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

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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.
URI
https://repository.icr.ac.uk/handle/internal/1247
DOI
https://doi.org/10.1111/ecc.12766
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  • Other ICR Research
Subject
Humans
Neoplasms
Gastrointestinal Diseases
Gastritis
Blind Loop Syndrome
Steatorrhea
Vitamin D Deficiency
Diarrhea
Bile Acids and Salts
Prospective Studies
Algorithms
Clinical Competence
Aged
Female
Male
Symptom Assessment
Clinical Decision-Making
Gastroenterologists
Language
eng
Date accepted
2017-08-03
License start date
2018-01
Citation
European journal of cancer care, 2018, 27 (1)

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