Journal of behavioral medicine
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Comparative Study
Predicting patient satisfaction: a study of two emergency departments.
To identify perceptions that predict overall patient (dis)satisfaction with Emergency Department (ED) care, we studied responses to a survey mailed to all discharged patients over a 6-month period (Academic Hospital), and to a telephone interview of a random sample of discharged patients over a 1-year period (Community Hospital). The survey and interview both assessed overall satisfaction, as well as satisfaction with perceived waiting times, information delivery, and expressive quality of physicians, nurses, and staff. ⋯ The findings suggest that overall patient (dis)satisfaction with care received in the ED is nearly perfectly predictable on the basis of patient-rated expressive qualities of ED staff, particularly physicians and nurses. Interventions designed to reinforce positive (and extinguish negative) expressive health-care provider behaviors may cut the number of extremely dissatisfied patients in half.
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The Pain Catastrophizing Scale (PCS; Sullivan et al., Psychol. Assess. 7, 524-532, 1995) has recently been developed to assess three components of catastrophizing: rumination, magnification, and helplessness. We conducted three studies to evaluate the factor structure, reliability, and validity of the PCS. ⋯ Also, in the clinic sample, we evaluated evidence of concurrent and predictive validity for the PCS. The internal consistency reliability indices for the total PCS and subscales were examined in all three studies. Limitations and future directions are discussed.
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Randomized Controlled Trial Clinical Trial
The effects of medical evidence and pain intensity on medical student judgments of chronic pain patients.
This study examined symptom judgments made by medical students of hypothetical chronic low back pain patients. Eight vignettes were varied as to the pain intensity reported by the hypothetical patient (low vs. moderate vs. high vs. very high) and the availability of medical evidence supportive of the pain report (present vs. absent). Ninety-five subjects read vignettes and made judgments of patient emotional distress, pain intensity, and pain-related disability. ⋯ Judgments of pain and disability were higher for patients for whom medical evidence was present compared to those for whom it was absent. The results support and extend previous research on the effects of situational and patient variables on observer pain judgments. Future research should examine the influence of these biasing variables on the assessment and treatment of chronic pain patients.
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This study examined the extent to which measures of psychosocial features of employment status predict emotional distress in chronic pain (n = 83) and healthy comparison (n = 88) samples. Participants completed measures of emotional distress, pain severity, psychosocial features of employment status, and demographic data. ⋯ Structured and purposeful time use emerged as the most significant individual predictor of emotional distress for both samples. Findings are discussed in terms of their potential implications for treating chronic pain patients and the need to develop multidimensional measures that assess features of employment status within chronic pain samples.
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Anxiety sensitivity (AS) is the fear of anxiety-related bodily sensations, arising from beliefs that the sensations have harmful consequences. There has been a good deal of research on the role of AS in anxiety disorders, and only recently have investigators begun to assess its role in other conditions. In a preliminary report, Asmundson and Norton (1995) found that chronic back-pain patients with high AS (n = 14), compared to those with lower AS (n = 56), reported greater pain-related fear, and tended to have greater avoidance. ⋯ Support also was found for the prediction that AS indirectly promotes pain-related escape/avoidance via its influence on fear of pain. This indirect effect was significant even when controlling for the direct influence of pain severity on pain-related escape/avoidance. These results suggest that AS plays an important role in pain-related fear and escape/avoidance in people with chronic pain.