Psychological flexibility and attitudes toward evidence-based interventions by amyotrophic lateral sclerosis patients

Objective Declining a percutaneous endoscopic gastrostomy (PEG) or non-invasive ventilation (NIV) by people with amyotrophic lateral sclerosis (ALS) is often contrary to advice provided by health-care-professionals guided by evidence-based principles. This study proposes relational frame theory (RFT) to offer a viable explanation of this phenomenon. Design A total of 35 people (14 female, 21 male) aged between 34 and 73 years, with ALS, participated in this cross-sectional research. Main outcome measures This research examined the predictive power and interaction effect of psychological flexibility (the fundamental construct of RFT) and psychological well-being on attitudes toward intervention options. Results Participants with high psychological flexibility reported lower depression, anxiety, and stress, and higher quality of life. In addition, psychological flexibility was predictive of a participant’s understanding and acceptance of a PEG as an intervention option. Psychological flexibility was not found to be a significant predictor of understanding and acceptance of NIV. Conclusion Although the criterion measure had not been piloted or validated outside of the current study and asks about expected rather than actual acceptance, findings suggest that applied RFT may be helpful for clients with ALS.

109 to be non-compliant with medical advice, compared to non-depressed patients (Di Matteo et al. 110 2000).

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Firstly, it should be noted that the terms accept and acceptance used throughout this 113 paper are used in the context of RFT mental processes exclusively and not, for example, 114 confirming the physical adoption of an intervention. A recent study by Greenaway et al. (2015) 115 has elucidated important factors that influence ALS patient's understanding and acceptance of  Psychological flexibility is the key construct of interest in RFT and is defined by two 131 parts: (a) the processes of experiential avoidance and acceptance, requiring the individual to The aim of the current study was to examine the relationship between psychological   Manuscript to be reviewed  Table 2.
324 The model overall was a good fit with approximately 38% of the variance in understanding and 325 acceptance of a PEG being explained by the predictors. Table 2 shows that people with ALS who 326 scored highly on action and quality of life, were expected to have a better understanding and be 327 more accepting of a PEG as an intervention.

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The second hypothesis suggested that psychological flexibility (willingness and action), 329 depression, anxiety, stress, and quality of life would predict understanding and acceptance of 330 NIV. The fit for the overall model was not significant.

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The data also suggested that a patient's ability to take action in line with chosen goals is 359 positively related to the time they have had ALS. This relationship may be somewhat intuitive.

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The current study recruited participants from a number of different countries. Given 418 variation in medical practices (e.g., propensity to perform gastrostomies) and differences in 419 patient's access to resources (e.g., access to BiPAP machines though the public health system) 420 between countries, there may be some sources of variation not accounted for in the current study 421 design. Furthermore, the current study did not allow for any possibility that there might be some 1 -4 0 -10 1 -5 1 -5 Range Actual 2.43 -5.86 3.56 -5.86 1.00 -3.14 1.00 -2.86 1.14 -3.14 1.17 -9.02 1.89 -5.00 1.00 -5.00 5 Note. UAI (PEG) = Understanding and Acceptance of Interventions (Percutaneous Endoscopic Gastrostomy). UAI (NIV) = 6 Understanding and Acceptance of Interventions (Non-Invasive Ventilation). To reduce the family-wise error rate when examining 7 these correlations without a priori hypothesis a criterion of r > .40 is suggested. 8 * p < .05, two-tailed. ** p < .01, two-tailed. 9 1 2 .11 5 Note. Fit for model R² = .49, Adjusted R² = .38, F(6, 28) = 4.40, p < .01. The squared semi-6 partial (sr²) correlation given is the squared part-correlation given from SPSS. The r given is the 7 zero-order correlation given from SPSS.  .03 5 Note. Fit for model R² = .28, Adjusted R² = .12, F(6, 28) = 1.80, p > .05. The squared semi-6 partial (sr²) correlation given is the squared part-correlation given from SPSS. The r given is the 7 zero-order correlation given from SPSS. The transformed data showed the same pattern of 8 findings (beta values) but a higher Adjusted R² (.19), thus the more conservative raw findings are 9 examined due to the small sample size. 10