A qualitative study of dermatology patients and providers to understand discordant perceptions of symptom burden and disease severity

Abstract

Background

Patients often present with symptoms that are disproportionate to the observed disease state, and grade disease severity differently from healthcare providers (HPs). This discordant symptom burden and severity grading (DSG) results in poorer patient care. Current research on DSG is limited, relying on structured models that are theoretically incomplete.

Objective

To fully understand the factors driving DSG.

Methods

Qualitative study of dermatology patients and HPs. Interview data were analyzed using grounded theory to derive a model of the causes of DSG.

Results

Eighteen patients and 12 HPs were interviewed. Results reflect a tendency for patients to grade their conditions more severely than HPs. Factors driving DSG are related to emotional and cognitive disparities in the constructs used to grade severity, varying consequences of disease due to differing resilience and coping methods, socio-psychological factors influencing how patients report their symptoms, and the context of the consult.

Conclusion

A better understanding of DSG is required for achieving mutual understanding and patient-centered collaborative care. It is easy to label a patient with high symptom burden as having a low threshold for discomfort, or for a patient to presume that the doctor is unempathetic. This study suggests the causes of DSG are nuanced and multifactorial.

Keywords:

• Discordant severity grading
• symptom burden
• qualitative research
• health services research
• behavioral medicine

Acknowledgments

The authors would like to extend their gratitude to patients and colleagues who have generously shared their experiences, and to Associate Prof. Wong Mee Lian and Dr. Martin Chio for sharing their passion for and knowledge of qualitative research.

Disclosure statement

There are no financial or personal conflicts of interest to declare.

Ethical approval

The study was approved by the hospital institutional review board (DSRB Reference: 2019/00880).

Author contributions

EC designed, implemented the study, and wrote the first draft. EC, LT, and FY conducted the interviews and coded the data. PP, EC, LT, and FY interpreted the data and wrote subsequent drafts. All approved the manuscript for submission.

Data availability statement

Deidentified datasets are available from the corresponding author upon reasonable request.

Additional information

Funding

This study was funded by the Chan Heng Leong Research Award, National University Hospital. The funding organization had no role in the design, conduct, interpretation, review, or approval of the manuscript.