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Patient Perceptions and Illness

By February 20, 2012Commentary

It has become increasingly apparent, at least in regard to health, that the mind is a powerful thing, more powerful than commonly understood.  Placebo and nocebo effects, which can intensify positive and negative outcomes, are now accepted as forces to be accounted for in patient treatment.  But a patient’s general framework of beliefs about their disease provides great assistance in understanding how those beliefs may affect the course of treatment and outcomes.  A review article in Current Directions in Psychological Science summarizes research in this area.   (Psych. Article)  The major components of a patient’s cognitive representation of his or her disease include how the illness was caused, how long it will last, what the consequences for the patient’s life are, the symptoms that are part of the illness and how the illness will be controlled or cured.  Patients with the same disease and in similar circumstances can build very different illness perceptions, and more importantly, can have very different perceptions and beliefs than do their treating physicians.  There are now standardized survey instruments to help understand a patient’s cognitive disease model, which can help identify patients who may need an intervention.

These patient illness perceptions have been shown to be related to a variety of health outcomes.  One area of research is how perception models change in regard to new diagnostic information.  As might be expected, patients with positive diagnostic data tend to see a lessening of health concern, but also tend to attribute the positive result to some personal action.  Patients with a disease diagnosis as a result of a test tend to strengthen their beliefs that treatment will control or cure it.   Four major outcomes have been examined:  emotional distress, recovery, survival and treatment adherence.  As an example, heart attack patients who believe their illness will last a long time are more likely to develop depression and to have other poor outcomes, including greater mortality.   Treatment adherence is a particularly important outcome, and patients who understand that their own behavior may have been a factor in the development of the disease are more likely to be adherent to behavioral change therapies.   Changing perceptions to help improve outcomes is now an important aspect of this area of research.

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