M. Locadia

Self-reported adherence is more predictive of virological treatment response among patients with a lower tendency towards socially desirable responding.

BACKGROUND Self-report is the most commonly used measure of adherence to highly active antiretroviral therapy, but typically shows weaker associations with virological treatment outcome than more objective adherence assessment methods. Socially desirable responding might hamper the validity of self-reported adherence. We investigated whether stratifying patients according to their socially desirable response set might improve the prediction of virological treatment response by self-reported adherence. METHODS Patients enrolled in the focus group of the Dutch national cohort ATHENA completed a social desirability scale, four self-report adherence questions, and had their plasma HIV type-1 (HIV-1) RNA concentrations measured. We calculated odds ratios and 95% confidence intervals for self-reported non-adherence to predict HIV-1 RNA>50 copies/ml among patients with a lower or a higher tendency towards socially desirable responding. RESULTS A total of 331 patients were included. Self-reported non-adherence was significantly predictive of HIV-1 RNA>50 copies/ml on three out of four questions among patients with lower socially desirable responding (n=198). Self-reported non-adherence did not predict HIV-1 RNA>50 copies/ml among patients with higher socially desirable responding (n=132). CONCLUSIONS Stratifying patients according to their socially desirable response set improved the prediction of virological treatment response by self-reported adherence. This finding emphasizes the importance of discussing medication adherence with patients in a non-threatening and non-judgemental way that normalizes non-adherence in order to reduce socially desirable responding.

A comparison of 3 valuation methods for temporary health states in patients treated with oral anticoagulants.

Background. The application of the time tradeoff (TTO) method in temporary health states may lead to less valid results because an unrealistic scenario is presented to patients. The chained TTO has been proposed to solve this problem. Objectives. To compare a chained TTO method with a conventional TTO method in the valuation of temporary health states, in terms of consistency and reliability. To compare both TTO methods with direct rating. Patients and Methods . Eighty-four patients treated with oral anticoagulants were interviewed twice. During the 1st interview, values for 5 temporary health states were obtained with a rank ordering procedure, direct rating, and the chained TTO method. During the 2nd interview, either the 1st interview was repeated (n = 30) or health state values were obtained with the conventional TTO method (n = 54). Consistency was assessed by comparing the 3 valuation methods with the rank ordering procedure. Generalizability theory was used to assess reliability. Results . The 3 methods produced significantly different valuations of health states. Chained TTO values were higher than values obtained with direct rating and the conventional TTO. Consistency and reliability did not differ across the 3 methods. Conclusion. The authors found no evidence for a difference in consistency and reliability between the chained TTO method and the conventional TTO method in the valuation of temporary health states. As direct rating is simpler to administer than both TTO methods, one could consider using direct ratings for the valuation of temporary health states. Biases associated with the conventional and the chained TTO method are discussed.

Kwaliteit van leven

Het hebben van een ziekte en het ondergaan van een behandeling heeft vaak grote gevolgen voor het dagelijks leven van patienten. In navolging van de definitie van gezondheid van de World Health Organization (WHO), wordt het geheel van lichamelijke, psychische en sociale gevolgen van een ziekte en/of behandeling, zoals die door de patient worden ervaren, aangeduid met de term ‘kwaliteit van leven’. Tot de lichamelijke gevolgen behoren de hinder die de patient heeft van lichamelijke klachten en de mate waarin de patient beperkt is in de uitvoering van dagelijkse handelingen. Tot de psychische gevolgen behoren psychische klachten zoals boosheid, angst en depressie maar ook gevoelens van welbevinden. Daarnaast omvatten psychische problemen klachten die de patient ervaart bij het cognitieve functioneren, zoals concentratie- en geheugenstoornissen. De sociale gevolgen verwijzen naar mogelijke veranderingen in persoonlijke relaties, sociale activiteiten en maatschappelijke participatie. Met behulp van de onderstaande casus wordt geillustreerd hoe het doormaken van een hersenbloeding de drie domeinen van kwaliteit van leven op verschillende manieren kan beinvloeden.