Persistent negative illness perceptions despite long-term biochemical control of acromegaly: novel application of the drawing test.
OBJECTIVE
Patients with acromegaly have persistent complaints despite long-term biochemical control. Drawings can be used to assess patients' perceptions about their disease. We aimed to explore the utility of the drawing test and its relation to illness perceptions and quality of life (QoL) in patients after long-term remission of acromegaly.


METHODS
A cross-sectional study was conducted to evaluate the utility of the drawing test.


METHODS
A total of 50 patients after long-term remission (mean±s.e.m., 16±1.2 years) of acromegaly were included in this study. Patients completed the drawing test (two retrospective drawings of their body perception before acromegaly and during the active phase of acromegaly, and one drawing on the current condition after long-term remission), Illness Perception Questionnaire-Revised, Physical Symptom Checklist, EuroQoL-5D, and AcroQoL.


RESULTS
Patients perceived a dramatic change in body size during the active state of the disease compared with the healthy state before the awareness of acromegaly. Patients reported that their body did not completely return to the original proportions after long-term remission. In addition, larger drawings indicated more negative consequences (P<0.05), a higher score on emotional representations (P<0.05), and more perceived symptoms that were attributed to acromegaly (P<0.01). Larger drawings also indicated more impaired QoL, especially disease-specific QoL (all P<0.05).


CONCLUSIONS
There are strong correlations among the drawing test, illness perceptions, and QoL. The drawing test appears to be a novel and relatively easy tool to assess the perception of patients after long-term remission of acromegaly. The assessment of drawings may enable health care providers to appreciate the perceptions of patients with long-term remission of acromegaly, and enable discussion of symptoms and remission.
Psychological ScienceUniversity of California Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology & Metabolism and Center for Endocrine Tumors Leiden (CETL)Leiden University Medical Center, Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Psychological MedicineUniversity of Auckland, Auckland, New ZealandDepartment of Medical PsychologyLeiden University Medical Center, Leiden, The Netherlands Psychological ScienceUniversity of California Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology & Metabolism and Center for Endocrine Tumors Leiden (CETL)Leiden University Medical Center, Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Psychological MedicineUniversity of Auckland, Auckland, New ZealandDepartment of Medical PsychologyLeiden University Medical Center, Leiden, The Netherlands jtiemensma@ucmerced.edu.
Jitske
J
Tiemensma
Psychological ScienceUniversity of California Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology & Metabolism and Center for Endocrine Tumors Leiden (CETL)Leiden University Medical Center, Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Psychological MedicineUniversity of Auckland, Auckland, New ZealandDepartment of Medical PsychologyLeiden University Medical Center, Leiden, The Netherlands.
Alberto M
AM
Pereira
Psychological ScienceUniversity of California Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology & Metabolism and Center for Endocrine Tumors Leiden (CETL)Leiden University Medical Center, Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Psychological MedicineUniversity of Auckland, Auckland, New ZealandDepartment of Medical PsychologyLeiden University Medical Center, Leiden, The Netherlands.
Johannes A
JA
Romijn
Psychological ScienceUniversity of California Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology & Metabolism and Center for Endocrine Tumors Leiden (CETL)Leiden University Medical Center, Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Psychological MedicineUniversity of Auckland, Auckland, New ZealandDepartment of Medical PsychologyLeiden University Medical Center, Leiden, The Netherlands.
Elizabeth
E
Broadbent
Psychological ScienceUniversity of California Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology & Metabolism and Center for Endocrine Tumors Leiden (CETL)Leiden University Medical Center, Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Psychological MedicineUniversity of Auckland, Auckland, New ZealandDepartment of Medical PsychologyLeiden University Medical Center, Leiden, The Netherlands.
Nienke R
NR
Biermasz
Psychological ScienceUniversity of California Merced, 5200 North Lake Road, Merced, California 95343, USADepartment of Endocrinology & Metabolism and Center for Endocrine Tumors Leiden (CETL)Leiden University Medical Center, Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Psychological MedicineUniversity of Auckland, Auckland, New ZealandDepartment of Medical PsychologyLeiden University Medical Center, Leiden, The Netherlands.
Adrian A
AA
Kaptein
D000172:Acromegaly / Q000188:drug therapy* / Q000523:psychology*; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D012649:Self Concept; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult