Beyond Intuition: Patient Fever Symptom Experience

Abstract

Context Fever is an important sign of inflammation recognized by health care practitioners and family caregivers. However, few empirical data obtained directly from patients exist to support many of the long-standing assumptions about the symptoms of fever. Many of the literature-cited symptoms, including chills, diaphoresis, and malaise, have limited scientific bases, yet they often represent a major justification for antipyretic administration. Objectives To describe the patient experience of fever symptoms for the preliminary development of a fever assessment questionnaire. Methods Qualitative interviews were conducted with 28 inpatients, the majority (86%) with cancer diagnoses, who had a recorded temperature of ≥38°C within approximately 12 hours before the interview. A semi-structured interview guide was used to elicit patient fever experiences. Thematic analyses were conducted by three independent research team members, and the data were verified through two rounds of consensus building. Results Eleven themes emerged. The participants reported experiences of feeling cold, weakness, warmth, sweating, nonspecific bodily sensations, gastrointestinal symptoms, headaches, emotional changes, achiness, respiratory symptoms, and vivid dreams/hallucinations. Conclusion Our data not only confirm long-standing symptoms of fever but also suggest new symptoms and a level of variability and complexity not captured by the existing fever literature. Greater knowledge of patients’ fever experiences will guide more accurate assessment of symptoms associated with fever and the impact of antipyretic treatments on patient symptoms in this common condition. Results from this study are contributing to the content validity of a future instrument that will evaluate patient outcomes related to fever interventions.

Development of the Flu-PRO: a patient-reported outcome (PRO) instrument to evaluate symptoms of influenza

“…We have also noted in this and previous work that the term “feverishness” relates to a multi-dimensional concept; therefore, the symptoms encompassed by the single word “feverishness” may not be clearly understood by patients. Our previous work showed that “fever” can relate to up to 16 different types of symptoms [ 14 ]. In the Flu-PRO, the various symptoms associated with fever are evaluated separately (warmth, chills, etc.)…”

A systematic approach for studying the signs and symptoms of fever in adult patients: the fever assessment tool (FAST)

“…The FAST was developed to address the need for a simple, standardized approach for studying fever-associated signs and symptoms. The 21 “yes/no” signs and symptoms comprising the instrument reflect the signs and symptoms experienced by patients during febrile states, employing terminology used by the patients themselves [ 7 ]. This manuscript describes the methods used to further assess the FAST’s content validity and reliability of the instrument.…”

“…The Fever Assessment Tool (FAST) was developed as a simple, standardized method for studying fever-associated signs and symptoms. Candidate items for this patient-reported questionnaire were based on results of semi-structured interviews with 28 medical-surgical inpatients conducted within approximately 12 h of a recorded fever (≥38 °C) and reported previously [ 7 ]. This research suggested patients experience a range of signs and symptoms during a febrile state including feeling cold, warm, and weak and informed the development of a draft instrument (FAST) of 21 signs and symptoms each with a yes/no response [ 7 ].…”

“…Candidate items for this patient-reported questionnaire were based on results of semi-structured interviews with 28 medical-surgical inpatients conducted within approximately 12 h of a recorded fever (≥38 °C) and reported previously [ 7 ]. This research suggested patients experience a range of signs and symptoms during a febrile state including feeling cold, warm, and weak and informed the development of a draft instrument (FAST) of 21 signs and symptoms each with a yes/no response [ 7 ]. This manuscript describes the qualitative methods used to refine the instrument, assure content validity and perform quantitative analysis to assess reliability and validity of the FAST in a clinical setting prior to its use in a larger study.…”

A community feasibility study of a cooking behavior intervention in African-American adults at risk for cardiovascular disease: DC COOKS (DC Community Organizing for Optimal culinary Knowledge Study) with Heart

“…While in phase 2, we will gather an understanding of the participation experience within the specific setting of the cooking intervention. In both phases, qualitative data collection and analysis will use the four criteria that comprise the rigorous standards for qualitative research: credibility, dependability, confirmability, and transferability [69]. Credibility will be maintained by the independent analyses of our transcribed interview data to ensure that our theme categories cover all relevant data.…”