Purpose: This study examined symptoms reported by patients after openended questioning versus those systematically assessed using a 48-question survey.
Patients and Methods: Consecutive patients referred to the palliative medicine program at the Cleveland Clinic Foundation were screened. Open-ended questions were asked initially followed by a 48-item symptom checklist. Each symptom was rated for severity as mild, moderate, or severe. Symptom distress was also evaluated. Data were collected using standardized pre-printed forms.
Results: Two hundred and sixty five patients were seen: 200 were eligible for assessment. Of those assessed, the median age was 65 years (range 17-90), and median ECOG performance status was 2 (range 1-4). A total of 2397 symptoms were identified, 322 volunteered and 2075 by systematic assessment. The median number of volunteered symptoms was 1 (range 0-6). Eighty three percent of volunteered symptoms were moderate or severe and 17% mild. Ninety one percent were distressing. Fatigue was the most common symptom but pain was volunteered most often. The median number of symptoms found using systematic assessment was 10 (0-25). Fifty two percent were rated moderate or severe and 48% mild. Fifty three percent were distressing. In total, 69% of 522 severe symptoms and 79% of 1393 distressing symptoms were not volunteered. Certain symptoms were more likely to be volunteered; this was unaffected by age, gender or race.
Conclusion: The median number of symptoms found using systematic assessment was 10-fold higher (p<0.001) than those volunteered. Specific detailed symptom inquiry is essential for optimal palliation in advanced disease.