title: Assessment of biopsychosocial risk factors for medical treatment: a collaborative approach.
abstract: There is a growing body of evidence that psychosocial variables have a significant ability to predict the outcome of medical treatment procedures, especially when the procedure is performed to reduce pain. The study described in this paper serves as an illustration of the valuable role psychologists can play in dealing with the challenges of biopsychosocial assessment of patients who are candidates for medical treatments, especially elective, invasive procedures. Based on a convergent model of risk factors that can potentially influence outcomes from spinal surgery and spinal cord stimulation, exclusionary and cautionary risk factors were identified, and the BHI 2 and BBHI 2 tests were used to assess them. An estimate of the prevalence of these risk factors was calculated using data obtained from 1,254 patient and community subjects gathered from 106 sites in 36 US states. Standardized Cautionary Risk and Exclusionary Risk scores demonstrated a test-retest reliability of .85 to .91. Evidence of validity of these scores was also provided based on subjective and objective criteria, using multiple groups of patients and community subjects. Recommendations are made regarding how biopsychosocial assessments could be used in collaborative settings for presurgical candidates to identify risks that could compromise a patient's ability to benefit from other medical treatments as well. Once identified, appropriate interventions could ameliorate these risks, or lead to the consideration of other treatments that are more likely to be effective. Methods of refining this approach for specific clinical applications are also discussed.
authors.affiliation: Health Psychology Associates, 1610 29th Avenue Place, Suite 200, Greeley, CO, 80634, USA. daniel.bruns@healthpsych.com
authors.forename: Daniel
authors.initials: D
authors.lastname: Bruns
authors.forename: John Mark
authors.initials: JM
authors.lastname: Disorbio
mesh_terms: D004599:Electric Stimulation Therapy / Q000523:psychology*; D015438:Health Behavior; D006801:Humans; D008016:Life Change Events; D008950:MMPI / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology; D008960:Models, Psychological; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010552:Personality Assessment / Q000706:statistics & numerical data*; D011300:Preoperative Care; D011379:Prognosis; D011594:Psychometrics / Q000706:statistics & numerical data; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012307:Risk Factors; D013116:Spinal Cord / Q000503:physiopathology*; D013122:Spinal Diseases / Q000523:psychology* / Q000601:surgery*; D016896:Treatment Outcome