The use of patient’s diaries in Gastroenterology In the diagnostic and therapeutic work-up, which represents a relevant component of the complex patient-doctor relationship, the listening and understanding by the doctor of the patient’s personal and medical history is crucial. However, this communicative moment may be difficult and misleading for several reasons, e.g. the inability of the patient to fully recall his symptoms, but also difficulties for the doctor to understand the timely evolution of the clinical picture and its relationship with the daily activities. Research has shown that patient recall of symptoms is unreliable, possibly showing inaccuracies and biases. Recognition of recall's shortcomings has led to the use of diaries, which are intended to capture experiences close to the time of occurrence, thus limiting recall bias and producing more accurate data. Furthermore, clinical diaries represent a way for the patient to assess his own health status without clinician bias or interpretation. Self-reported diaries are also useful tools for both researchers and clinicians in collecting numerous subjective and behavioural variables relevant to research and clinical practice. Diaries have been used in different clinical conditions, such as to measure pain, sleep, coping with smoking urges, illness or injury and health care use, medication taking, exercise, eating-related behaviours. Different types of diaries are available and have been tested in clinical practice: paper-and-pencil and electronic diaries. The available literature regarding both the systematic reviews and the comparative studies has identified the main limits of the paper-and-pencil diaries: the patient’s literacy, the time to complete the daily diaries, the social acceptability of self-monitoring in public situation, the difficulties in determining when the diary is completed; beside the main limitation for electronic diaries is represented by the technical functioning and use of the device. Gastrointestinal diseases represent a field where the patient’s diary could have an important role not only in the patient-doctor relationship, but also in the overall clinical management. In fact the recognition and measurement of gastrointestinal symptoms is subject to several difficulties. This is particularly true in patients with functional dyspepsia or irritable bowel syndrome, very frequent conditions since they affect 20-40% of adults in the western world, whose definition is based on only clinical parameters. In fact functional dyspepsia is defined as a pain, or discomfort, localized at the epigastrium, with possibly associated symptoms such as postprandial fullness or heartburn, while irritable bowel syndrome is characterized by an abdominal pain, or discomfort, associated with a change in stool frequency or form. Since there are no biological markers for these two pathological conditions, clinical studies rely entirely on patient’s diary. Furthermore, since in most cases symptoms are related, if not induced, by food ingestion, it is very important, from a diagnostic and therapeutic point of view, to identify the possible causative role of nutrient/s in inducing abdominal symptoms. Dietary recall is a widely used diagnostic tool, with two main indications: to self-monitor one’s eating behaviour and food consumption on a daily basis as a part of an intervention and to record in detail all foods consumed for a computerized nutrient analysis for outcome assessment. In fact self-monitoring food intake is considered the cornerstone of behavioural treatment of obesity and other chronic disorders that can be managed by dietary modification and control, such as diabetes, dylipidemia and end stage renal disease. Also in this field, most of the available studies have compared different types of diaries, e.g. paper-based or digital based (for recording food intake: computerized assessment, personal digital assistants, digital photography and small cards) and most frequently they deal separately with clinical symptoms and food intake. On the contrary, the ideal condition could be represented by the simultaneous presence, in the self-reported diary, of both the symptoms occurring in the daily life and the nutrient assumption. However, very few studies have been performed using this type of diary in patients with functional gastrointestinal diseases. In the present chapter a critical analysis of the data actually available and a proposal for future studies will be performed.
How to improve the doctor-patient relationship:the role of the symptoms and food diary
FESTI, DAVIDE;PASQUI, FRANCESCA
2015
Abstract
The use of patient’s diaries in Gastroenterology In the diagnostic and therapeutic work-up, which represents a relevant component of the complex patient-doctor relationship, the listening and understanding by the doctor of the patient’s personal and medical history is crucial. However, this communicative moment may be difficult and misleading for several reasons, e.g. the inability of the patient to fully recall his symptoms, but also difficulties for the doctor to understand the timely evolution of the clinical picture and its relationship with the daily activities. Research has shown that patient recall of symptoms is unreliable, possibly showing inaccuracies and biases. Recognition of recall's shortcomings has led to the use of diaries, which are intended to capture experiences close to the time of occurrence, thus limiting recall bias and producing more accurate data. Furthermore, clinical diaries represent a way for the patient to assess his own health status without clinician bias or interpretation. Self-reported diaries are also useful tools for both researchers and clinicians in collecting numerous subjective and behavioural variables relevant to research and clinical practice. Diaries have been used in different clinical conditions, such as to measure pain, sleep, coping with smoking urges, illness or injury and health care use, medication taking, exercise, eating-related behaviours. Different types of diaries are available and have been tested in clinical practice: paper-and-pencil and electronic diaries. The available literature regarding both the systematic reviews and the comparative studies has identified the main limits of the paper-and-pencil diaries: the patient’s literacy, the time to complete the daily diaries, the social acceptability of self-monitoring in public situation, the difficulties in determining when the diary is completed; beside the main limitation for electronic diaries is represented by the technical functioning and use of the device. Gastrointestinal diseases represent a field where the patient’s diary could have an important role not only in the patient-doctor relationship, but also in the overall clinical management. In fact the recognition and measurement of gastrointestinal symptoms is subject to several difficulties. This is particularly true in patients with functional dyspepsia or irritable bowel syndrome, very frequent conditions since they affect 20-40% of adults in the western world, whose definition is based on only clinical parameters. In fact functional dyspepsia is defined as a pain, or discomfort, localized at the epigastrium, with possibly associated symptoms such as postprandial fullness or heartburn, while irritable bowel syndrome is characterized by an abdominal pain, or discomfort, associated with a change in stool frequency or form. Since there are no biological markers for these two pathological conditions, clinical studies rely entirely on patient’s diary. Furthermore, since in most cases symptoms are related, if not induced, by food ingestion, it is very important, from a diagnostic and therapeutic point of view, to identify the possible causative role of nutrient/s in inducing abdominal symptoms. Dietary recall is a widely used diagnostic tool, with two main indications: to self-monitor one’s eating behaviour and food consumption on a daily basis as a part of an intervention and to record in detail all foods consumed for a computerized nutrient analysis for outcome assessment. In fact self-monitoring food intake is considered the cornerstone of behavioural treatment of obesity and other chronic disorders that can be managed by dietary modification and control, such as diabetes, dylipidemia and end stage renal disease. Also in this field, most of the available studies have compared different types of diaries, e.g. paper-based or digital based (for recording food intake: computerized assessment, personal digital assistants, digital photography and small cards) and most frequently they deal separately with clinical symptoms and food intake. On the contrary, the ideal condition could be represented by the simultaneous presence, in the self-reported diary, of both the symptoms occurring in the daily life and the nutrient assumption. However, very few studies have been performed using this type of diary in patients with functional gastrointestinal diseases. In the present chapter a critical analysis of the data actually available and a proposal for future studies will be performed.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
