Bradley, Clare

McMillan, CV

Royal Holloway Research Online

Quality of life and treatment satisfaction in patients with hypothyroidism

Acknowledgements This project was funded by a grant from the Diabetes Charitable Fund, Queen Elizabeth Hospital, Gateshead. The authors also acknowledge the essential contributions of the patients themselves. Access to questionnaires Clare Bradley PhD, Professor of Health Psychology Royal Holloway, University of London Egham, Surrey, TW20 0EX, UK. E-mail: c.bradley@rhul.ac.uk   Hypothyroidism is a life-long chronic disease that slows the metabolism, with both physiological symptoms (e.g. cold intolerance) and psychological symptoms (e.g. depression, and problems with cognitive functioning)1. The disorder is particularly prevalent in women and the elderly1.  Measures of satisfaction with treatment and the impact of the condition on quality of life (QoL), similar to the DTSQ*2 and ADDQoL**3 for diabetes, were needed for future research and in the clinical management of hypothyroidism.            *Diabetes Treatment Satisfaction Questionnaire      **Audit of Diabetes-Dependent Quality of Life Treatment satisfaction  (1) Present satisfaction All but one patient reported improvements in some symptoms after commencing thyroxine treatment. However, several patients (24%) were dissatisfied about receiving sub-optimal thyroxine replacement that did not relieve lingering symptoms. Seven ThyTSQ-Present items were designed to measure: satisfaction with current treatment, the degree to which treatment is working and controlling symptoms, understanding of the condition, convenience of treatment, and whether the patient would encourage others to have the treatment, and how satisfied they are to continue with their present treatment. (2) Around the time of diagnosis  Interviewees reported:  concerns that the doctor had not taken the condition or the patient seriously (32% of interviewees),   difficulty and delay in receiving a diagnosis of hypothyroidism and/ or prescription of thyroxine treatment to alleviate symptoms (27%),    dissatisfaction with lack of information provided by healthcare professionals about (a) the condition (32%) and (b) the treatment (32%). The 4-item ThyTSQ-Past was designed to cover past satisfaction with these four aspects of treatment. Quality of life and treatment satisfaction in patients with  hypothyroidism Quality of life Patients described the negative impact of underactive thyroid, both before and after thyroxine treatment, on several aspects of life, (Fig. 1). All 18 domains in the figure are included in the new ThyDQoL questionnaire.   Fig 1: Reports of negative impact of hypothyroidism on domain (%).   (*excludes those respondents who indicated the domain was not applicable)                  Multiple aversive symptoms of hypothyroidism remain, despite thyroxine treatment, causing considerable dis-satisfaction and marked impairment of QoL in many patients. Results suggest the need for improved provi-sion of information about both condition and treatment. Condition-specific measures of QoL (the ThyDQoL) and treatment satisfaction (ThyTSQ) have now been developed for use in evaluating and improving treatment for people with hypothyroidism. They are now ready for use in research and clinical practice.  References 1Wiersinga, WM (2002) Adult Hypothyroidism. In: Thyroid Disease Manager. Retrieved July 2004, from www.thyroidmanager.org.  2Bradley C (1994) The Diabetes Treatment Satisfaction Questionnaire: (DTSQ) In: Bradley C (ed) Handbook of Psychology and Diabetes: A Guide to Psychological Measurement in Diabe-tes Research and Practice. Harwood Academic Publishers, Chur, Switzerland. 3Bradley C et al. (1999) The development of an individualized questionnaire measure of per-ceived impact of diabetes on quality of life: the ADDQoL. Qual Life Res 8:79-81. 4McMillan CV et al. Design of new questionnaires to measure quality of life and treatment satisfaction in hypothyroidism. Thyroid (in press). “Before diagnosis, I was constantly asleep. I was freezing cold. I had no energy. My skin was like leather. My hair was really brittle…. I felt really ill, but I couldn’t explain how I felt, and I thought people would think I was a hypochon-driac….Then it was diagnosed, and I felt good, because I thought, ‘I’ve actually got something wrong with me’, which was a relief!” (a woman aged 38 yrs) C V McMillan1, C Bradley1, S Razvi2, J U Weaver3          1Health Psychology Research, Dept of Psychology, Royal  Holloway University of London, Egham, Surrey, UK.          2Department of Diabetes and Endocrinology, Queen Elizabeth Hospital, Gateshead, UK.          3University of Newcastle-upon-Tyne, School of Clinical Medical Sciences, Queen Elizabeth Hospital, Gateshead. Background Findings Methods Discussion  Semi-structured interviews were conducted with 38 patients with hypothyroidism:   30 women and 8 men, 37 treated with thyroxine,     mean age 51.9 (range 29-79) years,    three centres: Gateshead, London and Surrey. The prime purpose of the interviews was to deter-mine item selection for two new condition-specific questionnaires measuring QoL and treatment satis-faction, the ThyDQoL and ThyTSQ respectively4. Open questions concerned:  (1) the effects of underactive thyroid and its treat-ment on QoL, with interviewees being asked to imagine life without the disorder (to elicit domains impacted by hypothyroidism), (2) satisfaction with treatment.   Interviewees “thought aloud” whilst completing draft questionnaires. Interview data were analysed for content. 0102030405060708090EnergyPhysically doMotivationHolidays*Household tasksPhysical appearanceWeightSpeed doWorking life*Family life*Spare timeGetting out & aboutFutureRelationship*Social lifeSex life*Bodily discomfortDepressedPercentage

Royal Holloway - Pure

 1 McMillan CV, Bradley C, Razvi S and Weaver JU (2005) Quality of life and treatment satisfaction in patients with hypothyroidism. Proceedings of the British Psychological Society 13 (1) 83.  Poster presented at the British Psychological Society Division of Health Psychology Annual Conference, 8-10th September 2004, Edinburgh.  ABSTRACT FORM   Authors & Affiliation. CV MCMILLAN, C BRADLEY, Royal Holloway, University of London; S RAZVI, Queen Elizabeth Hospital, Gateshead; JU WEAVER, University of Newcastle upon Tyne. Title. Quality of life and treatment satisfaction in patients with hypothyroidism Content. Background: Hypothyroidism, a life-long chronic disease that slows the metabolism, is particularly prevalent in women and the elderly.  Treatment satisfaction and the impact of the condition on quality of life (QoL) were investigated. Methods: Semi-structured interviews were conducted with 38 patients with hypothyroidism (30 women and 8 men, mean age 51.9 (29 – 79) years, 37 treated with thyroxine) at three UK centres. The prime purpose of the interviews was to determine item selection for two new condition-specific questionnaires measuring QoL and treatment satisfaction. Open questions concerned the effects of underactive thyroid and its treatment on QoL, with interviewees being asked to imagine life without the disorder, (to elicit life domains impacted by hypothyroidism), and to comment aloud whilst completing draft questionnaires. Interview data were analysed for content. Findings: Patients described the negative impact of underactive thyroid on a number of life domains, particularly on energy, weight, physical appearance, physical capabilities, and motivation.  The great majority reported on-going negative impact on some aspects of life despite thyroxine treatment. Several patients (24%) expressed concerns about receiving sub-optimal thyroxine replacement that did not relieve lingering symptoms, and there was much dissatisfaction with lack of information provided by healthcare professionals about the condition and its treatment, particularly at diagnosis.  Discussion: Multiple aversive symptoms remain despite thyroxine treatment, causing considerable dissatisfaction and marked impairment of QoL in many patients. Condition-specific measures of QoL and treatment satisfaction were designed for use in evaluating and improving treatment for people with hypothyroidism and are now under development.    

https://pure.royalholloway.ac.uk/ws/files/4393033/McMillan_Bradley_et_al_QoL_in_hypothyroidism_BPS_DHP_2004_abstr.pdf

Quality of life and treatment satisfaction in patients with hypothyroidism

Abstract

Similar works

Full text

Available Versions

Royal Holloway Research Online

Royal Holloway Research Online

Royal Holloway Research Online

Royal Holloway Research Online

Royal Holloway Research Online

Royal Holloway - Pure

Royal Holloway Research Online

Royal Holloway Research Online