Su1442 Patient Related Factors (Patient Activation and Health Locus of Control) in Patients With Refractory Symptoms of Gastroparesis

Abstract

Treatment of gastroparesis (GP) often requires long-term adherence to dietary modifications and medications. Patient beliefs on internal (self) and external (others) control of their health and patient empowerment (self activation) have been shown in other chronic diseases to impact disease presentation and outcome. AIMS: 1) Compare health locus of control and patient activation in patients with diabetic (DG) and idiopathic (IG) gastroparesis; and 2) Compare health locus of control and patient activation measure in patients with delayed gastric emptying to patients with similar symptoms but normal gastric emptying.METHODS: This prospective study evaluated patients from June 2014 to October 2014 referred for refractory symptoms of gastroparesis. Patients completed Patient Assessment of Upper GI Symptoms (PAGI-SYM), Multidimensional Health Locus of Control (MHLOC), and Patient Activation Measure (PAM-13). MHLOC measures three localizations of health control: internality (belief that health status depends only on personal decision and behaviors); chance externality (belief that health status is determined by chance, fate or luck), and externality (conviction that health depends on powerful people such as doctors, family members or close friends). RESULTS: 40 patients with refractory gastroparesis symptoms were evaluated. Of the 31 patients with delayed GES, 8 were diabetic and 19 idiopathic. Patient activation scores were similar between normal GES vs delayed GES (61.1±14.9 [SD] vs 57.9±12.1) and DG vs IG (58.6±12.7 vs 58.4±12) (Table 1). These activation scores translate to patient's beginning to take action to self-manage their own disease (Level 3). Abdominal pain was negatively correlated to PAM scores in patients with delayed gastric emptying (r=-0.30; p=0.09). When evaluating localization of health control, externality was higher in patients with delayed GES compared to normal emptying (3.4±0.9 vs 2.9±0.7; p=0.16) and DG compared to IG (3.9±0.9 vs 3.2±0.9; p= 0.11) (Table 2). The other localizations such as internality and chance externality were similar when comparing patients with normal GES to delayed GES and DG to IG. DISCUSSION: This study investigates the role of internal and external control and patient activation in patients with gastroparesis. Our study suggests higher abdominal pain severity scores were related to lower activation levels. Furthermore, patients with delayed gastric emptying tend to have higher scores for externality compared to patients with normal gastric emptying. Within the subset of GP, patients with DG had higher scores for externality. These results suggest a reliance of patients with gastroparesis, especially diabetic patients and those with abdominal pain, on others (including physicians), rather than themselves. Table 1. Patient Activation Measure in patients with normal GES vs delayed GES and diabetic GP vs idiopathic GP