Personality characteristics of health care satisfaction survey non-respondents.

PURPOSE: Patient satisfaction surveys are increasingly used to assess the quality of health care delivery. Unfortunately, survey non-response may compromise generalizability (and inferential value). Although prior studies demonstrate an association between patient socio-demographic variables and response rate, relatively little information is available linking personality factors to non-response. This paper's purpose is to define outpatient satisfaction survey non-responder personality characteristics. DESIGN/METHODOLOGY/APPROACH: Minnesota Multiphasic Personality Inventory profiles of patients who completed an outpatient satisfaction survey were compared with non-responder profiles. Multivariate analysis was used to adjust for demographic and personality covariates. The study sample included 1,862 medical outpatients who were sent a satisfaction survey and Minnesota Multiphasic Personality Inventory results on record at this institution. Of these, 1,255 were survey responders and 607 were non-responders. FINDINGS: Scores on three Minnesota Multiphasic Personality Inventory scales were significantly correlated with non-response: higher scores on scales 4--Psychopathic deviate (Pd) and 8--Schizophrenia (Sc) predicted an increased likelihood of non-response (odds ratio [OR], 1.02; p < or = 0.05 for both), and higher scores on 7--sychasthenia (Pt) were associated with a decreased likelihood of non-response (OR, 0.98; p < or = 0.01). ORIGINALITY/VALUE: Prior investigations demonstrate an association between patient socio-demographic factors and survey non-response. This paper uniquely highlights patient personality characteristics' contribution to non-response. This information is an important consideration for patient satisfaction survey design, administration and interpretation.

Focus groups of Alaska Native adolescent tobacco users: preferences for tobacco cessation interventions and barriers to participation.

Tobacco cessation interventions developed for Alaska Native adolescents do not exist. This study employed focus group methodology to explore preferences for tobacco cessation interventions and barriers to participation among 49 Alaska Natives (61% female) with a mean age of 14.6 (SD = 1.6) who resided in western Alaska. Using content analysis, themes from the 12 focus groups were found to be consistent across village, gender, and age groups. Program location or site (e.g., away from the village, hunting, fishing), a group-based format, and inclusion of medication and personal stories were reported to be important attributes of cessation programs. Motivators to quit tobacco were the perceived adverse health effects of tobacco, improved self-image and appearance, and the potential to be a future role model as a non-tobacco user for family and friends. Parents were perceived as potentially supportive to the adolescent in quitting tobacco. The findings will be used to develop tobacco cessation programs for Alaska Native youth.

Development of a telephone-based intervention for support persons to help smokers quit.

This study represents the first step toward systematic behavioral treatment development and pilot testing of a novel approach to smoking cessation that utilizes adults interested in helping someone to stop smoking (i.e., support persons) as the agent of change. The counselor manual for a telephone-based intervention for support persons was developed based on a previous clinic-based intervention. Social cognitive theory served as the conceptual basis for the intervention. Ten adult non-smoking females completed the treatment protocol, consisting of six 20 - 30-min sessions and written materials. The support person was the sole recipient of the professional intervention. Feedback was obtained from 8 of the 10 participants and all 4 telephone counselors 1 week post-treatment (week 10). Results indicate that the telephone-based intervention was feasible and acceptable to participants. The intervention was refined based on participant and counselor feedback and will be subsequently tested in a randomized pilot trial.

Evaluation of a Tobacco Educational Intervention for Pregnant Alaska Native Women.

Tobacco cessation interventions developed and evaluated for Alaska Native women do not exist. As part of routine clinical care provided at a prenatal visit, a brief tobacco educational intervention for Alaska Native pregnant women (N=100; mean ± SD age = 25.9±6.2 years; mean 6.3±2.6 months gestation) was piloted at the Y-K Delta Regional Hospital in Bethel, Alaska. This retrospective study reports on the evaluation of this clinical program. The intervention was consistent with the clinical practice guidelines (i.e., 5 A's - ask, advise, assess, assist, arrange), with an average duration of 20.2 ± 6.8 minutes. The self-reported tobacco abstinence rate following the intervention was 11% at the last prenatal visit and 12% at delivery. Delivering a tobacco cessation intervention at a prenatal visit is feasible, but there is a need to identify more effective interventions for Alaska Native pregnant women.

Characteristics of six-month tobacco use outcomes of Black patients seeking smoking cessation intervention.

Although Blacks experience disproportionately greater morbidity and mortality attributable to smoking than other racially-classified social groups, few studies have examined the impact of clinical interventions for nicotine dependence within this population. The main objective of this study was to examine 6-month outcomes among 146 self-identified adult Black patients who received an individually-tailored nicotine dependence intervention in an academic medical setting. Measures included a baseline demographic questionnaire and telephone follow-up to obtain self-reported 6-month tobacco use status. Univariate analysis was performed to assess the association of baseline patient characteristics with tobacco abstinence at 6 months following the clinic intervention. Of the 146 patients, 83% were seen in an outpatient clinic setting, while 17% were seen as inpatients in the hospital. At baseline, 53% reported smoking an average of 20 or more cigarettes per day, 32% were highly nicotine dependent, and 53% were in the preparation or action stage of change. Six months following the intervention, the 7-day point-prevalence tobacco abstinence rate was 43/146 (29%; 95% C.I. 22% to 37%). An individualized nicotine dependence intervention conducted in an academic medical setting yielded encouraging abstinence rates for Black smokers.

Colorectal cancer screening with CT colonography, colonoscopy, and double-contrast barium enema examination: prospective assessment of patient perceptions and preferences.

PURPOSE: To prospectively assess and compare perceptions of and preferences for computed tomographic (CT) colonography, colonoscopy, and double-contrast barium enema examination (DCBE) by asymptomatic patients undergoing colorectal cancer screening. MATERIALS AND METHODS: A total of 696 asymptomatic patients at higher-than-average risk undergoing colorectal cancer screening were consecutively recruited to undergo both CT colonography and colonoscopy (group 1), and a like group of 617 patients was separately recruited to undergo both CT colonography and DCBE (group 2). Standard bowel preparations were different between the groups undergoing colonoscopy and DCBE. Each patient completed a questionnaire that assessed preparation inconvenience and discomfort, examination discomfort, willingness to repeat examinations, and examination preference. Survey results were compared for significance by using the Wilcoxon rank sum or chi2 test. RESULTS: The majority of patients considered the preparation to be uncomfortable (group 1, 460 of 515 [89%]; group 2, 482 of 538 [90%]) and inconvenient (group 1, 393 of 502 [78%]; group 2, 427 of 527 [81%]). Reported discomfort was similar at CT colonography and colonoscopy (P =.63) but was less at CT colonography than at DCBE (P <.001). Patients experienced significantly less discomfort than expected at both CT colonography and colonoscopy but not at DCBE. Patients' willingness to undergo frequent rescreening was significantly greater for CT colonography than for either colonoscopy or DCBE. The acceptable time interval between screenings was significantly shorter for all examinations if the bowel preparation could be avoided. Overall, patients preferred CT colonography to colonoscopy (group 1, 72.3% vs 5.1%; P <.001) or to DCBE (group 2, 97.0% vs 0.4%; P <.001). CONCLUSION: Patients undergoing colorectal cancer screening prefer CT colonography to both colonoscopy and DCBE. The majority of patients experience discomfort and inconvenience with cathartic bowel preparation.

Assessing the unmet information, support and care delivery needs of men with prostate cancer.

This study identified the key Unmet Needs of men with localized prostate cancer. A series of Nominal Groups were used to identify needs, from which a 135-item survey was developed to assess both the Importance and Unmet Need of each item. An Importance-Weighted Unmet Need score was calculated for each item, incorporating both the Importance and the degree to which the need was unmet. Surveys (n=500) were distributed in four geographically distinct areas, with a response rate of 46%. Respondents were 90% Caucasian, 80% married, with a mean age of 66 years, and mean education of 14 years. Care delivery needs were most important and least unmet, while Support needs were least important and most unmet. However, when degree to which needs were unmet was weighted by Importance, information needs had the highest Importance-Weighted Unmet Need scores. The greatest Unmet Needs for information were in knowledge of recurrence issues and in side effects of the illness and its treatment.