Is the high intensity symptoms experienced by patients admitted with chronic obstructive pulmonary disease documented by health professionals? - a prospective survey with comparison of patient reported outcomes and medical records

ABSTRACT

Context: Patients with chronic obstructive pulmonary disease (COPD) have a high symptom burden and reduced quality of life. There is an increasing attention on palliation for patients with COPD. Recognition of symptoms is a prerequisite for palliation.

Objectives: We aim to investigate the extent to which symptoms in patients with COPD are recognized in the documentation of the health professionals, indicated in ‘Doctors Symptom Recognition Rate’ (DSR), ‘Nurses Symptom Recognition Rate’ (NSR) or ‘Doctors and/or Nurses Symptom Recognition rates ’(DNSR) as a team, respectively.

Methods: Patients with COPD (n = 40) admitted in two respiratory units, responded within 48 h on two symptom-screening-tools that access quality of life; COPD assessment test (CAT) used for the treatment of COPD and EORTC-QLQ-C15-PAL used for palliation in patients with cancer. Patient-described symptomatology was compared to the symptoms as recognized in the documentation of doctors and/or nurses.

Results: There was a significant discrepancy between the symptomatology indicated by patients with COPD on CAT and EORTC-QLQ-C15-PAL, and the degree by which it was recognized in the medical records indicated in DSR or NSR. In 30 out of 44 items DSR or NSR were < 70%. There was a significant difference between DNSR versus DSR or NSR, respectively, in 19 out of 22 items.

Conclusion: A team-based symptom recognition DNSR is superior when compared to DSR or NSR.

Team-based systematic screening is suggested as a pathway to increase symptom recognition in patients with COPD. Increased rates of symptom recognition may improve symptom alleviation and thus palliation.

KEYWORDS:

• COPD
• Patient reported outcomes
• palliative care
• symptomatology
• HRQoL
• COPD assessment test
• EORTC-QLQ-C15

Acknowledgments

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Charlotte Sandau

Charlotte Sandau is a Clinical Nursing Specialist in the Medical Unit of Hvidovre Hospital in Copenhagen. She has a degree of MSc in Health Science and is a RN with prior clinical experience within respiratory medicine. She has a special interest in non-malign palliatve care.

Dorthe Gaby Bove

Dorthe Bove is a postdoctoral researcher in nursing. She has a wide interest in the psychosocial aspects of COPD and non-malign palliative care, and has a primary focus on self-management strategies.

Kristoffer Marsaa

Kristoffer Marsaa is a MD specialist in respiratory medicine, senior consultant, palliative unit Herlev and Gentofte hospitals. Clinical and research interest in COPD, pulmonary fibrosis, palliative care and consequences of life-threatening disease measured by patient reported outcomes.

Camilla Sørli Bekkelund

Camilla Sørli Bekkelund is a RN working within respiratory medicine with a special interest in non-malign palliative care.

Matias Greve Lindholm

Matias Greve Lindholm is a senior doctor at University Hospital Copenhagen.He is a trained cardiologist with special interest in out of hospital cardiac arrest and cardiogenic shock. He is at the moment working at the intensive cardiac care unit. Besides he is an associate professor at the University of Copenhagen participating in both pre- and postgraduate education.