SYMPTOM MANAGEMENT OUTCOMES - DO THEY REFLECT VARIATIONS IN CARE DELIVERY SYSTEMS

OBJECTIVES. Symptom management is increasingly recognized as a critica l element of patient care, particularly in managing chronic illness. H owever, research on outcomes related to symptom management is in its i nfancy, except for the symptom of pain. This symptom was therefore cho sen as a prototype to review the state of the science regarding relati ons between organizational variables and symptom management outcomes a nd to illustrate the issues regardless of the symptom managed. This ar ticle discusses pain outcome measures appropriate for acute and cancer pain, proposes attributes of the care delivery system that may affect outcome measures, and identifies challenges associated with this type of research. METHODS. Review of quality assurance studies raises issu es concerning the adequacy of currently used outcomes for pain and sat isfaction with pain management. Although considerable effort has been expended in developing pain measurement in adults and children, critic al issues for examining pain management outcomes include deciding what perspectives should be used as the most valid indicator of the pain o utcome and when the measures should be obtained. RESULTS. Critical con cerns are raised about the measure of satisfaction with pain managemen t and its appropriateness as the end-result outcome. A key issue is wh ether respondents actually disentangle satisfaction with pain manageme nt from satisfaction with other aspects of care, including caring disp ositions of health-care providers. Finally, the question is raised: Ar e pain outcomes affected by organizational context? CONCLUSIONS. Altho ugh the answer to this question is unknown, a few research studies sug gest that organizational context is likely to influence pain outcomes. It is clear, however, from ongoing work that until several conceptual , methodological, and analytic challenges are resolved, research is un likely to capture the influence of variations in care delivery systems on symptom management outcomes.