Journal of IiME Volume 4 Issue 1 www.investinme.org An Effort to Influence Medical Textbook Writers (continued) patients with physician interactions may be caused by negative attitudes towards CFS patients. These attitudes may be due to lack of education about the illness. Bowen, Pheby and Mcnulty (2005) found that 48% of physicians do not feel confident in making a diagnosis of CFS and 41% do not feel confident in treating CFS patients once they have been diagnosed. Chew-Graham (2008) found that family physicians reported that continuing education and training left them unable to adequately diagnose and treat CFS. Jason et al. (2010) recently examined 119 medical textbooks for CFS material. Of 129,527 total pages only 116.3 pages, less than .1%, mentioned CFS. Multiple Sclerosis was represented on .12% and Lyme disease was on .15%; yet, CFS has a prevalence rate of .42% (Jason et al., 1999), four times the prevalence rate of Multiple Sclerosis and ten times that of Lyme disease. Further, only 21% of the texts reviewed included the criteria for diagnosis of CFS and only 28.6% included treatment options, two vital topics of knowledge for physicians working with CFS patients. These findings suggest not only that the topic of CFS is under reported in published medical textbooks, but also that there are large discrepancies in the information provided. These types of inequities of the material covered in medical textbooks have rarely been the focus of interventions. One exception is the work of Rabow, Hardie et al. (2000), who conducted a content analysis on end-of-life care in multiple medical specialties, and then held a conference with major textbook publishers where they discussed their results; this effort was successful in initiating some change (Rabow, McPhee et al., 1999). In the present study, we attempted to change the amount of CFS coverage in medical textbooks. The authors contacted the editors of the textbook sample from the study by Jason et al. (2010) and encouraged them to increase the representation of CFS. In addition, we classified the chapters that mentioned CFS as psychological, biological, or biopsychosocial and determined if theoretical orientation influenced the editors’ receptiveness to our efforts to influence them. Methods Contacting Editors We used the sample of textbook chapters collected in Jason et al.’s (2010) previous content analysis. We used the Internet to locate the lead editor of each textbook and found their current email address. If the lead editor’s email address was not Invest in ME (Charity Nr. 1114035) available then a secondary editor’s email address was used instead. We then emailed one editor per textbook explaining the importance of improving the material on CFS in textbooks. The letter sent is located in Appendix A. We succeeded in emailing 78 editors. Of those 78 who were emailed, four had written multiple textbooks. The e-mails only addressed one book to eliminate confusion, and each editor was sent only one email. Three of those four editors had edited two texts; the fourth had been lead editor on four texts. Though there was a total of 119 texts there were only 113 editors. Classifying CFS Section The sections on CFS in our sample of textbooks were categorized into four groups: biological, psychological, biopsychosocial, and an exclusion group. The criterion for a biological classification was that the section discussed CFS as a biological illness (e.g., biological tests to rule out other illnesses before diagnosis of CFS, pathophysiology, biological etiology, and biological treatments). The criterion for a psychological classification was that the section focused on the psychological factors of CFS (e.g., the text discussed individuals with personality types thought more prone to suffer from CFS, or the psychological effects of the illness. For biopsychosocial classification, the section needed to combine both biological and psychosocial factors contributing to CFS. The exclusion category indicated that there was inadequate information to make a classification into one of the three categories above (often there was no CFS information in these texts). Two research assistants individually read and classified each section. The two research assistants then discussed every section where they did not agree and carefully came to an agreed-upon consensus. Classifying Replies The replies from editors were categorized by two research assistants and were deemed positive, negative or neutral. Positive responses were categorized as such because the editors had stated in their responses that they would either edit their current sections on CFS to include the information provided to them, or that a new section was going to be added to the next edition containing this information. Neutral was used to classify those editors who had given a positive response; however, they chose for one reason or another not to include CFS in any future editions of their text. Negative responses indicated that the editors had not only chosen not to make a change in their inclusion of CFS but that they still viewed the Page 14/56

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