Table 3.
Individual theme name | Individual theme definition |
---|---|
Theme A. Glucocorticoids are effective and withdrawal can potentiate a flare | |
Positive effects of GC | Relief at starting treatment after prolonged investigations. |
Symptoms improve quickly; feeling of the problem being fixed. | |
Staying on GC “for ever” may control symptoms | |
Flaring on reduction of glucocorticoids | Withdrawal symptoms on reducing GCs Flare linked to reducing GCs |
Feeling of GC reduction being an “experiment” | |
Increasing dosages of GCs resolving flares swiftly | |
Theme B. Description of salient emotional, physical and social effects of glucocorticoid therapy | |
Change in appearance | Significant weight gain |
Puffiness and change in facial features | |
Not recognising oneself | |
Feeling “weird” | |
Not able to wear certain clothes | |
Feeling depressed by change in appearance | |
Others comments on appearance | Partners comments about weight |
Family support to lose weight | |
Family unsupportive or derogatory about weight | |
Others unable to understand increase in energy with GCs | |
Looking “well” on GC masking underlying illness to others | |
Appetite | Hunger pains and increase in appetite |
Adaptations needed to reduce weight gain | Exercise and diet |
Diabetes | New diabetes and difficult to control established diabetes |
Monitoring of blood sugars: painful and intrusive | |
Skin changes | Easy bruising and skin fragility |
Sleep disturbance | Difficulty getting to sleep/insomnia |
Requiring less sleep | |
Muscle strength | Reduced muscle strength |
Emotional symptoms | Feeling manic or euphoric |
Increased energy/hyperactivity | |
Anxiety | |
Mood swings | |
Depression | |
Effect of personality change on personal life and or work | |
Theme C. Patient perceptions of balancing the risks and benefits of glucocorticoids | |
Process of weighing up use of GC | Long-term side effects versus short-term death |
Body can only take GC for so long | |
Maintenance dose may be needed long-term | |
Concern about long-term adverse effects | Bone loss |
Diabetes | |
Glaucoma |