Differences in perception of sick children's and adolescents' symptoms by caregivers and doctors

Better symptom control is known to increase the quality of life in patients with chronic, life-threatening or life-limiting conditions. Key point for a better symptom control is the awareness about the presence of symptoms and to define them accurately. This cross-sectional and descriptive study aimed to assess doctors' and caregivers' awareness on symptoms of 10 – 18 years old patients. Ten to 18 years old children & adolescents who were hospitalised for at least seven days in Dokuz Eylül University Hospital, their caregivers, an experienced and an unexperienced doctors who are in charge of the patient were included in the study. Required data were collected by filling demographic and medical data collection forms, Memorial Symptom Assesment Scale (MSAS 10-18) and a modified form of MSAS for proxy reports on face-to-face interventions with patients, their caregivers and doctors. 17 out of 121 patient-caregiver pairs who met the criteria refused to join the study therefore 104 patient-caregiver-experienced and unexperienced pediatrics residents tetrades were included. The most prevalent symptoms in patients reports were feeling nervous, pain, lack of energy, feeling sad and nausea. Symptom burden of girls was higher than boys. Caregivers reported higher, doctors reported lower symptom scores than patients did. Patients' and their caregivers' scores were correlated in all subscales and symptoms. The correlation that was found between patients, caregivers and unexperienced doctors was absent with experienced doctors. MSAS subscale scores reported by both experienced and unexperienced doctors were similar. 32 out of 104 patients with cancer reported feeling nervous, lack of appetite, lack of energy, pain, nausea and feeling sad as the most frequent symptoms. Patients with non-malignant disorders reported pain, feeling nervous, lack of energy, feeling sad and sweating most frequently. Unexperienced doctors reported lower symptom scores in patients with cancer however patient-reported symptom scores shown no significant difference in both groups. This study has outlined a requirement of further research focused on determining the causes of inadequate symptom perceptions of pediatrics residents and new programs to overcome the barriers.