Symptom management in women with recurrent ovarian cancer: Do patients and clinicians agree on what symptoms are most important?

Abstract

Objective: We sought to compare symptoms identified as a priority by patients with recurrent ovarian cancer to symptoms most frequently documented by their clinicians, and examine the association between clinician documentation of symptoms and subsequent clinical intervention.

Methods: Single-institution, retrospective chart review of patients enrolled in WRITE Symptoms Study (GOG 259), a randomized controlled trial of internet-based recurrent ovarian cancer symptom management. As part of the trial, women completed the Symptom Representation Questionnaire for 28 symptoms and selected 3 priority symptoms (PS). We compared patient-reported PS to clinician documentation of symptoms and interventions over the time period corresponding to study enrollment.

Results: At least one PS was documented in 92% of patients. Of 150 PS reported by patients, 53% were never documented by clinicians; these symptoms tended to be less directly related to disease or treatment status. Symptoms not identified by patients as PS were frequently documented by clinicians; these symptoms tended to relate to physiologic effects of disease and treatment toxicity. 58% of patients had at least one PS intervention. PS intervened for were documented at 2.58 visits vs 0.50 visits for PS not receiving intervention (p≤0.0001).

Conclusions: Discordance was identified between symptoms reported by patients as important and symptoms documented by clinicians. Symptoms more frequently documented were also more frequently intervened for. Our study illustrates the need to improve identification of symptoms important to patients, and suggests that improving communication between patients and clinicians could increase intervention rates to enhance quality of life in women with recurrent ovarian cancer.

Keywords: Communication; Palliative; Recurrent ovarian cancer; Symptom management.

Conflict of interest statement

Statement The remaining authors listed on this manuscript have no conflicts of interest to disclose.

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

Figure 1

Symptoms reported by patients and clinicians

Figure 2

Number of patients reporting the four most common priority symptoms (PS), number of PS documented in the EMR, and number of PS for which an intevention was provided.

Figure 3

Frequency of clinician documentation for patient-reported priority symptoms versus symptoms not identified as a priority by patients.