title: Anger, provider responses, and pain: prospective analysis of stem cell transplant patients.
abstract: OBJECTIVE
  Patient anger can be challenging for providers, and may hinder the patient-provider relationship. Research on the relationships among patient anger, relationships with health care providers and medical outcomes, however, has been limited to anecdotal accounts and cross-sectional studies. This study examined relationships among patient anger, perceptions of provider positive support and negative interactions, by prospectively studying a sample of stem cell transplant (SCT) patients.
  
  
  METHODS
  A prospective design was used to study patient anger, perceived positive support from providers and perceived negative interactions with providers among 88 SCT patients. Data were obtained upon patient's hospitalization before SCT and at 1, 2, and 3 month follow up periods. Repeated-measures mixed models assessed relationships among study variables.
  
  
  RESULTS
  Patient anger was associated with a gradual decline in perceived positive support and higher levels of concurrent perceived negative interactions with providers. Further, a significant lagged relationship was found such that patient anger was associated with increased perceived negative interactions with providers 1 month later. Exploratory analyses revealed that perceived negative interactions were also associated with higher levels of physical distress. Perceived positive support buffered the relationship between patient anger and physical distress, such that anger was not associated significantly with physical distress when perceived provider support was high.
  
  
  CONCLUSIONS
  Patient anger may contribute to a deterioration of the patient-provider relationship, and contribute to negative medical outcomes including physical distress. The association between patient anger and physical distress may be reduced by supportive providers.
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center.
authors.forename: James I
authors.initials: JI
authors.lastname: Gerhart
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center.
authors.forename: Veronica
authors.initials: V
authors.lastname: Sanchez Varela
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center.
authors.forename: John W
authors.initials: JW
authors.lastname: Burns
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center.
authors.forename: Stevan E
authors.initials: SE
authors.lastname: Hobfoll
authors.affiliation: Coleman Foundation Comprehensive Blood & Bone Marrow Transplantation Clinic, Rush University Medical Center.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Fung
mesh_terms: D000328:Adult; D000368:Aged; D000786:Anger; D001291:Attitude of Health Personnel; D058443:Catastrophization; D005260:Female; D006282:Health Personnel; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010146:Pain; D010465:Perception; D011369:Professional-Patient Relations; D011446:Prospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000523:psychology*