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Friday, March 18, 2011
Wednesday, March 16, 2011
Recent NYT Article re Patient State of Mind and treatment success
Optimistic Heart Patients Live Longer
By TARA PARKER-POPEHeart patients who were optimistic about their treatment and recovery were more likely to be alive after 15 years than patients with similar disease but lower expectations, new research shows.
Researchers at Duke University Medical Center tracked the psychological and physical health of more than 2,800 patients who had undergone coronary angiography, a procedure used to monitor blood flow to the heart. The patients, all of whom had been diagnosed with heart disease, were given an 18-item questionnaire to assess how much or little optimism they felt about their diagnosis and recovery.
Patients with more optimism, for example, might agree with the statement “My heart condition will have little effect on my ability to work.’’ A less optimistic patient might be more likely to agree with the statement “I doubt I will ever fully recover from my heart problems.’’
Over the next 15 years, more than 1,600 of the study patients had died, and about half the deaths were related to heart disease. The researchers found that optimism was a strong predictor of overall survival. Patients who scored low on optimism tests were 30 percent more likely to die during the study period, even after the researchers controlled for factors like depression and severity of disease.
The results were the same whether the researchers compared death by all causes or just death caused by heart disease. The findings were were published Monday in the The Archives of Internal Medicine.
The study’s lead author, John C. Barefoot, professor emeritus in the department of psychiatry at Duke, said the findings are important because they show that a patient’s attitude about an illness is not only associated with short-term recovery but overall health over the long term. The researchers noted that the level of optimism displayed by patients didn’t have to be extreme to have an effect. The benefit of optimism was calculated by comparing moderately optimistic patients, who scored in the 75th percentile, to moderately pessimistic patients, who were in the 25th percentile of scoring.
“It’s not unrealistic, unbridled optimism,” said Dr. Barefoot. “You’ve got to temper your optimisms with some realism, but you can have both.”
Dr. Barefoot said the benefit of optimism may be that an optimistic patient is more likely to pay attention to doctors, take medicine regularly and adopt long-term lifestyle changes, compared with a pessimistic patient. Or it may be that optimism helps patients better manage stress and avoid the health consequences associated with stress and worry.
“If you get depressed and feel a lot of stress and worry, then that exacerbates your problems,’’ said Dr. Barefoot. “Looking at these patients, the impression I get is that they are determined. They are thinking positively about getting things done.’’
In an accompanying editorial, Dr. Robert Gramling and Dr. Ronald Epstein said the findings suggest more research is needed into the effect of optimism on health.
“The degrees of benefit observed in these studies suggest that optimism is a powerful drug that compares favorably with highly effective medical therapies,’’ the doctors wrote. “Given the magnitude of effect that optimism has on heart heath and survival, more research is needed to unveil the pathways underlying this phenomenon.”
Dr. Barefoot noted that the next step for researchers is to determine whether simple interventions aimed at boosting optimism in patients can make a meaningful difference in long-term health.
“There are a couple of promising studies out there that show you can do relatively brief counseling in the hospital with people and have a positive effect at least on their ability to return to work and function normally when they get out of the hospital,” said Dr. Barefoot. “Whether that will translate into longevity after treatment we don’t know, but we ought to try and find out.”
http://well.blogs.nytimes.com/2011/02/28/optimistic-heart-patients-live-longer/
A Narrative
Please meet Allison. She is a HR specialist for an elite law firm on Wall Street and she is a fortysomething single mother to two sons. She works long hours during the law school recruiting season but typically works a 40 hour work week. Her father is suffering from Parkinson’s disease and she is his primary caregiver. She has siblings that live in other regions of the country and support the care of her father financially, but she is the one that makes the major decisions. She is a savvy internet user and in constantly learning of breakthroughs about the disease. She is trying to get her dad into a clinical trial because his health insurance refuses to pay for medications and treatments that they deem “experimental”.
She has experienced doctors who only want to use Western medicine, who think that their way is the only way to treat the disease and who do not use language the average person can follow. She wants to get the best medical care for her father while making educated decisions and is frustrated at her inability to get neutral information from a third party. She has asked around and has received a recommendation to go to a self-care research facility to get the answers to her questions.
The self-care research facility is a collective that was created so that patients and their families could research illnesses and their treatments in a supportive environment. This facility was clearly needed as more and more studies conducted showed a positive correlation between patients involved in their treatment plan and the success rate of said plan. The facility believes that a patient empowered with knowledge and actively involved in his or her treatment will more likely comply with the plan of action and has a more positive outlook on its success rate. The more research Allison does on the facility, the more she feels that she can make informed decisions about her father’s care.
At her first visit, Allison goes to the research library and does research on Parkinson’s. She researches its history, the typical treatment and the new breakthroughs that are being written about in current periodicals. Although she feels like she has a more comprehensive understanding about her father’s illness, she feels that the research center so far is just a medical library for laypeople. It has been very helpful however Allison is starting to feel that her expectations were too high. As she leaves, she stops by the information desk to sign up for a workshop.
Allison was expecting to find one or two workshops in the next month relating to Parkinson’s disease but when she started to read the listings, she realized that there was not only an extensive class list for Parkinson’s related issues, there were also workshops related to natural medicine, being your parent’s guardian, illness related stress and a host of other topics she could benefit learning about. There was even programming for patients, so that her father could attend learning workshops and support groups. She began to realize that she had stumbled upon a support system that was better equipped to understand her situation than well-meaning friends and family.
Her attendance to the workshops became a weekly thing. Through FMLA, she was able to work out a work schedule where she worked earlier each day so she could have Friday afternoons off to attend adult child caretaker support group sessions and take her father to his support group as well. It took some convincing, but after a meetings, her father began looking forward to it. It was his way of interacting with people who understood what he was going through. Members of the group could relate and didn’t pity him; they didn’t give him the sad eyes like so many people in his life did when they learned of his illness. Allison and her father even bonded during some of the workshops they took together. It gave a greater insight into the others’ point of view and lead to a more open dialog.
Allison and her dad have been able to make key changes in his lifestyle that will help lessen the effects of his disease. Along with his doctor directed physical therapy, her dad has introduced other exercise routines into his schedule such as Tai Chi and Yoga, which he has learned can improve the range of mobility. His diet had always been a concern for Allison and a source of disagreement between the two but has become less of a fight now that he has had more control ove the meals that he eats. After doing research that initial day, Allison approached her father’s doctor about introducing Coenzyme Q10 into his treatment. Although the doctor said that it has not been proven to be an effective treatment, he believed that it did work. He typically didn’t suggest that course of action because he knows that insurance companies don’t always pay for the treatment but in this case, he thought it would be beneficial.
The use of Coenzyme Q10 became a problem with the insurance company. But armed with knowledge from the center’s healthcare advocate, Allison was able to challenge the insurance company’s ruling and get coverage for the supplement. She was also able to meet with a family law attorney at the center and put a structure in place with her siblings to care for her father’s estate and set up a healthcare proxy and power of attorney. Although her father’s quality of life has improved since attending the center, she wanted to have everything set up when the disease eventually progresses. Her father, never one to discuss his death, realized that he needed to take responsibility and created a living will and trust.
The self-care center was able to help Allison and her family better manage a situation that more and more people are facing as their parents get older and they become caregivers. But the center is in existence to help patients and their caregivers in all instances and should be used in conjunction with their medical professionals’ recommendations. It is hoped to be the beginning of collaborative treatment between patients and doctors for positive and successful treatment plans.
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