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Original Research: CRITICAL CARE MEDICINE |

Factors Associated With Illness Perception Among Critically Ill Patients and Surrogates

Dee Ford, MD, MSc, FCCP; Jane Zapka, ScD; Mulugeta Gebregziabher, PhD; Chengwu Yang, MD; Katherine Sterba, PhD
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Ford), and the Division of Biostatistics, Bioinformatics, and Epidemiology (Drs Zapka, Gebregziabher, Yang, and Sterba), Medical University of South Carolina, Charleston, SC.

Correspondence to: Dee W. Ford, MD, MSc, FCCP, Medical University of South Carolina, 96 Jonathan Lucas Dr, 812-CSB, Charleston, SC 29425; e-mail: fordd@musc.edu


Funding/Support: This study was funded by the Agency for Healthcare Research and Quality EXCEED [Grant PO11HS10871] and the South Carolina Resource Centers for Minority Aging Research.

For editorial comment see page 8

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(1):59-67. doi:10.1378/chest.09-2124
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Background:  We investigated illness perceptions among critically ill patients or their surrogates in a university medical ICU using a prospective survey. We hypothesized that these would vary by demographic, personal, and clinical measures.

Methods:  Patients (n = 23) or their surrogates (n = 77) were recruited. The Illness Perception Questionnaire-Revised (IPQ-R) measured six domains of illness perception: timeline-acute/chronic, consequences, emotional impact, personal control, treatment efficacy, and illness comprehension. Multiple variable linear regression models were developed with IPQ-R scores as the outcomes.

Results:  African Americans tended to perceive the illness as less enduring and reported more confidence in treatment efficacy (P < .01 for each). They also tended to report the illness as less serious, having less emotional impact, and having greater personal control (P = .0002 for each). Conversely, African Americans reported lower illness comprehension (P = .002). Faith/religion was associated with positive illness perceptions, including less concern regarding consequences (P = .02), less emotional impact (P = .03), and more confidence in treatment efficacy (P < .01). Lower patient quality of life (QOL) precritical illness was associated with negative perceptions, including greater concern about illness duration and consequences as well as perception of less personal control and less confidence in treatment efficacy (P < .01 for each). These variables were independently associated with illness perceptions after controlling for race, faith/religion, and survival to hospital discharge, whereas clinical measures were not.

Conclusions:  Illness perceptions among critically ill patients and surrogates are influenced by patient/surrogate factors, including race, faith, and precritical illness QOL, rather than clinical measures. Clinicians should recognize the variability in illness perceptions and the possible implications for patient/surrogate communication.

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