A Prospective, Randomized, Double-blind, Placebo-controlled Study of Orbital Radiotherapy for Graves' Ophthalmopathy.

CONTEXT: Although widely used for more than 85 years, the efficacy of radiotherapy for Graves' ophthalmopathy (GO) has not been established convincingly. OBJECTIVE: To evaluate the efficacy of radiotherapy for GO. DESIGN: Prospective, randomized, internally controlled, double-blind clinical trial in a tertiary care academic medical center. PARTICIPANTS: The patients were ethnically diverse males and females over age 30 seen in a referral practice. The patients had moderate, symptomatic Graves' ophthalmopathy (mean clinical activity score, 6.2) but no optic neuropathy, diabetes, recent steroid treatment, previous decompression, or muscle surgery. Forty-two of 53 consecutive patients were enrolled after giving informed consent and fulfilling study entry criteria. Eleven eligible patients declined to participate because of inconvenience, desire for alternative therapy, or concern about radiation. INTERVENTION: One randomly selected orbit was treated with 20 Gy of external beam therapy; sham therapy was given to the other side. Six months later, the therapies were reversed. MAIN OUTCOME MEASURES: Every 3 months for 1 year, we measured the volume of extraocular muscle and fat, proptosis, range of extraocular muscle motion, area of diplopia fields, and lid fissure width. Effective treatment for GO will modify one or more of these parameters. RESULTS: No clinically or statistically significant difference between the treated and untreated orbit was observed in any of the main outcome measures at 6 months. At 12 months, muscle volume and proptosis improved slightly more in the orbit that was treated first. CONCLUSIONS: In this group of patients, representative of those for whom radiotherapy is frequently recommended, we were unable to demonstrate any beneficial therapeutic effect. The slight improvement noted in both orbits at 12 months may be the result of natural remission or of radiotherapy, but the changes are of marginal clinical significance.

Tobacco cessation treatment for Alaska native adolescents: group randomized pilot trial.

INTRODUCTION: Tobacco cessation treatments have not been evaluated among Alaska Native (AN) adolescents. This pilot study evaluated the feasibility and the potential efficacy of a targeted cessation intervention for AN youth using a group randomized design. METHODS: Eight villages in western Alaska were randomly assigned to receive the intervention (n = 4 villages) or a delayed treatment control condition (written materials only; n = 4 villages). Ten adolescents aged 12-17 years were targeted from each village with a planned enrollment of 80. The intervention was held over a weekend, and youth traveled from their villages to quit tobacco use with other teens. The intervention comprised 8 hr of group-based counseling. Talking circles, personal stories from elders, and recreational activities were included to enhance cultural acceptability and participation. Newsletters were mailed weekly for 5-weeks postprogram. Assessments were conducted at baseline, week 6 (end-of-treatment), and 6 months. Self-reported tobacco abstinence was confirmed with salivary cotinine. RESULTS: Recruitment targets were met in the intervention (41 enrolled) but not in control villages (27 enrolled). All intervention participants attended the weekend program. Retention was high; 98% of intervention and 86% of control participants completed 6-month follow-up. The 7-day point-prevalence self-reported tobacco abstinence rates for intervention and control participants were 10% (4/41) and 0% (0/27) at both week 6 and 6 months (p = .15). Only 1 adolescent in the intervention condition was biochemically confirmed abstinent at week 6 and none at 6 months. CONCLUSION: The intensive individual-focused intervention used in this study was feasible but not effective for tobacco cessation among AN youth. Alternative approaches are warranted.

Development of a tobacco cessation intervention for Alaska Native youth.

Tobacco cessation treatments have not been evaluated among Alaska Native (AN) adolescents. This pilot study evaluated the feasibility and acceptability of a targeted cessation intervention developed for AN youth. Intervention components were informed by prior focus groups assessing treatment preferences among AN youth, a social cognitive theoretical framework and feedback obtained from a teen advisory group. The intervention consisted of a weekend program where youth traveled by small airplane from their villages to stay overnight with other adolescents who quit tobacco use together. The program included recreational activities, talking circles, personal stories from elders and teen advisors, and cognitive behavioral counseling. Two intervention pilots were conducted from October 2010 to January 2011 using a non-randomized, uncontrolled study design with assessments at baseline and six-week follow-up. One village in Western Alaska was selected for each pilot with a targeted enrollment of 10 adolescents each. Participants were recruited for each pilot within five days, but recruitment challenges and ''lessons learned'' are described. The first pilot enrolled nine adolescents (all female) aged 13-16 years; all nine attended the intervention program and 78% (7/9) completed follow-up. The second pilot enrolled 12 adolescents (eight females, four males) aged 12-17 years, of which seven attended the intervention program. Six of these seven participants (86%) completed follow-up. In both pilots, participants rated the intervention as highly acceptable. A targeted cessation intervention was feasible and acceptable to AN youth. The intervention will be tested for efficacy in a subsequent randomized controlled trial.

Web-based intervention for adolescent nonsmokers to help parents stop smoking: a pilot feasibility study.

A novel approach to tobacco control is to engage adolescent nonsmokers in support roles to encourage and help their parents stop smoking. This pilot study examined the feasibility and potential efficacy of a web-based support skills training (SST) intervention for adolescents to help a parent stop smoking. Forty nonsmoking adolescents 13-19 years of age (70% female, 93% White) were enrolled and randomly assigned to a health education (HE) control group (n=20) or SST (n=20). Both consisted of written materials and five weekly, 30 min, web-based, counselor-facilitated group sessions. Parents were enrolled for assessments only. Adolescents and parents completed assessments at baseline, week 6 (post-treatment), week 12 and 6-months follow-up. Both interventions were feasible based on treatment acceptability ratings, study retention and treatment compliance. The biochemically confirmed 6-month smoking abstinence rate was higher for parents linked to teens in HE (35%, 7/20) than in SST (10%, 2/20), p=0.13. About half of parents in each group reported a quit attempt since study enrollment. Teens can be engaged to help parents stop smoking. Future research is warranted on determining effective intervention approaches.

Support-person promotion of a smoking quitline: a randomized controlled trial.

BACKGROUND: Quitlines and other evidence-based cessation treatments are greatly underutilized by smokers, limiting their public health impact. Social support is correlated with successful cessation. Thus, efforts targeting the social network of smokers could be a potential avenue to promote quitline utilization. PURPOSE: This study examined the efficacy of an intervention for nonsmokers interested in helping a smoker (i.e., support people) to promote smoker utilization of the Minnesota QUITPLAN(®) Helpline. Data were collected from 2007 to 2010, and analyses were conducted from 2010 to 2011. DESIGN: Two-group randomized design evaluating the support-person intervention (n=267) compared with a control condition (written materials, n=267). SETTING/PARTICIPANTS: Enrolled were 534 support people (91% female, 93% Caucasian) residing in Minnesota. INTERVENTION: Written materials plus three weekly telephone sessions lasting 10-30 minutes each. Based on Cohen's theory of social support, the intervention provided participants with information and skills needed to encourage their smoker to call the QUITPLAN Helpline. MAIN OUTCOME MEASURES: Participants completed the Support Provided Measure (SPM) by mail at baseline and Week 4 (end-of-treatment). Helpline intake staff documented smoker calls to the Helpline through 6 months of follow-up. RESULTS: The proportion of calls to the Helpline was significantly (p=0.012) greater for smokers linked to support people in the intervention group (16.1%, 43/267) than in the control group (8.6%, 23/267). The treatment effect remained significant after adjusting for support person residing with the smoker (OR=2.04, 95% CI=1.19, 3.49, p=0.010). Among support people randomly assigned to the intervention group, greater number of sessions completed was associated with increased smokers' calls to the Helpline (p=0.004). After adjusting for the baseline score, the M±SD SPM score at Week 4 was significantly higher for support people in the intervention group (16.4±3.3) than for those in the control group (15.3±3.6), p=0.002. CONCLUSIONS: A support-person intervention is effective in increasing smoker utilization of the QUITPLAN Helpline. There is potential for increasing the reach of quitlines by targeting the social network of smokers. TRIAL REGISTRATION #: NCT01311830.

Clinician-delivered intervention to facilitate tobacco quitline use by surgical patients.

BACKGROUND: Telephone quitlines that provide counseling support are efficacious in helping cigarette smokers quit and have been widely disseminated; currently, they are underused. Surgery represents a teachable moment for smoking cessation, which can benefit surgical outcomes; however, few surgical patients receive smoking cessation interventions. This study developed and tested a clinician-delivered intervention to facilitate quitline use by adult patients scheduled for elective surgery. METHODS: After formative work involving patients and clinicians, a brief intervention was designed to facilitate telephone quitline use. It was then evaluated in a randomized trial of 300 adults scheduled for elective surgery. A control standard brief stop-smoking intervention served as a comparator, with both interventions delivered by clinicians. The primary outcome was the use rate of a quitline accessed through a dedicated toll-free telephone number, with use defined as completing at least one full counseling session. Secondary outcomes included self-reported abstinence from cigarettes at 30 and 90 days postoperatively. RESULTS: Subject characteristics were similar between the two groups. Records from the designated quitline documented that 29 of 149 subjects (19.5%) in the quitline intervention group and 0 of 151 subjects in the control group completed the first full counseling session (P < 0.0001). There were no significant differences in the self-reported point-prevalent and continuous abstinence rates between groups at either 30 or 90 days postoperatively, although rates tended to be higher in the quitline intervention group. CONCLUSIONS: Clinicians can effectively facilitate quitline use by surgical patients. Further work is necessary to evaluate the efficacy of this approach in terms of long-term abstinence from cigarette smoking.

Willingness of cancer patients to help family members to quit smoking.

OBJECTIVES: The impact of social support on successful smoking cessation has been well documented. However, little is known about whether personal experience with cancer may motivate cancer survivors to support smoking cessation among their family members and friends. As a first step in this line of research, we sought to explore interest in playing a supportive role for smoking cessation as well as correlates of such interest among cancer survivors. METHODS: Cancer survivors undergoing radiation therapy (N=211) completed a 77-item pencil-paper questionnaire. A section of the survey assessed interest in helping a smoker quit and characteristics of the smoking social network member. Respondents provided information on their smoking status, medical status, and psychosocial and behavioral factors related to cigarette smoking. RESULTS: Over half of the respondents 114 (54%) reported having someone close to them (family member or friend) smoking cigarettes who they thought should quit. Of these respondents (44 females, 70 males) 78% (89/114) reported they were definitely or probably interested in helping a smoker quit. Nearly all respondents wanted to help a family member (typically an adult child). CONCLUSIONS: Results suggest the potential feasibility of engaging cancer survivors to help family members quit smoking. Research is needed to determine the optimal methods and timing for engaging the cancer patient to maximize positive effects and minimize potential harms.

The association of alcohol consumption with tobacco use in Black and White college students.

This study explored the association of alcohol and tobacco use among college students. A survey was administered in 2004 to 2,189 Black and White students from the southeastern United States. The prevalence of alcohol and tobacco use, tobacco use characteristics according to level of alcohol consumed, and percentage of students using tobacco according to type of alcoholic beverages consumed were evaluated. The interaction of race and gender with alcohol and tobacco use was explored. Our findings extend prior investigations that have found alcohol use associated with smoking and suggest attention be paid to the relation of alcohol to other forms of tobacco. Racial and gender differences are highlighted. This study was funded by Mayo Clinic. The study's limitations were noted.

Validation of the support provided measure among spouses of smokers receiving a clinical smoking cessation intervention.

Studies indicate a positive association between social support and smoking cessation. However, clinic-based interventions designed to increase social support have had limited success. Most studies have relied on only the smoker's perceptions of support received while few have assessed the support provider's report of support delivered. Understanding supportive interactions between support providers and recipients may assist in developing effective support interventions for cessation. The current investigation examined the perceptions of smoking-specific support provided by the spouse of a partner who smokes and was seen for a nicotine dependence consultation. Specifically, we examined spouse reported willingness to help their spouse quit, interest in learning ways to help their spouse quit, and characteristics associated with the provision of smoking-specific supportive behaviors (as assessed via the Support Provided Measure, SPM), in the 2-weeks prior to the consultation. The current investigation also examined the concurrent validity of the SPM with a validated measure of support provided to a smoker, the Partner Interaction Questionnaire (PIQ), accounting for social desirability bias and smoker readiness to change. The sample comprised 84 adult cigarette smokers seen for a clinical smoking cessation intervention and their spouses (N = 84). Results indicate that a high percentage of spouses are willing to help their partner who smokes and interested in learning way to help. As expected, spouses who were females and had never smoked had higher scores on the SPM than males or current smokers. The SPM was significantly correlated with the PIQ positive (r = 0.50, p < 0.01) and negative (r = 0.44, p <0.01) item scales overall and for spouses whose partners reported higher levels of readiness to quit smoking (r = 0.54, p < 0.01; r = 0.50, p < 0.01, respectively). Suggestions for future research are offered.

A randomized, controlled trial of bupropion sustained-release for preventing tobacco relapse in recovering alcoholics.

INTRODUCTION: Studies examining the efficacy of tobacco dependence treatment among recovering alcoholic smokers have produced mixed findings. We set out to investigate this issue further by conducting a randomized, double-blind, placebo-controlled trial of bupropion sustained-release (SR) for smoking relapse prevention among abstinent alcoholic smokers. METHODS: Participants (N = 195) met DSM-IV criteria for a history of alcohol abuse or dependence and had at least 1 year of continuous abstinence from alcohol and drugs. Open-label treatment with nicotine patch therapy was provided to all subjects for 8 weeks. The initial nicotine patch dose was determined by the subject's baseline serum cotinine concentration with an aim to achieve 100% cotinine replacement. All subjects who were confirmed abstinent from smoking throughout the final week of nicotine patch therapy (Week 8) were randomly assigned to receive bupropion SR 300 mg/day or placebo through Week 52. RESULTS: A total of 110 participants were randomized to the double-blind treatment. No significant difference was observed between the bupropion and placebo groups for rates of continuous smoking abstinence, 41.1% (95% CI = 28.1%-55.0%) versus 40.7% (95% CI = 27.6%-55.0%), respectively, p = 1.0, or point prevalence abstinence, 39.3% (95% CI = 26.5%-53.3%) versus 40.7% (95% CI = 27.6%-55.0%), respectively, p = 1.0, at the end of the treatment (Week 52). Relapse to alcohol occurred in 4% of subjects (n = 4) during the study. DISCUSSION: Treatment with bupropion SR among abstinent alcoholic smokers did not delay relapse or result in improved long-term smoking abstinence.

Personality characteristics of health care satisfaction survey non-respondents.

PURPOSE: Patient satisfaction surveys are increasingly used to assess the quality of health care delivery. Unfortunately, survey non-response may compromise generalizability (and inferential value). Although prior studies demonstrate an association between patient socio-demographic variables and response rate, relatively little information is available linking personality factors to non-response. This paper's purpose is to define outpatient satisfaction survey non-responder personality characteristics. DESIGN/METHODOLOGY/APPROACH: Minnesota Multiphasic Personality Inventory profiles of patients who completed an outpatient satisfaction survey were compared with non-responder profiles. Multivariate analysis was used to adjust for demographic and personality covariates. The study sample included 1,862 medical outpatients who were sent a satisfaction survey and Minnesota Multiphasic Personality Inventory results on record at this institution. Of these, 1,255 were survey responders and 607 were non-responders. FINDINGS: Scores on three Minnesota Multiphasic Personality Inventory scales were significantly correlated with non-response: higher scores on scales 4--Psychopathic deviate (Pd) and 8--Schizophrenia (Sc) predicted an increased likelihood of non-response (odds ratio [OR], 1.02; p < or = 0.05 for both), and higher scores on 7--sychasthenia (Pt) were associated with a decreased likelihood of non-response (OR, 0.98; p < or = 0.01). ORIGINALITY/VALUE: Prior investigations demonstrate an association between patient socio-demographic factors and survey non-response. This paper uniquely highlights patient personality characteristics' contribution to non-response. This information is an important consideration for patient satisfaction survey design, administration and interpretation.

Feasibility of a telephone-based intervention for support persons to help smokers quit: a pilot study.

BACKGROUND: Nonsmokers have a potentially supportive role in tobacco cessation efforts. The present study examined the feasibility, acceptability, and potential efficacy of a telephone-based intervention for nonsmoking support persons. METHODS: A total of 59 support persons (mean age = 36 years, 92% female, 95% White) were randomly assigned to a control condition (N = 30; written materials only) or to a social cognitive theory-based intervention (N = 29; written materials and 5 weekly, 20- to 30-min telephone counseling sessions). Both support persons and smokers completed assessments separately by mail at baseline and at weeks 6 (end of treatment) and 26. RESULTS: Two thirds of the smokers reported low-moderate levels of motivation to quit at baseline as assessed by the contemplation ladder. Study retention rates were excellent, with 95% of both support persons and smokers completing the week 26 assessment. Moreover, 86% of support persons in the intervention group completed all five telephone sessions. Treatment acceptability was high for both support persons and smokers. Compared with the control condition, the intervention was associated with a significant increase in support person self-efficacy to help their smoker (p = .034) and outcome expectancies (p = .025) from baseline to week 6. However, the intervention was not associated with higher smoking abstinence rates or quit attempts. DISCUSSION: The program was successful in reaching smokers with lower levels of readiness to quit. The intervention was feasible and acceptable to both support persons and smokers. Although support persons and smokers can be engaged in this type of outreach program, refinements in the intervention approach are needed to improve the smoking outcomes.

Focus groups of Alaska Native adolescent tobacco users: preferences for tobacco cessation interventions and barriers to participation.

Tobacco cessation interventions developed for Alaska Native adolescents do not exist. This study employed focus group methodology to explore preferences for tobacco cessation interventions and barriers to participation among 49 Alaska Natives (61% female) with a mean age of 14.6 (SD = 1.6) who resided in western Alaska. Using content analysis, themes from the 12 focus groups were found to be consistent across village, gender, and age groups. Program location or site (e.g., away from the village, hunting, fishing), a group-based format, and inclusion of medication and personal stories were reported to be important attributes of cessation programs. Motivators to quit tobacco were the perceived adverse health effects of tobacco, improved self-image and appearance, and the potential to be a future role model as a non-tobacco user for family and friends. Parents were perceived as potentially supportive to the adolescent in quitting tobacco. The findings will be used to develop tobacco cessation programs for Alaska Native youth.

The MMPI-2: a contemporary normative study of midwestern family medicine outpatients.

For more than 60 years it has been known that profiles from the Minnesota Multiphasic Personality Inventory (MMPI), obtained from medical patients, are elevated when scores are plotted using general population norms. These elevations have been most apparent on the neurotic triad (NTd), the first 3 clinical scales on the MMPI profile. More than 45 years have passed since a nonreferred, normative sample of MMPIs was established from 50,000 consecutive medical outpatients. We present comparable but contemporary normative data for the revised MMPI (MMPI-2) based on a nonreferred sample of 1,243 family medicine outpatients (590 women; 653 men). As true for the original MMPI, contemporary medical outpatients have profiles that are significantly different, clinically and statistically, from the general population norms for the MMPI-2. This is particularly evident in elevations on the NTd. New normative tables of uniform medical T (UMT) scores were developed following the procedures used to create the uniform T scores for the MMPI-2. Measures of internal consistency are reported; test-retest reliability was established over a mean of 3.7 weeks, and results characterizing the stability of the validity and clinical scales are presented.

Support person intervention to promote smoker utilization of the QUITPLAN Helpline.

BACKGROUND: Effective cessation services are greatly underutilized by smokers. Only about 1.5% of smokers in Minnesota utilize the state-funded QUITPLAN Helpline. Substantial evidence exists on the role of social support in smoking cessation. In preparation for a large randomized trial, this study developed and piloted an intervention for an adult nonsmoking support person to motivate and encourage a smoker to call the QUITPLAN Helpline. METHODS: The support person intervention was developed based on Cohen's theory of social support. It consisted of written materials and three consecutive, weekly, 20-30 minute telephone sessions. Smoker calls to the QUITPLAN Helpline were documented by intake staff. RESULTS: Participants were 30 support people (93% women, 97% Caucasian, mean age 49). High rates of treatment compliance were observed, with 28 (93%) completing all three telephone sessions. The intervention was ranked as somewhat or very helpful by 77% of the support people, and 97% would definitely or probably recommend the program. Five smokers linked to a support person called the QUITPLAN Helpline. CONCLUSIONS: An intervention using natural support networks to promote smoker utilization of the QUITPLAN Helpline is both acceptable to a support person and feasible. A controlled randomized trial is under way to examine the efficacy of the intervention.

Telephone quitlines to help surgical patients quit smoking patient and provider attitudes.

BACKGROUND: The scheduling of elective surgery provides an excellent opportunity for cigarette smoking-cessation interventions. Abstinence from smoking may improve immediate surgical outcomes, and the surgical period represents a teachable moment for modifying smoking behavior. However, a variety of barriers to intervention exist. This qualitative, formative research identified themes to guide the development of a brief intervention used by the providers of surgical services to promote the use of telephone quitlines. METHODS: Structured interviews were conducted in 2007 with 19 cigarette smokers either scheduled for or recently receiving surgery at Mayo Clinic, Rochester MN and ten providers of surgical services (anesthesiologists and surgeons). RESULTS: Prominent patient themes included interest in quitting smoking around the time of surgery, a view of physicians having an important role in their cessation attempts, and a profound lack of knowledge regarding telephone quitline services. Patients were also poorly informed regarding the immediate benefits of quitting to surgical outcomes. Prominent provider themes included a similar ignorance of quitline services and a lack of time to deliver interventions. Although providers expressed interest in referring to quitlines if this could be easily accomplished, they were willing to spend only a limited amount of time learning how to intervene. CONCLUSIONS: Both surgical patients and providers are potentially receptive to a quitline-based smoking-cessation intervention in the peri-operative period, but significant barriers exist.

Willingness among college students to help a smoker quit.

OBJECTIVE: Between February and March 2003, the authors examined college students' willingness to help a smoker quit and assessed demographic and psychosocial characteristics associated with willingness to help. PARTICIPANTS: Survey respondents were 701 college students (474 women, 227 men) aged 18 to 24 years who indicated there was someone close to them whom they thought should quit smoking. METHODS: Respondents completed measures of willingness to help. The authors used multivariate logistic regression analysis to examine respondent characteristics associated with willingness to help. RESULTS: About half (54%; n = 381) reported that they "definitely would" be interested in helping this smoker quit. Characteristics significantly associated with willingness to help were lower levels of perceived stress, being a non-tobacco user, concern for a boyfriend, girlfriend, or spouse who smoked, and more severe levels of distress caused by this person's smoking. CONCLUSIONS: A high percentage of college students are willing to help a smoker. Future studies are needed to engage college students who are nonsmokers in tobacco control efforts, including the Healthy Campus 2010 initiatives to reduce smoking among college students.

Changes in readiness to quit and self-efficacy among adolescents receiving a brief office intervention for smoking cessation.

PURPOSE: To examine changes in readiness to quit and self-efficacy among adolescents who received a clinic-based, brief office intervention (BOI) for smoking cessation. METHODS: This study utilized a prospective, pre-post- treatment design. Participants were adolescent smokers (34 females, 35 males) with a mean +/- SD age of 15.8 +/- 1.4 years; 86% were Caucasian, who were randomly assigned to receive the BOI as part of a larger clinical trial. They were recruited from three cities in the Midwest and Northeastern part of the United States. After the baseline assessment, the BOI was designed for adolescents to receive four weekly individual sessions with a research counselor lasting between 10 and 40 min each. The BOI includes motivational interviewing and cognitive-behavioral techniques. Readiness to quit was assessed at each treatment session using the stages of change algorithm. The validated Adolescent Smoking Self-Efficacy Scale (SES) was used to assess self-efficacy at baseline (week 0) prior to the intervention and at post-treatment (week 4). The SES items comprise three factors or subscales: opportunities to smoke, emotional stress, and friends' influence. RESULTS: The percentage of adolescents who made improvement on readiness to quit from the baseline treatment session was statistically significant (p < .001) for each of the three subsequent treatment sessions. Self-efficacy scores increased significantly (p < .004) from baseline to post-treatment for all three subscales. CONCLUSIONS: Adolescents receiving a BOI progressed in their readiness and self-efficacy to quit. Understanding the change process among adolescent smokers during treatment could influence the design of future stop smoking interventions.

Pessimism and hostility scores as predictors of patient satisfaction ratings by medical out-patients.

PURPOSE: The purpose of this research is to determine whether a pessimistic or hostile personality style adversely affects satisfaction with out-patient medical visits. Many patient and health care provider demographic characteristics have been related to patient satisfaction with a health care encounter, but little has been written about the association between patients' personality characteristics and their satisfaction ratings. DESIGN/METHODOLOGY/APPROACH: An eight-item patient satisfaction survey was completed by 11,636 randomly selected medical out-patients two to three months after their episode of care. Of these, 1259 had previously completed a Minnesota Multiphasic Personality Inventory (MMPI). The association of pessimism and hostility scores with patient satisfaction ratings was assessed. FINDINGS: Among patients who scored high on the pessimism scale, 59 percent rated overall care by their physicians as excellent, while 72 percent with scores in the optimistic range rated it as excellent (p = 0.003). Among the hostile patients, 57 percent rated their overall care by physicians as excellent, while 66 percent of the least hostile patients rated it as excellent (p = 0.002). ORIGINALITY/VALUE: Pessimistic or hostile patients were significantly less likely to rate their overall care as excellent than optimistic or non-hostile patients.