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Symptoms overlooked in hospitalized cancer patients: Impact of concurrent symptoms on overlooked by nurses

  • Kaya Miyajima (a1) (a2), Daisuke Fujisawa (a1) (a3), Saori Hashiguchi (a2) (a4), Joichiro Shirahase (a1) (a2), Masaru Mimura (a1), Haruo Kashima (a1) (a5) and Junzo Takeda (a4)...

Abstract

Objective:

Physical and psychological symptoms in cancer patients are frequently overlooked by medical staff. However, little is known regarding the potential impacts of concurrent physical and psychological symptoms on the overlooking of other symptoms. The aim of this study was to examine the impact of concurrent symptoms on the overlooking of other symptoms in cancer inpatients.

Method:

A total of 255 cancer inpatients in the general wards of one university hospital, who were referred to the palliative care team, were included. On the day of referral, nurses and patients were independently assessed for the presence of the following eight symptoms: pain, fatigue, nausea and vomiting, shortness of breath, lack of appetite, dry mouth, sleep problems, and distressed feelings. The presence of delirium was also separately assessed by nurses and psychiatrists on the team. A total of nine symptoms detected by nurses and those reported by patients or psychiatrists were compared, and logistic regression analysis was performed to identify the variables associated with the overlooking of these symptoms.

Results:

The most frequently reported symptom was pain (76.5%), followed by distressed feelings (49.8%), sleep problems (34.1%), and delirium (25.1%). The proportion of those overlooked was more than one quarter (25.0–63.6%) for all symptoms except pain (12.8%). Significant associations were found between the overlooking of shortness of breath and concurrent delirium (odds ratio [OR] = 110.9); the overlooking of sleep problems and concurrent lack of appetite (OR = 9.1); and the overlooking of distressed feelings and concurrent dry mouth (OR = 27.7). No patient demographic characteristic was associated with the overlooking of any other symptoms.

Significance of results:

The presence of some specific concurrent symptoms is likely to lead to the overlooking of other symptoms in cancer inpatients by nurses. Comprehensive assessments of physical and psychological symptoms in daily clinical practice are needed.

Copyright

Corresponding author

Address correspondence and reprint requests to: Kaya Miyajima, Department of Neuropsychiatry, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. E-mail: qq923st9@tiara.ocn.ne.jp

References

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Aa Petersen, M., Pedersen, L. & Groenvold, M. (2007). Does the agreement of patient and physician assessments of health related quality of life in palliative care depend on patient characteristics? Palliative Medicine, 21, 289294.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
Brunelli, C., Costantini, M., Di Giulio, P., et al. (1998). Quality-of-life evaluation: When do terminal cancer patients and health-care providers agree? Journal of Pain and Symptom Management, 15, 151158.
Cleeland, C.S., Mendoza, T.R., Wang, X.S., et al. (2000). Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory. Cancer, 89, 16341646.
Endo, C., Akechi, T., Okuyama, T., et al. (2008). Patient-perceived barriers to the psychological care of Japanese patients with lung cancer. Japanese Journal of Clinical Oncology, 38, 653660.
Ewing, G., Rogers, M., Barclay, S., et al. (2006). Palliative care in primary care: a study to determine whether patients and professionals agree on symptoms. British Jouranl of General Practice, 56, 2734.
Fang, C.K., Chen, H.W., Liu, S.I., et al. (2008). Prevalence, detection and treatment of delirium in terminal cancer inpatients: a prospective survey. Japanese Journal of Clinical Oncology, 38, 5663.
Japan Ministry of Health, Labour and Welfare. (2010). Ethics Guidelines for Epidemiological Research. http://www.mhlw.go.jp/general/seido/kousei/i-kenkyu/rinsyo/dl/shishin.pdf.
Kishi, Y., Kato, M., Okuyama, T., et al. (2007). Delirium: patient characteristics that predict a missed diagnosis at psychiatric consultation. General Hospital Psychiatry, 29, 442445.
Laugsand, E.A., Sprangers, M.A., Bjordal, K., et al. (2010). Health care providers underestimate symptom intensities of cancer patients: A multicenter European study. Health and Quality of Life Outcomes, 8, 104.
McDonald, M.V., Passik, S.D., Dugan, W., et al. (1999). Nurses' recognition of depression in their patients with cancer. Oncology Nursing Forum, 26, 593599.
Nekolaichuk, C.L., Bruera, E., Spachynski, K., et al. (1999). A comparison of patient and proxy symptom assessments in advanced cancer patients. Palliative Medicine, 13, 311323.
Oi-Ling, K., Man-Wah, D.T. & Kam-Hung, D.N. (2005). Symptom distress as rated by advanced cancer patients, caregivers and physicians in the last week of life. Palliative Medicine, 19, 228233.
Oken, M.M., Creech, R.H., Tormey, D.C., et al. (1982). Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology, 5, 649655.
Okuyama, T., Endo, C., Seto, T., et al. (2008). Cancer patients' reluctance to disclose their emotional distress to their physicians: A study of Japanese patients with lung cancer. Psychooncology, 17, 460465.
Passik, S.D., Dugan, W., McDonald, M.V., et al. (1998). Oncologists' recognition of depression in their patients with cancer. Journal of Clinical Oncology, 16, 15941600.
Salminen, E., Clemens, K.E., Syrjanen, K., et al. (2008). Needs of developing the skills of palliative care at the oncology ward: an audit of symptoms among 203 consecutive cancer patients in Finland. Supportive Care in Cancer, 16, 38.
Spronk, P.E., Riekerk, B., Hofhuis, J., et al. (2009). Occurrence of delirium is severely underestimated in the ICU during daily care. Intensive Care Medicine, 35, 12761280.
Stephens, R.J., Hopwood, P., Girling, D.J., et al. (1997). Randomized trials with quality of life endpoints: Are doctors' ratings of patients' physical symptoms interchangeable with patients' self-ratings? Quality of Life Research, 6, 225236.
Stromgren, A.S., Groenvold, M., Pedersen, L., et al. (2001a). Does the medical record cover the symptoms experienced by cancer patients receiving palliative care? A comparison of the record and patient self-rating. Journal of Pain and Symptom Management, 21, 189196.
Stromgren, A.S., Groenvold, M., Sorensen, A., et al. (2001b). Symptom recognition in advanced cancer. A comparison of nursing records against patient self-rating. Acta Anaesthesiologica Scandinavica, 45, 10801085.
Wada, T., Wada, M. & Onishi, H. (2010). Characteristics, interventions, and outcomes of misdiagnosed delirium in cancer patients. Palliative & Supportive Care, 8, 125131.
Zloklikovits, S., Andritsch, E., Frohlich, B., et al. (2005). Assessing symptoms of terminally-ill patients by different raters: a prospective study. Palliative & Supportive Care, 3, 8798.

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