Evaluating Providers' Attitudes Towards Sickle Cell Patients at a Large Tertiary Academic Center in Saudi Arabia

Introduction

Sickle cell disease (SCD) is a common hematological condition affecting many worldwide. SCD has a fairly high prevalence rate in Saudi Arabia affecting approximately 20,000 people per 1,000,000. Although recurring vaso-occlusive (VOC) pain episodes are the most common reason for medical evaluation in SCD patients, it is often difficult to assess, define, describe, and manage. VOC pain is often acute on top of chronic requiring multiple doses opioid analgesia to control. and resulting in frequent hospital visits to manage. Studies have shown that health professionals overestimate the prevalence of addiction among patients with SCD which results in undertreatment, premature discharge from hospital or inadequate prescribed analgesia for use at home in SCD presenting with VOC. This then leads to inadequate pain control and higher likelihood of frequent recurring hospital visits for VOC. Patients with SCD have consistently provided compelling personal stories about their own negative experiences during hospital treatment for pain, including inadequate analgesia, conflicts with staff, and lack of respect from providers. While providers frequently voice concerns about the perceived ineffectiveness of management, high utilization of healthcare resources and concerns for opioid misuse.

Methods:

In order to better assess providers' attitudes towards SCD patients, we conducted this survey utilizing “Clinician Experiences with Sickle Cell Disease Questionnaire”. The survey evaluated Healthcare workers' (HCW) understanding and attitudes toward SCD pain based on 6 subscales: positive attitudes, negative attitudes, behaviors, understanding disease, empathy and understanding systemic issues about perception and treatment. Participants were HCW (physicians, trainees and nurses) from the emergency department (DEM), general internal medicine (GIM) department and hematology unit (HU) at King Saud University, large tertiary academic center with over 500 SCD patients under its care.

Results:

A total of 152 HCW responded (61.2% males, 38.8% females). Participants were from DEM (58.6%), GIM (33%) and HU (8.5%) with 48% trainees (senior & junior residents), 27% nurses and 25% physicians (Consultants and board-certified physicians). There were no statistically significant differences found between the opinions of the study participants regarding the various measures based on their gender (P-value > 0.05). Utilizing 5-point Likert scale, Negative attitudes were highest among DEM (2.72) followed by GIM (2.3) then HU (2.07) which was statistically significant (p value <0.05). The remaining subscales did not show a statistically significant difference based on specialty. By level of practice, board certified physicians were the highest in understanding systemic issues about perception and treatment; consultants exhibited the highest levels of empathy (3.5), while the least positive attitudes towards SCD patients were noted among senior residents & service residents (2.19), and nurses (2.38). Consultants demonstrated the lowest scores of negative attitude (2.21), while nurses exhibited the highest (2.74) scores. These differences were not clinically significant.

Conclusion:

Negative HCW attitudes towards patients with SCD remain high across specialties and training/experience levels overall with concerns related to drug-seeking behaviors and failure of compliance with medical advice. The higher negative attitude scores among nurses could be related to longer direct patient contact resulting in more conflicts. High similar scores of disease understanding could be attributed to the fact that this study was done in a teaching hospital. These findings must be utilized to improve care, decrease biases and develop educational interventions to better care for SCD patients.

Sewaralthahab:Pfizer: Consultancy, Honoraria; Astra Zenca: Honoraria.