Shift in Emergency Department Provider Attitudes Toward Patients With Sickle Cell Disease

Abstract

Patients with sickle cell disease frequently seek care in the emergency department. They have reported experiencing negative attitudes from emergency providers. This study was undertaken to evaluate change in emergency provider attitudes toward patients with sickle cell disease over a 2.5-year time period when several educational efforts were ongoing. The General Perceptions about Sickle Cell Disease Patients Scale was used to measure emergency provider attitudes at 2 emergency departments at baseline, 6 months, and 30 months into the project. Analyses of covariance were used to test for effects of site, time, and provider type, as well as their interactions, on Negative attitudes, Uneasiness With Care, and Positive Attitudes subscale scores, after controlling for years of provider experience. The number of surveys returned at the 3 time points was 216, 182, and 113, respectively. The mean Negative Attitudes subscale scores decreased significantly over time, with significantly higher mean Negative Attitudes subscale scores reported by nurses than by physicians. The mean Uneasiness With Care subscale scores did not differ significantly over time, but the mean score was significantly higher for physicians than for nurses. The mean Positive Attitudes subscale scores significantly improved over time, with physicians tending to have a higher mean Positive Attitudes subscale scores than nurses. During the observation period, there was improvement in attitudes, with a decline in mean Negative Attitudes subscale scores and increase in mean Positive Attitudes subscale scores. Physicians reported better attitudes than nurses.

Emergency Department (ED), ED Observation, Day Hospital, and Hospital Admissions for Adults with Sickle Cell Disease

“… 17 , 18 Details of the project have been published. 17 – 20 Briefly, the project attempted to optimize the treatment of VOC in the ED using best practices, 1 while monitoring healthcare utilization and psychosocial referral needs and practices. 17 – 19 In this paper, we report acute healthcare utilization data only (excluding the number of clinic visits).…”

Physicians’ and nurses’ perceptions and attitudes toward sickle cell disease patients in Jazan, Saudi Arabia

“…Nurses' negative attitude can be explained by that nurses spending more time with sickle cell patients. 16,18 Other factors that may also contribute to nurses' negative attitudes include: they are the first responders to the patients' complaints, patients are blaming them for poor pain control, verbal abuse from the patients, and less participation in educational activities. 18 Moreover, nurses thought that sickle cell patients complain more than other patients and they do not use analgesics appropriately.…”

“…16,18 Other factors that may also contribute to nurses' negative attitudes include: they are the first responders to the patients' complaints, patients are blaming them for poor pain control, verbal abuse from the patients, and less participation in educational activities. 18 Moreover, nurses thought that sickle cell patients complain more than other patients and they do not use analgesics appropriately. 19 However, this finding does not match what Ratanawongsa et al, 20 had concluded, by using different scale they found that nurses had a more positive attitude toward sickle cell patients than other healthcare providers.…”

“…The negative attitudes of emergency providers may be attributed to the overrepresentation of sickle cell patients at ED and the high prevalence of addiction disorders among them. 9,10,18,20 Nevertheless, it seems to be like a vicious circle, the negative attitudes of emergency providers result in improper management of sickle cell pain, and thereafter, repeated ED visits seeking pain relief. 7,8,17 Different interventions programs had been implemented to improve healthcare providers' attitudes including 8-minute video consisted of discussion between physician expert and sickle cell patients about sickle cell pain management difficulties and misconceptions, the high-intensity educational program includes 2 and half days of educational and experimental intervention using videos about sickle cell patients' experience in comparison to low-intensity program consist of 90 minutes using same contents, and 60 minutes educational lectures together with 30 minutes informational updates and refresher talks together with website modules.…”

“…7,8,17 Different interventions programs had been implemented to improve healthcare providers' attitudes including 8-minute video consisted of discussion between physician expert and sickle cell patients about sickle cell pain management difficulties and misconceptions, the high-intensity educational program includes 2 and half days of educational and experimental intervention using videos about sickle cell patients' experience in comparison to low-intensity program consist of 90 minutes using same contents, and 60 minutes educational lectures together with 30 minutes informational updates and refresher talks together with website modules. 7,16,18,23 All these interventions have proven their efficacy in improving positive attitudes and reducing negative attitudes toward sickle cell patients. 7,16,18,23 Concern-rising behaviors.…”