[in Japanese]

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Quality of life (QOL) is a patient-reported outcome. QOL assessment studies based on psychometrics that target patients have progressed since the 1980s. Clinicians had a desire to use QOL assessments on patients being treated without waiting for QOL assessment results following statistical analysis. This led to the initiation of research on minimal important differences (MIDs) for QOL measurements. MID refers to the minimal difference in QOL score a patient senses in the clinical setting, and is calculated using distribution-based or anchor-based method. With anchor-based method, MID values differ depending on whether QOL worsens or improves. Based on this, anchor-based method is considered more useful for calculating MIDs in the clinical setting. While there remains a need to further debate how to use QOL assessments to maintain and improve QOL, MIDs have utility in the practical use of QOL assessment results for patient and physician decision making.

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[in Japanese]

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Quality of life (QOL) has attracted considerable attention in clinical research, and is now recognized as an important outcome of medical treatment, with advances in treatment of cardiovascular disease have contributed to improved survival of patients. An early QOL research in field of the cardiovascular disease was tied to the impact of hypertensive medications. Though every doctor participating in the study responded that their patients had improved after treatment, less than 10% of their patients recognized they had improved. It was clear that while doctors were most concerned with controlling patient blood pressure, patients were more concerned about low vitality and declining physical activity, which indicated the importance of measuring patient-reported outcomes. In Japan, QOL researches for cardiovascular diseases has increased, and referred to some clinical guidelines. But QOL evaluation in cardiovascular diseases is far from adequate. This paper reported a survey for adult congenital heart disease patients and their parents in the National Cerebral and Cardiovascular Center, as one example of a QOL research. This study showed that patientsʼ parents which the conventional practice has been missed impaired QOL, the need for QOL evaluation is re-recognized.

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Effective communication between cancer patients and their primary doctors is important in alleviating patients’ physical and psychological burdens. However, cancer outpatients often hesitate to speak with their doctors even when they have something to say or questions to ask. This study examines the relationships between patients’ hesitance to communicate with their primary doctors and patients’ communication behaviors during their medical interviews. The participants were 51 individuals undergoing outpatient treatment in the form of complementary and alternative medicine. They were asked to recall the most recent consultation with their primary doctor, and then completed questionnaires about the degree of their hesitation, their communication behaviors, and their degree of satisfaction with that particular social exchange. In order to examine the relationships between patients’ communication behaviors, satisfaction, and hesitation, partial correlation coefficients controlling for patients’ age, cancer type, and employment condition were calculated. The results revealed that patients’ hesitation was related to some of their communication behaviors: presenting information, asking questions, stating preferences, and checking information. Hesitation is an obstructive factor in the effective communication of patients. Therefore, it is necessary for primary doctors to recognize this hesitation, and to address it by actively engaging in communication with their patients.

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Behavioral medicine interventions for pre-dialysis patients with diabetic nephropathy are important, but diabetes clinics often find it difficult to conduct such interventions as compared with general hospitals. We provided multidisciplinary care over a 10-month period to patients with diabetic nephropathy. This care consisted of a nutrition education program and a clinical psychological intervention. We recruited 10 consecutive adult patients with diabetic nephropathy (mean age = 67.4 years). The patients received individual counseling sessions over 10 months from a clinical psychologist and underwent individual and group dietary interventions conducted by a registered dietitian. Both interventions were provided monthly during patients’ regular medical examinations. A clinical psychologist specializing in cognitive-behavioral therapy also conducted an assessment and consultation with clinic medical staff. In addition, joint conferences were held involving co-medical staff and a doctor. Five months after the start, the estimated glomerular filtration rate was found to have increased significantly. Uric acid and total cholesterol levels decreased significantly at 10 months. Although diabetes clinics often have limited time and other resources for diabetic nephropathy care, our results indicate that a behavioral medicine approach is effective in treating diabetic nephropathy.

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