Levy Joshua M, Mace Jess C, Smith Timothy L, Soler Zachary M
Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, GA.
Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Skull Base Surgery, Oregon Health & Science University, Portland, OR.
Int Forum Allergy Rhinol. 2017 Apr;7(4):414-420. doi: 10.1002/alr.21886. Epub 2016 Nov 11.
Patient-reported outcome measures (PROMs) measure health states in chronic rhinosinusitis (CRS) and have become the dominant metrics of treatment outcomes. Interpersonal traits (IPTs) are patient-specific factors that include personality type, perceived social support, and trust in physicians. The association of IPTs on treatment outcomes among patients with CRS has not been described previously, and IPTs may represent major clinical factors influencing treatment outcomes.
Adult patients electing medical or surgical treatment for recalcitrant CRS were prospectively enrolled into a multi-institutional, observational outcomes study. Validated measures of IPTs, including the Big Five Inventory-10 Short Version (BFI-10), Multidimensional Scale of Perceived Social Support (MSPSS), and the Trust in Physician Scale (TPS), were completed and compared with PROMs, which included the 22-item SinoNasal Outcome Test (SNOT-22), the Medical Outcomes Study Short Form-6D (SF-6D), and the Patient Health Questionnaire-2 (PHQ-2).
Three hundred fifty-four participants were included and followed for an average (± standard deviation) of 16.3 (±4.8) months. Significant within-subject improvement in mean PROM scores was reported (all p <0.001). No association was detected between PROM score improvement and baseline BFI-10 or MSPSS scores (p > 0.050). Significant, but weak, absolute correlations were reported between baseline TPS scores and improvement in SNOT-22, SF-6D, and PHQ-2 total scores (p < 0.050; r ≤ 0.138).
Personality type and perceived social support do not associate with improvement after treatment for CRS. However, increased trust in physicians is weakly associated with greater posttreatment improvement. Further study is needed to examine the relationship between physician trust, patient satisfaction, and treatment outcomes among patients with CRS.
患者报告的结局指标(PROMs)用于衡量慢性鼻-鼻窦炎(CRS)的健康状况,已成为治疗结局的主要衡量指标。人际特质(IPTs)是患者特有的因素,包括人格类型、感知到的社会支持以及对医生的信任。此前尚未描述IPTs与CRS患者治疗结局之间的关联,而IPTs可能是影响治疗结局的主要临床因素。
选择接受药物或手术治疗顽固性CRS的成年患者,前瞻性纳入一项多机构观察性结局研究。完成对IPTs的有效测量,包括大五人格量表10项简版(BFI-10)、多维感知社会支持量表(MSPSS)和对医生的信任量表(TPS),并与PROMs进行比较,PROMs包括22项鼻鼻窦结局测试(SNOT-22)、医学结局研究简表6维度(SF-6D)和患者健康问卷2项版(PHQ-2)。
纳入354名参与者,平均(±标准差)随访16.3(±4.8)个月。报告称受试者平均PROM分数有显著改善(所有p<0.001)。未检测到PROM分数改善与基线BFI-10或MSPSS分数之间存在关联(p>0.050)。报告称基线TPS分数与SNOT-22、SF-6D和PHQ-2总分的改善之间存在显著但微弱的绝对相关性(p<0.050;r≤0.138)。
人格类型和感知到的社会支持与CRS治疗后的改善无关。然而,对医生的信任增加与治疗后更大程度的改善存在微弱关联。需要进一步研究以探讨CRS患者中医生信任、患者满意度和治疗结局之间的关系。