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Biomedical subjects

D A Drossman

Publications and source records attributed to D A Drossman.

At least 55 records · Page 3Linked to original sources
PubMed1997

Psychosocial sound bites: exercises in the patient-doctor relationship.

In the course of evaluating and caring for patients, there are occasions when physicians feel "stuck" in not knowing how to respond to certain comments that arise during the interview. The difficulties may result from misunderstandings between patient and physician or from comments that reflect unstated issues. In both cases, mutual dissatisfaction ensues when these underlying factors are not properly addressed. Furthermore, particularly if feeling uncertain of the reasons for these difficulties or if dissatisfied with the conduct of the interview, physicians may respond in an authoritative manner, which diminishes the patient's ability to actively participate in the interaction. Included in this article are eight challenging comments made by patients in the course of a clinical visit. In each case, possible underlying theme(s) and responses that address these themes are provided as examples of a participatory style of communication. There can be more than one appropriate response. What is important is for the physician to develop a communication style that supports an effective patient-physician interaction, to improve the therapeutic outcome.

Abdominal Pain↗
PubMed1996

Health-care-seeking behaviors related to bowel complaints. Hispanics versus non-Hispanic whites.

Health-care-seeking behaviors related to bowel complaints may vary between ethnic groups. A survey of a nonpatient population in El Paso, Texas, was conducted in order to examine differences in health care behavior related to bowel dysfunction, and in the perception of health and bowel function, in Hispanics and non-Hispanic whites. Data from 905 subjects who were either Hispanic (580) or non-Hispanic white (325) given a forced-choice, self-report questionnaire were used for analysis. Data on health care behavior variables were studied using logistic regression, in ethnic and gender groups, controlling for age and socioeconomic status. A log-linear analysis was applied to health perception variables in ethnic and gender groups. Hispanics were less likely than non-Hispanic whites to have seen a physician for bowel symptoms (P < 0.02). Of the subjects with symptoms compatible with irritable bowel syndrome, Hispanics were less likely to have seen a physician (P < 0.05). More Hispanics reported buying folk remedies (P < 0.001), and herbal teas were taken more often to maintain good bowel function (P < 0.02) and to treat bowel problems (P < 0.005). Additionally, Hispanics had a poorer perception of their health in general (P < 0.001), reported more concern about their health (P < 0.02), more concern about bowel function (P < 0.001), and more time spent attending to bowel function (P < 0.001). Therefore, data on health-care-seeking behaviors related to bowel dysfunction showed that Hispanics were less likely than non-Hispanic whites to seek health care for bowel complaints and that Hispanics were more likely to self-medicate with folk remedies to maintain good bowel function. The perception of health and bowel function is in part determined by ethnic differences.

Attitude to Health↗
PubMed1996

Newer aspects of the irritable bowel syndrome.

IBS is a challenging, functional GI disorder that affects many individuals around the world. Early life experiences, the biologic nature of the condition, and the psychosocial milieu interact to affect the severity and outcome of symptoms. Most people do not seek medical attention for their GI symptoms, or they require intermittent, limited medical therapy and assurance from their physician. Fewer patients, but still a significant number, demand frequent interaction with their physician, who may select pharmacotherapy or psychological and behavioral treatments to control symptoms, depending on the severity. A biopsychosocial approach with attention to the patient-doctor relationship is recommended as the basis for treatment.

Colonic Diseases, Functional↗
PubMed1996

Health status by gastrointestinal diagnosis and abuse history.

BACKGROUND & AIMS: Standardized assessment of health status by diagnosis (functional vs. organic) and the relative influence of abuse history on health status have not been studied previously. The aim of this study was to estimate the health status and abuse history for gastrointestinal diagnoses among patients seen in a tertiary-care gastroenterology clinic and to evaluate the relative predictive effects of diagnosis and abuse history on health status. METHODS: Standardized measures of sexual and physical abuse history and six health status measures were estimated for the patients by diagnosis. Analysis of covariance was performed to determine the relative contributions of diagnosis type and abuse history on the health status measures. RESULTS: Patients with functional gastrointestinal diagnoses had poorer health status and a higher frequency of severe types of abuse than patients with structural diagnoses. Independent of abuse history, functional diagnosis was significantly associated with greater pain severity and psychological distress and poorer daily function. Independent of diagnosis, abuse history significantly contributed to greater pain severity, more days in bed, more psychological distress, and poorer daily function. CONCLUSIONS: The type of diagnosis and abuse history independently contributed to the health status of this population. Therefore, medical symptoms alone may not be sufficient to understand patients' health status. Attention must also be paid to contributing psychosocial factors.

Activities of Daily Living↗
PubMed1996

Gastrointestinal illness and the biopsychosocial model.

The derivation of and concepts underlying the biopsychosocial model have not been well explained. This model does not relate psychosocial processes to illness in a linear fashion (e.g., as "psychogenic" or "psychophysiologic"). Rather, the model considers the degree to which factors interact to explain an illness condition. As an example, the irritable bowel syndrome is not caused by a single etiology. Rather, it may result from dysregulation of central and enteric nervous system (CNS/ENS) function manifest as dysmotility and/or visceral sensitivity, and modified by psychosocial processes, all of which uniquely determine the experience of the illness. In this discussion, I trace the derivation of the biopsychosocial model and its application in modern gastroenterologic research and clinical practice.

Gastrointestinal Diseases↗
PubMed1996

The role of psychosocial factors in gastrointestinal illness.

Psychosocial factors have a complex relationship with gastrointestinal illness. Early life factors can contribute to illness susceptibility and condition later illness experiences and behaviors. Existing psychosocial factors, gut physiology and pathology are not associated in a linear or causative fashion, but instead interact to determine symptoms and illness behavior. Investigation of the clinical outcome of these disorders, an area of recent interest, involves both 'hard' (i.e., disability, healthcare use, costs) and 'soft' (i.e., physical and psychologic status and function, health-related Quality of Life) endpoints. In this article I present a biopsychosocial framework for understanding these integrated relationships which are supported by recent data involving both functional and structural (i.e., 'organic') gastrointestinal disorders.

Cost of Illness↗
PubMed1996

A preliminary study of patients' concerns related to GI endoscopy.

OBJECTIVES: In addition to the well known complications of bleeding and perforation, GI endoscopy also can produce discomfort, anxiety, and dissatisfaction. In this pilot study, our objective was to obtain information on the fears and concerns of patients about to undergo endoscopy and to assess the relationship of such worries to patient satisfaction and difficulty with the procedure. METHODS: At our two referral hospitals, 793 unsedated patients (45% men, 55% women, average 58 yr) were interviewed by GI nurses before the intended procedure. Information on procedure-related concerns and difficulty/satisfaction with the procedure was obtained. RESULTS: Sixty percent of our sample reported preprocedure concerns, most often: 1) finding out what is wrong (18%); 2) pain (12%); and 3) finding cancer (4%). New York patients were more concerned than North Carolina patients with finding out what was wrong (23 vs 12%) although patients at both sites were equally concerned about having pain during the procedure (12%); women (16%), younger patients (16%), and those about to have their first procedure (17%) reported more concerns about pain. Regression analysis indicated that women and persons having no or fewer procedures were more likely to report a concern. Having had previous endoscopic procedures predicted greater satisfaction with subsequent endoscopies. Finally, a high level of preprocedure concerns was associated with perceived difficulties related to the procedure. CONCLUSIONS: We believe that, by considering patient demographics, asking about previous experiences with endoscopy, and eliciting special concerns, the nurse or physician can focus patient education in a fashion that may reduce anticipatory anxiety.

Adolescent↗
PubMed1995

Sexual and physical abuse and gastrointestinal illness. Review and recommendations.

OBJECTIVES: To summarize the existing data on abuse history and gastrointestinal illness, suggest a conceptual scheme to explain these associations, suggest ways to identify patients at risk, and provide information about mental health referral. DATA SOURCES: Review of the pertinent literature by clinicians and investigators at referral centers who are involved in the care of patients with complex gastrointestinal illness and who have experience in the diagnosis and care of patients with abuse history in these settings. STUDY SELECTION: All research articles and observational data that addressed abuse history in gastroenterologic settings. Articles were identified through a MEDLINE search. DATA EXTRACTION: Independent extraction by multiple observers. DATA SYNTHESIS: On the basis of literature review and consensus, it was determined that abuse history is associated with gastrointestinal illness and psychological disturbance; appears more often among women, patients with functional gastrointestinal disorders, and patients seen in referral settings; is not usually known by the physician; and is associated with poorer adjustment to illness and adverse health outcome. Although the mechanisms for this association are unknown, psychological factors (somatization, response bias, reinforcement of abnormal illness behavior) and physiologic factors (psychophysiologic response, enhanced visceral sensitivity) probably contribute. On the basis of these data, recommendations are made on how to identify patients at risk, how to obtain this information, and, if needed, how to make appropriate referrals. CONCLUSIONS: The authors agree with existing data on the association between abuse history and gastrointestinal illness. Physicians should ask patients with severe or refractory illness about abuse history. Appropriate referral to a mental health professional may improve the clinical outcome.

Domestic Violence↗
PubMed1995

Diagnosing and treating patients with refractory functional gastrointestinal disorders.

One of the clinician's most difficult tasks is to successfully care for patients with painful and refractory functional gastrointestinal disorders. Because the diagnosis of these disorders is never assured and symptomatic treatments are not always successful, these patients are susceptible to receiving unnecessary, costly, and sometimes risky studies and treatments. This article offers an approach to the diagnosis and care of these patients that emphasizes 1) using a diagnostic strategy that incorporates symptom-based criteria, a screening evaluation, early symptomatic treatment, symptom monitoring, and reassessment; 2) asking several questions during the first visit to assess the psychosocial contributions to the illness; 3) developing an effective patient-physician relationship through empathy, reassurance, education, and a negotiated and realistic treatment plan; and 4) providing the option for psychological consultation and treatment as a way to help the patient better control symptoms. This approach is likely to improve patient and physician satisfaction, adherence to treatment, and clinical outcome.

Gastrointestinal Diseases↗
PubMed1995

Functional bowel disorders. A multicenter comparison of health status and development of illness severity index.

In a multicenter study of patients with painful functional bowel disorders (FBD), we compared the demographic, health status, and diagnostic features of patients with FBD and developed a functional bowel disorder severity index (FBDSI) for research and clinical care. Two hundred seventy patients with FBD in the United States, England, and Canada were surveyed on symptoms and health status, and their physicians made a diagnosis and rated illness severity as mild, moderate, or severe. Comparisons of 22 demographic and clinical variables were made by study site in addition to physicians' severity ratings. To develop the FBDSI, multiple regression analysis used the demographic and clinical variables to predict the physician's rating of severity. We found that most health status measures of patients with FBD across study sites are comparable and the derived and validated FBDSI scoring system uses three easy to obtain variables: FBDSI = [current pain by visual analog scale (0-100)] + [diagnosis of chronic functional abdominal pain (0 if absent and 106 if present)] + [number of physicians visits over previous six months x 11]. The FBDSI can be used to select patients for research protocols and/or follow their clinical outcome or response to treatments over time.

Abdominal Pain↗
PubMed1995

Comparison of bowel patterns in Hispanics and non-Hispanic whites.

Survey questionnaires can be used to characterize normal bowel habits and the prevalence of bowel dysfunction. To determine whether ethnic and sex-related differences in bowel patterns exist between Hispanics and non-Hispanics whites, we conducted a survey of a nonpatient population in El Paso, on the U.S.-Mexico border. A forced-choice, self-report questionnaire was distributed to 1014 subjects and returned by 1000. Data from the 905 Hispanic and non-Hispanic white subjects were compared. Stool frequency was analyzed by multiple linear regression, and bowel dysfunction variables were analyzed by stepwise logistic regression, in ethnic and sex groups. Data were also analyzed controlling for age, socioeconomic status, dietary factors, and use of laxatives. There was a significant sex difference in mean number of stools per week reported (P < 0.0001): Hispanic males greater than Hispanic females (8.6 vs 7.5) and non-Hispanic white males greater than non-Hispanic white females (9.3 vs 7.2). The frequency of irritable bowel syndrome-type symptoms was greater in females than in males (23.4% vs 9.6%, P < 0.001) and was less in Hispanics than non-Hispanic whites (16.9% vs 21.8%, P < 0.05), but a significant ethnic difference was not found after controlling for covariates. Additionally, females reported more alternating bowel pattern (44.0% vs 28.5%, P < 0.001) and constipation (25.5% vs 12.4%, P < 0.01) than males, and non-Hispanic white females more abdominal pain than the other subgroups (P < 0.05). Ethnic differences in dietary factors that may be relevant to bowel function were identified.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Pain↗
PubMed1995

The reliability and validity of a sexual and physical abuse history questionnaire in female patients with gastrointestinal disorders.

Although the literature on the psychological and medical sequelae of sexual and physical abuse has been growing, researchers have made few attempts to standardize the measurement of abuse history. The authors of this article report the first standardization of a screening instrument to identify sexual and physical abuse in a medical population. Reliability was assessed using test-retest methodology, and validity was supported by comparison with an interview (criterion validity). The sample included 139 female patients in a gastroenterology clinic. Data indicate acceptable test-retest reliability of the sexual abuse instrument (81%) and 81% overall agreement between the questionnaire and the interview on any sexual abuse. In comparison, the authors found 77% agreement in test-retest reliability of the physical abuse questionnaire and 70% agreement between the questionnaire and the interview on physical abuse. From their analyses, they concluded that the sexual abuse questionnaire and, to a lesser extent, the physical abuse instrument have acceptable levels of reliability and validity. As a screening tool, the abuse measures could be used to identify women in clinic settings for further study.

Adult↗
PubMed1995

The relationship of psychiatric illness with gastrointestinal disease.

Higher rates of psychiatric comorbidity as well as more impaired psychosocial adjustment occur with the functional bowel disorders and are particularly high in self-selected referral patients compared with community populations. Reciprocally, some studies show higher rates of functional bowel disturbances in patients with psychiatric diagnoses. Remaining alert for and addressing coexisting psychiatric illness will enhance treatment outcome (increased patient compliance, functioning, and satisfaction). Additionally, psychological factors affect the clinical expression of structural disease. Resetting treatment goals from cure to coping with chronic illness and setting personal limits are important.

Adaptation, Psychological↗
PubMed1995

Sexual and physical abuse and gastrointestinal illness.

BACKGROUND: Clinicians are becoming aware of the increased attention paid to the occurrence of sexual and physical abuse in our society and its consequences. However, only recently has attention been paid to their association with medical and particularly gastrointestinal illnesses. METHODS AND RESULTS: Recently, we investigated the frequency of sexual or physical abuse among female patients in our gastroenterology clinic, and their association with health status. Of 206 women, 89 (44%) reported some type of sexual or physical abuse in their lifetime. We also found that patients diagnosed with functional GI disorders when compared with those with organic diagnoses reported a significantly greater frequency of sexual (53% versus 37%) and physical abuse (13% versus 2%). Of these, 59% had never discussed the abuse experience outside their families, a third had never told anyone, and only 17% of their GI physicians were aware of this history. We also found that abuse history led to a poorer health outcome: more severe GI pain and a higher frequency of pelvic pain (16% versus 6%), more non-GI symptoms (7.1 versus 5.8), more physician visits in the previous six months (4.2 versus 3.3) and more lifetime operations (2.8 versus 2.0). CONCLUSIONS: In a GI referral practice, abuse history is a hidden factor that is associated with poorer adjustment to illness, greater symptom severity and higher health care use rates. Since the publication of these data, several groups have supported our findings and obtained additional new data on associating factors and possible mechanisms of symptom generation. This paper will: (i) review this epidemiologic data, (ii) propose hypotheses about their association, (iii) offer suggestions to identify this information in a sensitive and supportive manner, and (iv) discuss how to initiate referral for ancillary psychosocial care.

Adolescent↗