Question 10.1

For the past year, the nursing department has included two fatigue assessment items on the form completed by the nurse every time a patient is admitted. The items are read to the patient and the responses are recorded by the nurse. The form becomes part of the medical record. The first fatigue item states, "We are interested in learning whether fatigue was a problem for you prior to the illness that brought you to the hospital. On an average week, did you experience a level of persistent fatigue that prevented you from functioning as you wanted to?" The second fatigue item states, "If so, we would like to know the severity of your fatigue during a typical week before you developed the illness that brought you to the hospital. On a scale from 0 to 10, where 0 is no fatigue and 10 is the worst fatigue imaginable, how severe was your fatigue on average during a typical week?"

You have an interest in learning about the differences in baseline fatigue between a population with metastatic solid tumor and a population with advanced congestive heart failure. You would like to acquire scientifically credible data, but your resources are limited and you also are considering writing a grant proposal to seek funding for a large and methodologically exquisite study. You gather together a group of potential collaborators to discuss the research issues. One of the collaborators states that the data included on the nurse assessment form is useless and the only way forward is a prospective study of patients after admission.

How do you respond to your colleague?

	Although the data on the nurse form would be collected retrospectively, the nurses who completed the form were acquiring the information prospectively. The data include not only prevalence, but severity as well, and a large amount of additional data about demographics and the disease could be collected from the charts. A chart review could yield a large sample size, facilitating a multivariate statistical analysis that could describe differences in factors associated with fatigue in cancer and fatigue in CHF. The chart review is consistent with the resources we have. The data we would get are scientifically credible and would duplicate any cross-sectional prospective study that we could do. We should definitely do the chart review.
	The chart review is indeed useless and a prospective survey of patients after admission is the minimum required to address this scientific question.
	The chart review is not useless. Let's start with a review of 100 records---50 from cancer patients and 50 from CHF patients---and see whether the information we collect can help us design a prospective survey.