title: Is there a discrepancy between patient and physician quality of life assessment?
abstract: OBJECTIVE
  Quality of Life (QoL) assessment remains integral in the investigation of women with lower urinary tract dysfunction. Previous work suggests that physicians tend to underestimate patients' symptoms and the bother that they cause. The aim of this study was to assess the relationship between physician and patient assessed QoL using the Kings Health Questionnaire (KHQ).
  
  
  METHODS
  Patients complaining of troublesome lower urinary tract symptoms (LUTS) were recruited from a tertiary referral urodynamic clinic. Prior to their clinic appointment they were sent a KHQ, which was completed before attending. After taking a detailed urogynecological history, a second KHQ was filled in by the physician, blinded to the patient responses, on the basis of their impression of the symptoms elicited during the interview. These data were analyzed by an independent statistician. Concordance between patient and physician assessment for individual questions was assessed using weighted kappa analysis. QoL scores were compared using Wilcoxons signed rank test.
  
  
  RESULTS
  Seventy-five patients were recruited over a period of 5 months. Overall, the weighted kappa showed relatively poor concordance between the patient and physician responses; mean kappa: 0.33 (range 0.18-0.57). The physician underestimated QoL score in 4/9 domains by a mean of 5.5% and overestimated QoL score in 5/9 domains by a mean of 6.9%. In particular, physicians underestimated the impact of LUTS on social limitations and emotions (P < 0.05).
  
  
  CONCLUSIONS
  This study confirms that physicians often differ from patients in the assessment of QoL. This is most likely due to a difference in patient-physician perception of "significant" LUTS and clearly demonstrates the importance of patient evaluated QoL in routine clinical assessment.
authors.affiliation: Department of Urogynaecology, King's College Hospital, Denmark Hill, London, UK. sushmasrikrishna@hotmail.com
authors.forename: Sushma
authors.initials: S
authors.lastname: Srikrishna
authors.forename: Dudley
authors.initials: D
authors.lastname: Robinson
authors.forename: Linda
authors.initials: L
authors.lastname: Cardozo
authors.forename: Juan
authors.initials: J
authors.lastname: Gonzalez
mesh_terms: D000328:Adult; D000368:Aged; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D018401:Sample Size; D011795:Surveys and Questionnaires; D014570:Urologic Diseases / Q000175:diagnosis / Q000523:psychology; D055815:Young Adult