Dr Elaine McColl and colleagues aimed to determine the extent of agreement between clinicians and patients regarding assessments of reflux symptom severity in patients with gastroesophageal reflux disease.
The researchers analyzed data from 4 randomized clinical trials involving 2 674 patients treated with esomeprazole, omeprazole, ranitidine, or placebo.
The research team determined the extent of agreement for symptom severity before and after 48 weeks of treatment, and for the absence of symptoms after treatment.
The team further analyzed agreement by determining weighted kappa values, which were interpreted according to the criteria of Landis and Koch.
Before treatment, clinician-patient agreement regarding symptom severity in the 4 studies was slight to moderate.
Poor agreement reflected clinician underestimation of symptom severity relative to patient ratings|
|The American Journal of Gastroenterology|
The investigators found that 48 to 52% of assessments agreed for heartburn, 24 to 35% for epigastric pain, 36 to 43% for regurgitation, and 63% agreed for dysphagia.
Poor agreement reflected clinician underestimation of symptom severity relative to patient ratings in 3 studies and clinician overestimation in 1 study.
The team also noted that agreement regarding symptom severity improved following treatment, and was fair to substantial.
The investigators reported that 58 to 78% of assessments agreed for heartburn, 42 to 60% for epigastric pain, 66 to 76% for regurgitation, and 86% agreed for dysphagia.
In addition the researchers found after treatment, agreement was greatest for patients reporting absence of symptoms and decreased with increasing severity of symptoms.
Dr McColl’s team conclude, “The agreement between clinicians and patients in their assessments of the severity of reflux symptoms is poor, particularly before treatment and for more severe symptoms.”
“Improvements in clinician-patient communication may help to bridge this gap, and greater reliance on patient assessments may be appropriate.”