Qualitative Exploration of Illness Perceptions of Rheumatoid Arthritis in the General Public

Treating patients with rheumatoid arthritis (RA) within three months of symptom onset 2 leads to significantly improved outcomes. However, many people delay seeking medical 3 attention. In order to understand the reasons for this delay, it is important to have a thorough 4 understanding of public perceptions about RA. The current study investigated these perceptions 5 used the Self-Regulation Model (SRM) as a framework to explain how health behavior is 6 influenced by illness perceptions (prototypes) through qualitative interviews with 15 members of 7 the public without RA. Interviews were audio-recorded, transcribed and analyzed using 8 framework analysis based on SRM illness perceptions. 9 Both accurate and inaccurate perceptions about the identity, causes, consequences, 10 controllability and timeline of RA were identified. This highlights opportunities to enhance public 11 knowledge about RA. These findings further support the utility of exploring prototypical beliefs of 12 illness, suggesting their potential role in influencing help-seeking behaviors and identifying 13 probable drivers/barriers to early presentation

Chronic non-specific low back pain - sub-groups or a single mechanism?

Copyright 2008 Wand and O'Connell; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Low back pain is a substantial health problem and has subsequently attracted a considerable amount of research. Clinical trials evaluating the efficacy of a variety of interventions for chronic non-specific low back pain indicate limited effectiveness for most commonly applied interventions and approaches. Discussion: Many clinicians challenge the results of clinical trials as they feel that this lack of effectiveness is at odds with their clinical experience of managing patients with back pain. A common explanation for this discrepancy is the perceived heterogeneity of patients with chronic non-specific low back pain. It is felt that the effects of treatment may be diluted by the application of a single intervention to a complex, heterogeneous group with diverse treatment needs. This argument presupposes that current treatment is effective when applied to the correct patient. An alternative perspective is that the clinical trials are correct and current treatments have limited efficacy. Preoccupation with sub-grouping may stifle engagement with this view and it is important that the sub-grouping paradigm is closely examined. This paper argues that there are numerous problems with the sub-grouping approach and that it may not be an important reason for the disappointing results of clinical trials. We propose instead that current treatment may be ineffective because it has been misdirected. Recent evidence that demonstrates changes within the brain in chronic low back pain sufferers raises the possibility that persistent back pain may be a problem of cortical reorganisation and degeneration. This perspective offers interesting insights into the chronic low back pain experience and suggests alternative models of intervention. Summary: The disappointing results of clinical research are commonly explained by the failure of researchers to adequately attend to sub-grouping of the chronic non-specific low back pain population. Alternatively, current approaches may be ineffective and clinicians and researchers may need to radically rethink the nature of the problem and how it should best be managed

Decision-making preferences and information needs among Greek breast cancer patients

Objectives: We aimed at assessing Greek breast cancer patients' preferences for participation in treatment decision making and their information needs. Methods: In a cross-sectional study, 329 breast cancer patients were administered at the Control Preferences Scale, a card-sort measurement designed to elicit preferences for participation in decision making. Information needs were assessed with Cassileth's Information Styles Questionnaire. Results: The majority of patients (71.1%) preferred to play a passive role in treatment decision making, with most of them wanting to delegate responsibility of the decision completely to their doctor (45.3%). A collaborative role was preferred by 24%, whereas only 4.6% chose an active role. Most women expressed a general desire for as much information as possible about their illness (62.6%), but a substantial proportion (37.4%) did not want detailed information; instead, they wished to avoid awareness of bad news. Women who desired less informational details and preferred a passive role requested less frequently a mammography (

The Greek Version of the Sense of Coherence Scale (SOC-29): Psychometric Properties and Associations with Mental Illness, Suicidal Risk and Quality of Life

Background: Sense of coherence (SOC) is defined as a global orientation based on a person’s confidence that stimuli are structured and predictable, the resources needed to meet these demands are available, and these demands are seen as challenges, worthy of investment, and engagement. The SOC scale is an instrument measuring how people manage stressful situations and stay well. We aimed to assess the psychometric properties of its Greek version in two samples, people with and without long-term conditions (LTCs). Associations between sense of coherence and mental illness, suicidality, and quality of life were also investigated. Methods: The Antonovski’s Sense of Coherence Scale (SOC-29) was administered to 374 participants; 245 patients with diabetes, chronic pulmonary obstructive disease and rheumatic diseases attending specialty clinics or the emergency department and 129 individuals without LTCs. Diagnosis of mental disorders was established by the Mini International Neuropsychiatric Interview. Associations with depressive symptom severity (PHQ-9), suicidal risk (RASS), and health-related quality of life (WHOQOL-BREF) were also investigated. Results: The Greek version of SOC-29, when used as a whole, presented a coherent structure with remarkable stability in people with and without LTCs. Cronbach’s alphas were 0.89 for patients with LTCs and 0.91 for people without LTCs, being 0.90 for the entire sample. Greater levels of SOC were associated with better mental health, lower depressive symptom severity and better quality of life. Furthermore, greater levels of SOC were associated with lower suicidal risk even after adjustment for depressive symptom severity. Conclusion: The results of the present study showed that the Greek version of SOC-29 may reliably assess SOC. Moreover, lower levels of SOC are associated with established mental disorders and increased suicidal risk, and thus may detrimentally impact mental health. These findings may have important clinical implications, especially as far as the prevention of suicidal risk is concerned.Journal of Psychology and Clinical Psychiatr

“Empathize with me, Doctor!” Medical Undergraduates Training Project: Development, Application, Six-months Follow-up

The aim of the study was to assess the effectiveness of specially designed, empathy training for medical undergraduates, based on the principles of Person-Centered Approach.Within the context of the humanistic person-centered patient care, the experiential, 60-hour “Empathize with me, Doctor!” training program contains theory, personal development and skills development. Role plays, experiential exercises, self-awareness exercises, active listening practice and conduction of a person-centered interview constituted the training.Forty-two medical undergraduates (66% females; 29% fourth year of study, 40% fifth, 31% sixth) from the University of Ioannina in Greece applied and all of them completed the empathy training. Forty-five medical students comprised a similar according to age and year of studies control group.The Jefferson Scale of Physician Empathy (JSPE) was used to assess the empathic performance, and Cohen’s d to assess the practical importance of any statistical difference.The JSPE mean score (and standard deviation) before, after and six months follow-up was 109.3(12.7), 121.1(9.0), 121.1(9.5), respectively. The before–after and before–follow-up difference was highly significant (CI95%, p<0.001 in both cases), and of great practical importance (d=1.072, d=1.052, respectively), while no decrease was observed six-months later (CI 95%, p=0.999, d<0.001). Control group reached a JSPE 108.7(10.5), similar to intervention group before training (CI95%, p=0.832), and highly different and important compared to after (CI 95%p<0.001; d=1.268) and follow-up (CI 95%, p<0.001; d=1.238) intervention scores.The “Empathize with me, Doctor!” improved significantly and importantly medical undergraduates’ empathic performance, which was maintained intact for at least six months