Biomedical subjects

H D Hadjistavropoulos

Publications and source records attributed to H D Hadjistavropoulos.

16 recordsLinked to original sources

PubMed2001

Information provision, patient involvement, and emotional support: prospective areas for improving anesthetic care.

PURPOSE: To explore patients' perceptions of anesthetic care as measured by a patient-centered care survey. Specifically, the survey examined patient views of multiple diverse dimensions of care that are not typically fully addressed among patients receiving anesthesia services, namely opinions on Information Provision, Involvement in Care, Respect Shown, Physical Comfort, and Emotional Support. METHOD: A total of 268 patients responded to a patient-centered care survey, a self-report factor analytically derived instrument designed to measure the aforementioned dimensions of care. RESULTS: Analyses revealed that the highest ratings of care were given to Physical Comfort and Respect. Ratings of Information Provision, Involvement, and Emotional Support were significantly lower. Ratings did not differ as a function of site of service, inpatient vs day surgery, surgical service, type of anesthetic, or anesthesiologist. DISCUSSION: The findings generated from the study are of value in obtaining a broader understanding of anesthesia services from the patient's perspective, and also in directing quality improvement initiatives. Other departments of anesthesiology interested in quality improvement initiatives may similarly benefit from measurement of patient-centered care.

Analysis of Variance↗

PubMed2001

Using outcome evaluations to assess interdisciplinary acute and chronic pain programs.

BACKGROUND: Outcome evaluations can be useful for reassuring patients that their time and effort are well spent on treatment and for providing staff with confidence in their treatment provision. Outcome evaluations were carried out in 1997 and 1999 to assess two initiatives for the treatment of patients within the Regina Health District (RHD), Saskatchewan, Canada-the Chronic Pain Team Evaluation and Management (CP TEAM) Service and the Acute Injury Management (AIM) Program. STUDY 1: The CP Team Service was an individualized interdisciplinary treatment program intended to serve patients with chronic pain. Of 47 eligible chronic pain patients, 36 participants completed treatment within 15 months, and 27 completed follow-up questionnaires on discharge; the comparison group was composed of the remaining 11 nontreated participants, 8 of whom responded to follow-up questionnaires. Only patients in the treatment group reported a decrease in pain and a decrease in interference in activities. Overall, satisfaction with treatment received was high. STUDY 2: The AIM Program was intended to aid employees with acute musculoskeletal injuries who could not perform regular job duties. Following injury, employees were contacted by an occupational health nurse and informed of the program. If the employee was interested, the AIM coordinator carried out an assessment and designed an individualized treatment package, including physical therapy, exercise therapy, and/or occupational therapy. Treatment was expected to continue until the employee returned to normal duties. Of 72 eligible employees, 43 employees participated and 29 opted not to participate-15 of whom agreed to participate as control participants for this study. Of the employees receiving AIM, 20 agreed to participate in this study. Of the employees not participating in AIM, 15 agreed to participate as control participants. Although pain and interference were greater among AIM participants before commencing treatment, by the end of treatment participants had improved more in level of pain severity and interference compared with controls. All participants reported improved job function over time. AIM participants, however, reported lower job function before treatment than control participants and similar job function after treatment- and indicated they were highly satisfied with the service they received. SUMMARY AND CONCLUSIONS: Evaluations are not only used to assess program outcomes but are an important aspect of program validation and development. Data collection was incorporated, as much as possible, into routine treatment protocols and staff focused on obtaining essential information regarding patient outcomes rather than the whole scope of information.

Acute Disease↗

PubMed2001

Contributions of pain-related adjustment and perceptions of control to coping strategy use among cervical sprain patients.

Coping is a cyclical process in which an individual evaluates stressful events, chooses and implements coping strategies, re-evaluates the outcome of the coping effort and modifies the strategy if necessary. The intent of the present study was to evaluate the extent to which pain-related adjustment (i.e. pain severity, pain interference, negative affect) and perceptions of control are associated with the implementation of particular coping strategies. Participants were 136 patients assessed at an interdisciplinary pain clinic for cervical sprain injuries. As part of a routine assessment, participants completed a questionnaire package regarding background, pain severity, pain interference, negative affect, perceived control and use of particular coping strategies. Results of hierarchical multiple regression analyses revealed that pain interference, after controlling for all other variables, was associated with greater use of less physically demanding strategies (i.e. resting, guarding, asking for assistance, seeking social support and coping self-statements). Negative affect, on the other hand, after controlling for other variables, was associated with reduced use of task persistence. Finally, perceived control, independent of other variables, was associated with greater use of cognitive and social coping strategies (i.e. asking for assistance, seeking social support and coping self-statements). The results of the study shed light on the complex relationship between use of particular coping strategies and situational variables of pain-related adjustment and perceived control. Implications for clinicians who assist patients via implementation or modification of particular coping techniques are discussed.

Adaptation, Psychological↗

PubMed2000

Extent and nature of anxiety experienced during physical examination of chronic low back pain.

There is strong evidence to suggest that anxiety is a common problem for many chronic pain patients and can exacerbate a patient's pain condition. Notwithstanding, there is little information about the extent and nature of anxiety experienced during physical examination of pain, or the primary factors associated with anxiety in this context. In the present study, 45 chronic low back pain patients completed a questionnaire battery at the time of intake to an interdisciplinary treatment program. After approximately four weeks on program, patients underwent a routine standardized physiotherapy review of their condition following which they completed a second questionnaire battery. The examination was videotaped and coded for pain behavior. Physiotherapists provided objective scoring of non-organic signs and physical impairment. Results suggested that participants experienced substantial anxiety at the point of examination with scores on the Beck Anxiety Inventory (M = 30.47, S.D. = 6.96) comparable to scores that have been found with DSM-IV panic disorder patients. Regression analyses revealed that catastrophic cognitions, behavioral displays of pain and somatic sensations measured during examination uniquely predicted anxiety experienced during examination. Demographic, injury-related, personality, and patient-practitioner variables did not significantly contribute to explaining examination anxiety. Findings support cognitive-behavioral formulations of anxiety and strongly suggest that anxiety may complicate the assessment process. Implications for the assessment and treatment of pain are presented along with future research directions.

Adult↗

PubMed2000

Health anxiety moderates the effects of distraction versus attention to pain.

Little is known about the relationship between health anxiety and chronic pain. The present study explored whether individual differences in health anxiety would influence the response of chronic pain patients to physical therapy. Furthermore, the interaction of health anxiety with coping strategy usage (distraction versus attention) was studied. Participants were 81 chronic pain patients who were interviewed and completed measures of pain, anxiety and cognition following an active physiotherapy session in which they either: (1) attended to physical sensations; (2) distracted from physical sensations or (3) completed the session as usual. Health anxious, compared to non-health anxious, individuals worried more about their health and injury during the session and attended to and catastrophically misinterpreted sensations more frequently. A complex interaction between health anxiety and coping strategy emerged. Among health anxious patients, attention to sensations resulted in lower anxiety and pain than did distraction. It appears as though attention had a short-term anxiety reducing effect for health anxious patients. Among non-health anxious patients, attention resulted in greater worry about health than distraction. Clinical and theoretical implications are discussed.

Adaptation, Psychological↗

PubMed1999

Exploratory and confirmatory factor analytic investigations of the Illness Attitudes Scale in a nonclinical sample.

The Illness Attitudes Scale (IAS) assesses fears, beliefs and attitudes associated with hypochondriasis [Kellner, R. (1986). Somatization and hypochondriasis. New York: Praeger Publishers.]. Recent factor analytic investigations of the IAS in non-clinical samples have suggested a number of different factor solutions. In study 1, we used principal components analysis with both orthogonal and oblique rotation to better explore the structure of this measure. Using a random selection of 390 participants from a larger pool of 780, a five-factor solution was identified: (1) fear of illness, death, disease and pain, (2) effects of symptoms, (3) treatment experiences, (4) disease conviction and (5) health habits. In study 2, confirmatory factor analysis (CFA) of responses from the remaining 390 students evaluated: (a) a single-factor model, (b) Kellner's original nine-factor model, (c) a four-factor model proposed by Ferguson and Daniel [Ferguson, E. & Daniel, E. (1995). The Illness Attitudes Scale (IAS): a psychometric evaluation on a nonclinical population. Personality and Individual Differences, 18, 463-469.], (d) a different four-factor model proposed by Stewart and Watt [Stewart, S. H. & Watt, M. C. (1998). A psychometric investigation of the Illness Attitudes Scale (IAS) in a nonclinical young adult sample. Submitted for publication.] and (e) the five-factor model derived in study 1. Of these models, greatest support was obtained for our five-factor model. However, it was also clear that this model could be improved. Based on the results of the CFA, as well as previous research and theoretical considerations, we tested a revised model in which the health habits factor was deleted. Analysis of the revised model showed that it received the greatest support and could be conceptualized as either four distinct factors or as hierarchical in nature, with four lower-order factors loading on a single higher-order factor. Future directions for research as well as suggestions for scoring and using the IAS with nonclinical samples are discussed.

Adult↗

PubMed1999

Validation of the coping with health, injuries, and problems scale in a chronic pain sample.

OBJECTIVE: The Coping with Health, Injuries, and Problems (CHIP) Scale is a self-report instrument that is designed for diverse patient populations to provide measures of emotion-focused (e.g., emotional preoccupation) and task-oriented (e.g., palliative, instrumental, distraction) responses to injury. The present investigation assessed the factor structure, reliability, and validity of the measure in patients (n = 203) with chronic musculoskeletal pain. METHOD: Patients were administered questionnaires, including the CHIP Scale, and measures of pain coping strategies, adjustment, and personality. RESULTS: The factor structure, with one exception, was replicable, and the subscale reliabilities were acceptable. The subscales related in predictable ways to other similar questionnaires, to pain adjustment, and to personality. CONCLUSION: Overall, the CHIP Scale is both reliable and valid in assessing responses to chronic pain. Researchers and clinicians who want to use a psychometrically sound measure of response to illness that is applicable across diverse patient populations are encouraged to consider this measure.

Adaptation, Psychological↗

PubMed1998

Cognitive and behavioral responses to illness information: the role of health anxiety.

The cognitive-behavioral theory of health anxiety predicts atypical responses in health anxious individuals when exposed to health related information. Systematic research is still needed to support the theory. This investigation examined 192 participants varying a subclinical levels of health anxiety, who were randomly given feedback on an ostensible diagnostic measure, indicating positive, negative or ambiguous risk for health complications. Responses to a cold pressor task were then measured. The results indicated that regardless of the type of feedback patients were given, health anxious individuals displayed the predicted cognitive (e.g. negatively interpreted information) and behavioral responses (e.g. increased reassurance seeking). Important and perhaps central cognitions to health anxiety were identified. Health anxious individuals regarded themselves to be at greater risk for disease overall, and attached greater accuracy to health related information. Extending the cognitive-behavioural theory, health anxiety was found to be associated with decreased usage of positive somatic monitoring of symptoms, suggesting health anxiety may be associated with a failure to engage in protective strategies. Health anxiety did not result in cognitive or behavioural avoidance of illness information. Clinical implications and future directions for research are described.

Adaptation, Psychological↗

PubMed1998

Factor analytic investigation of the Illness Attitudes Scale in a chronic pain sample.

The Illness Attitudes Scale (IAS) is a self-report instrument comprising nine subscales designed to assess fears, beliefs and attitudes associated with hypochondriasis and abnormal illness behaviour [Kellner (1986). Somatization and hypochondriasis. New York: Praeger.]. The purpose of the present study was to explore the factor structure of the IAS in a chronic pain sample as a preliminary step toward determining the use of this measure in this sample. Hypochondriacal tendencies have been postulated to play a role in maintaining and exacerbating responses to chronic pain and, therefore, appropriate measurement in this sample is important. In the present study, consecutive chronic pain patients presenting to a pain treatment program (N = 198) were administered the IAS. Principal component analysis with oblique (Oblimin) rotation identified that five factors best explain the measure in this population. These factors were (1) fear of illness, (2) effects of symptoms, (3) health habits, (4) disease phobia and conviction and (5) fear of death. The factor structure overlapped to some degree with the scoring of the IAS proposed by Kellner (1986), as well as with the factor structure identified in a non-clinical sample [Ferguson, E. & Daniel, E. (1995). The Illness Attitudes Scale (IAS): a psychometric evaluation on a non-clinical population. Personality and Individual Differences, 18, 463-469.]. There were enough discrepancies, however, to suggest an alternative method for scoring the IAS with chronic pain patients. Implications for the use of the measure with chronic pain patients, as well as future research directions for exploring the utility of this measure with chronic pain patients, are discussed.

Adult↗

PubMed1998

Measuring the quality of performance in the management of waiting lists: using cataract surgery as an example.

BACKGROUND: Quality of care committees monitor waiting lists to ensure that patient care is not compromised. Frequently, waiting lists are determined by individual physicians, and no explicit criteria determine who is first in the queue. The quality of ophthalmologists' decisions for managing waiting lists of cataract patients, a high-volume elective patient group, was examined in a study of patients undergoing cataract surgery in 1997 in the Regina Health District, Saskatchewan, Canada. METHOD: Ninety-eight patients scheduled for surgery were interviewed pre- and postoperatively regarding cataract symptomatology, visual and emotional functioning, coping strategies, and concerns with waiting periods. Ophthalmologists provided preoperative and postoperative information on visual functioning. RESULTS: Even though no formal criteria guided decision making about how long patients should wait, wait periods conformed to general standards set by consensus of ophthalmologists unless patients decided to delay surgery. Patients voiced little concern about the waiting period, and difficulties with visual and emotional functioning were minimal. Surgery outcomes were not negatively affected by waiting periods, which were in part a function of physician case load but were also related to patient preference and the tendency to seek out reassurance. Visual acuity, cataract symptomatology, and visual functioning were not predictive of waiting time, suggesting that this information is not consistently being used to prioritize patients. CONCLUSION: Waiting lists can be well managed by using individual physician decision making, although explicit formal decision-making rules would be helpful. A variety of methodologies and analyses can be used to evaluate the management of waiting lists and to assist in identifying criteria for assigning priority to patients.

Aged↗

PubMed1995

Appearance-based information about coping with pain: valid or biased?

Previous research led to the conclusion that patient characteristics such as physical attractiveness and non-verbal expressiveness affected judgements of patient pain and distress. This study investigated whether this represents an intrusive bias or whether there indeed are psychological differences between physically attractive vs physically unattractive and expressive vs inexpressive pain patients. The findings led to the conclusion that both variables are related to the types of coping strategies pain patients use. Specifically, physically attractive and nonverbally expressive patients were found to be less likely to utilize passive coping strategies. Coping style also was found to be related to demographic characteristics of the patients. Theoretical reasons for the identified relationships are discussed as are the implications of these findings for the assessment of pain.

Adaptation, Psychological↗

PubMed1994

Acute and chronic low back pain: cognitive, affective, and behavioral dimensions.

Despite strong suppositions concerning differences between patients suffering acute and chronic low back pain, relatively few data-based comparisons have been made. In this study, affective, cognitive, behavioral, and demographic contrasts were conducted. Chronic patients were divided into those who demonstrated signs and symptoms that were either congruent or incongruent with underlying anatomical and physiological principles. Low socioeconomic status, compensation claims, use of opiate analgesics, greater disability, catastrophizing cognitions, stronger emotionality, and passive coping were more characteristic of both acute and chronic incongruent patients than chronic congruent patients. A relatively stereotyped, spontaneous facial expression of pain was observed in all groups when responding to painful movements during a physical examination. The similarities between acute and chronic incongruent patients have implications for the assessment and treatment of low back pain.

Adult↗

PubMed1994

A comparison of two measures of facial activity during pain in the newborn child.

Facial activity is strikingly visible in infants reacting to noxious events. Two measures that reduce this activity to composite events, the Neonatal Facial Coding System (NFCS) and the Facial Action Coding System (FACS), were used to examine facial expressions of 56 neonates responding to routine heel lancing for blood sampling purposes. The NFCS focuses upon a limited subset of all possible facial actions that had been identified previously as responsive to painful events, whereas the FACS is a comprehensive system that is inclusive of all facial actions. Descriptions of the facial expressions obtained from the two measurement systems were very similar, supporting the convergent validity of the shorter, more readily applied system. As well, the cluster of facial activity associated with pain in this sample, using either measure, was similar to the cluster of facial activity associated with pain in adults and other newborns, both full-term and preterm, providing construct validity for the position that the face encodes painful distress in infants and adults.

Age Factors↗

PubMed1994

Judging pain in newborns: facial and cry determinants.

Explored the facial and cry characteristics that adults use when judging an infant's pain. Sixteen women viewed videotaped reactions of 36 newborns subjected to noninvasive thigh rubs and vitamin K injections in the course of routine care and rated discomfort. The group mean interrater reliability was high. Detailed descriptions of the infants' facial reactions and cry sounds permitted specification of the determinants of distress judgments. Several facial variables (a brow bulge, eyes squeezed shut, and deepened nasolabial fold constellation, and taut tongue) accounted for 49% of the variance in ratings of affective discomfort after controlling for ratings of discomfort during a noninvasive event. In a separate analysis not including facial activity, several cry variables (formant frequency, latency to cry) also accounted for variance (38%) in ratings. When the facial and cry variables were considered together, cry variables added little to the prediction of ratings in comparison to facial variables. Cry would seem to command attention, but facial activity, rather than cry, can account for the major variations in adults' judgments of neonatal pain.

Adolescent↗

PubMed1990

Are physicians' ratings of pain affected by patients' physical attractiveness?

The degree to which physical attractiveness and nonverbal expressions of pain influence physicians' perceptions of pain was investigated. Photographs of eight female university students were represented in four experimental conditions created by the manipulation of cosmetics, hairstyles, and facial expressions: (a) attractive-no pain, (b) attractive-pain, (c) unattractive-no pain, and (d) unattractive-pain. Each photograph was accompanied by a brief description of the patient's pain problem that was standard across conditions. Medical residents (N = 60) viewed the photographs and rated each patient's pain, distress, negative affective experience, health, personality, blame for the situation, and the physician's own solicitude for the patient. The results showed that physicians' ratings of pain were influenced both by attractiveness of patients and by nonverbal expressions of pain. Unattractive patients, and patients who were expressing pain, were perceived as experiencing more pain, distress, and negative affective experiences than attractive patients and patients who were not expressing pain. Unattractive patients also received higher ratings of solicitude on the doctor's part and lower ratings of health than attractive patients. Physician's assessments of pain appear to be influenced by the physical attractiveness of the patient.

Adult↗

PubMedDate not supplied

Subjective judgments of deception in pain expression: accuracy and errors.

Accuracy and errors in judges' attempts to differentiate facial expressions that displayed genuine pain, no pain or were dissimulated (i.e., masked and exaggerated) were examined. Judges were informed that misrepresentations in the facial expressions were present and were asked to rate their confidence in classifying these expressions. Detailed, objective coding of the patients' facial reactions (e.g., brow lowering, mouth opening) were related to judges' decisions. Judges' classification decisions were better than chance, but there were many errors. Extreme expressions (i.e., no pain, and exaggerated expressions) were identified more accurately than genuine and masked expressions. Judges level of confidence was consistent with their level of accuracy. Judges consistently used rules of thumb based on specific facial cues when making judgments. Certain cues were effectively discriminative. Systematic training in the use of specific cues or the use of articulated decision rules may be helpful in improving judges' accuracy.

Adult↗