Shorter-length symptom diaries more complete

Limiting patients' homework could make it more likely that they actually do it.

By Victoria Stagg Elliott — Posted Feb. 26, 2007

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Nobody likes having a lot of homework. Now, a recent study found this true in physician-patient interaction, too.

Specifically, when it comes to symptom diaries, asking patients to keep brief logs may be more effective and result in more useful information than requesting that they keep a record for a longer period, according to a study published in this month's Obstetrics and Gynecology.

Researchers evaluated seven- and three-day diaries kept at the beginning and end of a two-month trial investigating a nurse-led urinary incontinence intervention. Just over 90% of the patients who were asked to keep a diary for the shorter duration completed them, but only 50% of those charged with keeping the journal longer did. The three-day diary was also more complete than the first three days of the week-long journal.

"We would recommend a shorter diary, because the long diary appears to make patients less likely to fill it in, even at the beginning," said Dr. Douglas G. Tincello, lead author and a senior lecturer in the Dept. of Cancer Studies and Molecular Medicine at the University of Leicester, England.

Researchers blamed this phenomenon on diary fatigue and despair at the prospect of having to keep track of symptoms for a week. Experts agreed that it was generally preferable to give patients as little work as possible.

"People just won't keep diaries for seven days," said Roger Dmochowski, MD, professor of urology at Vanderbilt Medical Center in Nashville, Tenn. He is also chair of the American Urological Assn.'s practice guideline committee.

Diaries are commonly used in practice and research to assess symptoms and monitor treatment effects. Several previous studies have found that quality data, at least in the case of urinary incontinence, can be gleaned as easily from the three-day logs as from the longer ones, although some say it may be possible to ask for them to be even shorter.

"All the studies say that doing a diary helps, but I cannot see how seven days is useful clinically. It's probably too much. The physician and the patient would be fatigued," said Jeanette S. Brown, MD, director of the Women's Continence Center at the University of California, San Francisco. "One to three days seems reasonable. One day might be OK."

But while some physicians debate the length of time such diaries should cover, others say the problem is not the assignment but that these records are not asked for enough.

"We don't want to kill the patient with a big workload," said Barry Weiss, MD, professor of clinical family and community medicine at the University of Arizona College of Medicine in Tucson. "But many physicians don't even ask patients to keep a diary at all."

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External links

"Urinary Diaries: A Comparison of Data Collected for Three Days Versus Seven Days," abstract, Obstetrics & Gynecology, Feb. 1 (link)

"Bladder-health diaries: An assessment of 3-day vs. 7-day entries," abstract, BJU International, November 2005 (link)

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