Abstract: OBJECTIVE: All healthcare workers' communication skills are recognised as valuable indicators of quality of care from the patient's perspective. Most of the studies measure doctor-patient communication, giving scarce attention to other professionals. This study is aimed at developing and providing preliminary validation of a questionnaire to measure outpatients' experience of communication with hospital personnel other than doctors. METHODS: Small groups of outpatients and hospital staffs were involved in identifying the domains and generating the items. A quantitative validation phase involving 401 outpatients followed in order to verify the hypothesised dimensionality of selected items and to measure reliability. RESULTS: A 13-item questionnaire emerged, comprising four components of outpatients' experience in the healthcare communication domain: problem solving, respect, lack of hostility, and nonverbal immediacy. Psychometric tests were promising as regards factorial validity, evaluated with confirmatory factor analysis, and scales reliability. Factor scores were independent of patients' gender, age, and education. CONCLUSION: The developed Health Care Communication Questionnaire (HCCQ) is a self-administered brief measure with good psychometric properties. PRACTICE IMPLICATIONS: The HCCQ gives information that could be taken as an indirect and subjective indicator of the quality of hospital services as provided by non-medical staff. This aspect may have a role in local quality improvement initiatives.
Abstract: Carotid Endarterectomy (CEA) is a surgical treatment validated to prevent cerebral ischemia, embolism and stroke in patients affected by severe stenosis of the carotid artery. A 1999 systematic review of the literature found controversial results about CEA influence on improvement of post-surgical cognitive performance. Moreover, few studies addressed the issue of the positive effects of CEA on quality of life and depression, reporting also controversial findings. The present review was aimed at considering the last 20 years studies focusing on the effects of CEA on the psychological dimensions. The purpose was to clarify the benefits, in terms of psychological well-being, offered by CEA, besides a reduction of the cardiovascular risk, as well as to have indication to lead further research in this area. Results of the 39 studies considered suggest that, although few studies show cognitive deterioration, most of them show stability with a tendency to improve both in cognitive functions and in other psychological areas. Further research is needed to clarify when it would be appropriate the use of CEA, the characteristics of eligible patients, and psychological as well as physical expected outcomes.
Abstract: Knowledge of patients' opinions and beliefs about their illness is fundamental in interdisciplinary health care interventions. The IPQ and its revised version (IPQ-R) are questionnaires designed to assess components of the mental representation of illness described in Leventhal's self-regulation model. To validate the IPQ-R in the Italian population, verifying its psychometric properties and focusing on Part II of the instrument (opinions about disease), we enrolled 277 inpatients (216 males and 61 females) affected by myocardial infarction (n=70), coronary artery by-pass graft surgery (n=52), chronic heart failure (n=47), valve replacement (n=20), obstructive sleep apnoea syndrome associated to obesity (n=53) and respiratory failure (n=35). All patients completed the Italian version of the IPQ-R obtained by means of 3 translations and a back version. IPQ-R scores were compared to patients' scores on the SF-36 and AD schedule (on anxiety and depression). Structural validity and reliability (both internal and test-retest) of the Italian IPQ-R were assessed. The validity of Part II of the IPQ-R was confirmed. As in the original version, 7 factors were extracted. ANOVA revealed statistically significant differences between the different diseases. Correlations between IPQ-R and, respectively, the SF-36 and AD schedule were statistically significant and coherent with the constructs analyzed. Finally statistically significant correlations emerged between the IPQ-R factors. The test-retest reliability and internal consistency of the questionnaire were confirmed. The psychometric properties of the Italian version of the IPQ-R were demonstrated to be robust. Hence, the Italian version of the IPQ-R, which resulted homogeneous with the original version, could be useful in assessing the cognitive factors involved in patients' adjustment to various chronic illnesses.
Abstract: BACKGROUND: A relationship exists between non-adherence and clinical outcomes in health care, including renal transplantation. The aim of this study was to identify the psychological variables associated with non-adherence to medication after renal transplantation. METHODS: This cross-sectional study involved 34 patients, 38% male, with a mean age of 49 yr (range 26-70) and a mean of six yr post-transplantation. Adherence to medication was measured by two items: (i) the frequency of not taking medications and (ii) the frequency of not taking medications exactly as prescribed. The psychological variables were: dispositional coping style (COPE) and five items measuring barriers and perceived characteristics of the medication regimen. Descriptive and multivariate analyses were utilized to examine the data. RESULTS: Twenty-four per cent of patients reported less than perfect adherence. Individuals who were younger, who perceived less autonomy in the management of treatment and who were characterized by an active coping style were less likely to adhere to medication. Individuals who perceived less autonomy and a higher level of interference of treatment with their life patterns were less likely to take medication exactly as prescribed. CONCLUSIONS: The finding of this study suggests that adherence to medications after renal transplant is associated with psychological variables, such as coping style and perceived autonomy in the management of treatment. Understanding of the patient's perspective may help to develop effective interventions to increase the levels of adherence to medications that may result in better clinical outcomes.
Abstract: We investigated the psychological impact of testing for the presence of thrombophilic alterations. The enrolled subjects received counseling from a physician before blood sampling and after receiving results, with a view to provide clear information about the aim of thrombophilia screening (TS). Participants were requested to complete a pre-test questionnaire during this interview and a post-test questionnaire 20 days after receiving the TS results. One hundred ninety-seven subjects completed the pretest questionnaire and 140/197 (71.1%) returned the post-test one. The TS results were altered in 36 (25.7%, R506Q mutation n = 19; G20210A mutation n = 9; antithrombin deficiency n = 1; LAC phenomenon n = 4; hyperhomocysteinemia n = 3) and normal in 104 subjects. We assessed: perceived health status (PHS), state of anxiety, health fears, depressive reactions, moods, perceived well-being, and perceived daily-life stress. For both groups, both at pre- and post-test, none of the psychological variable scores showed significant worsening, regardless of whether TS resulted altered or normal. Anxiety significantly (p < or = 0.05) decreased at post-test in the altered group and a non-significant improvement in PHS after TS result communication was recorded in both groups. Age was an important factor in mediating psychological impact. In conclusion, diagnosis of thrombophilic alterations seems to be well accepted in the short term and TS should not be discouraged for potential adverse psychological effects. However, the psychological impact over a longer period of receiving altered results needs to be further investigated. The relationship between absence of adverse psychological reactions and quality of counseling program provided before and after TS should also be investigated.
Abstract: BACKGROUND: Evidence suggests that metabolic syndrome and hostility are independent risk factors for the development of coronary heart disease. Recently, the combined effect of metabolic syndrome and hostility has shown to predict the incidence of myocardial infarction. This study tested whether cynical hostility was associated with the metabolic syndrome in a sample of Italian adults. METHODS: 992 subjects participated in the study. Among them, 546 participants were classified as having metabolic syndrome and 446 as controls, not having any of the risk factors that constitute the metabolic syndrome. Cynicism, the cognitive component of hostility, was measured with a self-report questionnaire derived from the Cook-Medley Hostility Scale. Metabolic syndrome was based on having the following risk factors: obesity, hyperinsulinemia, dyslipidemia, and elevated arterial blood pressure. RESULTS: The cross-sectional association of cynical hostility with metabolic syndrome was statistically significant (p < 0.0001). Hostility was also associated with age (p < 0.0001) and educational level (p < 0.02). Predictors of having metabolic syndrome were higher cynicism (O.R. 1.12), older age (O.R. 1.39), and lower educational level (O.R. 1.05). CONCLUSIONS: The results highlight the potential importance of intervention on psychological factors (i.e. hostility) to prevent coronary heart disease.
Abstract: Anger and hostility have long been considered important factors in the etiology of essential hypertension (EH) and coronary heart disease (CHD). This case-control study investigates the association of hostility, as measured by the Cook and Medley Hostility Scale (HO), and anger, as measured by the Multidimensional Anger Inventory (MAI), with CHD and EH in 80 CHD patients, 80 EH patients, and a control group of 80 healthy adults from Italy. Cases revealed significantly higher scores than controls in two subsets of HO and in two subscales of MAI. Some of these subscales appeared to be age-dependent. The results indicate that particular components of anger-hostility could be taken into consideration when studying psychological risk factors for CHD and EH.
