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.
Key words
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Article info
Publication history
Published online: September 06, 2010
Accepted:
July 6,
2010
Received in revised form:
June 16,
2010
Received:
October 28,
2009
Footnotes
Supported by grants from the National Institutes of Health (1 U01-AR052170-01; Arthur A. Stone, principal investigator) and (R01 AR054626; Joan E. Broderick, principal investigator); and by GCRC Grant M01-RR10710 from the National Center for Research Resources.
Identification
Copyright
© 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.
