GRAPHIC REPRESENTATION OF ILLNESS - A NOVEL METHOD OF MEASURING PATIENTS PERCEPTIONS OF THE IMPACT OF ILLNESS

Background: Health outcome is multi-faceted, and for both research and clinical practice, greater knowledge of its facets is required. The P ictorial Representation of Illness and Self Measure (PRISM) was develo ped as a simple, rapid measure of the current impact of illness and sy mptoms on the individual. Methods: The PRISM task was completed by 26 outpatients with rheumatoid arthritis participating in a larger study of psychosocial correlates of arthritis, which included assessment of disease variables, functional impairment, pain, depression and patient s' appraisals of their illness. In the PRISM task, the patient was ask ed to imagine that a small board represents his/her life and a fixed d isk on the board represents his/her 'self'. The task was to place anot her (Illness) disk on the board to represent the current importance of illness in the patients' life. The main outcome measure was the dista nce between the Self and Illness disks. Findings: Only 2 patients had difficulty understanding the task. PRISM distance did not correlate wi th any disease variables. It correlated inversely with pain, functiona l impairment and depression, and positively with coping resources. PRI SM distance correlated with perceived control over illness and negativ ely with awareness of illness. Interpretation: PRISM is an innovative measure, simple and well accepted by patients. It appears to measure w hat in German is termed leidensdruck, the burden of suffering due to i llness. It offers a promising measure of an intangible but important h ealth outcome, hitherto neglected, applicable to research intervention s and clinical practice.