The Influence of Discordance in Pain Assessment on the Functional Status of Patients with Chronic Nonmalignant Pain

Panda, Mukta; Staton, Lisa J.; Chen, Ian; Kurz, James; O’Rorke, Jane; Pasanen, Mark; Menon, Madhusudan; Genao, Inginia; Wood, JoAnn; Mechaber, Alex J.; Rosenberg, Eric I.; Faselis, Charles; Carey, Tim; Calleson, Diane; Cykert, Sam

doi:10.1097/00000441-200607000-00004

Cited by 17 publications

(17 citation statements)

References 26 publications

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“…In contrast, a physician who overestimates dyspnea may continue with aggressive treatment when this is not necessary. Second, lack of awareness of dyspnea severity experienced by the patient may result in premature discharge and patient's frustration with the provider, as was shown in several studies evaluating physician‐patient agreement for pain perception . We found that discrepancy between patients and healthcare providers was more pronounced for patients with COPD.…”

Section: Discussionmentioning

confidence: 61%

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How well do patients and providers agree on the severity of dyspnea?

Stefan

Priya

Martin

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Understanding the severity of patients' dyspnea is critical to avoid under‐ or overtreatment of patients with acute cardiopulmonary conditions. OBJECTIVE To evaluate the agreement between dyspnea assessment by patients and healthcare providers and to explore which factors contribute to discordance in assessment. DESIGN, SETTINGS AND PARTICIPANTS Prospective study of patients hospitalized for acute cardiopulmonary diseases at an urban teaching hospital. INTERVENTION AND MEASUREMENTS A numerical rating scale (0–10) was used to assess dyspnea severity as perceived by patients and assessed by providers. Agreement was defined as a score within ±1 between patient and healthcare provider; differences of ≥2 points were considered over‐ or underestimations. The relationship between patient self‐perceived dyspnea severity and provider rating was assessed using a weighted kappa coefficient. RESULTS Of the 138 patients enrolled, 33% had a diagnosis of heart failure, 30% chronic obstructive pulmonary disease, and 13% pneumonia; median age was 72 years, and 57% were women. In all, 96 patient‐physician and 138 patient‐nurses pairs were included in the study. The kappa coefficient for agreement was 0.11 (95% confidence interval [CI]: 0.01 to 0.21) between patients and physicians and 0.18 (95% CI: 0.12 to 0.24) between patients and nurses. Physicians underestimated patients' dyspnea 37.9% of the time and overestimated it 25.8% of the time, whereas nurses underestimated it 43.5% of the time and overestimated it 12.4% of the time. Admitting diagnosis was the only patient factor associated with discordance. CONCLUSIONS Agreement between patient perception of dyspnea and healthcare providers' assessment is low. Future studies should prospectively test whether routine assessment of dyspnea results in better patient outcomes. Journal of Hospital Medicine 2016;11:701–707. © 2016 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 61%

“…Discrepancies between patient and provider assessments for pain, depression, and overall health have been reported . One explanation is that patients and healthcare providers measure different factors despite using the same terminology.…”

Section: Discussionmentioning

confidence: 99%

How well do patients and providers agree on the severity of dyspnea?

Stefan

Priya

Martin

et al. 2016

Journal of Hospital Medicine

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“…Along these lines, studies that used the SF-36 with chronic headache patients in primary care treated with acupuncture have confirmed that the treated group only reached significant differences in the physical domains as well (21,22). Another study in patients with non-malignant pain has confirmed that these patients have poor physical functioning and worse bodily pain according to the SF-36 (23). In contrast, the four scales with the most mental factor content (VT, MH, RE and SF) have been shown to be most responsive in comparisons of patients before and after recovery from depression (24).…”

Section: Discussionmentioning

confidence: 93%

Impact of Preventive Therapy with Nadolol and Topiramate on the Quality Of Life Of Migraine Patients

Foncea

Bilbao

et al. 2007

Cephalalgia

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Preventive therapy is aimed at reducing migraine frequency, but should also improve the much deteriorated quality of life of the migraneur. We aimed to evaluate the impact of preventive therapy with two widely employed drugs (topiramate and nadolol) on the quality of life of migraine patients. A population of consecutive migraineurs aged > or = 16 years, with frequent migraines, was selected prospectively for evaluation at baseline and after 16 weeks of therapy with nadolol or topiramate (40 mg and 100 mg daily, respectively) by generic and specific quality of life questionnaires (SF-36 and MSQOL) and by an anxiety and depression scale (HADS). Preventive therapy resulted in a statistically significant improvement in physical domains of the SF-36, whereas mental domains remained almost unchanged. Despite this improvement, all domains remained below the population norms. The HADS revealed a moderate depressive state at baseline that did not change with therapy. The MSQOL global score also revealed statistically significant improvement. Both drugs were similarly effective, although topiramate was superior on the role physical domain compared with nadolol. Preventive therapy with nadolol and topiramate significantly improves the quality of life of migraineurs, although additional efforts are needed to place them in a nearer-to-normal situation compared with the general population.

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“…We intended to measure the frequency of self‐reported CAM and to analyze the factors associated with CAM usage in this population. The principal objective of the 4‐P study was to evaluate whether discordant perceptions among patients and physicians of pain intensity and loss of function are associated with reduced patient satisfaction with chronic pain management [17–19]. We hypothesized that patients who decided to use CAM for relief of chronic pain would be more likely to report diminished physical functional status and would have discordant pain scores when compared with their primary care physicians.…”

Section: Introductionmentioning

confidence: 99%