Persistent negative illness perceptions despite long-term biochemical control of acromegaly: novel application of the drawing test

Abstract

Context and objective: Patients with acromegaly have persistent complaints despite long-term biochemical control. Drawings can be used to assess patients' perceptions about their disease. We aimed to explore the utility of the drawing test and its relation to illness perceptions and quality of life (QoL) in patients after long-term remission of acromegaly. Design: A cross-sectional study was conducted to evaluate the utility of the drawing test. Methods: A total of 50 patients after long-term remission (meanGS.E.M., 16G1.2 years) of acromegaly were included in this study. Patients completed the drawing test (two retrospective drawings of their body perception before acromegaly and during the active phase of acromegaly, and one drawing on the current condition after long-term remission), Illness Perception Questionnaire-Revised, Physical Symptom Checklist, EuroQoL-5D, and AcroQoL. Results: Patients perceived a dramatic change in body size during the active state of the disease compared with the healthy state before the awareness of acromegaly. Patients reported that their body did not completely return to the original proportions after long-term remission. In addition, larger drawings indicated more negative consequences (P!0.05), a higher score on emotional representations (P!0.05), and more perceived symptoms that were attributed to acromegaly (P!0.01). Larger drawings also indicated more impaired QoL, especially disease-specific QoL (all P!0.05). Conclusion: There are strong correlations among the drawing test, illness perceptions, and QoL. The drawing test appears to be a novel and relatively easy tool to assess the perception of patients after long-term remission of acromegaly. The assessment of drawings may enable health care providers to appreciate the perceptions of patients with long-term remission of acromegaly, and enable discussion of symptoms and remission.

Major obstetric hemorrhage: a follow-up survey on quality of life of women and their partners

“…In the hysterectomy group, the score dropped from 5.9 to 2.6. These results are consistent with results from other drawing studies in that the size of the drawn organs is reduced after the upsetting event has taken place [21,[29][30][31][32][33]. The intraclass correlation coefficient between G. S. and L. R. on Drawing 1 and Drawing 2 was 0.82 and 0.66, respectively.…”

“…A relatively new method to assess illness perceptions is through patients' drawings of affected organ(s) [21,[28][29][30][31][32][33]. It has the advantage of circumventing possible social desirability issues and provides a unique and value free illustration of a person's illness perceptions [31].…”

“…Mean scores of drawing 1 and drawing 2 were calculated and compared. This approach to illness perceptions scoring has been described earlier by Tiemensma et al [31,33].…”

Morphometric changes correlate with poor psychological outcomes in patients with acromegaly

“…Several studies have demonstrated an increased prevalence of psychopathology, cognitive dysfunction and personality changes both in patients with active acromegaly (4,5,6,7) as well as those in remission (8). In addition, patients with acromegaly have a negative self-perception based on the drawing test (9), a novel technique that can illustrate their notions in a more concrete and specific way than questionnaires or structured interviews limited by operating along predefined dimensions (10,11). The drawings can also be useful in identifying idiosyncratic beliefs, which can play a critical role in illness perceptions, medication adherence, self-management skills and quality of life (QoL) (12).…”

Using drawings to explore patients’ perceptions of their illness: a scoping review

“…Drawing size also represented the clinical severity of heart failure59 and Cushing’s syndrome 60. While there were no clear associations between drawings and illness perceptions or quality of life in patients with long-term remission of Cushing’s syndrome,60 strong correlations between larger sized drawings and impaired quality of life were identified in patients with long-term remission of acromegaly 28. Also, quality of life was negatively associated with the illustration of emotions for patients with vestibular schwannoma29 and was related to images of recovery for participants who experienced emergency embolization in postpartum hemorrhage 61.…”