title: A self administered reliable questionnaire to assess lower bowel symptoms.
abstract: BACKGROUND
  Bowel symptoms are considered indicators of the presence of colorectal cancer and other bowel diseases. Self administered questionnaires that elicit information about lower bowel symptoms have not been assessed for reliability, although this has been done for upper bowel symptoms. Our aim was to develop a self administered questionnaire for eliciting the presence, nature and severity of lower bowel symptoms potentially related to colorectal cancer, and assess its reliability.
  
  
  METHODS
  Immediately before consulting a gastroenterologist or colorectal surgeon, 263 patients likely to have a colonoscopy completed the questionnaire. Reliability was assessed in two ways: by assessing agreement between patient responses and (a) responses given by the doctor at the consultation; and (b) responses given by patients two weeks later.
  
  
  RESULTS
  There was more than 75% agreement for 78% of the questions for the patient-doctor comparison and for 92% of the questions for the patient-patient comparison. Agreement for the length of time a symptom was present, its severity, duration, frequency of occurrence and whether or not medical consultation had been sought, all had agreement of greater than 70%. Over all questions, the chance corrected agreement for the patient-doctor comparison had a median kappa of 65% (which represents substantial agreement), interquartile range 57-72%. The patient-patient comparison also showed substantial agreement with a median kappa of 75%, interquartile range 68-81%.
  
  
  CONCLUSIONS
  This self administered questionnaire about lower bowel symptoms is a useful way of eliciting details of bowel symptoms. It is a reliable instrument that is acceptable to patients and easily completed. Its use could guide the clinical consultation, allowing a more efficient, comprehensive and useful interaction, ensuring that all symptoms are assessed. It will also be a useful tool in research studies on bowel symptoms and their predictive value for colorectal cancer and other diseases. Studies assessing whether bowel symptoms predict the presence of colorectal cancer should provide estimates of the reliability of the symptom elicitation.
authors.affiliation: Screening and Test Evaluation Program (STEP), School of Public Health, University of Sydney, Australia. badelstein@health.usyd.edu.au
authors.forename: Barbara-Ann
authors.initials: BA
authors.lastname: Adelstein
authors.forename: Les
authors.initials: L
authors.lastname: Irwig
authors.forename: Petra
authors.initials: P
authors.lastname: Macaskill
authors.forename: Peter H
authors.initials: PH
authors.lastname: Katelaris
authors.forename: David B
authors.initials: DB
authors.lastname: Jones
authors.forename: Les
authors.initials: L
authors.lastname: Bokey
mesh_terms: D015746:Abdominal Pain; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis; D003672:Defecation; D005260:Female; D006471:Gastrointestinal Hemorrhage; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012647:Self-Assessment; D011795:Surveys and Questionnaires