsis with injurious falls, incontinence, vision loss, hearing loss, and chronic pain after such controls. Conclusions: Geriatric conditions are common after severe sepsis. However, severe sepsis is associated with increased rates of only a subset of geriatric conditions, not all. In studying outcomes after acute illness, failing to measure and control for both preillness levels and trajectories may result in erroneous conclusions.Keywords: severe sepsis; long-term outcomes; geriatric conditions; cohort studies; trajectory bias A substantial body of research has demonstrated that survivors of critical illness face extensive physical, psychological, cognitive, and social deficits in the aftermath of their critical illness (1). For example, survivors of acute respiratory distress syndrome (ARDS) have prolonged 6-minute walk times, executive dysfunction, other neuropsychiatric deficits, and diminished ability to return to work (2-13). Numerous studies have found quality of life among survivors of critical illness (14, 15), severe sepsis (16,17), and ARDS (4-8, 13, 18) to be abnormally low.Patients surviving critical illness have limitations and disabilities somewhat characteristic of an older adult population. Rubenfeld recently postulated a "progeric hypothesis" that the sequelae of critical illness mirror accelerated aging (19). This hypothesis suggests that severe sepsis may be associated with the development of so-called geriatric conditions (15,20,21). These are conditions common among older adults, multifactorial in etiology, and associated with disability, often contributing to decreased quality of life (20-23). The followin...

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“…Comprehensive assessment of how a patient feels and functions requires a thorough inquiry. The traditional medical history and physical examination are often insufficient for assessing the full range of health-related problems in cancer patients and in chronically ill patients in general (Calkins et al, 1991;Passik et al, 1998). A standardized measurement of patients' symptoms and functioning offers an alternative structured way of collecting subjective information.…”

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confidence: 99%

Computer-based quality of life questionnaires may contribute to doctor–patient interactions in oncology

et al. 2002

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It is well recognized that oncologists should consider patients' quality of life and functioning when planning and delivering anticancer treatment, but a comprehensive assessment of how a patient feels requires a thorough inquiry. A standardized measurement of patients' quality of life may support clinicians in identifying important problems for discussion during the limited time of the medical consultations. The aim of this study was to assess the feasibility of computer-administered individual quality of life measurements in oncology clinics with immediate feedback of results to clinicians and to examine the impact of the information on consultations. The study employed a prospective non-randomized design with pre-test post-test within subjects comparisons and involved three medical oncologists and 28 cancer patients receiving chemotherapy. The intervention consisted of completion of quality of life questionnaires before the consultations and informing clinicians of the results. The main outcome measures were patients' perceptions of the content of baseline and intervention consultations and satisfaction with communication. A qualitative analysis of clinicians' interviews was performed. When clinicians had the quality of life results they enquired more often about daily activities (Z=72.71, P=0.007), emotional problems (Z=72.11, P=0.035) and work related issues (Z=71.89, P=0.058). There was an increase in the number of issues discussed during the intervention consultation (Z=71.89, P=0.059). Patients were highly satisfied with both consultations. The computer measurement was well accepted by patients who felt that the questionnaires were a useful tool to tell the doctors about their problems. The clinicians perceived that the quality of life data broadened the range of the clinical inquiry and helped them identify issues for discussion. Having symptoms and functional problems expressed quantitatively on a scale was useful for detection of change over time.

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Failure of Physicians To Recognize Functional Disability in Ambulatory Patients

Cited by 268 publications

References 14 publications

Quality of life among patients with severe aortic stenosis

Quality of life among patients with severe aortic stenosis

Spurious Inferences about Long-Term Outcomes

Computer-based quality of life questionnaires may contribute to doctor–patient interactions in oncology

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