Stephen L. Ristvedt

Patient Preferences for CT Colonography, Conventional Colonoscopy, and Bowel Preparation

Abstract Objectives The aim of this study was to determine patient pre-examination expectations and postexamination appraisals for CT colonography, conventional colonoscopy and bowel preparation. Methods Prospective evaluation of 120 patients at defined risk for colorectal neoplasia was performed with CT colonography followed by colonoscopy on the same day. Subjects were stratified by age and sex (67 women and 53 men) and were randomized to receive either manual air (n = 61) or CO2 (n = 59) insufflation during CT colonography. Patients’ expectations were assessed just before the two examinations, and appraisals were assessed 2 to 3 days afterward regarding pain/discomfort, embarrassment, difficulty, overall assessment, preference for future testing, and bowel preparation. Results No significant differences were found in appraisals of manual air versus CO2 insufflation techniques. For both CT colonography and colonoscopy, patients’ appraisals after the procedure were significantly more positive than prior expectations. Patients expressed more favorable appraisals of colonoscopy for pain (p Conclusions Overall appraisals were similar and positive for both CT colonography and colonoscopy, with less favorable appraisals of the bowel preparation. Most patients stated that they would prefer CT for future evaluation.

Delayed treatment for rectal cancer

PURPOSEReports of the relationship between length of delay before diagnosis of rectal cancer and stage of the disease have been mixed. The present study documented the magnitude and medical ramifications of delay in diagnosing rectal cancer.METHODSOne hundred twenty patients who had been recently diagnosed with rectal cancer provided information regarding history of symptoms and initial perceptions of those symptoms. Patients also estimated the time elapsed from onset of symptoms until their first consultation with a physician, as well as time elapsed from consultation until the diagnosis of rectal cancer was made. Stage information was gathered from patient charts.RESULTSFor 106 of the patients, the first sign of rectal cancer was in the form of symptoms, and the most common first symptom was rectal bleeding. For the remaining 14 patients, their cancer was first discovered through routine examination. Over 75 percent of patients with symptoms did not initially believe that they were caused by cancer or any other serious problem, and over 50 percent attributed their symptoms to hemorrhoids. There was a clear trend, albeit statistically nonsignificant, toward worsening disease with longer delays. Median delay times in weeks were Stage I (10.0 weeks), Stage II (14.0 weeks), Stage III (18.5 weeks), and Stage IV (26.0 weeks).CONCLUSIONSDelayed diagnosis for rectal cancer remains a significant problem, with instances of delay attributable to both patient and physician. Delayed diagnosis can result in more serious disease and, when attributable to the physician, can result in damaged trust and sometimes legal action.

Trait anxiety as an independent predictor of poor health-related quality of life and post-traumatic stress symptoms in rectal cancer

OBJECTIVES To determine the influence of trait anxiety on patient reports of health-related quality of life (HRQoL) and post-traumatic stress symptoms (PTSS) in a sample of rectal cancer survivors. DESIGN Eighty patients who had been diagnosed with rectal cancer were assessed at two points in time in a longitudinal study. METHODS At Time 1, soon after initial treatment, participants completed the State-Trait Anxiety Inventory and the Temperament and Character Inventory Harm Avoidance scale, which were combined into a composite measure of trait anxiety. At Time 2, 2-5 years following Time 1, participants were assessed for HRQoL using the Functional Assessment of Cancer Therapy-Colorectal scale (FACT-C) and for PTSS using the Impact of Event Scale-Revised (IES-R). RESULTS HRQoL and PTSS were generally favourable on average, although many of the patients reported faring poorly. Higher levels of trait anxiety were predictive of poorer scores on all of the FACT-C and the IES-R total and subscale measures. More severe faecal incontinence was associated with poorer scores on the FACT Emotional well-being subscale, the FACT-Colorectal Cancer Scale, and all of the IES-R scales. Males were more likely than females to have poorer scores on the FACT Social well-being subscale, and those patients who were further out from active treatment had more favourable scores on the FACT-Colorectal Cancer Scale. The presence of a colostomy did not impact HRQoL or PTSS. CONCLUSION Trait anxiety had a significant influence on HRQoL and PTSS several years following diagnosis and treatment of rectal cancer.

The use of pharmacologic pain sensitization in the treatment of repetitive hair-pulling.

A significant problem for many individuals who engage in repetitive hair-pulling is the fact that they experience no discomfort associated with their behavior, and can thus carry on with hair-pulling outside of conscious awareness. The present case study was an attempt to address this problem through the use of a commercially available topical cream which enhances pain sensitivity. A 38-yr-old female applied the cream daily to two affected areas on her scalp. The increased pain sensitization, in conjunction with the habit reversal technique, resulted in markedly decreased hair-pulling.

The Impact of Physicians’ Health Beliefs on Colorectal Cancer Screening Practices

Primary-care physicians have significant influence on whether or not their patients participate in colorectal cancer screening (CRCS). This study explored the association of physicians’ personal health beliefs, medical history, and personal participation in CRCS with their practice patterns regarding CRCS. Perceived personal risk for colorectal cancer (CRC) was associated with compliance with American Cancer Society (ACS) guidelines for CRCS for their patients (P = 0.03). For physicians at low risk for CRC, their perception of the seriousness of CRC was significantly associated with compliance (P = 0.047). For physicians at, at least, average risk for CRC, personal participation in CRCS did not predict whether they recommend CRCS to their patients. Efforts to improve physicians’ understanding about their own susceptibility to CRC and the seriousness of CRC may improve their compliance with making recommendations for CRCS to their patients and may improve their participation in CRCS.

Identification of cues associated with compulsive, bulimic, and hair-pulling symptoms

Subjects with obsessive compulsive disorder, bulimia nervosa, or trichotillomania selected cues which elicited or worsened their symptoms from a 339 item list. Principal components analysis suggested a four-component solution. Each disorder was significantly associated with one of these components. Diagnostic assignment based on component scores yielded 85% correct classification. The diagnostic groups did not differ on a negative feeling state component. The results indicate that both disorder-specific and generic components exist. This approach has potential for defining clinical subtypes, studying the interaction of feeling states and environmental cues in evoking symptoms, and designing treatment strategies.

Sex differences in responding to rectal cancer symptoms

Many people who develop cancer symptoms wait inordinate amounts of time before seeking medical attention. Studies have found that symptom appraisal time–the time that passes before the individual concludes that their symptoms could be serious–accounts for most of the total delay time across subjects. It is thus important to understand the individual characteristics associated with slow recognition of dangerous symptoms. In this study, 62 patients (38 males) recently diagnosed with rectal cancer answered questions regarding the development of symptoms as well as their decisions and behaviors prior to seeking help. One subgroup of patients–males with the lowest scores on a measure of trait anxiety–took significantly longer to recognize the seriousness of their symptoms as compared to all other patients. This finding is discussed in the context of recent studies where the interaction of sex and negative affect is related to symptom reporting and other health-related behaviors.

Endogenous testosterone levels are associated with assessments of unfavourable health information

The purpose of this study was to investigate whether participants’ assessments of unfavourable health information are associated with individual differences in basal testosterone. Testosterone has previously been related to assessments of threat in social and other domains. 52 undergraduate males were tested for a minor, fictitious medical condition thioamine acetylase deficiency (‘TAA deficiency’) in a paradigm that was developed to examine the thoughts and behaviours of individuals who have just received unfavourable medical news. In a variation on the classic paradigm, all participants were told that they had ‘TAA deficiency,’ after which they rated the seriousness and prevalence of that condition as well as 19 other actual conditions. Higher testosterone levels were significantly correlated with lower estimates of both the seriousness and prevalence of TAA deficiency as well as lower median seriousness and prevalence estimates of the 19 actual conditions. Findings are discussed in light of current research in the field of behavioural endocrinology. This study provides preliminary evidence that individual differences in assessments of threatening health information may be associated with neurobiological characteristics.