Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.
BMC Gastroenterol. 2012 Sep 22;12:130. doi: 10.1186/1471-230X-12-130.
People vary in how they respond to symptoms. The purpose of this study was to assess whether serious disease is more likely to be present in patients who report that they take any symptoms less seriously than other people do, and to assess the reliability of a question which can be used to identify the extent to which patients take any symptom seriously. To do this we assessed whether the likelihood of detecting colorectal cancer is higher in patients who report that they take symptoms less seriously than other people do.
Cross sectional study of 7736 patients who had colonoscopy to find colorectal cancer. Before colonoscopy, patients completed a questionnaire on bowel symptoms and were also asked: "Compared to other people of your age and sex, how seriously do you think you take any symptoms?" Likelihood of detecting colorectal cancer according to responses to this question was assessed by logistic regression models, unadjusted and adjusted for symptoms and other known predictors of colorectal cancer.Question reliability was assessed in a different sample using percentage agreement and the kappa statistic for the answers given by each patient on two occasions. Agreement between patient and doctor responses was also assessed (n = 108).
Patients who reported they took symptoms less seriously were 3.28 (95%CI: 2.02, 5.33) times more likely to have colorectal cancer than patients who took symptoms more seriously than others. The effect was smaller (1.85 (95%CI: 1.11, 3.09)), but remained statistically significant in models including symptoms and other predictors of colorectal cancer. The question was reliable: on repeat questioning, 70% of responses were in absolute agreement and 92% were within 1 category, kappa 57%. Patient-doctor agreement was 66%, within 1 category 92%, kappa 48%.
Patients who take their symptoms less seriously have a considerably higher likelihood of colorectal cancer than those who identify themselves as taking any symptoms more seriously than other people. The question is easy to ask and has good reliability. Doctors also reliably identify how patients assess themselves. Assessment of how seriously patients take any symptoms can contribute to the clinical assessment of a patient.
人们对症状的反应各不相同。本研究旨在评估报告称自己对某些症状的重视程度低于他人的患者是否更有可能患有严重疾病，并评估可用于确定患者对任何症状重视程度的问题的可靠性。为此，我们评估了报告称自己对症状的重视程度低于他人的患者检测出结直肠癌的可能性是否更高。
对 7736 名接受结肠镜检查以发现结直肠癌的患者进行横断面研究。在结肠镜检查之前，患者完成了一份关于肠道症状的问卷，并被问到：“与您同年龄和性别的其他人相比，您认为自己对任何症状的重视程度如何？”根据该问题的回答，通过逻辑回归模型评估检测结直肠癌的可能性，未调整和调整症状以及其他已知的结直肠癌预测因素。在另一组样本中，使用每个患者两次回答的百分比一致性和 Kappa 统计来评估问题的可靠性。还评估了患者和医生之间的一致性（n=108）。
报告称自己对症状的重视程度较低的患者患结直肠癌的可能性是报告称自己对症状的重视程度高于他人的患者的 3.28 倍（95%CI：2.02，5.33）。在包括症状和其他结直肠癌预测因素的模型中，这种影响较小（1.85（95%CI：1.11，3.09）），但仍具有统计学意义。该问题具有可靠性：在重复提问时，70%的回答是绝对一致的，92%的回答在同一类别内，Kappa 值为 57%。患者与医生的一致性为 66%，在同一类别内为 92%，Kappa 值为 48%。
与认为自己对任何症状的重视程度都高于他人的患者相比，对自己的症状重视程度较低的患者患结直肠癌的可能性要高得多。该问题易于询问，具有良好的可靠性。医生也能可靠地识别患者对自身的评估。评估患者对任何症状的重视程度可以为患者的临床评估做出贡献。
