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A Video-Intervention to Improve Clinician Attitudes Toward Patients with Sickle Cell Disease: The Results of a Randomized Experiment

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ABSTRACT

BACKGROUND

Clinician attitudes toward patients are associated with variability in the quality of health care. Attitudes are typically considered difficult to change, and few interventions have attempted to do so. Negative attitudes toward adults with sickle cell disease have been identified as an important barrier to the receipt of appropriate pain management for this patient population.

OBJECTIVE

To test the effect of a video-intervention designed to improve clinician attitudes toward adults with sickle cell disease.

INTERVENTIONS

An 8-minute video depicting a clinician expert and patients discussing challenges in seeking treatment for sickle cell pain.

DESIGN AND PARTICIPANTS

A randomized post-test only control group design was used to assess the impact of the intervention on the attitudes of 276 nurses and housestaff working at a large, urban, academic medical center.

MAIN MEASURES

Attitudes toward adult sickle cell patients assessed using 5- and 6-point Likert-scale items. Exploratory factor analysis was used to identify underlying attitudinal domains and develop scales. Examples of the negative and positive attitudes assessed include clinician estimates of the percentage of SCD patients that exaggerate pain (negative) or make clinicians glad they went into medicine (positive).

KEY RESULTS

Compared to the control group, the intervention group exhibited decreased negative attitudes (Difference in means = -8.9, 95%CI [-14.2, -3.6]; Cohen’s d = 0.41), decreased endorsement of certain patient behaviors as “concern-raising” (Difference in means = -7.8, 95%CI [-13.1, -2.5]; Cohen’s d = 0.36), and increased positive attitudes toward sickle cell patients (Difference in means = 6.6, 95% CI [0.6, 12.6]; Cohen’s d = 0.27).

CONCLUSIONS

Our results suggest that the attitudes of clinicians toward sickle cell patients may be improved through a short and relatively easy to implement intervention. Whether the attitudinal differences associated with our intervention are sustainable or are linked to clinical outcomes remains to be seen.

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ACKNOWLEDGEMENTS

Contributors: Mr. Nigel Noble, the film-maker who produced our video intervention, significantly contributed to the success of the project.

Funders: This work was supported by an Osler Center for Excellence institutional award. Dr. Haywood’s effort on this project was supported by the Johns Hopkins Clinical Research Scholars Program (5KL2RR025006-03). Dr. Lanzkron’s effort on this project was supported by a grant from the National Heart, Lung and Blood Institute (5K23HL083089-03). Dr. Beach’s effort on this project was supported by a grant from the Agency for Healthcare Research and Quality (K08 HS013903-05). Drs. Beach and Hughes were also supported as Blaustein Scholars through the Johns Hopkins Berman Institute of Bioethics.

Prior presentations: The main findings of this paper were presented during oral presentations given at the following conferences 1) Sickle Cell Disease: The Next 100 Years (April 14th - April 16th, 2010); and 2) the 33 rd Annual Meeting of the Society of General Internal Medicine (April 28th – May 1st, 2010).

Conflicts of Interest

None disclosed.

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Authors and Affiliations

  1. Division of Hematology, The Johns Hopkins University School of Medicine, The Johns Hopkins Berman Institute of Bioethics, 624 N. Broadway Hampton House, Room 355, Baltimore, MD, 21205, USA

    Carlton Haywood Jr. PhD, MA

  2. Division of Hematology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Sophie Lanzkron MD, MHS

  3. Division of General Internal Medicine, The Johns Hopkins University School of Medicine, The Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA

    Mark T. Hughes MD & Mary Catherine Beach MD, MPH

  4. Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Rochelle Brown MD, MS & Michele Massa

  5. University of California, San Francisco, San Francisco General Hospital, San Francisco, CA, USA

    Neda Ratanawongsa MD, MPH

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  1. Carlton Haywood Jr. PhD, MA
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  2. Sophie Lanzkron MD, MHS
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  3. Mark T. Hughes MD
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  4. Rochelle Brown MD, MS
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  6. Neda Ratanawongsa MD, MPH
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  7. Mary Catherine Beach MD, MPH
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Correspondence to Carlton Haywood Jr. PhD, MA.

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Haywood, C., Lanzkron, S., Hughes, M.T. et al. A Video-Intervention to Improve Clinician Attitudes Toward Patients with Sickle Cell Disease: The Results of a Randomized Experiment. J GEN INTERN MED 26, 518–523 (2011). https://doi.org/10.1007/s11606-010-1605-5

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  • DOI: https://doi.org/10.1007/s11606-010-1605-5

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