Good Physician-patient Communication Research Articles

Decades of beauty: Achieving aesthetic goals throughout the lifespan.

Several elements, including age, influence judgments of beauty and attractiveness. Aging is affected by intrinsic factors (e.g., genetics, race/ethnicity, anatomical variations) and extrinsic factors (e.g., lifestyle, environment). To provide a general overview of minimally invasive injectable procedures for facial beautification and rejuvenation to meet the aesthetic goals of patients across their lifespan, organized by decade. This case study review describes aesthetic considerations of females in their third to sixth decade of life (i.e., 20-60 years of age or beyond). Each case study reports the treatments, specifically botulinum toxin type A and soft tissue fillers, used to address aesthetic concerns. Signs of aging, as well as aesthetic goals and motivations, vary by age groups, cultures, and races/ethnicities. However, there are overarching themes that are associated with each decade of life, such as changes in overall facial shape and specific facial regions, which can be used as a starting point for aesthetic treatment planning. Appropriate patient selection, thorough aesthetic evaluation, product knowledge, and injection technique, as well as good physician-patient communication, are essential for optimal treatment outcomes. Nonsurgical facial injectable treatments can successfully enhance and rejuvenate facial features across different age ranges. A comprehensive understanding of facial aging and the aesthetic considerations of patients by the decade contributes to optimal treatment planning and maintenance.

Patient-Physician Communication and Perception of Treatment Goals in Rheumatoid Arthritis: An Online Survey of Patients and Physicians.

To evaluate patient-physician communication and patients' understanding of treatment goals in rheumatoid arthritis (RA). A cross-sectional online survey of patients with RA and physicians treating RA was conducted between 16 and 30 June 2021. Participants were asked to rate the importance of 17 goals on a 6-point Likert scale, and mean scores were compared between patients and physicians by the Wilcoxon rank sum test. Patients' satisfaction with physician communication and their understanding of treatment goals were also assessed. The responses of 502 patients and 216 physicians were analyzed. The most common patient age group was 50-59years (28.5%), and the mean disease duration was 10.3years. Physicians had a mean of 19.2years of treatment experience and were treating a mean of 44.3 patients. Among the 17 goals assessed, patients placed significantly more importance on drug tapering or discontinuation as short-term goals (3-6months) and on performing basic activities of daily living, being able to engage in daily tasks, achieving and maintaining remission, maintaining better laboratory values, and drug tapering or discontinuation as long-term goals (5-10years; all adjusted p < 0.05). Patient treatment satisfaction was significantly associated with disease activity, a feeling of treatment effectiveness, satisfaction with physician communication, and agreement with physician goals. Differences exist among patients with RA and physicians treating RA regarding the importance of short- and long-term treatment goals. Good patient-physician communication appears to be important for improving patient satisfaction. University Hospital Medical Information Network identifier: UMIN000044463.

Com-On Questionnaire: Development and validation of a questionnaire for evaluating communication skills of oncologists.

The present study aimed to develop and validate an instrument for assessing the communication skills of oncology physicians from a patient's point of view. A first draft of the questionnaire was compiled based on skills reflecting good physician-patient communication identified in the literature. The questionnaire was critically revised by experts to ensure the validity of its contents. The revised questionnaire was completed by a sample of 153 cancer patients. The questionnaire was developed in German and later translated into English. After analysis using classical test theory and an exploratory factor analysis, four different factors could be extracted. These factors were labelled setting, patient-centeredness, empathy and consulting competencies. Unsuitable items were eliminated within the analysis. All remaining items hold an appropriate degree of selectivity, item difficulty and reliability/consistency. A novel questionnaire for evaluating communication skills of physicians was developed. It contains 36 items and is named 'Com-On Questionnaire: Questionnaire for the Evaluation of Physician's Communication Skills in Oncology'. The questionnaire is suitable for measuring both the strengths and deficits within the physician-patient communication in oncology from the patients' perspective.

Patients experience regarding home mechanical ventilation in an outpatient setting.

The patient's experience of treatment is a cornerstone of high-quality healthcare, along with clinical safety and effectiveness. We aimed to evaluate the patients' perspectives regarding home mechanical ventilation (HMV) follow up in an outpatient setting and ascertain differences between patients that started HMV in the outpatient setting compared to other settings. This cross-sectional study was conducted with patients with chronic respiratory failure under HMV in the Outpatient Ventilation Clinic. Patients filled in a patient experience questionnaire and the S3-NIV questionnaire. The study included 235 patients (127, 54% male), median 70 [25-75 percentiles 64-76]years) and about half were adapted to HMV in the outpatient setting (117, 49.8%). Patients had a daily ventilator usage of 8.0 [6.0-10.0]hours and have been on ventilator for a median of 35.0 [12.0-66.0] months. Patients reported an overall good experience regarding education at initiation (209 [88.9%] considered the information given was enough), short time to adaptation [104 (44.3%) felt adapted after some hours], with perceived benefits (171 [72.8%] reported less shortness of breath, 158 (67.2%) improved quality of life and 150 (63.8%) less tiredness). Benefits overcame the treatment side-effects (158 [67.2%] reported mucosal dryness, 109 (46.4%) mask sores and 96 (40.9%) leaks). There was no difference in terms of reported health gains, side effects or time to adaptation between adaptation settings, but patients starting HMV in the outpatient setting reported better communication and education at adaptation. Outpatient setting was perceived as a positive experience, both in HMV initiation and follow up, with good patient-physician communication leading to significant health reported gains, improvement of health status and well-being and good treatment adherence.

Parents\u2019 knowledge, attitude and practice towards children\u2019s vaccination in Lebanon: role of the parent-physician communication

BackgroundOne of the most effective public health interventions in the world is immunization. However, some parents doubt its usefulness and safety. Many factors influence their decision to vaccinate, including their sociodemographic characteristics, their trust in the public health system, the parent-physician relationship, their level of knowledge and their attitudes towards vaccination. Our objective was to determine the factors, especially the parent-physician communication, associated with parental knowledge, attitudes and practices of their children’s vaccination.MethodsThree thousand five hundred parents (father, mother or both) of children aged between 1 month and 15 years were approached by a trained personnel who performed the data collection through personal interviews (February–April 2019).ResultsThe response rate was 79.5%. The results of the multivariable analysis showed that a better patient-physician communication was significantly associated with higher knowledge, better attitude and practice. Better knowledge was significantly associated with better attitude, whereas better knowledge and attitude were significantly associated with better practice.ConclusionOur study shows the importance of good physician-patient communication in improving knowledge, attitude and practice of parents towards their children’s vaccination.

The Physician-Patient Relationship: How It Is Represented in Iranian National Television

Background: In modern-day medicine, there is plenty of evidence-based communication studies implying that good physician-patient communication provides better diagnosis and treatment, as well as patient satisfaction and compliance with the therapeutic plan. Medical educators who promote better communication to strengthen the physician-patient relationship believe that shared decision-making is the most favorable model after the era of paternalistic and consumeristic models as the dominant types of interpersonal communication between doctors and their patients. On the other hand, different media, especially medical dramas, if properly targeted, can be used as an educational tool for health workers and a cultural factor for the whole society to ameliorate the current difficulties in the physician-patient relationship. Objectives: Therefore, this study aimed to determine how the Iranian national TV medical drama represents the physician-patient relationship. Methods: We used a qualitative inquiry to analyze a medical drama about hospital affairs, named The Nurses, which was produced by the Iranian national television with the cooperation and sponsorship of Iran’s Ministry of Health and broadcasted as a two-season television drama in 46 episodes during 2016 - 2017. In this regard, all aspects of physician-patient communication were analyzed based on the thematic deductive content analysis method. Results: The study reviewed 46 out of 51 episodes. Each sene that represented the physician-patient relationship was analyzed based on a developed checklist. The checklist was prepared based on a literature review, and its content validity was approved by the medical ethics experts. Conclusions: The findings of this study showed that this medical drama paradoxically represented the paternalistic model of the physician-patient relationship that was inconsistent with the formal views of Iranian authorities.

Physician-patient communication: a qualitative study of perceptions, barriers, and needs in four European member states

ABSTRACT Background: Good physician-patient communication is an important aspect of patient-centered care and contributes to positive health outcomes, however, there is a lack of standard European Union (EU) communication training policies for physicians. This study explores the barriers to good communication for both physicians and patients across four EU countries as part of the EU-funded project, Health Communication Training for Health Professionals – H-COM. Method: Focus groups were conducted with 31 patients and 38 physicians from Germany, Greece, Spain, and Cyprus. Two separate discussion guides were constructed for each target group around three themes: perceptions of, barriers to, and needs for health communication. Thematic analysis was used. Results: Commonalities and differences between countries and target groups were identified, with participants discussing attitudinal, emotional, educational, and systemic barriers to good communication. Participants indicated a significant gap in health communication knowledge, skills, and training for physicians, with regional differences. Conclusion: The results imply that there is a need for EU-wide communication training for physicians that would be best addressed by common themes and tailoring to specific regional differences. The results also imply that effective training should encompass a blend of theory and practical methods, and should be delivered via an e-learning platform for maximum accessibility. Training programs that adhere to these suggestions can begin to address the gaps in patient-centered care in the EU.

Patient-physician communication in the context of diabetes care: Adaptation and assessment of psychometric properties of a Persian version of the interpersonal process of care survey (P-IPC)

AimsTo examine the psychometric characteristics and explore the preliminary validity of the Persian version of the Interpersonal Processes of Care Survey (P-IPC) to assess patient-physician communication in the context of diabetes care. MethodsAfter adapting, translating, examining content validity, and pretesting the questionnaire, it was administered to 300 patients with diabetes. Confirmatory factor analysis identified the factor structure (scales). Variability, item-scale correlations, reliability, and construct validity of the final scales were examined. ResultsFactor analysis supported the hypothesized second-order factor model with 27 of the 29 items:11 first-, and 7 second-order common factors. Scale scores were calculated for the 7 second-order factors. Internal-consistency reliability for the 7 scales ranged from 0.60 to 0.90 and 2-week test–retest correlations ranged from 0.89 to 0.96. The communication and interpersonal style domains of the P-IPC demonstrated high ceiling effects suggesting good patient-physician communication. The P-IPC scales differentiated between patients in the language-concordant and language-discordant groups, and patterns of correlations with three patient satisfaction measures corresponded to hypotheses. ConclusionThe P-IPC includes all of the second-order scales identified in the original IPC. Evidence of its reliability and validity suggest it can be useful for assessing patient-physician communication in the context of diabetes care.

The drug adherence and lifestyle factors that contribute to blood pressure control among hypertensive patients

Objectives: To investigate drug adherence and lifestyle behaviors affecting the blood pressure (BP) control among hypertensive patients that have uncontrolled and controlled BP. Methods: Seventy-eight uncontrolled BP and 98 controlled BP hypertensive patients matched on age, gender, time since hypertension diagnosis and the number of antihypertensive drugs used were investigated using a standardized questionnaire to evaluate lifestyle behaviors, drug adherence, the use of complementary and alternative medicine, and health related quality of life. Drug-drug interactions were evaluated with an electronic drug reference software. Results: Not taking therapy when feeling better was observed significantly more frequently in the uncontrolled hypertensive group (OR: 0.297, %95 CI: 0.115-0.770). Uncontrolled BP hypertensive patients live more frequently in extended family settings (p = 0.043), they sleep less controlled BP hypertensive patients (OR: 0.749, %95 CI: 0.605-0.929). The groups did not differ statistically in terms of Complementary and Alternative Medicine (CAM) use (p = 0.795) and informing doctors about the use of CAMs (p = 0.910). The EuroQol five-dimensional 3 level (EQ5D3L) questionnaire Visual Analogue Scale (VAS) score was significantly higher in the control group (p = 0.011). In both groups over 70% of patients should be monitored for therapy due to drug interactions evaluation. Conclusions: Our study shows that increasing the drug adherence and sleeping hours and living in the nuclear family is associated with improvement in blood pressure control and health related quality of life. A comprehensive approach and good patient-physician communication and trust are essential for well-managed hypertension.

Video Recording Patient Visits to Improve Patient Satisfaction and Hospital Consumer Assessment of Healthcare Providers and Systems Scores

Abstract INTRODUCTION A history of good physician-patient communication is critical to improving patient satisfaction with their physicians. This study sought to evaluate the impact of video recording healthcare visits on patient satisfaction using Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. METHODS HCAHPS surveys are administered by hospitals through Press Ganey. This institute's HCAHPS results were collected and analyzed from June 2016 through February 2019. The results of these surveys were divided into 2 physician groups: video recording users and non-users. The resulting percentile rankings of top-box answers (“always”) of HCAHPS measures were compared. RESULTS A total of 3516 HCAHPS surveys were completed between June 2016 and February 2019 at this institute. Of these, 1860 were completed by patients in the video recording users' group and 1656 were completed by patients in the non-users' group. Video recording users' HCAHPS scores were notably higher than non-users' scores. Most importantly, video recordings group patients vs non-users group patients who answered “always” (top-box score) for “Communication with the Doctor” and “Doctor Explained” had percentiles ranks of 91st vs 60th and 91st vs 57th, respectively. Perceived “Physician Skill” was the only category in which both groups scored high: 92nd percentile for video recordings users vs 93rd for non-users. In addition, 96% (137/142) of the video recordings patients watched their videos 1 to 5 times, and many reported that they chose to share their video with family or friends. CONCLUSION Physicians who provided patients with video recorded visits achieved higher HCAHPS physician satisfaction scores than those who did not. Practices that seek to improve their HCAHPS scores, especially considering incentivized payments of quality care, should consider offering video recordings for patients and their families to help improve real or perceived communication.

A betegelégedettséget befolyásoló tényezők és a lojalitás vizsgálata a háziorvosi ellátásban

THE AIM OF THE PAPER Our study deals with the influencing factors of patients’ satisfaction with their primary care physicians, and with satisfaction-loyalty connection. We investigated which service-quality items may influence the best the satisfaction with the primary care and whether the satisfaction has an effect on the loyalty to the physician. METHODOLOGY Data were collected by interviews using nationally and internationally validated questionnaires. The sample was chosen from inhabitants of three different cities. The data was processed by IBM SPSS Statistics 24 and SmartPLS programmes. The sample was evaluated with mathematical-statistical methods: descriptive statistics, one-way ANOVA, and PLS Path Modeling. MOST IMPORTANT RESULTS The satisfaction results of this paper can be compared with similar national publications. 80% of respondents were still satisfied or very satisfied with their family physicians. Their average performance was 4,27 measured on a five-point Liker-scale. According to PLS regression results, the satisfaction of patients is influenced remarkably by the involvement of patients into decision-making (s=0,459) and providing information to patients (s=0,210), but the role of the physical environment is not a relevant factor in satisfaction. Our novel finding is that patient-physician communication significantly influence the overall satisfaction. Moreover, a linear correlation was also proved between satisfaction and loyalty (s=0,727). RECOMMENDATIONS The results of the present research highlight new aspect of quality improvement factors in the everyday practice. Besides the conventional quality dimensions in the primary care (waiting times, physical environment) newer items appeared as relevant factors (communication, patient involvement). Based on our results, the directions of practice development can be appointed: the good patient-physician communication, handling patients as equal partner and involvement of the patient into the decision-making process should play a crucial role in the future.

Exploring Physician-Older Patient Communication. A Qualitative Analysis of Communication between Older Patients and General Practitioners

An great body of research has been carried out to study physician-patient communication and its impact on quality of care, patient satisfaction, treatment and health. Good physician-patient communication is proved to increase patient’s health. Most of the existent literature on the field has been done on younger patients and only a small part of the studies conducted took into consideration the older patients’ communication and relationship with their doctors. We depart from the idea that age has an important role in doctor-patient interaction, as age moderates the relationship between the style of interaction and patient satisfaction.&#x0D; This study aims to explore the physician-older patient communication by analyzing the way elders experience the relationship with the general practitioner. By doing so, the current study looks at the way elders perceive their relationship with the general practitioner and the level of their satisfaction. Elements like tone of voice, forms of address, topics, explanations given, motifs of the visit have been considered in the present study in order to explore de doctor-older patient communication.

Acne vulgaris.

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit and it is observed equally in both sexes and nearly all races. It generally begins at puberty, but the healing period is variable. There is no known etiological factor, except genetic tendency. Androgens play a very limited role in some female patients. The effects of cosmetics, foods and drinks are also discussible and too limited. There are four factors in acne pathogenesis: Increase of the sebum excretionKeratinization of infrainfundibulumBacterial colonization of the follicleInflammation It is mainly observed on the face and back, shoulders and chest. Initial lesions are comedons. Papules, pustules and cysts of severe types follow it. The most important factor in treatment is a very good patient-physician communication. Topical or systemic treatment or both can be used depending on the severity of acne. Benzoyl peroxyde, azelaic acid, AHA's antibiotics, retinoic acid and derivatives are the topical choices. For systemic treatment antibiotics are the most commonly used medicines, but isotretinoine has a very spesific place with the possibility of permanent healing. All kind of treatments need approximately six months for a good result.

Advance Care Planning and Patient Preferences in a Feasibility Pilot Study to Improve End-of-Life Communication among Men with Metastatic Urological Malignancies

IntroductionRates of advance care planning for patients with cancer are poor despite efforts to enhance discussions regarding goals of care. Good patient-physician communication is critical to providing quality end-of-life care and, thus, it is important to identify effective interventions to improve systems through which patient preferences are addressed. MethodsTo improve rates of advance care planning as well as examine patient preferences regarding end-of-life care, we developed an integrated urology-palliative care clinic. All patients with a new diagnosis of a metastatic urological malignancy or castration resistant prostate cancer seen in a urology clinic within the Veterans Affairs Greater Los Angeles Healthcare System were offered a palliative care referral to be performed immediately after their urology appointment. The primary outcome was completion of an advance directive or POLST (Physician Orders for Life-Sustaining Treatment) form and the secondary outcome was patient preference regarding end-of-life care. ResultsA total of 59 patients were enrolled in the study between February 2012 and October 2016, and no patients were lost or excluded. There were 25 eligible patients who declined enrollment. Overall 85% of patients completed an advance directive or POLST form, and 98% chose to withhold cardiopulmonary resuscitation, advanced cardiac life support and artificially administered nutrition. ConclusionsHigh levels of advance care planning are achievable in an integrated urology-palliative care clinic and the majority of patients with a terminal illness are averse to aggressive end-of-life care.

A multidimensional view of racial differences in access to prostate cancer care.

Racial disparities in prostate cancer treatment and outcomes are widespread and poorly understood. In the current study, the authors sought to determine whether access to care, measured across multiple dimensions, contributed to racial differences in prostate cancer. The Philadelphia Area Prostate Cancer Access Study (P2 Access) included 2374 men diagnosed with localized prostate cancer between 2012 and 2014. Men were surveyed to assess their experiences accessing care (response rate of 51.1%). The authors determined appointment availability at 151 urology practices using simulated patient telephone calls and calculated travel distances using geospatial techniques. Multivariable logistic regression models were used to determine the association between 5 different domains of access (availability, accessibility, accommodation, affordability, and acceptability) and receipt of treatment, perceived quality of care, and physician-patient communication. There were 1907 non-Hispanic white and 394 black men in the study cohort. Overall, approximately 85% of the men received definitive treatment with no differences noted by race. Black men were less likely to report a high quality of care (69% vs 81%; P<.001) and good physician-patient communication (60% vs 71%; P<.001) compared with white men. In adjusted models, none of the 5 domains of access were found to be associated with definitive treatment overall or with radical prostatectomy. All access domains were associated with perceived quality of care and communication, although these domains did not mediate racial disparities. To the authors' knowledge, the current study presents the first comprehensive assessment of prostate cancer care access, treatment, and patient experience, demonstrating that although access was related to overall perceived quality of care and better physician-patient communication, it did not appear to explain observed racial differences. Cancer 2017;123:4449-57. © 2017 American Cancer Society.

What is competent communication behaviour of patients in physician consultations? – Chronically-ill patients answer in focus groups

Many desirable outcomes depend on good patient-physician communication. Patient-based perspectives of what constitutes competent communication behavior with physicians are needed for patient-oriented health care. Therefore it was our main aim to identify competent patient communication skills from the patient’s perspective. We also wanted to reveal any differences in opinion among various groups (chronic ischemic heart disease, chronic low back pain, breast cancer). This study examined nine guideline-supported focus groups in rehabilitation centers. The criterion for study inclusion was any one of the three diagnoses. Enrolled in the study were N = 49 patients (32 women) aged M = 60.1 (SD = 12.8). The interview recordings were transcribed and subjected to content analysis. We documented 396 commentaries in these interviews that were allocated to 82 different codes; these in turn resulted in the formation of 12 main topics. Examples are: posing questions, being an active and participatory patient, being aware of emotions and communicating them. This study represents stage two (‘documentation of patient and clinician views’) in the seven-stage model of communication research. Findings reveal that chronically-ill patients name behaviours that contribute to successful discussion with a physician. These enable us to develop communication trainings and design-measuring tools used for patient-based communication skills.

Can a feedback report and training session on medication counseling for general practitioners improve patient satisfaction with information on medicines?

BackgroundRegular intake of medicines prevents hospitalization and improves treatment outcomes in patients with chronic diseases; however, requires good patient–physician communication. Yet, this communication is often insufficient and characterized by misunderstandings. This paper aimed to explore whether a training session on medication counseling for general practitioners (GPs) can improve patient satisfaction about information on medicines.MethodsWithin a seamless care project (HeiCare®), a questionnaire to assess patient satisfaction with information on medicines and other questions related to medication issues was distributed among 370 patients. Results were returned to physicians in a feedback report, discussed in a training session, and a subsequent second questionnaire was sent to patients.ResultsPatients showed a significant increase in satisfaction with overall information on medicines and with information on potential problems when experiencing medication counseling after their GP received a feedback report and/or training session.ConclusionIndividual feedback and training sessions can improve medication counseling and GPs’ awareness of patients’ attitudes toward medicines and thus increase patients’ satisfaction with medicines information received. Regular feedback to the GP on patients’ satisfaction with information and patients’ beliefs in medicines can be obtained by patient surveys or by addressing these issues in regular medication counseling encounters. Physicians need to be trained to listen to patients’ views and concerns on medication.

What makes them (not) talk about proper medication use with their patients? An analysis of the determinants of GP communication using reflective practice

Many patients do not use their medication as prescribed. This non-adherence is a well-known and resistant problem, requiring good physician-patient communication. However, when it comes to talking about (non-)adherence, both physician and patient refrain from putting the topic high on the agenda. The reasons for doing so are far from clear. We therefore conducted a qualitative, video-facilitated study to find out why physicians communicate with their patients about medication use and adherence in the way they do. Using reflective practice, 20 general practitioners (GPs) independently watched videorecordings of their own visits and were asked to reflect on ‘critical incidents’ operationalised as segments of a visit which ask for a discussion of proper medication use or adherence. Determinants of such a discussion appeared to be the type of medication, patient and GP characteristics, and particular elements of the medical visit and of the broader practice organisation in which the visit took place. Determinants mentioned most often were a lack of time, other priorities, being acquainted with the patient, reluctance to disclose too much information out of a risk of reinforcing side-effects, and relying on the patient for returning to the GP office when existing complaints persist. Apparently, many GPs are biased when it comes to discussing proper medication use and preventing non-adherence. These results provide input for developing communication interventions and guidelines for discussing medication use with patients more elaborately. Reflective practice appeared to be a valuable and appreciated tool to investigate determinants of physician behaviour.

A percepção de pacientes sobre a comunicação não verbal na assistência médica

A confiança no médico e o sucesso terapêutico dependem, além de outros fatores, de uma boa comunicação entre profissional de saúde e paciente. O presente estudo buscou conhecer a percepção dos pacientes sobre aspectos da comunicação não verbal que influenciam a consolidação da confiança no médico. Trata-se de um estudo transversal, descritivo e analítico, com amostra aleatória de pacientes alocada em locais públicos da cidade. Foram realizadas 182 entrevistas com pessoas de idades entre 18 e 88 anos, registrando-se preferência pelo perfil mais tradicionalista do profissional, com roupas brancas, cabelos aparados e sem acessórios. O uso de maquiagem e acessórios (brincos, pulseiras, etc.) para mulheres é aceito com moderação. Existe restrição ao uso de piercings, tatuagens e brincos em homens, especialmente pela população idosa. Confirmando a importância da aparência na comunicação médico-paciente, o estudo destaca a necessidade da inserção do tema nos currículos médicos, uma vez que esses aspectos são pouco discutidos na formação do profissional médico, o que permitirá reflexões sobre aspectos não verbais da comunicação na relação médico-paciente e poderá influenciar positivamente as atitudes dos novos profissionais.

Impact of Implantable Cardioverter‐Defibrillator Recalls on Patients' Anxiety, Depression, and Quality of Life

In the past 2 years, multiple implantable cardioverter-defibrillator (ICD) manufacturers have issued recalls on ICD models due to the potential for serious malfunction and even patient death. Previous studies examining the relationship between these recalls and patients' psychological well-being have been limited by small sample size and conflicting results. The purpose of this study is to examine the association between ICD recalls and patients' anxiety, depression, and quality of life. Patients were drawn from an outpatient electrophysiology clinic at a tertiary care hospital in New York City. Patients who had devices subject to a recall (cases) were identified from lists provided by device manufacturer and controls (patients with ICDs not subjected to a recall) were drawn from a convenience sample of outpatients. The survey instrument consisted of two validated questionnaires--Hospital Anxiety and Depression Score (HADS) and MacNew heart disease health-related quality of life (QOL) instrument. In addition, a series of Likert-type scales were designed to elucidate patients' concerns related to the following domains: anger, trust, hope, concerns regarding ICD shock, fear of death (FOD), and physicians' ability to reduce their concern about the ICD recall. Data were analyzed using simple descriptive statistics and bivariate analyses (chi(2) and t-test) as appropriate. Sixty-one cases and 43 control patients were enrolled. Thirty-two patients (52%) with devices subject to a recall opted for a generator replacement. There were no significant differences in the mean scores on the HADS scale, or the MacNew QOL scale between these two groups of patients (cases and controls). Subgroup analysis within the group of patients whose ICDs were recalled (cases) revealed a reduced QOL among patients with a class I recall (reasonable probability that the product will cause serious adverse health consequences or death) as compared to those with a class II recall (product may cause temporary or medically reversible adverse health consequences) (P = 0.01). Both cases and control patients reported having reduced trust in the health-care system. On the whole, however, patients were satisfied with the way their physicians dealt with the recall. There was no significant change in the overall concern of ICD shocks or FOD between the two groups. In this study of ICD recall, we found no difference in the levels of anxiety, depression, or QOL expressed by patients with an ICD subject to a recall as compared to those without. These findings may be a reflection of good physician-patient communication, which might have reduced any anxiety associated with recalls.