Discussion

Symptom diaries have a long history in the medical literature with benefits including patient engagement, trigger identification, and information gathering. Severe nosebleeds have always been a feature of life for “xxx” and something that for the most part has been out of her control. The creation of her symptom diary allowed her to form a sense of ownership and understanding over her condition and accept it as a part of herself. Chronic disease can strip suffers (and particularly children) of a sense of self and autonomy as decisions are gradually taken away from them. “xxx’s” diary has returned some of this control back to her and has allowed her to finesse the use of her rescue medications.
By removing cognitive and recollection biases, epistaxis diaries are a useful tool to review in clinic. Objectively measuring the efficacy of treatment and symptom severity can enable more personalised treatment and allow surgery to be booked for a time when its efficacy will be maximal.
Surgery, particularly surgery under a general anaesthetic is not completely benign. It is accompanied by not only physical risks but additional stress and anxiety for patients and/or their carers. This is also true on a lesser scale for minimally invasive procedures such as blood tests, especially in the case of children. A symptom diary can help to minimise exposure to these procedures by only performing them at a time when their impact will be maximised or when symptoms have become unmanageable. Diaries can help to empower patients to engage in shared decision making regarding these choices; the bidirectional sharing of key information between patient and doctor will help to guide ongoing management in colaberative way that improves the satisfaction of both parties.
The important role of patient self-care in chronic conditions such as diabetes and asthma is well understood, however, there is little research as to the benefit of self-care and disease engagement in patients who suffer from chronic epistaxis. Hayama et al. found that although HHT can significantly impact QoL proportionally to epistaxis severity, less than 50% of surveyed participants used prophylactic medications or took lifestyle precautions. We suggest that by facilitating the use of symptom diaries, patients will be encouraged to take ownership of their disease, identify symptom triggers and therefore take additional precautionary measures.