As oncology care continues to move toward delivery in the outpatient setting, the number of patients reporting symptoms by telephone also continues to increase. Unlike face-to-face symptom reporting, telephone reports are initiated by patients or caregivers, which offers insight into the natural occurrence of symptom reporting and which symptoms are considered priorities by patients.
In their article in the September 2013 issue of the Oncology Nursing Forum, Flannery, McAndrews, and Stein described their analysis of symptom reporting phone calls from patients with cancer. They identified the number of calls made and symptoms reported on each call and concluded the priority symptoms for patients based on that data. Recommendations for oncology nurses were also discussed.
Patients’ Symptom Priorities
Standard symptom inventory tools that clinicians use in face-to-face patient visits don’t always tell the whole story of patients’ symptoms. Reporting symptoms on a checklist form initiated by clinicians leads patients to identify any symptoms they may be experiencing, regardless of priority. Rather, when patients are motivated to call to report their symptoms, unprompted by clinicians or forms, it’s because the symptoms were distressing enough to initiate the call and are a priority for them to address.
To confirm this hypothesis, Flannery et al. looked at the data collected in their earlier study of patient calls. In that study, 563 patients made 1,229 calls during a four-month time period, reporting a total of 2,378 symptoms (62 unique symptoms). Ninety-two percent of patients reported 10 or fewer symptoms during all of their calls in those four months. In any individual call, from 1–8 symptoms were reported, with 45% reporting one symptom, 31% reporting two, 16% reporting three, and less than 10% reporting 4–8 symptoms.
The most common symptoms reported were pain (38%), fatigue (16%), nausea (16%), swelling (12%), diarrhea (12%), dyspnea (10%), and anorexia (10%). In addition, 31% of the patients calling about pain reported that symptom 2–8 times during the four-month interval. Of note was that all 45 of the symptoms listed in ONS’s Telephone Triage for Oncology Nurses manual were reported by patients in the study, although some by only a few individuals.
Pain Is the Highest Priority for Most Patients
Even after sorting for type of cancer, Flannery et al. found that pain emerged as the highest priority for all patients except those with lymphoma and brain cancer, where it was the second and fifth highest, respectively (see Figure 1). More than twice the number of patients reported pain compared to any other symptom. It was also the symptom most likely to be reported more than once during the four-month time period.
Flannery et al. noted that this finding is consistent with that of other studies, and it reinforces the belief that paint is a sentinel symptom that may be associated with an increase symptom profile and worse experience and outcomes. They theorized that the pain symptom is a naturally occurring priority that patients deemed important enough to prompt them to spontaneously report to their healthcare providers.
As the key providers of patient education for symptom management, oncology nurses should evaluate what information is provided during patient visits and what instructions are given for contacting the cancer center between visits. Because pain appears to be a common and highly prioritized symptom, efforts should focus on managing pain during in-person clinic visits and developing protocols for managing pain reported by telephone.
For more information on patient symptom priorities reported by phone, refer to the full article by Flannery et al. For more information on evidence-based interventions for pain, refer to the ONS Putting Evidence Into Practice resources for pain.
Five-Minute In-Service is a monthly feature that offers readers a concise recap of full-length articles published in the Clinical Journal of Oncology Nursing or Oncology Nursing Forum (ONF). This edition summarizes “Telephone Calls by Individuals With Cancer,” by Marie Flannery, RN, PhD, AOCN®, Leanne McAndrews, LMSW, and Karen F. Stein, RN, PhD, FAAN, which was featured in the September 2013 issue of ONF. Questions regarding the information presented in this Five-Minute In-Service should be directed to the ONF editor at ONFEditor@ons.org. Photocopying of this article for educational purposes and group discussion is permitted.