Health care provider attitudes toward patients with acute vaso-occlusive crisis due to sickle cell disease: Development of a scale

Neda Ratanawongsa, Carlton Haywood, Shawn M. Bediako, Lakshmi Lattimer, Sophie Lanzkron, Peter M. Hill, Neil R. Powe, Mary Catherine Beach

Research output: Contribution to journalArticlepeer-review

40 Scopus citations


Objective: Patients with sickle cell disease (SCD) often perceive negative provider attitudes, which may affect the quality of patient-provider communication and care during vaso-occlusive crises (VOCs). This study investigated the validity and reliability of a scale to measure provider attitudes toward patients with acute VOC. Methods: Using a cohort of adults with VOC (September 2006 to June 2007), we administered a 10-item provider questionnaire within 72 h of patient encounters. After factor analysis, we created a 7-item Positive Provider Attitudes toward Sickle Cell Patients Scale (PASS); higher scores indicate more positive attitudes. We assessed internal consistency and evidence of construct validity, exploring bivariate relationships between provider or patient characteristics and the PASS score using multilevel modeling. Results: We collected 121 surveys from 84 health care providers for 47 patients. Patients averaged 30.3 years in age, and 60% were women. Among providers, 79% were nurses, and 70% worked in inpatient settings. PASS scores averaged 24.1 (S.D. 6.7), ranged 7-35, and had high internal consistency (Cronbach's alpha = 0.91). As hypothesized, inpatient vs. emergency department providers (Δ = 4.65, p < 0.001) and nurses vs. other providers (Δ = 0.95, p < 0.001) had higher PASS scores. Higher patient educational attainment (Δ per year = 2.74, p < 0.001) and employment (Δ = 5.62, p = 0.001) were associated with higher PASS scores. More frequent hospitalizations (Δ per episode = -0.52, p < 0.001) and prior disputes with staff (Δ = -7.53, p = 0.002) were associated with lower PASS scores. Conclusion: Our findings provide preliminary evidence for the reliability and construct validity of the PASS score in measuring provider attitudes toward patients with VOC. Practice implications: Future studies should examine the validity of PASS in other cohorts of patients with SCD and their providers. With further evidence, PASS may prove useful for investigating the impact of provider attitudes on the quality of communication and care provided to these patients.

Original languageEnglish (US)
Pages (from-to)272-278
Number of pages7
JournalPatient Education and Counseling
Issue number2
StatePublished - Aug 2009


  • Instrument development
  • Pain management
  • Patient-provider relationship
  • Sickle cell disease
  • Validity and reliability

ASJC Scopus subject areas

  • Medicine(all)


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