Peak and End Effects in Patients' Daily Recall of Pain and Fatigue: A Within-Subjects Analysis

• Published in: The journal of pain Vol. 12; no. 2; pp. 228 - 235
• Main Authors: Schneider, Stefan, Stone, Arthur A, Schwartz, Joseph E, Broderick, Joan E
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2011
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia & Perioperative Care; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - psychology; electronic diaries; fatigue; Fatigue Syndrome, Chronic - diagnosis; Fatigue Syndrome, Chronic - psychology; Female; heuristics; Humans; Male; Memory - physiology; Middle Aged; momentary assessment; Pain; Pain Measurement - methods; Pain Measurement - psychology; Pain Medicine; Pain, Intractable - diagnosis; Pain, Intractable - psychology; patient-reported outcomes; Retrospective Studies; patient-reported outcomes; fatigue; Pain; electronic diaries; heuristics; momentary assessment
• ISSN: 1526-5900; 1528-8447; 1528-8447
• DOI: 10.1016/j.jpain.2010.07.001

Abstract 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. Perspective 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.