Effect of physicians opinion on patients' choice of treatment

Development, reliability, and validity of a new Preference and Satisfaction Questionnaire

OBJECTIVES

Existing questionnaires that assess preference and/or satisfaction with postmenopausal bone loss treatments were reviewed and determined to be inadequate for the assessment of an oral pill versus a subcutaneous injection. The Preference and Satisfaction Questionnaire (PSQ) was developed to assess preference, satisfaction, and bother with a weekly oral tablet versus a once every 6 months subcutaneous injection for treatment of postmenopausal bone loss.

METHODS

Questions were developed based on literature review and expert input. Content validity of the PSQ in this patient population was assessed among current or previous bisphosphonate users in group interviews, and item comprehension and readability were also evaluated. Reliability, validity, and structure of the questionnaire were assessed in two phase 3 randomized clinical trials.

RESULTS

Twenty-four women participated in cognitive interviews and found the PSQ understandable and acceptable. Subsequently, 1583 trial participants took the PSQ. Interitem correlations, ranging from 0.50 to 0.97 for preference items, 0.85 to 0.94 for pill-satisfaction items, and 0.84 to 0.92 for injection-satisfaction items, and a well-fitting confirmatory factor analysis (root mean square error of approximation 0.04, nonnormed fit index 0.99, and root mean square residual 0.08) supported the structure of the instrument. Cronbach's alpha reliability values for pill satisfaction, injection satisfaction, pill bother, and injection bother were 0.93, 0.89, 0.82, and 0.61, respectively. Discriminative validity was indicated with better satisfaction and bother scores being related to adherence and the absence of adverse events.

CONCLUSIONS

The PSQ is a valid and reliable measure and may be a valuable tool to assess patient preference and satisfaction with a weekly oral tablet and 6-month subcutaneous injection for postmenopausal bone loss.

The effect of the addition of osteoporosis education to a bone health screening program for older adults

Osteoporosis affects approximately 26% of women and 4% of men after the age of 65 years. However, the diffusion of knowledge about osteoporosis risk factors, prevention and treatment remains low. The purpose of this longitudinal study was to investigate the value of adding initial and refresher osteoporosis education classes to a bone health screening program. A convenience sample of 376 men (n = 62) and women (n = 314) over the age of 62 years was assigned randomly to the Screening plus Education (n =193) or Screening only (n = 183) groups. Participants in both study groups demonstrated an increase in knowledge about osteoporosis, regardless of group assignment and other factors, over the two years of the study. Self-reported calcium use increased for all women and for men in the education group from baseline to year one, with a decline thereafter. There was no effect on exercise behaviors. This study points out the critical need for a more comprehensive and personalized bone health program that includes more than classroom-based education.

Changing views on the goal of reproductive genetic counselling in Hungary

Over the last few decades, the goal of genetic counselling has been interpreted as giving value-neutral information about the genetic risk, the genetic disorder, and screening, diagnostic or treatment possibilities in order to promote the autonomous decision-making of counsellees. Recently, however, the theoretical possibility and the practical necessity of this non-directive approach have been questioned, and redefinition of the objective of genetic counselling is required. In our paper, we intend to contribute to this clarification process by critically examining the views of Hungarian genetic counsellors on the objective of genetic counselling, and by exploring the expectations of the counsellees. Our ethical analysis has revealed that counsellors supported divergent counselling goals, such as preventing diseases by giving direct recommendations, promoting the autonomous decision-making of clients by providing value-neutral information and facilitating careful deliberation by actively taking part in the resolution. The self-administered survey conducted among 170 counsellees has discovered that the majority of the respondents expected detailed information (98%), psychological support (68%), the counsellor's help in making decisions (68%), and the possibility of control over the resolution process (92%). The need to tailor help to individual clients has also been demonstrated, since a direct relationship was found between success in decision-making and whether unanswered questions remained or the calming effect of the consultation was felt. Of the methods proposed by the counsellors, the interpretive counselling approach promised fulfilment of the clients' wishes and respect for the accepted ethical norms; thus, teaching of this approach should be taken into consideration during the development of the post-graduate training curriculum for counsellors.