title: Respect, trust, and the management of sickle cell disease pain in hospital: comparative analysis of concern-raising behaviors, preliminary model, and agenda for international collaborative research to inform practice.
abstract: OBJECTIVE
  Qualitative interview studies suggest that adult patients' experiences of hospital treatment for sickle cell disease (SCD) pain reflect an absence of respect by providers for patients, and an absence or breakdown of trust. Systematic comparisons between treatment settings could help identify contextual influences on respect and trust.
  
  
  METHODS
  Quantitative comparison of concern-raising behaviors (pain treatment outcomes indicating breakdowns of trust) among adult SCD patients in Baltimore, Maryland, USA, and London, UK, followed by analysis of potential explanations for differences, including socio-cultural and behavioral factors, with a preliminary model of the processes leading to concern-raising behaviors.
  
  
  RESULTS
  Rates of concern-raising behaviors were significantly higher in Baltimore than London. The model identifies respect and trust as key factors which could be targeted in efforts to improve the quality of SCD pain management in hospital.
  
  
  CONCLUSIONS
  An agenda for international, interdisciplinary research to improve the treatment of SCD pain in hospital should include: comparative analyses between countries and treatment settings of factors that could influence respect and trust; research to test hypotheses derived from models about the roles of respect and trust in the treatment of pain; studies of the impact of healthcare structures and policy on patients' experiences of care; research focusing on developmental and interpersonal processes related to respect and trust; applications of attribution and other social psychology theories; and development and evaluation of interventions to improve the hospital treatment of SCD pain by increasing respect and trust.
authors.affiliation: Department of Psychology, University of Derby, Kedleston Road, Derby, DE22 1GB, UK. j.elander@derby.ac.uk
authors.forename: James
authors.initials: J
authors.lastname: Elander
authors.forename: Mary Catherine
authors.initials: MC
authors.lastname: Beach
authors.forename: Carlton
authors.initials: C
authors.lastname: Haywood
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000188:drug therapy* / Q000453:epidemiology; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D059408:Pain Management; D010342:Patient Acceptance of Health Care; D010817:Physician-Patient Relations; D015995:Prevalence; D013240:Stereotyping; D035502:Trust; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult