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Clinical decision-making in managing changes in gastrointestinal function following cancer therapies: Is experience enough?

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Publication Date
2018-01
ICR Author
Marsden,
Author
Muls, AC
Klimova, K
Andreyev, HJN
Type
Journal Article
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Abstract
In patients with gastrointestinal (GI) disorders, identical symptoms may occur for many different reasons. This prospective study assessed whether experienced clinicians can predict accurately the underlying diagnosis or diagnoses contributing to specific symptoms based on the history and physical examination. Three clinicians assessed 47 patients referred for management of troublesome GI symptoms identified after treatment for cancer. Investigations were requested following our comprehensive, peer-reviewed algorithm. The clinicians then recorded their predictions as to the results of those investigations. After each patient had completed all their investigations, had received optimal management and had been discharged from the clinic, the predicted diagnoses were compared to those made. The clinicians predicted 92 diagnoses (1.9 per patient). After investigation, a total of 168 unique diagnoses were identified (3.5 per patient). Of the 92 predicted diagnoses, 41 (43%) matched the diagnosis. Of the 168 actual diagnoses identified, only 24% matched the prediction. None of the clinicians predicted the correct combination of diagnoses contributing to bowel symptoms. Clinical acumen alone is inadequate at determining cause for symptoms in patients with GI symptoms developing after cancer therapy.
URL
https://repository.icr.ac.uk/handle/internal/1247
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Version of record
10.1111/ecc.12766
Subject
algorithm
complex symptoms
consequences of treatment
pelvic radiation disease
radiation enteropathy
radiation proctopathy
Aged
Algorithms
Bile Acids and Salts
Blind Loop Syndrome
Clinical Competence
Clinical Decision-Making
Diarrhea
Female
Gastritis
Gastroenterologists
Gastrointestinal Diseases
Humans
Male
Neoplasms
Prospective Studies
Steatorrhea
Symptom Assessment
Vitamin D Deficiency
Language
eng
Date accepted
2017-08-03
License start date
2018-01
Citation
Eur J Cancer Care (Engl), 2018, 27 (1)

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