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1.
Giulia Casu Paola Gremigni Marinella Sommaruga 《Patient education and counseling》2019,102(1):126-133
Objective
To investigate how patients evaluate the provision of patient-centered care (PCC) by healthcare professionals and psychometrically test a questionnaire to assess it. A tool previously developed for self-assessment of professionals’ provision of PCC was adapted into a patient-rated form, named Patient-Professional Interaction Questionnaire (PPIQ).Methods
A sample of 1139 patients from six hospitals completed the 16-item PPIQ and the questionnaire structure, reliability, susceptibility to social desirability, and associations with other variables were tested.Results
The PPIQ confirmed the original four-factor structure (effective communication, interest in the patient’s agenda, empathy, and patient involvement in care) and showed acceptable reliability and measurement invariance across both in-/out-patients and first/non-first encounter with the evaluated professional. Associations with patients’ social desirability were negligible and effective communication was rated the highest among the PPIQ dimensions. PPIQ scores varied according to patients’ educational level and type of professional evaluated, while associations between first/non-first encounter and PPIQ scores varied according to in-/out-patient.Conclusion
The PPIQ is a psychometrically sound patient-rated measure of the provision of PCC by healthcare professionals.Practice implications
The PPIQ has potential value in promoting quality patient-professional interactions in the hospital setting, as patients’ reported experience is an important dimension of the clinician’s performance. 相似文献2.
Angela L. Palmer-Wackerly Heather L. Voorhees Sarah D’Souza Edward Weeks 《Patient education and counseling》2019,102(4):804-809
Objective
To identify how and why infertility patients’ communication with health care providers relates to their continuity of care within infertility treatment.Method
A grounded theory analysis was conducted for 25 in-depth interviews across three coding phases, where we remained open to all themes present in the data, narrowed to most prominent themes, and found the connections between the themes.Results
Based on our identified themes, we created a conceptual model that explains why infertility patients (dis)continued care with one or more clinician. Through this model, we describe two infertility identity transitions for patients: Transition 1: “Infertility as Temporary” to “Infertility as Enduring”; and Transition 2: “Infertility as Enduring” to “Infertility as Integrated.”Conclusion
The study explains how and why patients’ view of their infertility affects their communication, and thus their continuity of care, with clinicians.Practice implications
To provide patient-centered care within infertility treatment, providers can recognize how patients’ view of their infertility, and thus their needs, goals, and expectations, shift throughout their infertility experience. 相似文献3.
Katherine Treiman Lauren McCormack Laura Wagner Nancy Roach Rebecca Moultrie Hannah Sanoff Carla Bann Richard L. Street Mahima Ashok Bryce B. Reeve 《Patient education and counseling》2018,101(9):1585-1593
Objective
This study assessed patient-centered communication (PCC) among newly diagnosed colorectal cancer patients. PCC, a key part of patient-centered care, contributes directly and indirectly to health-related quality of life, satisfaction with care, and other outcomes.Methods
We conducted a survey of patients in North Carolina, using a theoretically-based and validated measure that provides an overall PCC score and subscale scores for six PCC functions.Results
A total of 501 patients participated. The highest scores were for the PCC functions of Fostering Healing Relationships, Exchanging Information, and Making Decisions. The lowest scores were for the functions of Managing Uncertainty and Enabling Self-Management, yet these were functions respondents rated as most important. Respondents who thought about more than one health professional (versus oncologist) reported better communication. PCC also varied by treatment type, mental and physical health status, age, race, and education.Conclusion
Most patients reported good communication overall, however patients in poor physical health and mental health reported worse communication. The quality of communication varied across the PCC functions.Practice implications
Health professionals need to use a PCC approach that builds trust, respects the patient, provides salient information that patients can understand, provides emotional support, and facilitates the patient’s engagement in care. 相似文献4.
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6.
Jakob Håkansson Eklund Inger K. Holmström Tomas Kumlin Elenor Kaminsky Karin Skoglund Jessica Höglander Annelie J. Sundler Emelie Condén Martina Summer Meranius 《Patient education and counseling》2019,102(1):3-11
Objective
To provide a synthesis of already synthesized literature on person-centered care and patient-centered care in order to identify similarities and differences between the two concepts.Methods
A synthesis of reviews was conducted to locate synthesized literature published between January 2000 and March 2017. A total of 21 articles deemed relevant to this overview were synthesized using a thematic analysis.Results
The analysis resulted in nine themes present in person-centered as well as in patient-centered care: (1) empathy, (2), respect (3), engagement, (4), relationship, (5) communication, (6) shared decision-making, (7) holistic focus, (8), individualized focus, and (9) coordinated care. The analysis also revealed that the goal of person-centered care is a meaningful life while the goal of patient-centered care is a functional life.Conclusions
While there are a number of similarities between the two concepts, the goals for person-centered and patient-centered care differ. The similarities are at the surface and there are important differences when the concepts are regarded in light of their different goals.Practice implications
Clarification of the concepts may assist practitioners to develop the relevant aspects of care. Person-centered care broadens and extends the perspective of patient-centered care by considering the whole life of the patient. 相似文献7.
8.
Özlem Örsal Pınar Duru Özgül Örsal Kazım Tırpan Abdullah Çulhacı 《Patient education and counseling》2019,102(2):376-382
Objective
The aim of the study was to examine the relationships between health literacy, primary care satisfaction levels and health awareness of the patients who were admitted to primary care centers (Family Health Centers).Methods
This is a cross-sectional study conducted on individuals who were admitted to Family Health Centers (n?=?1.055) in Eskisehir province. The study data were collected by using Turkish Health Literacy Scale, the European Patients Evaluate General/Family Practice Scale and Health Awareness Scale.Results
As health literacy of participants increases, health awareness and satisfaction with primary care also increases (for each, p?<?.001). Health awareness increases health literacy by 0.55 points, health literacy increases satisfaction in primary care by 0.26 points.Conclusion
In the province of Eskisehir, the health literacy level of 7 out of 10 patients, who admitted to the primary care institution, is inadequate or problematic. As health awareness of participants increases, their level of health literacy also increases. As health literacy of participants increases, their satisfaction with family physicians also increases.Practice implications
As an integral part of preventive health services, studies should be performed to increase and improve the level of health literacy of patients who are admitted to primary care services. 相似文献9.
Anika L. Hines Debra Roter Bri K. Ghods Dinoso Kathryn A. Carson Gail L. Daumit Lisa A. Cooper 《Patient education and counseling》2018,101(2):233-240
Objective
We examined the prevalence and extent of informed decision-making (IDM) and patient-centered decision-making (PCDM) in primary care visits of African Americans with depression.Methods
We performed a cross-sectional analysis of audiotaped clinical encounters and post-visit surveys of 76 patients and their clinicians. We used RIAS to characterize patient-centeredness of visit dialogue. IDM entailed discussion of 3 components: the nature of the decision, alternatives, and pros/cons. PCDM entailed discussion of: lifestyle/coping strategies, knowledge/beliefs, or treatment concerns. We examined the association of IDM and PCDM with visit duration, overall patient-centeredness, and patient/clinician interpersonal ratings.Results
Approximately one-quarter of medication and counseling decisions included essential IDM elements and 40% included at least one PCDM element. In high patient-centered visits, IDM was associated with patients feeling respected in counseling and liking clinicians in medication decisions. IDM was not related to clinician ratings. In low patient-centered visits, PCDM in counseling decisions was positively associated with patients feeling respected and clinicians respecting patients.Conclusions
The associations between IDM and PCDM with interpersonal ratings was moderated by overall patient-centeredness of the visit, which may be indicative of broader cross-cultural communication issues.Practice implications
Strengthening partnerships between depressed African Americans and their clinicians may improve patient-engaged decision-making. 相似文献10.
Jane McCusker Sylvie D. Lambert Jeannie Haggerty Mark J Yaffe Eric Belzile Antonio Ciampi 《Patient education and counseling》2019,102(3):571-577
Objectives
To examine: 1) whether patient characteristics predict perceived self-management support (usefulness of information and collaborative care planning) by primary care providers after six months, and 2) the association between perceived self-management support and patient activation at 6 monthsMethods
We conducted a secondary analysis among 120 primary care patients aged 40 and over with a chronic physical condition and comorbid depressive symptoms who participated in a randomized controlled trial of a coaching intervention for depression self-management. Activation was measured at baseline (T0) and 6 months (T1). Self-management support was captured at T1 for physical and mood problems.Results
The sample of analysis was 120 patients who completed all relevant measures. At T1, the perceived usefulness of information for mood self-management was independently associated with activation. More severe depressive symptoms at T0 predicted lower perceived usefulness of chronic condition self-management information at T1. Lower T0 mental health-related quality of life predicted lower perceived usefulness of mood self-management information at T1.Conclusions
Perceived informational support for mood self-management may contribute to increased activation. Patients with more severe mental health symptoms or impairment perceive that they receive less useful self-management information from their care team.Practice implications
Care teams should determine whether patients with mood problems need greater self-management support. 相似文献11.
Robert C. Smith Heather Laird-Fick Francesca C. Dwamena Laura Freilich Brian Mavis Katelyn Grayson-Sneed Dale D’Mello Mark Spoolstra David Solomon 《Patient education and counseling》2018,101(12)
Objective
We tested the hypothesis that trained medical faculty can train residents effectively in a mental health care model.Methods
After the authors trained medical faculty intensively for 15 months in primary care mental health, the newly trained faculty taught medical residents intensively. Residents were evaluated pre- and post-residency and compared to non-equivalent control residents in another city. Using ANOVA, the primary endpoint was residents’ use of a mental health care model with simulated patients. Secondary endpoints were residents’ skills using models for patient-centered interviewing and for informing and motivating patients.Results
For the mental health care model, there was a significant interaction between study site and time (F?=?33.51, p?<?.001, Eta2?=?.34); mean pre-test and post-test control group scores were 8.15 and 8.79, respectively, compared to 7.44 and 15.0 for the intervention group. Findings were similarly positive for models of patient-centered interviewing and informing and motivating.Conclusions
Training medical faculty to teach residents a mental health care model offers a new educational approach to the widespread problem of poor mental health care.Practice Implications
While the models tested here can provide guidance in conducting mental health care, further evaluation of the train-the-trainer program for preparing residents is needed. 相似文献12.
Victoria Land Ruth Parry Marco Pino Laura Jenkins Luke Feathers Christina Faull 《Patient education and counseling》2019,102(4):670-679
Objective
Giving terminally ill people opportunities to participate in advance care planning involves tensions between: endorsing and supporting patients’ expectations, plans and decisions, and addressing how realistic these are. The latter risks exerting undue pressure to change plans; undermining autonomy; jeopardising therapeutic relationships. Our objective is to describe how experienced hospice doctors raise potential/actual problems with patients’ expectations, plans or decisions.Methods
Conversation analysis of video-recorded consultations between five UK hospice consultants, 37 patients and their companions.Results
Eleven episodes involving five doctors were found. In all of these we identified a ‘Hypothetical Scenario Sequence’ where doctors raise a hypothetical future scenario wherein current plans/expectations turn out to be problematic, then engage patients in discussing what could be done about this. We describe features of this sequence and how it can circumvent the risks of addressing problems with patients’ expectations and plans.Conclusion
Our research breaks new ground, showing that by treating expectations, plans and decisions as potentially not actually problematic, practitioners can recognise and support patients’ preferences whilst preparing them for possible difficulties and inevitable uncertainties.Practice Implications
Where professionals judge it appropriate to raise problems about patients’ preferences, plans and decisions, this sequence can manage the associated risks. 相似文献13.
Mary M. Step Gretchen A. Ferber Catherine Downs-Holmes Paula Silverman 《Patient education and counseling》2019,102(1):77-84
Objective
To assess the feasibility of a team-based prognosis and treatment goal discussion for women living with advanced breast cancer.Methods
Female patients diagnosed with advanced breast cancer (n?=?25) participated in a mixed methods study that evaluated the feasibility and effects of a planned and structured prognosis discussion. Audio analysis of the intervention appointments was conducted to assess intervention feasibility. Patient self-reports of prognosis related beliefs and treatment preferences were compared across intervention and usual care groups.Results
Most patients found the T-PAT appointment challenging but worthwhile. Intervention uptake by clinicians was good, but some fidelity disruptions were noted. T-PAT participants were more likely to hold realistic beliefs about disease curability after the appointment.Conclusion
Productive prognosis discussions can be delivered effectively by a practice-based clinical team within a semi-structured patient education appointment. It was perceived by patients with advanced breast cancer as both valuable and acceptable. T-PAT clinicians found the intervention easy to deliver.Practice implications
Regular implementation of T-PAT may help clinicians’ build prognosis discussion communication skills. T-PAT documentation provides valuable information that can be used to tailor ongoing care. 相似文献14.
Dagoberto Cortez Douglas W. Maynard Toby C. Campbell 《Patient education and counseling》2019,102(2):216-222
Objectives
Analyze entire oncology clinical visits and examine instances in which oncologists have to break the bad news that patients’ treatments are no longer effective.Methods
Using conversation analysis we examine 128 audio recorded conversations between terminal cancer patients, their caregivers, and oncologists.Results
When oncologists break the bad news that a patient’s treatment is no longer effective, they often use a conversational device we call an “exhausted current treatment” (ECT) statement, which avoids discussing prognosis in favor of further discussing treatment options. Analysis suggests that improving and prioritizing patient-centered care and shared decision making is possible if we first understand the social organization of clinical visits.Conclusions
ECT statements and their movement towards discussing treatment options means that opportunities are bypassed for patients and caregivers to process or discuss scan results, and their prognostic implications.Practice Implications
When oncologists and patients, by fixating on treatment options, bypass opportunities to discuss the meaning of scan results, they fail to realize other goals associated with prognostic awareness. Talking about what scans mean may add minutes to that part of the clinic visit, but can create efficiencies that conserve overall time. We recommend that oncologists, after delivering scan news, ask, “Would you like discuss what this means?”. 相似文献15.
Thea Luig Glyn Elwyn Robin Anderson Denise L. Campbell-Scherer 《Patient education and counseling》2019,102(2):291-300
Objective
Care communication about obesity needs to respond to the complex biopsychosocial processes that affect weight and health. The collaborative deliberation model conceptualizes interpersonal work that underpins empathic communication and shared decision-making. The goal of this study was to elucidate how primary care practitioners can use the model to achieve shared obesity assessment and care planning.Methods
This qualitative study used direct observation of clinical encounters with twenty patients with obesity sampled for maximum variation in context, semi-structured patient and provider interviews, patient journals and two follow-up interviews over eight weeks. Themes were compared to the original model.Results
We identified five processes that may be relevant for collaborative deliberation about obesity in addition to the original model: (1) Exploring the story, (2) Reframing the story, (3) Co-constructing a new story, (4) Choosing a priority, and (5) Experimenting with alternatives.Conclusions
We propose an enhanced collaborative deliberation model for obesity that describes the interpersonal work needed before and after deliberation about preferences and courses of action.Practice implications
The enhanced model can support clinicians in achieving meaningful conversations about obesity and complex chronic disease resulting in care plans that are responsive to and achievable in the patient’s lifeworld. 相似文献16.
Stuart Ekberg Susan Danby Johanna Rendle-Short Anthony Herbert Natalie K. Bradford Patsy Yates 《Patient education and counseling》2019,102(2):198-206
Objective
To consider whether and how family members and clinicians discuss end of life during paediatric palliative care consultations.Methods
Nine naturally occurring paediatric palliative care consultations were video recorded and analysed using conversation analytic methods.Analysis
Focusing on three consultations in which end of life was treated as a certain outcome, analysis explored ways in which end of life was made either implicit or explicit within these consultations. Our analysis suggests that end of life was made explicit when: 1) ancillary to the current focus of discussion, 2) in relation to someone else’s child, or 3) specifically relevant to the local context of the discussion. More commonly, in all other instances in the data, end of life was made implicit during discussions relating to this matter.Conclusion
This preliminary research indicates that the local context of a conversation can influence how end of life is mentioned and discussed.Practice implications
Clinicians often are encouraged to promote honest and ‘open’ discussions about end of life. Our findings show that it is not necessary to explicitly mention end of life in order to discuss it. 相似文献17.
Emma J. Draper Marij A. Hillen Marleen Moors Johannes C.F. Ket Hanneke W.M. van Laarhoven Inge Henselmans 《Patient education and counseling》2019,102(2):266-274
Objective
To examine the relationship between physicians’ death anxiety and medical communication and decision-making. It was hypothesized that physicians’ death anxiety may lead to the avoidance of end-of-life conversations and a preference for life-prolonging treatments.Methods
PubMed and PsycInfo were systematically searched for empirical studies on the relation between physicians’ death anxiety and medical communication and decision-making.Results
This review included five quantitative and two qualitative studies (N?=?7). Over 38 relations between death anxiety and communication were investigated, five were in line with and one contradicted our hypothesis. Physicians’ death anxiety seemes to make end-of-life communication more difficult. Over 40 relations between death anxiety and decision-making were investigated, three were in line with and two contradicted the hypothesis. Death anxiety seemes related to physicians’ guilt or doubt after a patient’s death.Conclusions
There was insufficient evidence to confirm that death anxiety is related to more avoidant communication or decision-making. However, death anxiety does seem to make end-of-life communication and decision-making more difficult for physicians.Practice implications
Education focused on death and dying and physicians’ emotions in medical practice may improve the perceived ease with which physicians care for patients at the end of life. 相似文献18.
Alex D. Federman Lina Jandorf Joseph DeLuca Mary Gover Angela Sanchez Munoz Li Chen Michael S. Wolf Joseph Kannry 《Patient education and counseling》2018,101(8):1483-1489
Objective
To test the impact of a redesigned, patient-centered after visit summary (AVS) on patients’ and clinicians’ ratings of and experience with the document.Methods
We conducted a difference-in-differences (DiD) evaluation of the impact of the redesigned AVS before and after its introduction in an academic primary care practice compared to a concurrent control practice. Outcomes included ratings of the features of the AVS.Results
The intervention site had 118 and 98 patients in the pre- and post-intervention periods and the control site had 99 and 105, respectively. In adjusted DiD analysis, introduction of the patient-centered AVS in the intervention site increased patient reports that the AVS was an effective reminder for taking medications (p?=?.004) and of receipt of the AVS from clinicians (p?=?.002). However, they were more likely to perceive it as too long (p?=?.04). There were no significant changes in overall rating of the AVS by clinicians or their likelihood of providing it to patients.Conclusions
A patient-centered AVS increased the number of patients receiving it and reporting that it would help them remember to take their medications.Practice implications
Improvements in the patient-centeredness of the AVS may improve its usefulness as a document to support self-management in primary care. 相似文献19.
Anna Udvardi 《Patient education and counseling》2019,102(2):388-393
Objective
The aim of the study is to show how qualitative, linguistic analysis can be purposefully integrated into health communication research, based on the functions and outcomes of medical communication proposed by de Haes and Bensing 2009 [1].Methods
This article proposes a theoretical framework advancing health communication research and does not present primary research. The cited papers were selected on the basis of their relevance to the current purpose of the study, without the intention of being exhaustive.Results
Linguistic and conversation analytic research supports the legitimacy of commonly recommended patient-centered communication skills. However, research that directly relates linguistic analysis to certain functions and outcomes of the medical interview is sparse.Conclusion
Integrating linguistics into health communication research enhances the evidence base of healthcare communication and helps to develop effective communication training materials.Practice implications
Future research designs should purposefully and directly connect linguistic analysis with the functions and the outcomes of the medical interview. 相似文献20.
Aisha T. Langford Binhuan Wang Natasha A. Orzeck-Byrnes Sneha R. Aidasani Lu Hu Melanie Applegate Dana N. Moloney Mary Ann Sevick Erin S. Rogers Natalie K. Levy 《Patient education and counseling》2019,102(3):520-527