Introduction ‘Acceptance’ refers to the patient’s willingness to engage with their illness. Poor acceptance implies the avoidance or denial of an illness and the accompanying somatic experiences. A lack of acceptance highlights an unwillingness to make the necessary behavioural changes that are required to manage a disease effectively (e.g. missing clinical appointments, medication adherence, bad diet, poor coping strategies). This can have serious ramifications for long-term conditions such as inflammatory bowel disease (IBD).
Objective To assess the prevalence of poor acceptance within our IBD patients.
Methods 2400 patients with IBD in the Luton & Dunstable catchment area were invited to participate in a web-based quality of life assessment, with the option to request a paper copy. Eligibility required patients to be between 18 and 90 years of age, with no serious learning difficulties or pre-existing mental disorders. The 7-item self-report “Acceptance and Adjustment Questionnaire” (AAQ-II; Bond et al 2011) was used. AAQ-II scoring ranges from 7 to 49. A bimodal distribution suggested two groups of patients (Good and Poor Acceptance) separated by a cut-off score of 18. Logistic regression was used to identify predictors of acceptance and adjustment.
Results 245 patients completed the assessment (43% male; mean age = 53, SD = 17). Approximately 37% of patients fell in the Poor Acceptance group. Significant predictors of Poor Acceptance were found in Anxiety, Depression, Emotional Illness Perception and Socio-Economic Deprivation. Anxiety levels were scored on a scale from 0 to 21 using the GAD-7. Depression levels were scored on a scale from 0 to 27 using the PHQ-9. Emotional Illness Perception on a scale from 3 to 21 using the Brief Illness Perception Questionnaire. Deprivation based on postcode area was expressed as percentile ranks. For each one point increase in Anxiety, Depression and Emotional Illness Perception scores the likelihood of Poor Acceptance increased by 22%, 21% and 27% respectively. Greater deprivation increased the likelihood of Poor Acceptance by 2% per percentile rank.
Conclusion Predictors of Poor Acceptance may be grouped into Mood and Deprivation. Education through self-management programmes may tackle some of the problems caused by deprivation. To optimise treatment success in IBD, we would advocate further research into a mood-orientated approach using screening tools, coupled with clinical judgement and targeted psychological interventions such as Acceptance and Commitment Therapy (ACT), which is based upon Acceptance and Adjustment Theory.
Disclosure of Interest None Declared.
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