共查询到20条相似文献，搜索用时 31 毫秒
1.
Cindy B. Matsen Sarah Lyons Melody S. Goodman Barbara B. Biesecker Kimberly A. Kaphingst 《Patient education and counseling》2019,102(1):155-161
Objective
To better understand decision role preferences in women diagnosed with breast cancer at a young age for return of results of genome sequencing in research and clinical settings.Methods
Participants were surveyed about communication and decision-making preferences related to genome sequencing results and factors that may affect these preferences. The primary outcome was decision role preference (Control Preference Scale) for selecting what results to receive within medical care or within a research study.Results
For results returned as part of medical care, most patients preferred a collaborative (N?=?481, 45%) or active (N?=?488, 45%) role with only 107 (10%) choosing a passive role. When making the decision as part of a research study, most patients preferred an active role (N?=?617, 57%), 350 (33%) choosing a collaborative role, and110 (10%) choosing a passive role.Conclusion
Most women in this study preferred to share in decision making. Participants had somewhat different role preferences for clinical and research contexts, with greater preference for active roles in the research context.Practice Implications
We advocate for practice guidelines that incorporate discussion of decision role as an integral part of patient centered care and shared decision-making and recognize that more work is needed to inform guidelines. 相似文献2.
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3.
4.
Richard Wagland Johana Nayoan Lauren Matheson Carol Rivas Jo Brett Amy Downing Sarah Wilding Hugh Butcher Anna Gavin Adam W. Glaser Eila Watson 《Patient education and counseling》2019,102(4):797-803
Objectives
To explore experiences of treatment decision-making (TDM) amongst men diagnosed with stage 1–3 prostate cancer.Methods
Mixed-methods study incorporating UK-wide cross-sectional postal survey of men 18–42 months post-diagnosis and semi-structured interviews with a subsample (n?=?97), including men who received both radical treatments and active surveillance. Interview data was analysed using a Framework approach.Results
Within the context of TDM, 'drivers' included men's intra-personal preferences for decision-making responsibility or clinical direction, relative treatment intrusiveness or desire for excision, and work, personal and social life priorities; 'facilitators' were inter-personal mechanisms such as information and communication with clinicians to enact, but also sometimes challenge drivers. Drivers and facilitators can conflict, challenging patient empowerment. Men frequently undertook greater TDM responsibility than desired, without clinical recommendations; others received conflicting recommendations. Information on potential side-effects was often reportedly inadequate. Unchallenged preferences, absence of clinical recommendations and inadequate preparation for side-effects sometimes led to decision regret.Conclusions
Men are not empowered when expected to take more TDM responsibility than desired, when provided with conflicting recommendations, or when their potentially inappropriate preferences are unchallenged.Practice implications
TDM should involve men exercising preferences and priorities in discussion with clinicians. Clinicians should ensure patients do not receive conflicting recommendations. 相似文献5.
Sharon Manne Barbara Smith Anna Mitarotondo Sara Frederick Deborah Toppmeyer Laurie Kirstein 《Patient education and counseling》2019,102(5):902-908
Objectives
The study’s goals were to characterize decisional conflict and preparedness for making the decision about having CPM among breast cancer patients considering CPM who do not carry cancer-predisposing mutation and to evaluate correlates of decisional conflict and preparedness.Methods
93 women considering CPM completed a survey of decisional conflict and preparedness for the CPM decision, knowledge, perceived risk, self-efficacy, reasons for CPM, input from others and discussion with the doctor about CPM, and cancer worry.Results
Between 8% and 27% of women endorsed elevated decisional conflict. Most women were satisfied with preparatory information that they were provided. Knowledge was low. Top reasons for choosing CPM were the desire for peace of mind, lowering the chance of another breast cancer, and improving survival.Conclusions
Decisional conflict is elevated in a subset of patients considering CPM. A more well-informed decision may be fostered by a comprehensive discussion about CPM with the patient’s clinician, fostering self-efficacy in managing cancer worry, and helping patients understand their motivations for CPM.Practice implications
Clinicians working with breast cancer patients considering CPM should discuss the CPM decision, foster self-efficacy in managing cancer worry, and help patients understand their motivations for the surgery. 相似文献6.
Miyong T. Kim Kim Byeng Kim Tam H. Nguyen Jisook Ko Jim Zabora Elizabeth Jacobs David Levine 《Patient education and counseling》2019,102(4):709-717
Objective
To test the efficacy of a hybrid model of the self-help intervention program (hSHIP), which combines a mobile version of SHIP (mSHIP) and personal coaching, to address unique cultural and motivational factors for optimal self-management of type 2 diabetes and prediabetes among Korean Americans (KAs).Methods
A single-group feasibility study design was used. The hSHIP utilizes texts and motivational counseling based on well-tested intervention content for KAs. To facilitate the dissemination of hSHIP, we developed a web application adopting the principles of persuasive technology to motivate behavior changes.Results
Feasibility assessment found that hSHIP was well accepted by both participants and community health workers who delivered the intervention. An average of 1.3% A1C reduction (from 7.8% to 6.5%) was achieved by KAs with diabetes (n?=?165), 51.5% of whom lowered their A1C below 6.5% in 6-months. No one with prediabetes (n?=?50) progressed to diabetes. Other clinical outcomes (e.g., weight, depression, and blood pressure) also improved significantly; 41.2% were able to reduce or discontinue antidiabetic drugs.Conclusion
The feasibility and initial efficacy of hSHIP were demonstrated.Practice implication
This hybrid diabetes self-management model is a viable tool for traditionally underserved groups with diabetes or prediabetes. 相似文献7.
8.
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9.
Virginia Teas Gill 《Patient education and counseling》2019,102(2):207-215
Objective
To examine how, and for what interactional purpose, a surgeon raises the risk of death with an early-stage breast cancer patient.Method
Single-case analysis of a recorded surgical consultation, using conversation analysis.Results
The surgeon not only negotiates the surgical treatment decision with the patient, she provides an overview of what her non-surgical treatment is likely to entail. Analysis reveals how the surgeon addresses interactional challenges when providing this overview, including how to broach the rationale for administering chemotherapy, the possibility that cancer could spread to vital organs and prove fatal. To do this, the surgeon orients to the possibility that the patient has misconceptions about her risk of dying from breast cancer. She uses negatively-formulated assertions to invoke these possible misconceptions, making correction relevant and providing a point of entry into delicate interactional territory.Conclusion
The surgeon draws upon possible patient misconceptions to broach the rationale for administering adjuvant chemotherapy.Practice Implications
The surgical consultation is typically the first treatment-related consultation newly-diagnosed breast cancer patients have and represents an opportunity to educate patients and prepare them for future treatment decisions. The challenges of providing and receiving such overviews, and how they may influence future treatment decisions, merit consideration. 相似文献10.
Hsiu-Nien Shen Chia-Chen Lin Tammy Hoffmann Chia-Yin Tsai Wen-Hsuan Hou Ken N. Kuo 《Patient education and counseling》2019,102(2):360-366
Objectives
We explored the relationship between patient-perceived shared decision making (SDM) and three domains of health literacy (HL) in patients with breast cancer.Methods
In this cross-sectional study, we prospectively recruited a convenience sample of 511 breast cancer patients from 3 hospitals in Taiwan. Patients completed questionnaires about HL and perceived SDM in a recent consultation. Sequential regressions, controlling for International Classification of Functioning, Disability and Health (ICF)-related factors) were conducted. Interactions of each HL domain with age or education were also assessed for the relationship with perceived SDM.Results
Higher scores in the HL domains of healthcare and disease prevention, but lower scores in the health promotion domain, were significantly associated with a higher perceived level of SDM after controlling for ICF-related factors (R2?=?33.44%). The association of SDM with two domains of HL varied with age, while the relationship between the 3 HL domains and SDM differed across education levels.Conclusion
Each HL domain was significantly associated with perceived SDM after controlling for the ICF-related factors and across different age- and education-stratifications.Practice implications
Clinicians should be cognizant of patients’ HL levels and incorporate HL best practices into consultations and interactions with patients with breast cancer to facilitate SDM. 相似文献11.
Michelle D. Dannenberg John Carlo M. Bienvenida Martha L. Bruce Theresa Nguyen Michelle Hinn James Matthews Stephen J. Bartels Glyn Elwyn Paul J. Barr 《Patient education and counseling》2019,102(3):555-563
Objective
Our aim was to gather community stakeholder input to inform the development of a digital system linking depression screening to decision support.Methods
Views and feature requirements were identified through (1) focus groups with patients and consumers with depression, and interviews with primary care clinicians and (2) usability sessions where patients and consumers used the current version of encounter decision aid (eDA) in a primary care waiting room. Qualitative data were analyzed using the framework method.Results
We conducted six focus groups with 15 participants, seven clinician interviews and 10 usability sessions. Patients were comfortable completing the Patient Health Questionnaire (PHQ-9) and receiving the electronic eDA in clinic. They felt this would allow patients to prepare for their visit and instill a sense of agency. Participants were comfortable receiving the PHQ-9 results and a subsequent eDA on a tablet in the waiting room.Conclusion
Patients with and without depression, as well as clinicians, viewed linking the PHQ-9, results, and eDA positively. Patients were comfortable doing this in the clinic waiting room.Practice implications
Linking depression decision support to screening was viewed positively by patients and clinicians, and could help overcome barriers to shared decision-making implementation in this population. 相似文献12.
Objective
To break new ground by directly examining how patients seek life-expectancy estimates, and how doctors support them in doing so.Methods
Conversation analytic examination of 10 recorded UK hospice consultations involving 3 palliative specialists.Results
Life-expectancy estimate episodes frequently begin after a doctor has given a patient an opportunity to shape the consultation agenda. Rather than posing direct questions, patients cautiously display their interest in receiving an estimate using statements. These often contain preparatory information about: what they already know about their prognosis, their perspective on it, and readiness to hear more. When patients do not provide this information, doctors invite it before giving an estimate. Patients’ companions also contribute to this preparatory work.Conclusion
Doctors, patients, and companions collaboratively work to prepare a conversational environment wherein emotional states and uncertainties have been addressed prior to delivery of the actual estimate. This helps manage both possible emotional distress, and prognostic uncertainty entailed in seeking and delivering estimates.Practice implications
Clinicians should be mindful that rather than overtly requesting estimates, patients may seek them more cautiously. Before delivering estimates, doctors can support patients to articulate their existing understanding and perspective regarding prognosis, and their readiness to hear more. 相似文献13.
14.
U. Olivia Kim K. Barnekow S.I. Ahamed S. Dreier C. Jones M. Taylor Md.K. Hasan M.A. Basir 《Patient education and counseling》2019,102(4):701-708
Objective
To develop an educational mobile application (app) for expectant parents diagnosed with risk factors for premature birth.Methods
Parent and medical advisory panels delineated the vision for the app. The app helps prepare for preterm birth. For pilot testing, obstetricians offered the app between 18–22 weeks gestational age to English speaking parents with risk factors for preterm birth. After 4 weeks of use, each participant completed a questionnaire. The software tracked topics accessed and duration of use.Results
For pilot testing, 31 participants were recruited and 28 completed the questionnaire. After app utilization, participants reported heightened awareness of preterm birth (93%), more discussion of pregnancy or prematurity issues with partner (86%), increased questions at clinic visits (43%), and increased anxiety (21%). Participants reported receiving more prematurity information from the app than from their healthcare providers. The 15 participants for whom tracking data was available accessed the app for an average of 8?h.Conclusion
Parents with increased risk for preterm birth may benefit from this mobile app educational program.Practice implications
If the pregnancy results in preterm birth hospitalization, parents would have built a foundation of knowledge to make informed medical care choices. 相似文献15.
Objective
This study was conducted to examine the effect of education on quality of life and constipation severity in patients with primary constipation.Methods
This randomised controlled study was conducted with 80 patients who applied at the gastroenterology outpatient clinic of a university hospital. In the study, the Constipation Questionnaire, Constipation Quality-of-Life Questionnaire (PAC-QOL), and Constipation Severity Instrument (CSI) were used.Results
It was that found after 4 weeks of education, the total PAC-QOL mean score decreased to 60.85?±?5.65 and total CSI mean score decreased to 20.17?±?4.05 in the intervention group (p?<?0.001). No change was observed in the patients in the control group (p?>?0.05). After 4 weeks, a statistical difference was found between the two groups in PAC-QOL mean score and CSI mean score (p?<?0.05).Conclusion
It was determined that the education given to individuals with primary constipation decreased the constipation severity and increased the quality of life.Practice implications
Constipation education will make a contribution to the active use of follow-up forms by nurses in the clinic for the diagnosis of constipation, individual assessment of each patient, and their active role in constipation management. 相似文献16.
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17.
Natalia Cecon Marij A. Hillen Holger Pfaff Antje Dresen Sophie E. Groß 《Patient education and counseling》2019,102(5):998-1004
Objective
To examine breast cancer patients’ reasons to seek a second opinion (SO) and the underlying variables. To find out more about the outcome of the SO, the perceived helpfulness and the effect on the physician-patient relationship.Methods
In 2017, 4626 newly diagnosed breast cancer patients from 86 hospitals in Germany completed a postoperative mail survey (response rate?=?89.04%). Data from 419 SO-seeking patients was obtained and analyzed by conducting logistic regression and non-parametric group comparisons.Results
Reasons to seek an SO were mostly unrelated to the physician-patient relationship. Reasons related to the physician-patient-relationship were associated with a lower education level. The SO mostly (72.2%) equaled the first opinion. A different treatment plan recommendation (25%) reportedly affected the patients’ relationship with their primary physician. Patients who received a different diagnosis reported more fear of progression. Most patients found the SO helpful.Conclusion
The reasons to seek an SO are primarily unrelated to the physician-patient relationship. However, less educated patients seem to have different reasons to seek an SO. These reasons were reportedly associated with the physician-patient relationship.Practice implications
Physicians may need to explicitly ascertain the patient’s needs within the physician-patient communication to avoid inequalities based on patient education. 相似文献18.
Objective
The study was conducted to determine the effects of prenatal education on quality of life and complaints during pregnancy.Methods
This study is a quasi-experimental research with a control group. Personal Information Form and Scale of Complaints during Pregnancy and their Effects on Quality of Life (SCPEQL) were used to collect the data. Thirty participants were included in both the control and the intervention groups (N?=?60).Results
The mean scores of SCPEQL of the intervention group was 46.2?±?21.1 and the mean scores of SCPEQL of the control group was 99.8?±?21.6 in 2nd trimester. In the 3rd trimester, the mean score of SCPEQL of the intervention group was 43.5?±?16.4, and the mean score of SCPEQL of the control group was 108.0?±?16.8. The difference between the groups was statistically significant in 2nd and 3rd trimesters (p?<?0.05).Conclusion
Findings of the study suggest that providing prenatal education reduces complaints and increases quality of life of pregnant women.Practice implications
Assessing complaints during pregnancy by nurses is a part of the prenatal care. Therefore, nurses should evaluate pregnancy-related complaints. Quality of life should be increased by giving effective education about complaints during pregnancy. 相似文献19.
20.
Nahed A. Soliman Shaimaa M. Yussif Abdelhadi M. Shebl 《Pathology, research and practice》2019,215(5):977-982