Peak and end effects in patients' daily recall of pain and fatigue: a within-subjects analysis.
Clinical research often relies on retrospective recall of symptom levels, but the information contained in these ratings is not well understood. The "peak-and-end rule" suggests that the most intense (peak) and final (end) moments of an experience disproportionately influence retrospective judgments, which may bias self-reports of somatic symptoms. This study examined the extent to which peak and end symptom levels systematically affect patients' day-to-day recall of pain and fatigue. Rheumatology patients (N = 97) completed 5 to 6 momentary ratings of pain and fatigue per day as well as a daily recall rating of these symptoms for 28 consecutive days. For pain, peak and end momentary ratings predicted daily recall of average pain beyond the actual average of momentary ratings. This effect was small, yet was confirmed in both between-person and within-person (repeated measures) analyses. For fatigue, neither peak nor end momentary symptoms significantly contributed to daily recall. Of note, the evidence for peak- and end-effects in recall of pain and fatigue varied significantly between individual patients. These findings suggest that peak- and end-effects create a small bias in recall reports of pain, but not fatigue. However, there are considerable individual differences in susceptibility to peak and end heuristics.


CONCLUSIONS
The peak-end cognitive heuristic could bias end-of-day recall of pain and fatigue. An effect was shown for pain, but not for fatigue. The effects were small and were unlikely to substantially bias end-of-day assessments. Individuals were shown to differ in the degree that the heuristic was associated with recall.
Schneider
Stefan
S
Department of Psychiatry & Behavioral Science, Stony Brook University, Stony Brook, New York 11794-8790, USA. Stefan.Schneider@sunysb.edu
Stone
Arthur A
AA
Schwartz
Joseph E
JE
Broderick
Joan E
JE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000523:psychology; D015673:Fatigue Syndrome, Chronic / Q000175:diagnosis* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology*; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods / Q000523:psychology*; D010148:Intractable Pain / Q000175:diagnosis* / Q000523:psychology*; D012189:Retrospective Studies
Cancer. 1999 Mar 1;85(5):1186-96
10091805
Emotion. 2009 Apr;9(2):206-13
19348533
Comput Methods Programs Biomed. 2002 Nov;69(3):249-56
12204452
Pain. 2003 Jul;104(1-2):187-94
12855328
Pain. 2007 Mar;128(1-2):128-35
17055648
J Pain. 2009 Mar;10(3):274-81
19070550
Pain. 1996 Sep;67(1):35-40
8895229
Cancer. 1982 Nov 1;50(9):1913-8
7116316
Pain. 2008 Sep 30;139(1):146-157
18455312
Multivariate Behav Res. 1995 Jan 1;30(1):1-21
26828342
J Pers Soc Psychol. 1996 Aug;71(2):390-405
8765488
J Pain. 2000 Autumn;1(3):212-7
14622620
Best Pract Res Clin Rheumatol. 2003 Aug;17(4):575-92
12849713
Arthritis Care Res. 1997 Jun;10(3):185-93
9335630
Pers Soc Psychol Bull. 2005 Oct;31(10):1340-6
16143666
Psychol Methods. 2002 Jun;7(2):147-77
12090408
Stat Med. 2004 Dec 30;23(24):3821-39
15580603
Pain. 2008 Jul 15;137(2):422-427
18035495
Pain. 1996 Jul;66(1):3-8
8857625
J Rheumatol. 1996 Aug;23(8):1407-17
8856621
Health Qual Life Outcomes. 2006 Oct 11;4:79
17034633
Medsurg Nurs. 1999 Dec;8(6):363-9
11000775