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AMIA Annu Symp Proc. 2006; 2006: 1081.
PMCID: PMC1839509

Comparing Tailored Computerized Symptom Assessments to Interviews and Questionnaires

Cornelia Ruland, RN, Ph.D,1,3 Jo Røslien, Ph.D,2 Suzanne Bakken, RN, DNS,3 and Jørn Kristiansen, RN1


We compared the performance of a computerized symptom assessment tool called Choice in terms of number of symptoms and time needed for 92 cancer patients with two other standard methods: interview and questionnaire. Choice outperformed interviews in number and precision of reported symptoms, and did better than questionnaires in focusing on bothersome symptoms. There were high correlations between Choice and questionnaires. Interface and symptom structure play an important role for adequately eliciting patients’ symptoms.

Keywords: Computerized symptom assessments


When patients see their doctor/health care provider, they are normally asked about their complaints. This can pose considerable challenges: Given humans’ limited short-term memory and the nervousness patients often experience in this situation, they may mot be able to recall problems or important issues they want to talk about. Furthermore, studies have shown that patients have incomplete understanding of biomedical knowledge and terminology that makes it difficult to efficiently communicate their problems.1 Cultural-specific beliefs, language, and health literacy may pose additional barriers for patients to adequately report their symptoms. Research has demonstrated that clinicians often are not aware of patients’ symptoms that consequently, remain under- diagnosed and treated.2

To overcome these problems, patients and clinicians could benefit from support systems to assist them in individually tailored symptom and preference assessments. Choice is a system designed for this purpose. Modules for adult cancer and rehabilitation patients have demonstrated to significantly improve patient-centred care.3,4

The value of a tailored computerized assessment tool depends on its ability to adequately capture patients’ experienced symptoms and problems. Therefore, we conducted a study to compare Choice assessments with two other commonly used methods: patient interview and questionnaire. Our research questions were: What are the differences between the three methods in: (1) numbers and types of symptoms reported by cancer patients; and (2) time used for these assessments?


Choice instrument

The Choice assessment tool is individually tailored. First, patients identify among 19 problems those that apply. This triggers a subset of symptoms from which patients again only select those that apply. They then rate the degree of bother and their priorities for care for selected symptoms. In this manner patients are not troubled with questions that are not relevant, while focusing on those symptoms that matter. The resulting assessment summary is used to support patient-provider communication and care planning3.

Sample and Procedures

IRB approval was obtained. 92 patients (62% men); mean age 48.2 years, treated at a Norwegian cancer center for lymphoma, sarcoma or testicular cancer participated. First, they were asked in an interview to describe their symptoms/problems during the past week. In this task patients were dependent on recall. Next, they completed the Choice assessment that presented them with the tailored symptom list. Finally, they completed a questionnaire presenting them the full, untailored set of 141 symptoms contained in Choice. The interviewer recorded interview and questionnaire time; in Choice this was done automatically.


Using Choice, patients reported about three times as many symptoms as in the interview (table 1) and with greater precision. For example, patients who reported “bodily restlessness”, “stomach discomfort”, “difficult thoughts” in the interview selected in Choice “worried about the outcome of my illness”, “constipation”, and “afraid of dying”. Using Choice took on average 8.8 minutes, interviews three minutes.

Using the questionnaire, patients selected three times as many symptoms than with Choice. Only 52% of the symptoms were more than moderately bothersome, compared to 75% of those reported with Choice. The more bothersome the symptoms, the higher the correlation between Choice and questionnaire data: r=0.74 for all symptoms, and r = 0.85 for more than moderately bothersome symptoms. When statistically adjusting for minutes used, there was no difference between Choice and questionnaire for number of bothersome symptoms, indicating that more symptoms reported with the questionnaire is most likely due to more time spent, not the method in itself.


Choice clearly outperformed interviews in number and precision of reported symptoms, and did better than questionnaires in focusing on bothersome symptoms. Although patients reported more symptoms with the questionnaire, the number of questions and time needed to complete it makes this neither a feasible or clinically useful approach. The advantage of computerized assessments is that patients can skip unimportant problems but in sufficient detail hone in on and prioritize important ones. The system’s interface and symptom structure play, however, an important role for patients to locate the symptoms.


1. Soergel D, Tse T, Slaughter L. Helping healthcare consumers understand: an “interpretive layer” for finding and making sense of medical information. Medinfo. 2004;2004:931–5. [PubMed]
2. Grossman SA, Sheidler VR, Swedeen K, Mucenski J. Correlation of patient and caregiver ratings of cancer pain. JPSM. 1991;6:53–7. [PubMed]
3. Ruland CM. Handheld Technology to Improve Patient Care: Evaluating a Support System for Preference-based care Planning. JAMIA. 2002;9(2):192–201. [PMC free article] [PubMed]
4. Ruland CM, White T, Stevens M, Fanciullo G, Khilani SM. Effects of computerized system to support shared decision making in symptom management of cancer patients: preliminary results. JAMIA. 2003;0(6):573–579. [PMC free article] [PubMed]

Articles from AMIA Annual Symposium Proceedings are provided here courtesy of American Medical Informatics Association
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