title: Cancer patients' perceptions regarding the value of the physical examination: a survey study.
abstract: BACKGROUND
  Despite its clinical utility, progressive reliance on technology can lead to devaluing the physical examination in patients with advanced cancer. The primary objective of this study was to determine whether these patients have a positive or negative perception of the physical examination. A secondary objective was to determine whether these perceptions are related to interpersonal/relational values (symbolic) or diagnostic/objective values (pragmatic).
  
  
  METHODS
  One hundred fifty patients with cancer who were receiving concurrent oncology and palliative care were administered a 26-item survey regarding their overall perception of the physical examination. The primary outcome-patient responses to "In the last 3 months, I believe my experience while being examined has been overall: very negative (a score of -5) to very positive (a score of +5),"-was analyzed using the Sign test. Other items were predefined as either symbolic or pragmatic statements, and patient responses from strongly disagree (a score of 1) to strongly agree (a score of 5) were further analyzed. Multivariable logistic regression was used to test for associations between baseline characteristics and the primary outcome.
  
  
  RESULTS
  Most patients (83%) indicated that the overall experience of being examined was highly positive (median score, 4; interquartile range [IQR], 2-5; P ≤ .0001). Patients valued both the pragmatic aspects (median score, 5; IQR, 4-5) and symbolic aspects (median score, 4; IQR, 4-5) of the physical examination. Increasing age was independently associated with a more positive perception of the physical examination (odds ratio, 1.07 per year; 95% confidence interval, 1.02-1.12 per year; P = .01).
  
  
  CONCLUSIONS
  Patients with advanced cancer indicate that the physical examination is a highly positive aspect of their care. These benefits are perceived as having both symbolic and pragmatic value. The physical examination should remain a cornerstone of clinical encounters.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Kunal C
authors.initials: KC
authors.lastname: Kadakia
authors.forename: David
authors.initials: D
authors.lastname: Hui
authors.forename: Gary B
authors.initials: GB
authors.lastname: Chisholm
authors.forename: Susan E
authors.initials: SE
authors.lastname: Frisbee-Hume
authors.forename: Janet L
authors.initials: JL
authors.lastname: Williams
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology; D003142:Communication; D015986:Confounding Factors, Epidemiologic; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology; D010146:Pain / Q000209:etiology; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology* / Q000706:statistics & numerical data; D010808:Physical Examination / Q000009:adverse effects / Q000523:psychology*; D010817:Physician-Patient Relations; D012938:Social Perception; D013315:Stress, Psychological / Q000209:etiology*
keywords: patient acceptance of health care; patient satisfaction; patient-centered care; physical examination; physician-patient communication