Biopsychosocial Dimensions Research Articles

The Patient Centered Assessment Method (PCAM): integrating the social dimensions of health into primary care.

BackgroundSocial dimensions of health are known to contribute to what is often termed “patient complexity,” which is particularly common among patients with multimorbidity. Health-care professionals require tools to help them identify and manage these aspects of patient needs.ObjectivesTo examine: (i) the Patient Centered Assessment Method (PCAM), a tool for assessing patient complexity in ways that are sensitive to the biopsychosocial dimensions of health, in primary care settings in Scotland; (ii) the impact of the PCAM on referral patterns and its perceived value; and (iii) the PCAM’s perceived applicability for use in a complex patient population.DesignTwo studies are described: (i) a mixed-methods prospective cohort study of the implementation of the PCAM in primary care clinics; and (ii) a qualitative exploratory study that evaluated the value of the PCAM in a complex patient population.ResultsUse of the PCAM did not impact patient satisfaction or perception of practitioners’ empathy, but it did increase both the number of onward referrals per referred patient (9–12%) and the proportion of referrals to non-medical services addressing psychological, social, and lifestyle needs. Nurses valued the PCAM, particularly its ability to help them address psychological and social domains of patients’ lives, and found it to be highly relevant for use in populations with known high complexity.ConclusionsThe PCAM represents a feasible approach for assessing patient needs with consideration to the social dimensions of health, and allows practitioners to refer patients to a broader range of services to address patient complexity.

The Psychiatric Interview: Evaluation and Diagnosis

The Psychiatric Interview: Evaluation and Diagnosis

Quality of life after percutaneous coronary intervention: part 1

Quality of life (QOL) is a complex concept comprised of biopsychosocial, spiritual and environmental dimensions. However, the majority of research addresses only its physical function perspectives. This two-part series examines the holistic perspective of QOL of patients after percutaneous coronary intervention (PCI). Part1 explains the research process of a cross-sectional descriptive study and its limitations. Data were collected by a mailed WHOQOL-BREF questionnaire in Maltese from a systematic sample of patients who had undergone PCI; the response rate was 64% (n=228; males n=169, females n=59, age 40-89 years). Part 1 also considers limitations, such as its cross-sectional design and retrospective data collection. The hierarchy of human needs theory (Maslow, 1999) guided the study. Part 2 gives the findings on the holistic view of QOL. Having social and family support, as a characteristic of Maltese culture appeared to contribute towards a better QOL.

Prospektive Untersuchung zu den Auswirkungen aortokoronarer Bypassoperationen auf die gesundheitsbezogene Lebensqualität, kognitive Performanz und emotionale Befindlichkeit im 6-Monats-Verlauf

The success of routine coronary artery bypass graft surgery (CABG) is now no longer judged solely by its effects on traditional end points such as mortality rates but by its influence on biopsychosocial dimensions. The aim of this study was to assess the course of health-related quality of life, cognitive and emotional change during the six months after elective CABG, and to investigate how cognitive impairments, depression and posttraumatic stress symptoms were related to quality of life. In a prospective study, we followed up for 6 months 138 of the original 147 patients who had undergone elective CABG surgery. Preoperatively, and at 6 months after surgery, a series of psychometric observer-rating and self-rating scales were administered to evaluate cognitive functioning (SKT), depressive symptoms (BDI), posttraumatic stress symptoms (PTSS-10), and health-related quality of life (SF-36 Health Status Questionnaire). The measurements of health-related quality of life (HRQOL) indicated significantly higher SF-36 values on all of the eight health-related domains from preoperative to 6-month follow-up assessments. However, at 6-month follow-up, patients with clinical depression had significantly lower SF-36 values on all of the eight health-related domains when compared with patients without depression. Also, at 6-month follow-up, patients with posttraumatic stress disorder (PTSD) had significantly lower SF-36 values on six of the eight SF-36 health categories when compared with patients without PTSD. Finally, at 6-month follow-up, patients with cognitive deficits had significantly lower SF-36 values on physical functioning when compared with patients without cognitive impairments. We underscore the need for early and comprehensive bio-psycho-social diagnosis and therapy of post-CABG patients in order to treat emotional distress and CABG-related cognitive impairments and enhance patients' quality of life at an early stage after cardiac surgery.

Aspectos das fortalezas e fragilidades no uso das metodologias ativas de aprendizagem

A implementação de novos modelos de ensino-aprendizagem vem ocorrendo na Faculdade de Medicina de Marília (Famema) há mais de uma década. O presente estudo analisa as fortalezas e fragilidades dos métodos ativos de aprendizagem na ótica dos estudantes. Para a coleta de dados, realizaram-se entrevistas com estudantes dos cursos de Enfermagem e Medicina. Os dados foram interpretados por meio dos parâmetros da hermenêutica dialética. Os sentidos extraídos das falas dos estudantes indicam que as metodologias ativas estimulam o estudo constante, a independência e a responsabilidade, possibilitam a integração das dimensões biopsicossociais, preparam para o trabalho em equipe e aproximam os alunos dos usuários e da equipe. No entanto, nem todos estão preparados para isso; algumas vezes, sentem-se perdidos em busca de conhecimentos, além de apresentarem dificuldades quanto a sua inserção na equipe de saúde. A construção de novos modelos de aprendizagem requer constante empenho, visando ao seu aperfeiçoamento.

Interprofessional education: the interface of nursing and social work

To examine the influence of interdisciplinary seminars on undergraduate nursing and social work students' perceptions of their learning. Collaboration is considered to be important for health professionals in working towards good patient care, and interdisciplinary education is seen as one way of addressing this need for greater collaboration and team work. Today's health professionals are dealing with an increasing number of older and chronically ill patients. The biopsychosocial dimensions inherent in such chronic illnesses bring about a closer working relationship between the nursing and social work professions to foster good patient care. No local research in Hong Kong, however, has looked specifically at how these two professions can develop their collaborative skills and qualities through interdisciplinary education. Mixed methods design. Data from questionnaires, videotape recordings of the sessions and follow-up phone interviews were used for quantitative and qualitative analyses. The findings revealed three themes: an increased awareness of each other's professional values and personal judgement, a recognition of each other's disciplinary knowledge emphases and more, and an appreciation for, and learning about each other's roles for future collaboration. Whilst, it is usual to identify health professionals as non-judgemental, it is also important to recognise the existence of their personal and professional values and beliefs that shape their decision-making. Equally beneficial for students is their reported understanding of the other discipline's emphasis on the physical or social aspects of care, and the interrelationships and complementary values that lead to students' appreciation of each other's roles and the possibility for their future collaboration in the holistic care of patients. The sharing of each other's knowledge and their appreciation of the corresponding roles enhanced students' decision-making capacity and the extension of the holistic approach beyond one profession, which is essential for good patient care.

Geriatric bio-psychosocial dimensions through case presentations

Geriatric bio-psychosocial dimensions through case presentations

Preconception Care & PREGNANCY PLANNING

This study aimed to investigate the intersection of women's pregnancy planning beliefs with preconception care barriers. We assessed the meaning of "planned pregnancy" for African American women and explored its connection to preconception experiences. The role of race and economics as contextualizing women's experiences was considered. African American women (n = 168) recruited from health department sites discussed the following questions: "What does the term 'planned pregnancy' mean?" "Would you describe your most recent pregnancy as planned?" Substantive themes were extracted using phenomenological methodology. The following themes emerged: (1) Preconception care: An unfamiliar concept; (2) Planning for pregnancy: A continuum of responses; (3) The psychology of conception: Attitudes, beliefs, and behaviors; (4) The shared nature of pregnancy: It takes two to plan; (5) Birth control: The means to the end; and (6) The context of preconception care: The big picture. Nurses who care for women in the childbearing years should understand that planning for pregnancy is not a simple cognitive process, and that race and economics play a role in women's beliefs about pregnancy. Preconception care also encompasses the contexts of family, public health, and society. Linking preconception care with all medical encounters is an important but insufficient approach. Nurses should apply their understanding of the biopsychosocial dimensions of health in support of the goals of preconception healthcare. Holistic nursing and public health perspectives should be considered to broaden the scope of preconception interventions and more effectively address social factors that influence preconception care.

Spirituality and the Care of Patients at the End-of-Life: An Essential Component of Care

Spirituality is an essential component of the care of patients with serious illness and those that are dying. Dame Cicely Saunders developed the hospice movement based on the biopsychosocialspiritual model of care, in which all four dimensions are important in the care of patients. Of all the models of care, hospice and palliative care recognize the importance of spiritual issues in the care of patients and their families. The National Consensus Project Guidelines for Quality Palliative Care, in the United States, provides specific recommendations about all domains of care including the spiritual domain, which is recognized as a critical component of care (The National Consensus Project for Quality Palliative Care www.nationalconsensusproject.org). Studies indicate that the majority of patients would like their spiritual issues addressed, yet find that their spiritual needs are not being met by the current system of care. Interestingly, spirituality is the one dimension that seems to get slightly less emphasis than the biopsychosocial dimensions of care. Some reasons may include the difficulty with definitions of spirituality for clinical and research purposes, the time constraints and financial burdens in the current healthcare system in the United States, and the lack of uniform training for all healthcare professionals. Yet, there are theoretical and ethical frameworks that support spiritual care as well as some educational models in spirituality and health that have been successful in medical education in the United States. Spirituality can be seen as the essential part of the humanity of all people. It is at its root, relational and thus forms the basis of the altruistic care healthcare professionals are committed to. Spirituality has to do with respecting the inherent value and dignity of all persons, regardless of their health status. It is the part of humans that seeks healing, particularly in the midst of suffering. Spiritual care models are based on an intrinsic aspect that calls for compassionate presence to patients as well as an extrinsic component where healthcare professionals address spiritual issues with patients and their loved ones. Currently in the healthcare system, evidence-base models are the criteria for practice recommendations. Yet, spirituality may not be amenable entirely to strict evidence-base criteria. As hospice and palliative care continues to develop as a field, healthcare professionals are challenged to think of ways to advocate for and include the spiritual dimension of care.

A Multidimensional Model for Understanding Cancer Pain

The experience of pain pervades the physical and psychosocial domains of a patient's existence. It has a concrete underpinning in the form of an injury or disease process, yet subjective responses to pain sensations are psychosocial processes that influence the experience of pain and the capacity to cope with it. Anticipation of pain is one of the key fears associated with cancer, and uncontrolled pain strips away morale and quality of life. The interacting biopsychosocial dimensions are important areas for consideration in the comprehensive, skillful approach to assessment and treatment of cancer pain. This article addresses the interactive relationships between pain and mood using the biopsychosocial model as a heuristic for assessment.

Evolving concepts in functional gastrointestinal disorders: promising directions for novel pharmaceutical treatments

In recent years there has been an increasing appreciation of the complexity of functional gastrointestinal disorders. These represent a spectrum of conditions which may affect any part of the gastrointestinal tract in which there appears to be dysregulation of visceral function and afferent sensation and a strong association with emotional factors and stress. There is a clear psychological dimension, with up to 60% of irritable bowel syndrome (IBS) patients reported to have psychological co-morbidities and altered pain perception is also common in comparison with control populations. The role of the enteric nervous system, the sensory pathways and the brain as well as the influence of the latter on sympathetic and parasympathetic outflow have likewise attracted increasing interest and have led to exciting new methods to study their complex interactions. The concept of low-grade inflammation, such as might occur after infection, acting as a trigger for neuromuscular dysfunction has also led to the broad integrative hypotheses that help to explain the biopsychosocial dimensions seen in functional gastrointestinal disease. The multi-component model places a major emphasis on neurogastroenterology and enteric and neuro-immune interactions where new approaches to pharmacotherapy lie. Drugs may affect motility, visceral sensation and other aspects of gut function such as secretion or absorption. More particularly, however, has been the search for and attempts to influence important mediators of these primary gut functions. Such targets include serotonin and selected 5-HT receptors, which are involved in gut motility, visceral sensation and other aspects of gut function, CCK receptors which are involved in the mediation of pain in the gut and nociception in the CNS, opioid receptors involved in pain in the brain, spinal cord and periphery, muscarinic M 3-receptors, substance P and neurokinin A and B receptors which are involved in motor adaptation and pain transmission in association with inflammation, gabba receptors involved in nociception and cannabinoid receptors which are involved in the control of acetyl choline release in the gut. With a better understanding of the structures and pathways involved in visceral perception and hyperalgesia, in the CNS, spinal cord and the gut and new pharmacological tools we will be better able to elucidate the neuropharmacology of visceral perception and its relationship to gut dysfunction. It is likely that there will be multiple therapeutic options based on the spectrum of abnormalities capable of causing the spectrum of symptoms of functional gastrointestinal disorders in any individual patient.

Substance-related cravings and relapses: clinical implications.

To review the implications of current research on clinical practice. An examination of the literature over the last 10 years and the data from our own study group. A synopsis of current psychobiological and psychological conceptual underpinnings of the nature and process of cravings and relapses among substance-dependent individuals is presented. The biopsychosocial dimensions of the clinical assessment of craving components, relapse patterns, and predictors, including relevant instruments, are explored. The panoply of management strategies for cravings and relapses encompasses cue exposure treatment techniques, relapse prevention approaches, anticraving and psychotropic medication, family involvement, and twelve-step programs. A clinician's familiarity with these strategies should contribute significantly to the transformation of the sense of failure engendered by a patient's relapse into a constructive challenge and opportunity.

The relationship of suicidality and psychiatric diagnosis in hospitalized pre-adolescent children.

Two structured interview measures of suicidal behavior were administered to 43 child psychiatric inpatients between the ages of 7 and 11 and their parents. DSM-III-R diagnoses were assigned to the children, with twenty-six Axis I and Axis II diagnostic categories represented. Generally, the interview measures of suicidal behavior were found to be unrelated to psychiatric diagnosis. The results suggest that to better understand pre-adolescent suicidal behaviors, it may be more useful to examine associations between these behaviors and the biopsychosocial dimensions that underlie the diagnostic categories.

Psychosocial aspects of neoplastic disease: II. Affective and cognitive effects of chemotherapy in cancer patients.

A battery of cognitive and affective tests administered to 50 consecutively admitted medical oncology patients revealed cognitive impairment to be a common occurrence in the absence of affective disorders or other psychopathology. Chemotherapy was the major variable associated with cognitive impairment in these patients. These findings suggest that the consultant psychiatrist should be aware of chemotherapy as a possible source of behavioral change and emotional distress in cancer patients.

Psychosocial aspects of mastectomy: I. the women's perspective.

The authors administered a questionnaire to 41 women who had had mastectomies to investigate aspects of the procedure itself, pre- and postmastectomy adjustment, effects on sexual relationships, and the influence of age. Although most women reported good overall adjustment, there were strong indications of psychological suffering (suicidal ideation, increased use of alcohol and tranquilizers, etc.). Psychological intervention may be called for in many cases, and age, support systems, and premorbid functioning may be indicators of the amount and type of intervention needed. Counseling is particularly important before surgery, since this was viewed as the period of maximum stress by most women. Further research with larger, more random samples and postsurgical control groups is indicated to determine more precisely the factors related to adjustment to mastectomy.