Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, 96 Jonathan Lucas Dr, 812-CSB, Charleston, SC 29425, USA.
Chest. 2010 Jul;138(1):59-67. doi: 10.1378/chest.09-2124. Epub 2010 Jan 15.
We investigated illness perceptions among critically ill patients or their surrogates in a university medical ICU using a prospective survey. We hypothesized that these would vary by demographic, personal, and clinical measures.
Patients (n = 23) or their surrogates (n = 77) were recruited. The Illness Perception Questionnaire-Revised (IPQ-R) measured six domains of illness perception: timeline-acute/chronic, consequences, emotional impact, personal control, treatment efficacy, and illness comprehension. Multiple variable linear regression models were developed with IPQ-R scores as the outcomes.
African Americans tended to perceive the illness as less enduring and reported more confidence in treatment efficacy (P < .01 for each). They also tended to report the illness as less serious, having less emotional impact, and having greater personal control (P = .0002 for each). Conversely, African Americans reported lower illness comprehension (P = .002). Faith/religion was associated with positive illness perceptions, including less concern regarding consequences (P = .02), less emotional impact (P = .03), and more confidence in treatment efficacy (P < .01). Lower patient quality of life (QOL) precritical illness was associated with negative perceptions, including greater concern about illness duration and consequences as well as perception of less personal control and less confidence in treatment efficacy (P < .01 for each). These variables were independently associated with illness perceptions after controlling for race, faith/religion, and survival to hospital discharge, whereas clinical measures were not.
Illness perceptions among critically ill patients and surrogates are influenced by patient/surrogate factors, including race, faith, and precritical illness QOL, rather than clinical measures. Clinicians should recognize the variability in illness perceptions and the possible implications for patient/surrogate communication.
我们通过前瞻性调查研究了重症监护病房（ICU）中危重症患者或其代理人的疾病认知。我们假设这些认知会因人口统计学、个人和临床因素的不同而有所不同。
我们招募了患者（n=23）或其代理人（n=77）。使用修订后的疾病认知问卷（IPQ-R）测量了疾病认知的六个领域：时间维度-急性/慢性、后果、情绪影响、个人控制、治疗效果和疾病理解。以 IPQ-R 得分为因变量，建立了多个变量线性回归模型。
非裔美国人往往认为疾病的持续时间更短，对治疗效果更有信心（每个结果 P<0.01）。他们也往往认为疾病不那么严重，情绪影响较小，个人控制能力较强（每个结果 P=0.0002）。相反，非裔美国人报告的疾病理解能力较低（P=0.002）。信仰/宗教与积极的疾病认知有关，包括对后果的担忧较少（P=0.02）、情绪影响较小（P=0.03）以及对治疗效果的信心增强（P<0.01）。发病前患者生活质量（QOL）较低与消极的疾病认知有关，包括对疾病持续时间和后果的担忧增加，以及对个人控制和治疗效果的信心降低（每个结果 P<0.01）。这些变量在控制了种族、信仰/宗教和生存到出院后，与疾病认知独立相关，而临床指标则不然。
危重症患者及其代理人的疾病认知受患者/代理人因素的影响，包括种族、信仰和发病前的 QOL，而不受临床指标的影响。临床医生应认识到疾病认知的可变性及其对患者/代理人沟通的潜在影响。
