Capsule Commentary on Monahan et al., Development and Feasibility of SymTrak, a Multi-Domain Tool for Monitoring Symptoms of Older Adults in Primary Care
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Symptoms are the most common reason patients seek medical attention.1 Even after evaluation, up to one third of symptoms remain medically unexplained.2 Monahan and colleagues report on the development and feasibility of SymTrak for monitoring symptoms.3 SymTrak consists of 25 questions that were selected from measures that have a long track record of being reliable and valid, including PROMIS, the Somatic Symptom Scale, the PHQ-15, PHQ-9, GAD-7, the PEG pain scale, and the Healthy Aging Brain Care monitor. The goal of the instrument is to provide clinicians a method of quickly measuring the nature and impact of symptoms in older primary care patients. Probably no one has done more than one of the co-authors of this paper, Kurt Kroenke, to develop instruments that clinicians use in daily practice to assess for symptoms (PHQ-15), Depression (PHQ-9), and Anxiety (GAD-7). His work has been at the crossroads between symptoms and mental disorders for decades. Will SymTrak be as important to future clinicians as his previous instruments?
This paper does not answer that question; instead, it focuses on the development and feasibility of SymTrak. What remains is to use it in clinical visits and determine if it helps providers manage patients. It is not clear what advantage this constellation of questions has over already established instruments.
Most clinicians differentiate explained from unexplained physical symptoms. For patients with unexplained physical symptoms, undiagnosed mental disorders are often the underlying cause4; screening patients with unexplained symptoms for depression and anxiety is standard practice. When seeing patients with symptoms, experienced clinicians take a careful history and physical and do a limited battery of tests. If the symptom remains unexplained, clinicians screen for mental disorders, and if not present, use time as an ally. They reassure patients that the symptom is likely not serious, provide symptomatic treatment, and advise patients that most symptoms improve over time. This is an evidence-based approach; unexplained symptoms are rarely serious4 and generally improve over time.5 Additional studies need to be done to assess whether SymTrak is helpful to busy clinicians in tracking and managing symptoms over time.
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Conflict of Interest
The author declares that he does not have a conflict of interest.
- 3.Monahan PO, Kroenke K, Callahan CM, Bakas T, Harrawood A, Lofton P, Frye D, Draucker C, Stump T, Saliba D, Galvin JE, Keegan A, Austrom MG, Boustani M. Development and feasibility of SymTrak, a multi-domain tool for monitoring symptoms of older adults in primary care. J Gen Intern Med. https://doi.org/10.1007/s11606-018-4772-4