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Yoshimi R, Yajima N, Hidekawa C, Sakurai N, Oguro N, Shidahara K, Hayashi K, Ichikawa T, Kishida D, Miyawaki Y, Sada KE, Shimojima Y, Ishikawa Y, Yoshioka Y, Kunishita Y, Kishimoto D, Takase-Minegishi K, Kirino Y, Ohno S, Kurita N, Nakajima H. Effect of Shared Decision-Making on Trust in Physicians in the Management of Systemic Lupus Erythematosus: The Trust Measurement for Physicians and Patients With Systemic Lupus Erythematosus Prospective Cohort Study. Arthritis Care Res (Hoboken) 2024. [PMID: 39099215 DOI: 10.1002/acr.25409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 07/09/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE Few studies have explored whether the involvement of patients in shared decision-making (SDM) is beneficial to the management of systemic lupus erythematosus (SLE). Therefore, this study investigated the relationship between patient participation in SDM and their trust in physicians using data from the Trust Measurement in Physicians and Patients With SLE (TRUMP2-SLE) study. METHODS Data regarding the nine-item Japanese version of the Shared Decision-Making Questionnaire (SDM-Q-9) scores, Trust in Physician Scale (TIPS) scores, and Abbreviated Wake Forest Physician Trust Scale (A-WFPTS) scores for interpersonal trust in a physician and trust in the medical profession were collected from patients with SLE who visited the outpatient clinics of five facilities in Japan through a self-administered questionnaire. The relationships among these scores were analyzed by general linear models with cluster-robust variance. RESULTS This study included 433 patients with SLE. The median baseline TIPS and A-WFPTS (attending physician version) scores were 82 (73-93) and 80 (70-95), respectively. A higher baseline SDM-Q-9 score was correlated with an increase in the TIPS score at one year (coefficient per 10-point [pt] increase, 0.94 pts, 95% confidence interval [CI] 0.16-1.72). A higher baseline SDM-Q-9 score was correlated with a higher A-WFPTS score for interpersonal trust (coefficient per 10-pt increase, 2.20 pts, 95% CI 1.44-2.96). The baseline SDM-Q-9 score was also correlated with an increase in the general physician version of the A-WFPTS score at one year (coefficient per 10-pt increase, 1.29 pts, 95% CI 0.41-2.18). CONCLUSION Engagement of patients with SLE in SDM elevates their trust in the attending physicians and health care providers, potentially enhancing doctor-patient relationships and overall health care trust.
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Affiliation(s)
- Ryusuke Yoshimi
- Yokohama City University Graduate School of Medicine and Yokohama City University Hospital, Yokohama, Japan
| | - Nobuyuki Yajima
- Showa University School of Medicine, Tokyo, Kyoto University, Kyoto, and Fukushima Medical University, Fukushima, Japan
| | - Chiharu Hidekawa
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Natsuki Sakurai
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nao Oguro
- Showa University School of Medicine, Tokyo, Japan
| | - Kenta Shidahara
- Okayama University Graduate School of Medicine, Okayama, Japan
| | - Keigo Hayashi
- Okayama University Graduate School of Medicine, Okayama, Japan
| | | | - Dai Kishida
- Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshia Miyawaki
- Okayama University Graduate School of Medicine, Okayama, Japan
| | - Ken-Ei Sada
- Okayama University Graduate School of Medicine, Okayama, and Kochi University, Nankoku, Japan
| | | | - Yuichi Ishikawa
- University of Occupational and Environmental Health Japan, Kitakyushu, and Kanagawa University of Human Services, Kawasaki, Japan
| | - Yuji Yoshioka
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yosuke Kunishita
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | | | - Yohei Kirino
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shigeru Ohno
- Yokohama City University Medical Center, Yokohama, Japan
| | - Noriaki Kurita
- Showa University School of Medicine, Tokyo and Fukushima Medical University, Fukushima, and Fukushima Medical University Hospital, Fukushima, Japan
| | - Hideaki Nakajima
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Spies E, Andreu T, Hartung M, Park J, Kamudoni P. Exploring the Perspectives of Patients Living With Lupus: Retrospective Social Listening Study. JMIR Form Res 2024; 8:e52768. [PMID: 38306157 PMCID: PMC10873798 DOI: 10.2196/52768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease affecting various organs with a wide range of clinical manifestations. Cutaneous lupus erythematosus (CLE) can manifest as a feature of SLE or an independent skin ailment. Health-related quality of life (HRQoL) is frequently compromised in individuals living with lupus. Understanding patients' perspectives when living with a disease is crucial for effectively meeting their unmet needs. Social listening is a promising new method that can provide insights into the experiences of patients living with their disease (lupus) and leverage these insights to inform drug development strategies for addressing their unmet needs. OBJECTIVE The objective of this study is to explore the experience of patients living with SLE and CLE, including their disease and treatment experiences, HRQoL, and unmet needs, as discussed in web-based social media platforms such as blogs and forums. METHODS A retrospective exploratory social listening study was conducted across 13 publicly available English-language social media platforms from October 2019 to January 2022. Data were processed using natural language processing and knowledge graph tagging technology to clean, format, anonymize, and annotate them algorithmically before feeding them to Pharos, a Semalytix proprietary data visualization and analysis platform, for further analysis. Pharos was used to generate descriptive data statistics, providing insights into the magnitude of individual patient experience variables, their differences in the magnitude of variables, and the associations between algorithmically tagged variables. RESULTS A total of 45,554 posts from 3834 individuals who were algorithmically identified as patients with lupus were included in this study. Among them, 1925 (authoring 5636 posts) and 106 (authoring 243 posts) patients were identified as having SLE and CLE, respectively. Patients frequently mentioned various symptoms in relation to SLE and CLE including pain, fatigue, and rashes; pain and fatigue were identified as the main drivers of HRQoL impairment. The most affected aspects of HRQoL included "mobility," "cognitive capabilities," "recreation and leisure," and "sleep and rest." Existing pharmacological interventions poorly managed the most burdensome symptoms of lupus. Conversely, nonpharmacological treatments, such as exercise and meditation, were frequently associated with HRQoL improvement. CONCLUSIONS Patients with lupus reported a complex interplay of symptoms and HRQoL aspects that negatively influenced one another. This study demonstrates that social listening is an effective method to gather insights into patients' experiences, preferences, and unmet needs, which can be considered during the drug development process to develop effective therapies and improve disease management.
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Affiliation(s)
| | | | | | | | - Paul Kamudoni
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
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Oguro N, Yajima N, Ishikawa Y, Sakurai N, Hidekawa C, Ichikawa T, Kishida D, Hayashi K, Shidahara K, Miyawaki Y, Yoshimi R, Sada KE, Shimojima Y, Kurita N. Effect of Attending Rheumatologists' Big 5 Personality Traits on Patient Trust in Patients With Systemic Lupus Erythematosus: The TRUMP2-SLE Project. J Rheumatol 2024; 51:168-175. [PMID: 37914212 DOI: 10.3899/jrheum.2023-0603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Differences in communication styles based on physicians' personality traits have been identified, particularly in primary care, and these physician-related factors can be important in building patient-physician trust. This study examined the effects of rheumatologists' personality traits on patients' trust in their attending rheumatologists. METHODS This cross-sectional study included adult Japanese patients with systemic lupus erythematosus (SLE) at 5 academic medical centers between June 2020 and August 2021. The exposures were the Big 5 personality traits (ie, extraversion, agreeableness, openness, conscientiousness, and emotional stability) of attending rheumatologists using the Japanese version of the 10-Item Personality Inventory scale (1-7 points each). The outcome was the patients' trust in their attending rheumatologist using the Japanese version of the 5-item Wake Forest Physician Trust Scale (0-100 points). A general linear model was fitted. RESULTS The study included 505 patients with a mean age of 46.8 years; 88.1% were women. Forty-three attending rheumatologists (mean age: 39.6 years; 23.3% female) were identified. After multivariable adjustment, higher extraversion and agreeableness were associated with higher trust (per 1-point increase, 3.76 points [95% CI 1.07-6.45] and 4.49 points [95% CI 1.74-7.24], respectively), and higher conscientiousness was associated with lower trust (per 1-point increase, -2.17 points [95% CI -3.31 to -1.03]). CONCLUSION Whereas higher extraversion and agreeableness of attending rheumatologists led to higher patient trust in their rheumatologist, overly high conscientiousness may lead to lower trust resulting from the physicians' demand of responsibility and adherence to instructions from patients with SLE.
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Affiliation(s)
- Nao Oguro
- N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, and Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto
| | - Nobuyuki Yajima
- N. Yajima, MD, PhD, MPH, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima
| | - Yuichi Ishikawa
- Y. Ishikawa, MD, The First Department of Internal Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, and Graduate School of Health Innovation, Kanagawa University of Human Services, Yokosuka
| | - Natsuki Sakurai
- N. Sakurai, MD, C. Hidekawa, MD, R. Yoshimi, MD, PhD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama
| | - Chiharu Hidekawa
- N. Sakurai, MD, C. Hidekawa, MD, R. Yoshimi, MD, PhD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama
| | - Takanori Ichikawa
- T. Ichikawa, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, and Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto
| | - Dai Kishida
- D. Kishida, MD, PhD, Y. Shimojima, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto
| | - Keigo Hayashi
- K. Hayashi, MD, PhD, K. Shidahara, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Kenta Shidahara
- K. Hayashi, MD, PhD, K. Shidahara, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Yoshia Miyawaki
- Y. Miyawaki, MD, PhD, MPH, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, and Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama
| | - Ryusuke Yoshimi
- N. Sakurai, MD, C. Hidekawa, MD, R. Yoshimi, MD, PhD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama
| | - Ken-Ei Sada
- K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku
| | - Yasuhiro Shimojima
- D. Kishida, MD, PhD, Y. Shimojima, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto
| | - Noriaki Kurita
- N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan.
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Barraclough M, Howe A, Soberanis A, Kakvan M, Chattu V, Bani‐Fatemi A, Engel L, Vitti M, Nalder E, Goverover Y, Gignac M, Bonilla D, Nielsen W, Anderson N, Tartaglia C, Nowrouzi‐Kia B, Touma Z. The Effects of Systemic Lupus-Related Cognitive Impairments on Activities of Daily Living and Life Role Participation: A Qualitative Framework Study. ACR Open Rheumatol 2024; 6:21-30. [PMID: 37964675 PMCID: PMC10789303 DOI: 10.1002/acr2.11624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/30/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE Cognitive impairment (CI) in systemic lupus erythematosus (SLE) negatively impacts health-related quality of life leading to activity limitations. This qualitative study aimed to (1) explore the effect of SLE-related CI on activities of daily living and life role participation and (2) describe factors influencing activity restriction and life role participation. METHODS Semistructured, in-depth interviews of lived experience of CI in SLE were conducted with 24 participants with SLE. Sociodemographic and clinical data, and objective and subjective cognitive function, were collected to characterize participants. A qualitative thematic content analysis was undertaken guided by a framework analytical approach. RESULTS Participants reported problems in multiple cognitive domains, with multiple perceived causes. CI was felt to impact work, social, domestic, and family life, health, and independence. Five overarching themes were represented in the data: (1) characterization of SLE-reported CI, (2) perceived cause of CI, (3) perceived impact of CI on activities of daily living and life role participation, (4) adaptations for managing CI, and (5) influence of CI adaptations on activities of daily living and life role participation. CONCLUSION This study provides a better understanding of the patient experience of CI in SLE, how it impacts their lives, and what coping strategies they employ. It highlights the long-term challenges those with CI in SLE undergo and provides evidence for the urgent need to implement multidisciplinary treatment options. When managing CI, it may be beneficial to evaluate and understand available psychosocial support resources to help identify and reinforce relevant adaptations to improve health-related quality of life.
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Affiliation(s)
- Michelle Barraclough
- University Health Network, Toronto, Ontario, Canada, and The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, and Manchester Academic Health Science CentreManchesterUK
| | - Aaron Howe
- University of TorontoTorontoOntarioCanada
| | | | - Mahta Kakvan
- University Health Network, and University of Toronto Lupus Clinic, Toronto Western HospitalTorontoOntarioCanada
| | | | | | - Lisa Engel
- University of Manitoba, Winnipeg, Manitoba, and Institute for Work and HealthTorontoOntarioCanada
| | - Michelle Vitti
- University Health Network, and University of Toronto Lupus Clinic, Toronto Western HospitalTorontoOntarioCanada
| | | | | | - Monique Gignac
- University Health Network, University of Toronto, and Institute for Work and HealthTorontoOntarioCanada
| | - Dennisse Bonilla
- University Health Network, and University of Toronto Lupus Clinic, Toronto Western HospitalTorontoOntarioCanada
| | - Wils Nielsen
- University of Toronto Lupus Clinic and Western HospitalTorontoOntarioCanada
| | - Nicole Anderson
- University Health Network, and University of Toronto Lupus Clinic, Toronto Western HospitalTorontoOntarioCanada
| | | | | | - Zahi Touma
- University Health Network, and University of Toronto Lupus Clinic, Toronto Western HospitalTorontoOntarioCanada
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Cardwell FS, Elliott SJ, Barber MRW, Cheema K, George S, Boucher A, Clarke AE. Canadian patient experiences of lupus nephritis: a qualitative analysis. Lupus Sci Med 2023; 10:e000982. [PMID: 38087643 PMCID: PMC10729228 DOI: 10.1136/lupus-2023-000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE Lupus nephritis (LN) is one of the most severe manifestations of SLE; however, we know little about the lived experience of LN. This research investigates patient experiences and perspectives of (1) LN diagnosis; (2) living with LN; and (3) LN healthcare and treatment. METHODS Patients aged ≥18 years with biopsy-proven pure or mixed International Society of Nephrology/Renal Pathology Society class III, IV or V LN were purposefully recruited from a Canadian lupus cohort to participate in semistructured in-depth interviews. RESULTS Thirty patients with LN completed the interviews. The mean (SD) age was 42.1 (16.4) years, and 86.7% were female. Participants described challenges seeking, receiving and adjusting to a LN diagnosis, and some reported that their diagnosis process took weeks to years. While 16 participants were provided resources by healthcare providers to help them through the process of diagnosis, the need for accessible LN-specific information at diagnosis was highlighted (n=18). Participants also described the unpredictability of living with LN, particularly related to impacts on physical and mental health, relationships, leisure activities, employment and education, and family planning. While most (n=26) participants reported a positive impression of their care, the side effects of LN medications and the need to increase patient and societal awareness/understanding of LN were highlighted in the context of healthcare and treatment. CONCLUSIONS The unpredictability of living with LN, the heavy treatment burden and a lack of patient/societal awareness substantially affect the lived experience of LN. These findings will inform the development of LN-specific patient resources to increase understanding of LN and improve well-being for patients.
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Affiliation(s)
- Francesca S Cardwell
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan J Elliott
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario, Canada
| | - Megan R W Barber
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kim Cheema
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sydney George
- Health Outcomes and Economics, GSK, Mississauga, Ontario, Canada
| | - Adrian Boucher
- Health Outcomes and Economics, GSK, Mississauga, Ontario, Canada
| | - Ann Elaine Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Mazhariazad F, Dianati M, Taghadosi M, Zamani B. Uncertainty and its related coping strategies in systemic lupus erythematosus. Life in the fog. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:233. [PMID: 37727415 PMCID: PMC10506748 DOI: 10.4103/jehp.jehp_1080_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/09/2022] [Indexed: 09/21/2023]
Abstract
BACKGROUND One of the most prevalent problems of patients with systemic lupus erythematosus (SLE) is the uncertainty over an indefinite future. Uncertainty has significant effects on quality of life. The aim of this study was to explore uncertainty and personal strategies to cope with it among patients with SLE. MATERIALS AND METHODS This qualitative study was conducted in 2020-2021 using conventional content analysis. Participants were 21 patients with SLE who were purposefully selected from rheumatology clinics in Kashan, Kerman, and Bandar Abbass in Iran. Data collection was performed using face-to-face, in-depth, semi-structured interviews and was continued up to data saturation. Data were analyzed concurrently with data collection through conventional content analysis approach proposed by Graneheim and Lundman. RESULTS Two main themes, namely, "life in the fog" and "attempt to find peace" emerged from patients' experiences of illness uncertainty of SLE. Life in the fog included three main categories of "perception of threat to health", "challenge of doubt and certainty," and "indefinite future." Attempt to find peace included three main categories of "spirituality," "reflection," and "attempt to acquire SLE-related knowledge. CONCLUSIONS Uncertainty is a major psychological stress for patients with SLE. Healthcare providers should therefore consider the challenges and concerns faced by patients and, through utilizing appropriate training and communicational practices, plan interventions and strategies to empower patients for coping with uncertainty.
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Affiliation(s)
- Fereshteh Mazhariazad
- Department of Medical-Surgical Nursing, Kashan University of Medical Sciences, Kashan, Iran
| | - Mansour Dianati
- Department of Medical-Surgical Nursing, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohsen Taghadosi
- Department of Medical-Surgical Nursing, Kashan University of Medical Sciences, Kashan, Iran
| | - Batool Zamani
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
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Blamires J, Foster M, Napier S, Dickinson A. Experiences and Perspectives of Children and Young People Living with Childhood-Onset Systemic Lupus Erythematosus-An Integrative Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1006. [PMID: 37371240 PMCID: PMC10297543 DOI: 10.3390/children10061006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
Childhood-onset systemic lupus erythematosus (cSLE) impacts the daily life of children and young people. This study aimed to describe the experiences and perspectives of children and young people living with cSLE. An integrative review guided by Whittemore and Knafl was conducted. Extant empirical research published in peer-reviewed journals from 2000 to 2021 on children's self-reported experiences living with cSLE was identified from Scopus, CINAHL, Medline via PubMed, and PsycINFO via Ovid databases. Nineteen studies involving over 1400 participants were included. Four themes and fourteen sub-themes were identified: (1) challenging symptoms (disruptions to life and altered self, severity, fatigue, depression, and anxiety), (2) medicines and side effects (dreaded steroids, conflicting feelings, and medication adherence), (3) complicated life (school sports and social, giving things up, lack of understanding, and quality of life) and (4) ways of coping (family and friends, relationships with health providers, and maintaining positivity). While cSLE shares many similarities with adult-onset SLE, awareness of differences in experiences and perceptions of children and young people is crucial. The significant psychological and social impact of the disease and its treatments necessitates a comprehensive, holistic approach to managing cSLE that considers the unique needs of youth.
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Affiliation(s)
- Julie Blamires
- School of Clinical Sciences, Auckland University of Technology, Auckland 0627, New Zealand; (M.F.)
| | - Mandie Foster
- School of Clinical Sciences, Auckland University of Technology, Auckland 0627, New Zealand; (M.F.)
- School of Nursing and Midwifery, Edith Cowan University, Perth 6027, Australia
| | - Sara Napier
- School of Clinical Sciences, Auckland University of Technology, Auckland 0627, New Zealand; (M.F.)
| | - Annette Dickinson
- School of Clinical Sciences, Auckland University of Technology, Auckland 0627, New Zealand; (M.F.)
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Jolly M, Katz P. Predictors of stress in patients with Lupus. Front Med (Lausanne) 2022; 9:986968. [PMID: 36250087 PMCID: PMC9556948 DOI: 10.3389/fmed.2022.986968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background Stress is common in patients with Systemic Lupus Erythematosus (SLE), and is associated with depression, fatigue, and disease flares. Stress may be modifiable and identifying those at high risk allows clinicians and allied health care professionals to develop a multidisciplinary management plan to direct appropriate resources. This study is aimed at identifying predictors of high stress over time among patients with SLE. Methods Longitudinal data from two interviews of the Lupus Outcomes Study 2 years apart from 726 patients with SLE were analyzed for stress, measured using the Perceived Stress Scale (PSS; high-stress PSS ≥6). T-test and Chi-square analyses compared patient characteristics by high-stress status. Logistic regressions were conducted with high stress as the dependent variable. Covariates included demographics, disease features, quality of life (QOL), health care utilization (HCU), and comorbidities. QoL was measured using the SF-36 form (Physical Component Score, PCS; Mental Component Score, MCS) and MOS Cognitive Functioning Scale (CFS). HCU indicated having established care with a rheumatologist, use of an emergency room or hospitalization, and quality of care. P ≤ 0.05 were considered significant. Results The mean age of the cohort was 50.6 (12.5) years, 92% were women and 68% were Caucasian. The mean (SD) PSS was 5.3 (3.6), and high stress (PSS >6) was noted in 253 participants. Those with high stress were more frequently below the poverty line and less commonly employed. They had a greater prevalence of comorbidities and HCU; and worse disease severity (activity, flare, damage) and QOL. In regression analyses, high stress (baseline) was associated with younger age, married status, worse QOL, and presence of diabetes. Better QOL (PCS, MCS) independently predicted decreased odds of high stress, while high stress (baseline) predicted high stress (OR 3.16, 95% CI 1.85, 5.37, p < 0.0001) at follow-up, after adjusting for demographics, disease features, HCU, and comorbidities. Conclusion Patients with SLE should be routinely screened for QOL and stress during their clinical care, to identify those at risk for poor health outcomes. This information can facilitate multidisciplinary management for those at risk for worse health outcomes.
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Affiliation(s)
- Meenakshi Jolly
- Department of Medicine, Rush University Medical Center, Chicago, IL, United States
- *Correspondence: Meenakshi Jolly
| | - Patricia Katz
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Cornet A, Mazzoni D, Edwards A, Monzani D, Pravettoni G, Andersen J, Mosca M. Coping with systemic lupus erythematosus in patients' words. Lupus Sci Med 2022; 9:9/1/e000656. [PMID: 35568437 PMCID: PMC9109093 DOI: 10.1136/lupus-2022-000656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Previous research on coping strategies of patients with SLE showed that there are no absolute adaptive or maladaptive strategies and that the range of potential coping strategies is large and heterogeneous. In this paper, we aimed to identify, in a large sample of patients with SLE (N=3222), the most frequent words used by patients to describe their coping strategies, to group them into significant themes and to test their possible association with specific patient characteristics. METHODS Our analyses were based on the data set of the European survey 'Living with Lupus in 2020' (N=3222). Through the T-LAB software, we analysed the answers that adult participants gave to an open-ended question about how they cope with the disease. We identified the most frequent words, and with hierarchical cluster analysis we grouped them into semantic clusters (ie, themes) that were characterised by specific patterns of words. Finally, we tested the possible association between clusters and illustrative variables (sociodemographics, disease characteristics, quality of life). RESULTS Five coping strategies were identified, each of them constituting an important percentage of the total word occurrences: positive attitude (22.58%), social support (25.46%), medical treatments (10.77%), healthy habits (20.74%) and avoid stress (20.45%). Each strategy was statistically associated with specific patient characteristics, such as age and organ involvement. CONCLUSIONS Learning to adapt to a lifetime of having SLE may require replacing old coping strategies with more effective ones. Investigating patients' coping strategies in relation to different patient characteristics represents a useful starting point for developing more targeted and efficacious interventions.
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Affiliation(s)
| | - Davide Mazzoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | | | - Dario Monzani
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Marta Mosca
- Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy
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Emamikia S, Gentline C, Enman Y, Parodis I. How Can We Enhance Adherence to Medications in Patients with Systemic Lupus Erythematosus? Results from a Qualitative Study. J Clin Med 2022; 11:jcm11071857. [PMID: 35407466 PMCID: PMC8999748 DOI: 10.3390/jcm11071857] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 12/12/2022] Open
Abstract
Medication non-adherence is common among patients with systemic lupus erythematosus (SLE) and may lead to poor clinical outcomes. Our aim was to identify influenceable contributors to medication non-adherence and suggest interventions that could increase adherence. Patients with SLE from two Swedish tertiary referral centres (n = 205) participated in a survey assessing self-reported adherence to medications. Responses were used to select patients for qualitative interviews (n = 15). Verbatim interview transcripts were analysed by two researchers using content analysis methodology. The median age of the interviewees was 32 years, 87% were women, and their median SLE duration was nine years. Reasons for non-adherence were complex and multifaceted; we categorised them thematically into (i) patient-related (e.g., unintentional non-adherence due to forgetfulness or intentional non-adherence due to disbelief in medications); (ii) healthcare-related (e.g., untrustworthy relationship with the treating physician, authority fear, and poor information about the prescribed medications or the disease); (iii) medication-related (e.g., fear of side-effects); and (iv) disease-related reasons (e.g., lacking acceptance of a chronic illness or perceived disease quiescence). Interventions identified that healthcare could implement to improve patient adherence to medications included (i) increased communication between healthcare professionals and patients; (ii) patient education; (iii) accessible healthcare, preferably with the same personnel; (iv) well-coordinated transition from paediatric to adult care; (v) regularity in addressing adherence to medications; (vi) psychological support; and (vii) involvement of family members or people who are close to the patient.
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Affiliation(s)
- Sharzad Emamikia
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, 17176 Stockholm, Sweden; (C.G.); (Y.E.)
- Correspondence: (S.E.); (I.P.)
| | - Cidem Gentline
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, 17176 Stockholm, Sweden; (C.G.); (Y.E.)
| | - Yvonne Enman
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, 17176 Stockholm, Sweden; (C.G.); (Y.E.)
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, 17176 Stockholm, Sweden; (C.G.); (Y.E.)
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
- Correspondence: (S.E.); (I.P.)
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