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Somatization and Symptoms Evaluation
Author Bios
Introduction
Defining Somatization
Detecting Symptoms
Dimensions of Symptoms
Measuring Symptoms
Psychiatric Comorbidity
Interpreting Symptom Measures
Functional Syndromes and Symptoms
Etiology of Symptoms
Levels of Etiological Certainty
Strengthening Etiological Classification
Confounding Etiological Factors
Symptoms and Patient Expectations
Interpreting Patient Responses
Measuring Multiple Symptoms
Global Rating of Change
Measuring Somatization
Currently selected section: Measuring Other Domains
Conclusions


Chapter 16: Somatization and Symptoms Evaluation: Measuring Other Domains
        

Finally, investigators may desire, in some studies, to assess domains other than symptom status, health-related quality of life, psychological distress, and symptom-specific expectations. Although beyond the scope of this chapter, a few examples include:

  1. Satisfaction with care. There are generic satisfaction measures, one of the most popular being the 9-item Medical Outcomes Study measure developed by RAND (Rubin et al.,1993). A more symptom-specific measure, modified from a measure used in prior depression studies, is shown in Appendix 2 and may be considered for symptoms research.
  2. Functional status. Related terms include disability and health-related quality of life (HRQoL). The SF-36 and its shorter version, the SF-12, are among the most widely used generic HRQoL measures. Another internationally validated measure, also 36 items, is the World Health Organization Disability Assessment Schedule (WHO DAS). An even briefer assessment of disability and function is shown in Appendix 2, consisting of several global items from the Sheehan disability scale, plus a global rating of quality of life and of health utilities. Also, the 5-item EuroQol is a brief, widely-used functional status measure that has been translated into multiple languages. Finally, some of the multi-dimensional symptom scales have questions about symptom-specific disability and function.
  3. Provider satisfaction. It may seem ironic to measure (or be concerned about) the satisfaction of physicians or other health care providers in the context of patient care. However, research has established that physicians consider one-sixth of outpatient encounters to be difficult, and one of the strongest correlates of difficult (or frustrating) encounters are visits related to physical symptoms (Hahn, 2001). Thus, there may be research studies or health system interventions targeting the care of patients with symptoms for which a secondary outcome would be provider satisfaction. A well-validated measure is the 10-item Difficult Doctor-Patient Relationship Questionnaire, which has been used in various symptoms studies (Hahn et al.,1996; Jackson and Kroenke,1999).
  4. Health care costs. Symptoms are responsible for a large proportion of health care visits and also are a predominant reason the subset of high utilizing patients seek health care. Thus, assessing health care utilization and costs may be an important variable in symptoms research.
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