Can causal explanations about endothelial pathophysiology benefit patient education? A cluster randomized controlled trial in cardiac rehabilitation.

OBJECTIVE: To examine whether explaining causal links among endothelial pathophysiology, cardiac risk factors, symptoms and health behaviors (termed causal information) enhances patients' depth of knowledge about cardiovascular disease self-management and their perceptions of the cardiac rehabilitation and secondary prevention (CRSP) program. METHODS: Newly referred CRSP patients (N = 94) were cluster randomized to usual care (control; UC) or usual care with causal information (intervention; UC + CI). Depth of knowledge (factual vs. deep) was measured with an adapted cognitive-reasoning task. Patients' cardiovascular knowledge and beliefs about the efficacy of a CRSP program were assessed. RESULTS: After controlling for education level, patients in UC + CI demonstrated deeper knowledge about cardiovascular management than did those in UC. The UC + CI group showed higher factual knowledge than their counterparts after covarying education, occupation status and BMI. The UC + CI group also rated the CRSP program as more credible than those in UC, after controlling for age. Deep knowledge mediated the relationship between group conditions and perceived credibility of CRSP. CONCLUSION: Causal information can enhance the depth of patients' understanding of cardiovascular disease management and perceived treatment credibility of the CRSP program. PRACTICE IMPLICATIONS: Explaining causal links may help improve patient education delivery and enhance patient engagement in CRSP.

Explaining the causal links between illness management and symptom reduction: Development of an evidence-based patient education strategy.

OBJECTIVE: To determine whether explaining the causal links between illness management and symptom reduction would help younger and older adults learn and apply health information. METHOD: Ninety younger and 51 older adults read about a fictitious disease with or without explanations about the cause-and-effects (causal information) of illness management. A knowledge test (applied vs. factual items) was administered immediately and 1-week following the presentation of health booklets. Reading comprehension, working memory and health literacy were assessed as covariate variables. RESULTS: Younger adults outperformed older individuals on the applied and factual items at both time points. After controlling for covariates, causal information facilitated the comprehension and application of health information for younger but not older adults. Reading comprehension was the best predictor of test performance in the older sample. CONCLUSIONS: Providing an explanation of why illness management is effective for reducing symptomatology can help improve knowledge and application of health information for younger individuals. For older adults, lowering the verbal demands of patient education materials may be a better way to help them learn new health information. PRACTICE IMPLICATIONS: Use of causal information as a teaching strategy in patient education may enhance individuals' ability to learn about and implement self-care strategies.

What matters to patients with heart failure? The influence of non-health-related goals on patient adherence to self-care management.

OBJECTIVE: To describe the life goals of heart failure (HF) patients and to determine whether adherence is influenced by the extent to which these priorities are perceived as compatible with HF self-care regimens. METHOD: Forty HF outpatients identified their top-five life goals and indicated the compatibility of HF self-care regimens (diet, exercise, weighing) with these priorities. HF knowledge, self-efficacy and reported adherence were also assessed. RESULTS: Patients valued autonomy and social relationships as much as physical health. However, the rated importance of these domains did not predict adherence. Adherence positively correlated with the extent to which the regimen, specifically exercise, was considered compatible with life goals (r=.34, p<.05). Exercise adherence also correlated with illness severity and self-efficacy (rs=-.42 and .36, p<.05, respectively). The perceived compatibility of physical activity with personal goals predicted 11% of the variance in exercise adherence above and beyond that accounted for by illness severity and self-efficacy (FΔ (1, 36)=7.11, p<.05). CONCLUSIONS: Patients' goals outside of the illness management context influence self-care practices. PRACTICE IMPLICATIONS: Exploring patients' broad life goals may increase opportunities to resolve ambivalence and enhance motivation for self-care adherence.

Openness to psychological explanations and treatment among people with fibromyalgia versus rheumatoid arthritis.

OBJECTIVE: The classic perspective in the psychosomatic literature is that patients with medically unexplained syndromes do not acknowledge psychologically-based causes for their conditions and will not engage in psychological treatments. These assumptions were tested by contrasting the illness models and reported treatment experiences of individuals with fibromyalgia (FM), a syndrome with a currently unknown organic origin, with those of individuals with rheumatoid arthritis (RA), a 'legitimate' (i.e. organic) condition. METHOD: 193 patients with FM and 176 with RA completed measures assessing their views about the causes of their condition, the treatments they had used and their judged effectiveness. RESULTS: Contrary to prediction, compared to patients with RA, patients with FM were more likely to endorse psychological causes for their condition and reported having used more psychological management approaches. Moreover, patients with FM considered psychological approaches to be more effective than narcotics. CONCLUSION: These findings indicate that patients with FM do not react defensively to the implication of psychogenic causes. Rather, as a group, they tend to acknowledge both the psychosocial influences on and the effectiveness of psychological management approaches for their condition.

Cognitive-emotional decision making (CEDM): a framework of patient medical decision making.

OBJECTIVE: Assistance for patients faced with medical decisions has largely focussed on the clarification of information and personal values. Our aim is to draw on the decision research describing the role of emotion in combination with health behaviour models to provide a framework for conceptualizing patient decisions. METHODS: A review of the psychological and medical decision making literature concerned with the role of emotion/affect in decision making and health behaviours. RESULTS: Emotion plays an influential role in decision making. Both current and anticipated emotions play a motivational role in choice. Amalgamating these findings with that of Leventhal's (1970) SRM provide a framework for thinking about the influence of emotion on a patient medical decision. CONCLUSION: Our framework suggests that a patient must cope with four sets of elements. The first two relate to the need to manage the cognitive and emotional aspects of the health threat. The second set relate to the management of the cognitive and emotional elements of the decision, itself. PRACTICE IMPLICATIONS: The framework provides a way for practitioners and researchers to frame thinking about a patient medical decision in order to assist the patient in clarifying decisional priorities.

What accounts for the appeal of complementary/alternative medicine, and what makes complementary/ alternative medicine "alternative"?

The goal of this study was to elucidate the basis for the appeal of complementary/alternative medicine (CAM) and the basis upon which people distinguish between CAM and conventional medicine. Undergraduates (N = 173) rated 19 approaches to the treatment of chronic back pain on 16 rating scales. Data were analyzed via 3-mode factor analysis, which extracted conceptual dimensions common to both the scales and the treatments. A 5-factor solution was judged togive the best description of the raters'perceptions. One of these 5 factors clearly reflected the distinction between conventional versus CAM approaches, and a 2nd factor clearly referred to treatment appeal. The other 3 factors were invasiveness, health care professional versus patient effort, and "druglikeness." To the extent that treatment was seen as a CAM treatment (as opposed to a conventional treatment), it was seen to be more appealing, less invasive, and less druglike. Simple and partial correlations of the dimension weights indicated that both the appeal of CAM and the distinction between CAM and conventional medicine were largely driven by the view that CAM is less invasive than conventional medicine.

The factor structure of the Coping Strategies Questionnaire.

The Coping Strategies Questionnaire (CSQ) (Rosenstiel and Keefe 1983) is the most widely used measure of pain coping strategies. To date, with one exception (Tuttle et al. 1991), studies examining the factor structure of the CSQ have used the composite scores of its 8 a-priori theoretically derived scales rather than the 48 individual items. An examination of the match between the 8 theoretically derived scales and scales empirically extracted from an item analysis is lacking. Accordingly, the CSQ was administered to 126 chronic pain (whiplash) patients. Factor analyses of the individual items revealed an 8-factor structure to be uninterpretable. Of the 2-9-factor solutions tested, the 5-factor structure was the most interpretable: Factor 1, Distraction; Factor 2, Ignoring Pain Sensations; Factor 3, Reinterpreting Pain Sensations; Factor 4, Catastrophizing; Factor 5, Praying and Hoping. Eighteen Ph.D. or M.D. level clinicians classified items into their corresponding category with a high degree of accuracy (on average, 90.2%), attesting to the face and construct validity of the subscales. Four subscales, Catastrophizing, Reinterpreting Pain Sensations, Praying and Hoping and (to a lesser degree) Ignoring Pain Sensations, correspond with parallel subscales proposed by Rosensteil and Keefe (1983). The fifth subscale, Distraction, is comprised of items from their Diverting Attention and Increasing Activity Level subscales, suggesting that cognitive and behavioural distraction comprise 1 rather than 2 coping strategies. That CSQ items on the original Coping Self-Statements and the Increasing Pain Behaviour subscales failed to load consistently on any factor suggests that they do not reliably measure distinct coping strategies.(ABSTRACT TRUNCATED AT 250 WORDS)