title: Health care provider attitudes toward patients with acute vaso-occlusive crisis due to sickle cell disease: development of a scale.
abstract: OBJECTIVE
  Patients with sickle cell disease (SCD) often perceive negative provider attitudes, which may affect the quality of patient-provider communication and care during vaso-occlusive crises (VOCs). This study investigated the validity and reliability of a scale to measure provider attitudes toward patients with acute VOC.
  
  
  METHODS
  Using a cohort of adults with VOC (September 2006 to June 2007), we administered a 10-item provider questionnaire within 72 h of patient encounters. After factor analysis, we created a 7-item Positive Provider Attitudes toward Sickle Cell Patients Scale (PASS); higher scores indicate more positive attitudes. We assessed internal consistency and evidence of construct validity, exploring bivariate relationships between provider or patient characteristics and the PASS score using multilevel modeling.
  
  
  RESULTS
  We collected 121 surveys from 84 health care providers for 47 patients. Patients averaged 30.3 years in age, and 60% were women. Among providers, 79% were nurses, and 70% worked in inpatient settings. PASS scores averaged 24.1 (S.D. 6.7), ranged 7-35, and had high internal consistency (Cronbach's alpha=0.91). As hypothesized, inpatient vs. emergency department providers (Delta=4.65, p<0.001) and nurses vs. other providers (Delta=0.95, p<0.001) had higher PASS scores. Higher patient educational attainment (Delta per year=2.74, p<0.001) and employment (Delta=5.62, p=0.001) were associated with higher PASS scores. More frequent hospitalizations (Delta per episode=-0.52, p<0.001) and prior disputes with staff (Delta=-7.53, p=0.002) were associated with lower PASS scores.
  
  
  CONCLUSIONS
  Our findings provide preliminary evidence for the reliability and construct validity of the PASS score in measuring provider attitudes toward patients with VOC.
  
  
  CONCLUSIONS
  Future studies should examine the validity of PASS in other cohorts of patients with SCD and their providers. With further evidence, PASS may prove useful for investigating the impact of provider attitudes on the quality of communication and care provided to these patients.
authors.affiliation: General Internal Medicine, Center for Vulnerable Populations, University of California, San Francisco, CA 94110, USA. ratanawongsan@medsfgh.ucsf.edu
authors.forename: Neda
authors.initials: N
authors.lastname: Ratanawongsa
authors.forename: Carlton
authors.initials: C
authors.lastname: Haywood
authors.forename: Shawn M
authors.initials: SM
authors.lastname: Bediako
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Lattimer
authors.forename: Sophie
authors.initials: S
authors.lastname: Lanzkron
authors.forename: Peter M
authors.initials: PM
authors.lastname: Hill
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.forename: Mary Catherine
authors.initials: MC
authors.lastname: Beach
mesh_terms: D000755:Anemia, Sickle Cell / Q000150:complications*; D001157:Arterial Occlusive Diseases / Q000209:etiology*; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D003142:Communication; D004522:Educational Status; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010147:Pain Measurement; D010817:Physician-Patient Relations; D011594:Psychometrics; D015203:Reproducibility of Results; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D014481:United States; D014652:Vascular Diseases / Q000209:etiology