Personality and the physician-patient relationship as predictors of quality of life of cardiac patients after rehabilitation

Abstract

BackgroundNumerous studies document the influence of psychosocial variables on the course of coronary heart disease. This study examines the influence of personality traits (trait anger, cynicism) and aspects of the physician-patient relationship (promoting patient participation by the physician, active communication behavior of the patient, trust in the physician) on the health related quality of life (HRQOL) of cardiac patients after rehabilitation.MethodsN = 331 patients with chronic ischemic heart disease were surveyed using questionnaires at two time points (beginning and end of 3-weeks inpatient rehabilitation). In addition, characteristics of the disease and cardiac risk factors were provided by the physician. HRQOL was measured using a total of six scales and three instruments: SF-12, MacNew questionnaire, and SAQ. Hierarchical regression analyses were carried out to predict HRQOL after rehabilitation, in which the baseline values of HRQOL, sociodemographic variables, characteristics of the disease and risk factors, personality traits, and finally the aspects of the physician-patient relationship were included stepwise. As a number of variables were used for the regression models, multiple imputation was conducted.ResultsThe baseline values explain most of the variance (42%-60%). After controlling the baseline values, the sociodemographic variables explain up to 5% incremental variance of HRQOL, with income being the most important predictor. The characteristics of the disease and cardiac risk factors explain between 0.4% and 3.8% incremental variance, however, variance increase is often not significant. The personality traits added in the fourth step explain up to 2% additional variance; trait anger is a significant predictor of HRQOL in three of the six scales. The features of the physician-patient relationship included in the last step lead to a significant increase in explained variance (between 1.3% and 3.9%) for all six scales. In particular, the physician's promotion of patient participation has a significant influence. The overall explanation of variance for HRQOL is between 50% and 64%.ConclusionsLow income, a high level of trait anger, and low patient participation are significant risk factors, even if a number of potential confounders are adjusted. Research is needed that shows which causal pathway low income functions on and what therapies in rehabilitation can mitigate the disadvantage of persons with a high level of trait anger. The providers should implement measures to actively integrate rehabilitation patients in treatment (e.g. encourage them to ask questions).

Narrative review of health‐related quality of life and its predictors among patients with coronary heart disease

“…There appears to be sufficient evidence that socioeconomic status (SES), as measured by education, income and occupation, is a major predictive factor of HRQoL . Farin and Meder found that individuals with higher SES generally reported higher HRQoL and better health outcomes when compared with individuals with lower SES.…”

“…There appears to be sufficient evidence that socioeconomic status (SES), as measured by education, income and occupation, is a major predictive factor of HRQoL . Farin and Meder found that individuals with higher SES generally reported higher HRQoL and better health outcomes when compared with individuals with lower SES. Such a phenomenon is probably due to the increased accessibility and affordability of health‐care services for higher‐SES individuals, which ultimately improves their health outcomes .…”

HIV/AIDS patients’ medical and psychosocial needs in the era of HAART: A cross-sectional study among HIV/AIDS patients receiving HAART in Yunnan, China

“…The positive association between better physician-patient relationship and patients’ health related quality of life has been reported in many domains of health including HIV/AIDS (Beach, Keruly, & Moore, 2006; Farin & Meder, 2010; Farin & Nagl, 2012; Preau et al, 2004; Shanafelt et al, 2009). However, it seems that this key component of patient care was not fully utilized in China.…”

Kommunikationspräferenzen chronischer Rückenschmerzpatienten in der medizinischen Rehabilitation

“…Die Berücksichtigung von Patientenpräferen-zen erleichtert dem Behandler die Erfüllung der kommunikationsbezogenen Wünsche und somit die Herstellung eines kongruenten Gesprächsklimas, von dem angenommen wird, dass es in positivem Zusammenhang mit dem Behandlungserfolg steht (erste Ergebnisse in [12]). Farin u. Meder [8], Farin et al [10] sowie Farin u. Nagl (eingereichte Arbeit, [9]) zeigen außerdem, dass bei chronisch Kranken in der Rehabilitation die Patient-Behandler-Beziehung bedeutsamen Einfluss auf Verbesserungen der Lebensqualität nach der Rehabilitation besitzt.…”