Attitudes Toward Patients With Sickle Cell Disease in a Multicenter Sample of Emergency Department Providers

Abstract

Objective Patients with sickle cell disease (SCD) often seek care in the emergency department (ED) for pain associated with vaso-occlusive crises (VOC). Research has shown that negative provider attitudes serve as a barrier to care in this patient population. Our aim was to validate a survey that measures attitudes towards patients with SCD among ED providers (nurses and physicians) and to compare differences in attitude scores between provider types. Methods We administered the General Perceptions about Sickle Cell Disease Patients Scale, previously validated amongst internal medicine providers, and the Medical Condition Regard Scale (MCRS) to ED nurses and physicians from two emergency departments. Results 215 surveys were returned (63% response rate, 200 with attitude items completed). Three subscales were identified: Negative attitudes, Uneasiness with care, and Positive attitudes. Cronbach alphas exceeded 0.81 for each subscale. Mean (SD) scores for the Negative, Uneasiness, and Positive subscales and MCRS were 61.5 (20.3), 66.1 (17.1), 41.2 (17.8), and 42.2 (8.9) respectively. Compared to physicians, nurses had significantly higher mean Negative attitude scores and lower Uneasiness scores. Conclusions A slightly modified version of the General Perceptions about Sickle Cell Disease Patients Scale appears to be a valid measure of ED provider attitudes towards patients with SCD. Amongst ED providers, this scale identified a dimension not observed in research with the original instrument amongst internal medicine providers. Practice Implications Provider attitudes influence patient-provider interactions and quality of care. The scale we present here has major clinical implications, particularly for advanced practice nurses, who can use the scale not only to assess providers’ attitudes towards patients with SCD, but also determine the effectiveness of tailored interventions to improve those attitudes.

Level of agreement between adolescents’ self‐assessment and parent proxy report of health‐related quality of life in adolescents with sickle cell disease

“…Previous studies report on poor communication of patients with SCD with their healthcare providers with the former stating that their fears and anxieties are not understood, and they are not involved in decision making . Studies also report that negative attitudes of healthcare providers can impact on healthcare access and utilization by patients with SCD, which will negatively impact outcomes . None of these studies examine whether these issues resulting from poor communication are worse in females, but if female children are unable to adequately express their psychosocial functioning to their parents then it may be the same to their clinicians.…”

Transitioning Adolescents and Young Adults With Sickle Cell Disease From Pediatric to Adult Health Care

“…Pediatric providers cited the importance of a trusting relationship with the patient more often than adult providers. Recent studies also show that providers often have negative perceptions of patients with SCD, especially when they present to the emergency department 22,23 . Challenges in the emergency department also came up as a theme in the current study.…”

The Role of Bias by Emergency Department Providers in Care for American Indian Children

“…We had limited sample size and relatively low response rates compared to published surveys including both ED physicians and nurses 48–53 , but feel that our responses are representative of the population given the similarity between our sample and the demographics of the population as a whole (Table 1). Some research also suggests reduced non-response bias in physician surveys.…”