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Patient Health Communication Mediating Effects Between Gastrointestinal Symptoms and Gastrointestinal Worry in Pediatric Inflammatory Bowel Disease

Varni, James W. PhD*,†; Shulman, Robert J. MD; Self, Mariella M. PhD§; Saeed, Shehzad A. MD; Patel, Ashish S. MD; Nurko, Samuel MD**; Neigut, Deborah A. MD††; Saps, Miguel MD‡‡; Zacur, George M. MD; Dark, Chelsea V. PhD§§; Bendo, Cristiane B. PhD‖‖; Pohl, John F. MD¶¶

doi: 10.1097/MIB.0000000000001077
Future Directions and Methods in IBD Research

Background: To investigate the effects of patient health communication regarding their inflammatory bowel disease (IBD) to their health care providers and significant others in their daily life as a mediator in the relationship between gastrointestinal symptoms and gastrointestinal worry in pediatric patients.

Methods: The Pediatric Quality of Life Inventory Gastrointestinal Symptoms, Gastrointestinal Worry, and Communication Scales, and Pediatric Quality of Life Inventory 4.0 Generic Core Scales were completed in a 9-site study by 252 pediatric patients with IBD. Gastrointestinal Symptoms Scales measuring stomach pain, constipation, or diarrhea and patient communication were tested for bivariate and multivariate linear associations with Gastrointestinal Worry Scales specific to patient worry about stomach pain or bowel movements. Mediational analyses were conducted to test the hypothesized mediating effects of patient health communication as an intervening variable in the relationship between gastrointestinal symptoms and gastrointestinal worry.

Results: The predictive effects of gastrointestinal symptoms on gastrointestinal worry were mediated in part by patient health communication with health care providers/significant others in their daily life. In predictive models using multiple regression analyses, the full conceptual model of demographic variables, gastrointestinal symptoms (stomach pain, constipation, or diarrhea), and patient communication significantly accounted for 46, 43, and 54 percent of the variance in gastrointestinal worry (all Ps < 0.001), respectively, reflecting large effect sizes.

Conclusions: Patient health communication explains in part the effects of gastrointestinal symptoms on gastrointestinal worry in pediatric patients with IBD. Supporting patient disease-specific communication to their health care providers and significant others may improve health-related quality of life for pediatric patients with IBD.

Article first published online 6 April 2017

*Department of Pediatrics, College of Medicine, Texas A&M University, College Station, Texas;

Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, Texas;

Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, Houston, Texas;

§Departments of Psychiatry and Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas;

Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Dr. Saeed is now at the Division of Pediatric Gastroenterology, Dayton Children's Hospital, Wright State University, Dayton, Ohio. Dr. Zacur is now at the Division of Pediatric Gastroenterology, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan;

Division of Pediatric Gastroenterology, Children's Medical Center of Dallas, University of Texas Southwestern Medical School, Dallas, Texas;

**Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts;

††Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Colorado, Aurora, Colorado;

‡‡Division of Gastroenterology, Hepatology and Nutrition, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Dr. Saps is now at the Division of Digestive Diseases, Hepatology, and Nutrition, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio;

§§Department of Psychology, Texas A&M University, College Station, Texas. Dr. Dark is now at the Division of Pediatric Pulmonology, Children's Medical Center, Dallas, Texas;

‖‖Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil; and

¶¶Department of Pediatric Gastroenterology, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.

Address correspondence to: James W. Varni, PhD, Colleges of Architecture and Medicine, Texas A&M University, 3137 TAMU, College Station, TX 77843-3137 (e-mail: jvarni@tamu.edu).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.ibdjournal.org).

Author disclosures are available in the Acknowledgments.

Received December 15, 2016

Accepted January 18, 2017

© Crohn's & Colitis Foundation of America, Inc.
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