title: Impact of invalidation and trust in physicians on health outcomes in fibromyalgia patients.
abstract: BACKGROUND
  Patients with fibromyalgia have reported experiencing discouragement, rejection, suspicion, and stigma during their encounters with health care professionals. The impact of these experiences on health outcomes has not been extensively examined. The aim of this study was to assess fibromyalgia patients' self-reported quality of life (QoL) and pain based on the following: perceptions of physician attitudes, trust in physicians, perceptions of medical professionals, type of treatment, and various demographic variables.
  
  
  METHODS
  An online survey was advertised in the electronic newsletter of the National Fibromyalgia and Chronic Pain Association and data were collected in February 2013. A new scale was developed to measure patient perceptions of physician attitudes. Patients' trust in physicians, patients' perceptions of medical professionals, and QoL were measured using the following standardized scales: Trust in Physician Scale, Illness Invalidation Inventory (3*I), and Quality of Life Scale-16 (QOLS-16).
  
  
  RESULTS
  The survey resulted in 670 usable responses. The Patient Perceptions of Physician Attitudes Scale showed high internal consistency and convergent validity (Cronbach α = 0.91). Factor analysis of the Trust in Physician scale, 3*I, and QOLS-16 showed a 1-dimensional structure. Invalidation, use of complementary and alternative medicine, income, age, and marital status were significant predictors of QoL (P < .001). Trust in physician, income, education, and number of referrals to health care providers were significant predictors of pain (P < .001).
  
  
  CONCLUSIONS
  Invalidation, trust in physician, and use of complementary medicine can have significant impact on QoL and pain in fibromyalgia. Further research in more representative fibromyalgia samples may help confirm findings.
authors: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh (Ms Lobo); Division of Clinical, Social and Administrative Sciences, Mylan School of Pharmacy (Drs Pfalzgraf and Giannetti) and Department of Educational Statistics, Educational Foundations and Leadership, School of Education (Dr Kanyongo), Duquesne University, Pittsburgh, Pennsylvania. This study was conducted while Ms Lobo was a student at Duquesne University as part of her Master's thesis.
authors: Carroline P
authors: CP
authors: Lobo
authors: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh (Ms Lobo); Division of Clinical, Social and Administrative Sciences, Mylan School of Pharmacy (Drs Pfalzgraf and Giannetti) and Department of Educational Statistics, Educational Foundations and Leadership, School of Education (Dr Kanyongo), Duquesne University, Pittsburgh, Pennsylvania. This study was conducted while Ms Lobo was a student at Duquesne University as part of her Master's thesis.
authors: Andrea R
authors: AR
authors: Pfalzgraf
authors: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh (Ms Lobo); Division of Clinical, Social and Administrative Sciences, Mylan School of Pharmacy (Drs Pfalzgraf and Giannetti) and Department of Educational Statistics, Educational Foundations and Leadership, School of Education (Dr Kanyongo), Duquesne University, Pittsburgh, Pennsylvania. This study was conducted while Ms Lobo was a student at Duquesne University as part of her Master's thesis.
authors: Vincent
authors: V
authors: Giannetti
authors: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh (Ms Lobo); Division of Clinical, Social and Administrative Sciences, Mylan School of Pharmacy (Drs Pfalzgraf and Giannetti) and Department of Educational Statistics, Educational Foundations and Leadership, School of Education (Dr Kanyongo), Duquesne University, Pittsburgh, Pennsylvania. This study was conducted while Ms Lobo was a student at Duquesne University as part of her Master's thesis.
authors: Gibbs
authors: G
authors: Kanyongo