Thesis: Clinical observation of deteriorating frail older patients. Improving the competence of homecare professionals
The PhD concerns olfactory dysfunction and the measurement of qualitative olfactory symptoms following COVID-19. Many experience an altered sense of smell following the viral infection, where odours have changed in their quality (i.e. they smell different from before) and/or their pleasantness. Some also report perceptions of odours without an apparent odour source. While a reduced or lost sense of smell (i.e. quantitative issues) is perhaps a more common symptom, the qualitative changes are thought to have a greater impact on the quality of life. Still, qualitative issues have gained substantially less attention both in research and media. When assessing qualitative olfactory dysfunction, the questions are often general, ambiguous, and unclear. Procedures also vary across practices and research studies. This may lead to misinterpreting or not noticing symptoms, consequently impacting treatment and care. What is more, patients may experience not being heard and understood. A standardised questionnaire with clear and concise questions that distinguishes quantitative from qualitative symptoms is therefore needed, and the development of this questionnaire became the aim and objective of this PhD project.
To improve the ways in which symptoms are captured, a systematic literature review was carried out to gain an overview of available tests and questionnaires. Based on their content and format, a novel questionnaire was designed: the Parosmia, phantosmia, and anosmia test, in short PARPHAIT. This questionnaire covers and distinguishes between three components: a reduced or lost sense of smell (anosmia), a change in an odour’s quality and/or pleasantness (parosmia), and the experience of odours without an apparent odour source (phantosmia). PARPHAIT was tested and refined by carrying out an exploratory factor analysis and by evaluating the content and format both from the perspective of patients and a group of experts in the field of smell.
The novel questionnaire has the potential of making sure patients feel heard and understood in meeting with the clinician and ensuring adequate diagnosis and treatment. Because the insight of one’s own condition varies across patients, PARPHAIT may enhance this understanding, which in turn may make it easier to cope with the symptoms experienced. In the context of research, PARPHAIT may clarify what is actually being measured, distinguish between anosmia, parosmia, and phantosmia, and assess symptoms in greater detail compared to the questionnaires and objective tests that exist today. This is especially the case for phantosmia, a symptom that hitherto has gained relatively little attention. PARPHAIT still needs to be further refined, tested in larger samples, and evaluated in different populations. However, PARPHAIT is a promising contribution and adds value both to the clinical context and the scientific community.
Annelin Espetvedt holds a bachelor’s degree from the University of Stirling, Scotland, and a master’s degree from UiT the Arctic University of Norway, both in psychology. She completed the PhD program in social sciences at the University of Stavanger and defended her thesis on December 9th, 2024.
Supervisors
Main supervisor:
Associate professor Daniel Adrian Lungu, University of Stavanger
Co-supervisor:
Professor Siri Wiig, University of Stavanger
Professor Kai Victor Myrnes-Hansen, University of Stavanger
