Health care provider attitudes toward patients with acute vaso-occlusive crisis due to sickle cell disease: Development of a scale

Abstract

Objective Patients with sickle cell disease (SCD) often perceive negative provider attitudes, which may affect the quality of patient–provider communication and care during vaso-occlusive crises (VOCs). This study investigated the validity and reliability of a scale to measure provider attitudes toward patients with acute VOC. Methods Using a cohort of adults with VOC (September 2006 to June 2007), we administered a 10-item provider questionnaire within 72 h of patient encounters. After factor analysis, we created a 7-item Positive Provider Attitudes toward Sickle Cell Patients Scale (PASS); higher scores indicate more positive attitudes. We assessed internal consistency and evidence of construct validity, exploring bivariate relationships between provider or patient characteristics and the PASS score using multilevel modeling. Results We collected 121 surveys from 84 health care providers for 47 patients. Patients averaged 30.3 years in age, and 60% were women. Among providers, 79% were nurses, and 70% worked in inpatient settings. PASS scores averaged 24.1 (S.D. 6.7), ranged 7–35, and had high internal consistency (Cronbach’s alpha = 0.91). As hypothesized, inpatient vs. emergency department providers (Δ = 4.65, p < 0.001) and nurses vs. other providers (Δ = 0.95, p < 0.001) had higher PASS scores. Higher patient educational attainment (Δ per year = 2.74, p < 0.001) and employment (Δ = 5.62, p = 0.001) were associated with higher PASS scores. More frequent hospitalizations (Δ per episode = −0.52, p < 0.001) and prior disputes with staff (Δ = −7.53, p = 0.002) were associated with lower PASS scores. Conclusion Our findings provide preliminary evidence for the reliability and construct validity of the PASS score in measuring provider attitudes toward patients with VOC. Practice implications Future studies should examine the validity of PASS in other cohorts of patients with SCD and their providers. With further evidence, PASS may prove useful for investigating the impact of provider attitudes on the quality of communication and care provided to these patients.

A Video-Intervention to Improve Clinician Attitudes Toward Patients with Sickle Cell Disease: The Results of a Randomized Experiment

“…2,14 The construct validity of our outcomes was assessed using the previously validated Medical Condition Regard Scale (MCRS), which measures the extent to which respondents find patients with a given medical condition to be enjoyable, treatable, and worthy of medical resources. 15 Clinicians expressing more negative attitudes about SCD patients were hypothesized to exhibit lower regard for these patients as measured by the MCRS.…”

Race and social attitudes about sickle cell disease

“…Of particular interest is whether provider attitudes influence the provision of sickle cell care. Findings from a recent study by Ratanawongsa et al (2009) indicated that health care providers reported more positive attitudes toward Black patients who had counter-stereotypic traits (e.g., were well-educated and gainfully employed). It would be interesting to assess whether providers also report less positive attitudes toward Black patients with stereotypic traits (e.g., low educational attainment and unemployed).…”

HIV Providers' Perceptions of and Attitudes Toward Female Versus Male Patients

“…Using items from existing scales, the Assessment of Positive Regard, a novel 7-item scale, was developed. [24][25][26] This scale asks the provider to evaluate his or her own attitudes toward a patient in comparison to other patients; for example, ''Compared to other patients, I like this patient''. Responses are on a 5-point Likert scale (1 = strongly agree to 5 = strongly disgree).…”