title: Strengthening the patient-provider relationship in the aftermath of physical trauma through an understanding of the nature and severity of posttraumatic concerns.
abstract: Few investigations have focused on patients' concerns in the immediate aftermath of physical trauma. A population-based sample of 120 hospitalized injury survivors was recruited and followed over the course of the year after injury. Open-ended, semi-structured items were developed to elicit up to three concerns related to the injury from each hospitalized inpatient. Concern narratives were coded into content domains, and concern severity was assessed. Patients most frequently expressed physical health concerns (68%), followed by work and finance (59%), social (44%), psychological (25%), medical (8%), and legal (5%) concerns. The expression of three severe concerns immediately after the trauma was associated with higher PTSD symptoms levels over the course of the year. Greater initial concern severity independently predicted persistent PTSD symptoms 12 months after the injury (Adjusted Relative Risk = 1.71, 95% Confidence Interval = 1.05, 2.78). Early posttraumatic concerns can be readily elicited and reliably interpreted. Psychological concerns constitute a minority of total concerns after physical trauma, and the presence of greater numbers of severe concerns predicts worsening symptomatic course. Incorporation of posttraumatic concern assessments has the potential to simultaneously strengthen the posttraumatic patient-provider relationship and to link patient-centered evaluation with individual and community-level PTSD and functional outcome evaluations.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 359896, HMC 325 Ninth Ave., Seattle, WA 98104, USA. dzatzick@u.washington.edu
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Zatzick
authors.forename: Joan
authors.initials: J
authors.lastname: Russo
authors.forename: Emily
authors.initials: E
authors.lastname: Rajotte
authors.forename: Edwina
authors.initials: E
authors.lastname: Uehara
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
authors.forename: Angela
authors.initials: A
authors.lastname: Ghesquiere
authors.forename: Gregory
authors.initials: G
authors.lastname: Jurkovich
authors.forename: Frederick
authors.initials: F
authors.lastname: Rivara
mesh_terms: D001294:Attitude to Health; D005500:Follow-Up Studies; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D033262:Narration; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards*; D010555:Personality Inventory / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011379:Prognosis; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012306:Risk; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D040701:Stress Disorders, Traumatic, Acute / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology; D011795:Surveys and Questionnaires; D014193:Trauma Centers / Q000706:statistics & numerical data; D015599:Trauma Severity Indices