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Differential Symptom Reporting by Mode of Administration of the Assessment: Automated Voice Response System Versus a Live Telephone Interview

Sikorskii, Alla PhD*; Given, Charles W. PhD; Given, Barbara PhD, RN, FAAN; Jeon, Sangchoon MS§; You, Mei MS

doi: 10.1097/MLR.0b013e3181a31d00
Original Article

Background: Automated voice response (AVR) systems have been used to collect patient-reported outcome data. Mode of administration of the assessment may affect patient reporting.

Objective: To evaluate if there is a differential reporting of symptoms by the mode of assessment: AVR versus a live telephone interview among cancer patients with solid tumors undergoing chemotherapy.

Research Design: Randomized clinical trial comparing a nurse-assisted symptom management with an automated telephone symptom management. After completing intake telephone interview administered by a person, patients were randomized to either nurse arm or AVR arm to receive a 6-contact 8-week symptom management intervention. Patients in the nurse arm were called by specially trained nurses, and patients in the AVR arm were contacted via automated system to assess their symptoms and deliver symptom management strategies.

Subjects: Two hundred patients in nurse arm, and 186 patients in the AVR arm completed the first intervention contact.

Measures: Severities of 14 cancer-related symptoms were rated by patients at intake interview and at first intervention contact before the receipt of any interventions.

Results: When compared with patients contacted by a nurse, patients contacted by the AVR reported higher severity of nausea and vomiting, diarrhea, poor appetite, constipation, diarrhea, pain, and alopecia controlling for prior intake symptom assessment that was free of mode effect. Symptom reporting varied by age, with the oldest group of patients reporting higher severity to the nurse.

Conclusion: Mode effect needs to be considered in designing trials for symptom management and in symptom monitoring in clinical practice.

From the *Department of Statistics and Probability, College of Natural Science, Michigan State University, East Lansing, Michigan; †Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan; ‡College of Nursing, Michigan State University, East Lansing, Michigan; and §School of Nursing, Yale University, New Haven, Connecticut.

Supported by Grant R01 CA79280 from the National Cancer Institute and in affiliation with the Walther Cancer Institute, Indianapolis Indiana.

Reprints: Charles W. Given, PhD, Department of Family Medicine, Michigan State University, College of Human Medicine, B108 Clinical Center, East Lansing, MI 48824. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.