title: Impact of a nurse-led counselling service on quality of life in patients with inflammatory bowel disease.
abstract: OBJECTIVE
  Health related quality of life is impaired in patients suffering from inflammatory bowel disease. Although counselling directed towards physical and psychological morbidity is assumed to improve health related quality of life, this has never been demonstrated.
  
  
  METHODS
  Physical and psychological well-being were assessed using questionnaires administered to 100 out-patients in the United Kingdom suffering from inflammatory bowel disease, 50 subjects not suffering from inflammatory bowel disease and a disease control group comprising 28 patients with psoriatic arthritis. A specific nurse led counselling package was given to half the inflammatory bowel disease group and health related quality of life was assessed at baseline, 6 and 12 months.
  
  
  RESULTS
  Inflammatory bowel disease and psoriatic arthritic patients had a range of physical disease activity, although none were severely ill during the course of the study. Medical therapy was similar in both groups throughout the duration of the trial. The mean Short Form 36 (SF-36) scores for mental health were low in inflammatory bowel disease patients; 62.9 +/- 9.1 (SD) in ulcerative colitis, 60 +/- 9.8 (SD) in Crohn's disease, compared with 72.4 +/- 7.2 (SD) in healthy controls (P < 0.05). Mean SF-36 scores for social function were also reduced in Crohn's disease patients; 68.4 +/- 10.1 (SD) in Crohn's disease, compared with 87 +/- 10.1 (SD) in healthy controls (P < 0.05). As expected, the mean SF-36 scores in psoriatic arthritic patients were significantly low 61.9 +/- 1.5 (SD) compared with 82.4 +/- 14 (SD) in healthy controls (P < 0.05). Crohn's disease patients were significantly more anxious than the other groups, mean HAD score was 10 +/- 3.7 (SD) in Crohn's disease patients and 6.86 +/- 3.5 (SD) in healthy volunteers (P < 0.05), although mean HAD scores for depression were similar in all groups. Maladaptive coping mechanisms were present in a significant proportion of Crohn's disease patients. At follow-up all aspects of psychological morbidity returned to the normal range in the Crohn's disease patients without significant change in the mean physical disease index.
  
  
  CONCLUSIONS
  Health related quality of life can be improved over 6 months by provision of a nurse led counselling service but the effects are not sustained for 12 months.
authors.affiliation: Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. graeme.smith@ed.ac.uk
authors.forename: Graeme D
authors.initials: GD
authors.lastname: Smith
authors.forename: Roger
authors.initials: R
authors.lastname: Watson
authors.forename: Derek
authors.initials: D
authors.lastname: Roger
authors.forename: Euan
authors.initials: E
authors.lastname: McRorie
authors.forename: Nigel
authors.initials: N
authors.lastname: Hurst
authors.forename: Widjaja
authors.initials: W
authors.lastname: Luman
authors.forename: Kelvin R
authors.initials: KR
authors.lastname: Palmer
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D003376:Counseling / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000451:nursing* / Q000523:psychology*; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009720:Nurse Clinicians / Q000592:standards*; D015403:Nursing Evaluation Research; D015397:Program Evaluation; D011788:Quality of Life; D011795:Surveys and Questionnaires