Biomedical subjects

C E Lerman

Publications and source records attributed to C E Lerman.

7 recordsLinked to original sources

PubMed1993

Psychosocial impact of cancer screening.

Cancer screening programs, including tests for early detection and programs aimed at identifying people with carcinogenic occupational exposure, may have psychological and behavioral sequelae. An abnormal screening result can lead to distress and anxiety that may continue even after further workup rules out cancer. Such psychological distress can affect subsequent health behavior. When testing or counseling indicates risk factors for cancer, the individual generally tries to adhere to the recommended preventive guidelines. A moderate amount of anxiety about the results may even be a motivating factor in getting subsequent check-ups. However, in some cases such knowledge leads to extreme levels of distress that can actually interfere with adherence behavior. Intervention studies now suggest that simple strategies can successfully reduce screening-related anxiety. Such interventions are particularly important to assure that people with positive tests do not drop out of the system for future screening.

Anxiety↗

PubMed1990

Identifying hypertensive patients with elevated systolic workplace blood pressures.

The present study was designed to identify patients who had systolic work blood pressures that were substantially higher than their clinic blood pressures. Fifty-two mild and moderate hypertensive patients were assessed using clinic blood pressures and ambulatory blood pressure monitoring in their natural environment. Thirty-eight percent of these patients had systolic work blood pressures that were more than 10 mm Hg above their clinic blood pressures. These patients did not differ from other patients in terms of the demographic or clinical factors which were assessed. Need for control and anger, two core features of the Type A Coronary-prone Behavior Pattern, were shown to discriminate these patients on a statistically reliable basis. Research on cardiovascular reactivity to stress suggests that such patients with elevated systolic work blood pressures may be at greater risk for cardiac morbidity and mortality.

Analysis of Variance↗

PubMed1990

Improvement in physicians' counseling of patients with mental health problems.

This study evaluated the impact of two interventions: (1) detailed feedback about a patient's mental health problem and desires for specific mental health interventions, and (2) a counseling protocol on medical residents' management of patients with mental health problems. These patients were seen in either a control, feedback, or feedback/protocol clinic. Immediately following their medical visit we found the following differences between feedback and control patients: feedback patients reported that the stress counseling they received was more valuable, and they were more satisfied with their physician; feedback patients also perceived greater decreases in the amount of overall stress experienced, and reported greater increases in their perceived control over stress. There were no outcome differences between feedback and feedback/protocol patients. We conclude that the feedback provided in this study can enhance physicians' ability to counsel primary care patients with mental health problems.

Attitude to Health↗

PubMed1989

The relationship between patients' satisfaction with their physicians and perceptions about interventions they desired and received.

This study was designed to determine the relationship between patients' satisfaction with their physician, the types of interventions that patients reported they received, and the congruence between those interventions and the types of interventions they desired. One hundred eighteen symptomatic adult primary-care patients completed questionnaires before and after their respective medical visits. Patients who indicated they received any one of the three nontechnical interventions: education (P less than 0.001), stress counseling (P less than 0.05), and negotiation (P less than 0.01), were significantly more satisfied than those who had not received these interventions. Patient perceptions about receiving technical interventions, i.e., examination, tests, medications, and nondrug therapy, were not related to patient satisfaction. The congruence between patient-intervention desires and perceptions about interventions received generally were not significantly related to satisfaction except for the interaction between receiving a medication and postvisit-medication desires (P less than 0.001). A series of multiple regression analyses revealed that, in general, perceptions about nontechnical interventions were better predictors of patient satisfaction than perceptions about technical interventions.

Adult↗

PubMedDate not supplied

The white-coat hypertension response: prevalence and predictors.

This study was designed to determine the clinical characteristics of hypertensive patients whose blood pressures are substantially higher in the medical office than in their natural environments. Thirty-nine percent of patients enrolled in a nonpharmacologic hypertension treatment program had systolic or diastolic office blood pressures (OBPs) that were at least 10 mm Hg higher than their ambulatory blood pressures (ABPs). Although these white-coat responders (WCRs) had higher systolic OBPs than did non-white-coat responders (NRs), both their systolic (p less than 0.02) and their diastolic (p less than 0.0001) ABPs were significantly lower than those of NRs. Furthermore, patients with white-coat hypertension did not have greater blood pressure reactivity in their natural environments, suggesting that their blood pressure elevations may be specific to the medical setting. White-coat hypertensives were older (p less than 0.005), had less angry dispositions (p less than 0.01), and reported less overt anger expression (p less than 0.005). They were also taking more antihypertensive medications than were the other patients in the study (p less than 0.001).

Antihypertensive Agents↗

PubMedDate not supplied

Patient perception of involvement in medical care: relationship to illness attitudes and outcomes.

OBJECTIVE: The purpose of this study was to explore the relationships among patients' perceptions about the roles they played during medical visits, their subsequent attitudes about their illnesses and treatments, and their self-rated improvement. DESIGN: Questionnaires were completed by patients before, one day after, and one week after their medical visits, and by their physicians following the visits. SETTING: The study was conducted in a general internal medicine faculty practice that provided adult primary care to a largely HMO population. PARTICIPANTS: Adult patients with new or increased symptoms who were capable of reading and understanding the study questionnaire. MAIN RESULTS: Fifty-five patients (47%) reported playing an active role; 62 patients (53%) reported playing a passive role. After adjusting for age, sex, baseline illness ratings, and physician-rated prognosis, "active" patients reported less discomfort (p = 0.04), greater alleviation of symptoms (p = 0.008), and more improvement in their general medical condition (p = 0.04) one week after the visits than did "passive" patients. These differences were not influenced by the roles patients desired to play. Active patients also reported less concern with their illnesses (p = 0.04), a greater sense of control of their illnesses (p = 0.04), and more satisfaction with their physicians (p = 0.02) one day after the visit. Post-visit dysfunction ratings were not related to patients' role perceptions. CONCLUSIONS: Patients' perceptions about their involvement in care appeared to be related to their attitudes about their illnesses as well as to recovery. Further research is needed, however, to determine the factors that influence these role perceptions and to define the types of patients, illnesses, and settings in which the benefits of active-role perceptions are most likely to be realized.

Adult↗

PubMedDate not supplied

Patients' Perceived Involvement in Care Scale: relationship to attitudes about illness and medical care.

This report describes the development of the Perceived Involvement in Care Scale (PICS), a self-report questionnaire for patients, and its relation to primary care patients' attitudes regarding their illnesses and the management of them. The questionnaire was administered to three independent samples of adult primary care patients. Patients' satisfaction and their attitudes regarding their illnesses are evaluated after their medical visits. This instrument is designed to examine three relatively distinct factors: 1) doctor facilitation of patient involvement, 2) level of information exchange, and 3) patient participation in decision making. Of these factors, doctor facilitation and patient decision making were related significantly to patients' satisfaction with care. Doctor facilitation and information exchange related consistently to patients' perceptions of post-visit changes in their understanding, reassurance, perceived control over illness, and expectations for improvement in functioning. The role of physicians in enhancing patient involvement in care and the potential therapeutic benefits of physician facilitative behavior are addressed.

Adult↗