Clinical importance of provider-reported HIV symptoms compared with patient-report

Medical Care
A C JusticeR Zackin

Abstract

Although the patient experiences the symptoms, only symptoms that providers recognize and report "count" in most clinical and research settings. Reliance upon provider-report has been justified by the claim that providers report only "clinically important" symptoms. To determine whether provider-reported symptoms constitute a more "clinically important" subset of patient-reported symptoms in HIV infection. Secondary analyses of AIDS Clinical Trials 175 (ACTG 175), a randomized controlled trial of combination antiviral therapy among patients with moderate HIV disease. Large, multicenter study. 1,262 patients who participated in the health-related quality of life (HRQOL) sub-study and for whom providers completed symptom forms. Patient- and provider-reported symptoms, HRQOL, risk of recent hospitalization, survival, CD4 cell count, and plasma HIV-1 RNA levels. On average, providers reported 3-fold fewer symptoms than patients did, but the degree of under report varied by symptom. When patient-reports were used as a gold standard, provider-reports demonstrated poor sensitivity (mean 0.25) and good specificity (mean 0.96). Agreement beyond chance was fair (mean kappa 0.35) and did not improve when weighted by symptom severity. Site...Continue Reading

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