Patient–staff agreement in the perception of spinal cord lesioned patients' problems, emotional well-being, and coping pattern
Study design:Matched patient/staff study.Objectives:To investigate spinal cord lesion (SCL) rehabilitation staff perceptions of SCL patient problems, coping efforts, and well-being, and to compare these evaluations with patient self-reports of the same aspects.Settings:Spinal Unit, Sahlgrenska University Hospital, Göteborg, Sweden.Methods:In all, 29 persons with SCL and 24 members of the caring staff participated. Each patient was matched to a staff person actually involved in his or her care. The participants completed a study-specific questionnaire containing 45 SCL-related problems covering six problem areas: somatic symptoms, functional limitations, role problems, family-related problems, psychosocial problems, and emotional problems. Coping activities were assessed by a self-report 47-item questionnaire covering eight aspects of coping: self-trust, problem focusing, acceptance, fatalism, resignation, protest, minimization, and social trust. The patients were instructed to respond to the items included in the questionnaires according to their situation during the last week, while staff members were instructed to reply as ‘they thought that their matched patient would answer’.Results:Moderate but statistically significant correlations were demonstrated between patient and staff ratings of most investigated problem areas. However, the staff systematically overestimated patients' emotional as well as family problems, and tended to underestimate patients' reported coping ability and mental health. Staff were most accurate in assessing patients' physical symptoms, functional limitations, and role problems, but less accurate in their perception of less visible symptoms.Conclusion:Relatively high agreement between patients and staff concerning patients' problems and states is possible to obtain in a caring setting. This may be more related to the quality of caring in the studied unit than to the study methodology used. Small units with high staff density and a long stay and/or prolonged contact with the patients probably facilitate communication with and knowledge about the patients. Interventions aimed at increasing staff awareness of patients' coping efforts may further improve staff ability to understand and support patients in their adaptation process.Sponsorship:The Foundation of Rehabilitation Research (FRF), The Vårdal Foundation, Sweden.