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A patient and physician survey of fibromyalgia across Latin America and Europe.

ABSTRACT: BACKGROUND: Patients and physicians from three Latin American (LA) and six European countries were surveyed in order to describe differences in journey to diagnosis, impact, and management of fibromyalgia (FM). METHODS: 900 patients (300 LA; 600 Europe) and 1824 physicians (604 LA; 1220 Europe) were surveyed between October-December 2010 (LA) and February-April 2008 (Europe). Patients and physicians (GP or specialists) completed separate questionnaires, on symptoms, impact, and FM management. Interviews were conducted in local languages. Appropriate rating scales were used throughout. Data were analyzed using cross-tabulations and descriptive statistics. Significance was determined at P<0.05 (indicated by *). RESULTS: In LA versus Europe, patients reported having FM symptoms for longer (100.8 vs. 83.7* months), and taking longer to be diagnosed (42.3 vs. 31.1* months). FM was characterized by multiple symptoms (11.2 vs. 6.9), but more LA patients reported 14 common symptoms*, and rated pain higher on 11-point scale (8.0 vs. 7.2*). LA patients were taking fewer medications (3.3 vs. 4.0). Patients from both regions found common symptoms very/extremely disruptive to their quality of life, but symptoms impacted daily living and ability to work more significantly in LA. Physicians (GPs or specialists) from LA more often considered problems sleeping*, difficulty concentrating*, anxiety*, depression*, numbness/tingling*, and leg cramps* very/extremely disruptive vs. European physicians. Despite headache, heightened sensitivity to touch, difficulty concentrating, and joint pain being experienced by ?50% of patients from both regions, <15% of PCPs or specialists considered these typical FM symptoms. Patients also considered 12/14 symptoms more disruptive than PCPs or specialists in the same region. However, a higher proportion of PCPs or specialists considered FM to have a strong/very strong impact on aspects of daily living vs. patients within the same region. CONCLUSIONS: Patient- and physician-rated disease perception and impact was often higher in LA than in Europe. Patient and physician perspective concerning FM impact and disruption were often misaligned within the same region. Our observations may be representative of cultural differences in stoicism, expression, beliefs, and attitudes to pain perception and management. Better understanding of these complexities could help targeted educational/training programs incorporating cultural differences, to improve chronic care.

SUBMITTER: Clark P

PROVIDER: S-EPMC3689629 | biostudies-other | 2013

REPOSITORIES: biostudies-other

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A patient and physician survey of fibromyalgia across Latin America and Europe.

Clark Patricia P Paiva Eduardo S ES Ginovker Anna A Salomón Patricia Arline PA

BMC musculoskeletal disorders 20130614

<h4>Background</h4>Patients and physicians from three Latin American (LA) and six European countries were surveyed in order to describe differences in journey to diagnosis, impact, and management of fibromyalgia (FM).<h4>Methods</h4>900 patients (300 LA; 600 Europe) and 1824 physicians (604 LA; 1220 Europe) were surveyed between October-December 2010 (LA) and February-April 2008 (Europe). Patients and physicians (GP or specialists) completed separate questionnaires, on symptoms, impact, and FM m ...[more]

PMID: 23767857

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Project description:ImportanceThe World Health Organization (WHO) designates early integration of palliative care as an ethical responsibility in the treatment of children with serious illness. Although structural barriers may influence provision of pediatric palliative care (PPC) for children with cancer in resource-limited settings, underlying physician perceptions may also impede early integration of PPC in cancer care.ObjectiveTo investigate perceptions among physicians in Latin America about the integration of palliative care for children with cancer.Design, setting, and participantsThis survey study used the Assessing Doctors' Attitudes on Palliative Treatment (ADAPT) survey, which was developed for physicians who care for children with cancer and was initially distributed in Eurasia. The survey was modified for use in Latin America, including translation into Spanish and adaptation for cultural context. The survey was distributed between August 21, 2020, and January 31, 2021, to physicians treating children with cancer in 17 Latin American countries. Each country had a specific survey distribution method based on guidance of local experts.Main outcomes and measuresThe ADAPT survey evaluated physicians' understanding of palliative care principles, comfort in addressing patient and family suffering, and identification of barriers to PPC integration for children with cancer. Univariate and multivariable linear regression analyses were used to assess factors associated with physicians' knowledge about and comfort with PPC practice and whether independent physician variables were associated with survey response alignment with WHO guidance on PPC. Open-ended questions were analyzed qualitatively to supplement the quantitative data.ResultsA total of 874 physicians from 17 countries participated, with an overall response rate of 39.9% (874 of 2193) and a median country response rate of 51.4% (range, 23.7%-100%). Most respondents were aged 35 years or older (577 [66.0%]), and 594 (68.0%) identified as female. Most physicians (486 [55.6%]) had no formal PPC training, and 303 (34.7%) had no access to PPC experts for consultation. Physician perspectives on PPC were generally aligned with WHO guidance (mean [SD] alignment, 83.0% [14.1%]; range among respondents, 24.0%-100%). However, only 438 respondents (50.1%) felt comfortable addressing physical symptoms of patients receiving PPC, 295 (33.8%) felt comfortable addressing emotional symptoms, and 216 (24.7%) felt comfortable addressing grief and bereavement needs of the patient's family. A total of 829 participants (94.8%) desired further education and training in PPC.Conclusion and relevanceAlthough physicians' perspectives aligned well with WHO guidance for PPC, this survey study identified opportunities for improving physician training in symptom management and emotional support for children with cancer and their families. These findings may inform the development of targeted interventions to improve the quality of PPC for children with cancer in Latin America.

Project description:BackgroundStudies and meta-analyses found individual, meso and micro-social factors that are associated with individual well-being, as well as a positive socio-emotional climate or collective well-being.AimThis article simultaneously studies and examines these factors of well-being.MethodWell-Being is measured as a dependent variable at the individual and collective level, as well as the predictors, in three cross-sectional and one longitudinal studies. Education and social intervention workers (N = 1300, K = 80) from Chile, Spain and Uruguay participate; a subsample of educators (k = 1, n = 37) from the south central Chile and from Chile, Uruguay and Spain (n = 1149); workers from organizations in Latin America and Southern Europe, military cadets from Argentina (N < 1000); and teams (K = 14) from Spanish companies.ResultsIndividual and collective well-being indicators were related, suggesting that the emotional climate as a context improves personal well-being. Individual factors (emotional creativity and openness and universalism values), psychosocial factors (low stress, control over work and social support supervisors and peers) were positively associated with personal well-being in education and social intervention context. Organizational dynamic or transformational culture is directly and indirectly associated with individual well-being through previously described psychosocial factors. Group processes such as internal communication and safe participation, task orientation or climate of excellence as well as leadership style that reinforces participation and belonging, were positively associated with collective well-being in labor and military context and predict team work socio-emotional climate in a longitudinal study- but were unrelated to individual well-being. Transformational leadership plays a mediating role between functional factors and social-emotional climate in work teams. Organizational role autonomy, functional organizational leadership, integration and resources were associated with collective well-being in organizations. Organizational leadership moderates the relationship between task orientation and collective well-being in military context.ConclusionIndividual and microsocial factors influence personal well-being. Meso level factors favorable to well-being through processes which reinforce social belonging, influence directly collective well-being and indirectly personal well-being. Leadership that reinforces participation and belonging play a central role for emotional climate. Stress and emotional climate playing an important pivotal role for psychological well-being.

Project description:BACKGROUND: Fibromyalgia (FM) is a condition characterized by widespread pain and is estimated to affect 0.5-5% of the general population. Historically, it has been classified as a rheumatologic disorder, but patients consult physicians from a variety of specialties in seeking diagnosis and ultimately treatment. Patients report considerable delay in receiving a diagnosis after initial presentation, suggesting diagnosis and management of FM might be a challenge to physicians. METHODS: A questionnaire survey of 1622 physicians in six European countries, Mexico and South Korea was conducted. Specialties surveyed included primary care physicians (PCPs; n=809) and equal numbers of rheumatologists, neurologists, psychiatrists and pain specialists. RESULTS: The sample included experienced doctors, with an expected clinical caseload for their specialty. Most (>80%) had seen a patient with FM in the last 2 years. Overall, 53% of physicians reported difficulty with diagnosing FM, 54% reported their training in FM was inadequate, and 32% considered themselves not knowledgeable about FM. Awareness of American College of Rheumatology classification criteria ranged from 32% for psychiatrists to 83% for rheumatologists. Sixty-four percent agreed patients found it difficult to communicate FM symptoms, and 79% said they needed to spend more time to identify FM. Thirty-eight percent were not confident in recognizing the symptoms of FM, and 48% were not confident in differentiating FM from conditions with similar symptoms. Thirty-seven percent were not confident developing an FM treatment plan, and 37% were not confident managing FM patients long-term. In general, rheumatologists reported least difficulties/greatest confidence, and PCPs and psychiatrists reported greatest difficulties/least confidence. CONCLUSIONS: Diagnosis and managing FM is challenging for physicians, especially PCPs and psychiatrists, but other specialties, including rheumatologists, also express difficulties. Improved training in FM and initiatives to improve patient-doctor communication are needed and may help the management of this condition.

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Dataset Information

A patient and physician survey of fibromyalgia across Latin America and Europe.

Publications

A patient and physician survey of fibromyalgia across Latin America and Europe.

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