ABSTRACT
AIM: This article is a report of a study exploring the subjective illness perceptions of patients with chronic pruritus (>6 weeks). BACKGROUND: Pruritus is a common symptom of dermatological as well as other conditions. This pervasive symptom has a substantial impact on quality of life. Little is known about how patients with chronic pruritus construct the symptom, what causes they ascribe, consequences they endure, how they control the symptom and experience the healthcare system. DESIGN: A qualitative design taking a constructivist inquiry perspective. METHODS: Semi-structured interviews with 16 patients were conducted between September 2008-February 2009 and analysed by qualitative content analysis. RESULTS: Many patients find it very difficult to adequately describe the symptom to others resulting sometimes in bizarre accounts of the symptom that provoke irritation in lay people and health professionals. This irritation frequently leaves the sufferer feeling misunderstood. Patients often feel their burden is not taken seriously by health professionals. This and various other reasons contribute to difficulties in accepting a given diagnosis. This can leave patients unsatisfied with their current health care and the system. They respond with frequent doctor changes and consideration of complementary and alternative therapeutic methods. CONCLUSION: Assisting patients with chronic pruritus in their efforts to adequately describe the symptom along with unconditional regard and empathy are key factors that can help enhance the provider-patient relationship and subsequent acceptance of a given diagnosis. A stronger emphasis on the perspectives of these patients may also improve the quality of healthcare provision.
Subject(s)
Attitude to Health , Pruritus/psychology , Activities of Daily Living , Adaptation, Psychological , Adult , Aged , Aged, 80 and over , Chronic Disease , Cost of Illness , Female , Humans , Male , Middle Aged , Perception , Physician-Patient Relations , Young AdultABSTRACT
OBJECTIVE: Occupational skin disease (OSD) is the most frequent work-related disease in most industrialised countries and poses a high social, economic and personal burden. However, to date no study has examined the illness perceptions of individuals with refractory OSD. PARTICIPANTS AND METHODS: Semi-structured guided interviews with 50 patients with OSD were conducted. Data was subjected to qualitative content analysis. RESULTS: Most patients were not able to see the prodromal symptom-character of dry skin or the involvement of psychological factors in the formation and maintenance of eczema. Patients rejected a personal accountability for the condition. Before being willing to act upon skin protection measures, external agencies (employer, insurance organisations) have to overcome a variety of perceived barriers. Previous negative experiences with skin protection often lead to the conclusion that these measures, in general, are not efficacious. CONCLUSIONS: In order to accommodate the needs of patients with OSD, health care providers need to be aware of what these patients' illness cognitions consist of, and how they interact with current preventive efforts. Many details of the patient's perspective are often overlooked, but need to be considered. Failure to do so may mean that well-meant interventions will not reach the addressed audience successfully.
Subject(s)
Adaptation, Psychological , Dermatitis, Occupational/psychology , Occupational Health Services/methods , Quality of Life , Self Concept , Adolescent , Adult , Chronic Disease/prevention & control , Chronic Disease/psychology , Chronic Disease/therapy , Dermatitis, Irritant/etiology , Dermatitis, Irritant/prevention & control , Dermatitis, Irritant/psychology , Dermatitis, Occupational/diagnosis , Dermatitis, Occupational/therapy , Germany , Hand Dermatoses/diagnosis , Hand Dermatoses/prevention & control , Hand Dermatoses/psychology , Hand Dermatoses/therapy , Humans , Interpersonal Relations , Interviews as Topic , Male , Middle Aged , Occupational Exposure/prevention & control , Patient Compliance , Personnel Staffing and Scheduling , Protective Devices/statistics & numerical data , Qualitative Research , Quality of Life/psychology , Sex Distribution , Surveys and Questionnaires , Workplace/psychology , Workplace/standardsABSTRACT
Chronic pruritus (> 6 weeks) is a worldwide symptom and a burden in many dermatological, systemic and psychosomatic/psychiatric diseases. Patients with chronic pruritus frequently endure a long and complicated disease course, failure of therapy and a substantial reduction in quality of life. Psychological mechanisms may be involved in eliciting and coping with chronic pruritus. Treatment of pruritus aims to be aetiological, but as a primary illness it is symptomatic. The needs of patients with chronic pruritus are diverse. Multi-disciplinary educational and psychological training programmes aim to improve patients' understanding of the disease, raise the motivation to apply more adaptive self-care measures, and consequently improve quality of life. Maintenance of health through educational programmes, such as the one presented here, can be considered as important complementary measures in the field of medicine and psychosomatics, which should also be offered to patients with chronic pruritus.
