共查询到20条相似文献，搜索用时 562 毫秒
1.
Inge Henselmans Sabrina D. Brugel Hanneke C.J.M. de Haes Kim J.A. Wolvetang Laura M. de Vries Arwen H. Pieterse Monique C.M. Baas-Thijssen Filip Y.F. de Vos Hanneke W.M. van Laarhoven Ellen M.A. Smets 《Patient education and counseling》2019,102(5):916-923
Objective
To learn how to configure a patient communication aid (PCA) to facilitate shared decision-making (SDM) about treatment for advanced cancer.Methods
The PCA consists of education about SDM, a question prompt list, and values clarification methods. Study 1. A first version was presented to 13 patients, 8 relatives and 14 bereaved relatives in interviews. Study 2. A second version was used by 18 patients in a pilot study. Patients and oncologists were interviewed, patients were surveyed, and consultations were audio-recorded.Results
Respondents reported that the aid facilitated patient control over information, raised choice awareness and promoted elaboration. Risks were identified, most importantly that the aid might upset patients. Also, some respondents reported that the PCA did not, or would not support decision making because they felt sufficiently competent, did not perceive a role for themselves, or did not perceive that the decision required elaboration.Conclusions
Opinions on the usefulness of the PCA varied. It was challenging to raise awareness about the presence of a choice, and to find a balance between comprehensive information and sensitivity.Practice implications
A future study should demonstrate whether the PCA can improve SDM, and whether this effect is stronger when oncologists receive training. 相似文献2.
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3.
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
Background
Insulin titration is typically done face-to-face with a clinician; however, this can be a burden for patients due to logistical issues associated with in-person clinical care. The Mobile Insulin Titration Intervention (MITI) used basic cell phone technology including text messages and phone calls to help patients with diabetes find their optimal basal insulin dose (OID).Objective
To evaluate sociodemographic and clinical correlates of reaching OID, text message response rate, and days needed to reach OID.Methods
Primary care providers referred patients to MITI and nurses delivered the program. Three multivariable regression models quantified relationships between various correlates and primary outcomes.Results
The sample included 113 patients from 2 ambulatory clinics, with a mean age of 50 years (SD?=?10), 45% female, 79% Hispanic, 43% unemployed, and 46% uninsured. In regression models, baseline fasting blood glucose (FBG) was negatively associated with odds of reaching OID and 100% text responses, and positively associated with days to reach OID, p?<?.05).Conclusions
Patients with higher baseline FBG levels were less successful across outcomes and may need additional supports in future mHealth diabetes programs.Practical Implications
Basic cell phone technology can be used to adjust patients’ insulin remotely, thereby reducing logistical barriers to care. 相似文献4.
Karolien Aelbrecht Lise Hanssens Jens Detollenaere Sara Willems Myriam Deveugele Peter Pype 《Patient education and counseling》2019,102(4):776-781
Aim
The value of patient-centredness, of which effective physician–patient communication is one key element, has been established within medicine. However, research shows social differences in medical communication according to the patient’s social background. This study examines the role of the patient’s ethnicity, educational background and language proficiency in relation to physician-patient interaction in 31 countries.Method
More than fifty thousand patients were given a standardized questionnaire to gain insights into the professional behaviour of their family physician and their own expectations and actions.Results
While no effect of ethnicity was found, there was a significant effect of patients’ language proficiency and educational level. Patients with lower language proficiencies were more likely to experience more negative interactions with their physicians. Second-generation migrants who did not fill in the questionnaire in an official language were more negative about the patient–physician interaction. Patients who had a greater chance of having a positive patient–physician interaction were more likely to be higher educated.Conclusion
Despite the shift towards patient-centred care in medicine, physician–patient communication is still determined by the patient’s educational background and language proficiency.Practice Implication
GPs should primarily be trained to tailor their communication styles to match patients’ backgrounds. 相似文献5.
Eli Bjørnøy Urke Silje Søbye Asta Ellingvåg Gisle Langslet Kjetil Retterstøl Margareta Wandel 《Patient education and counseling》2019,102(5):1005-1012
Objectives
Familial hypercholesterolemia (FH) is a hereditary and usually asymptomatic condition characterized by elevated blood cholesterol and increased risk of premature cardiovascular disease. It is treated with dietary modifications and lipid lowering drugs. The objective was to learn about young FH patients’ perceptions and choices regarding treatment.Methods
Data were collected through in-depth interviews with 24 patients (ages 16–35), and analysed according to Grounded Theory.Results
The findings are presented as theoretical concepts describing the participants’ way of handling their condition. The core category was identified as “Thoughts of consequences vs. Postponing thoughts of consequences”, which could be described through the following subcategories: 1. Normalising the condition, 2. Belittling of treatment vs. Committed to treatment and 3. Trust in advice vs. Avoid unnecessary interference. The participants’ position regarding these categories was described to affect motivation and challenges with treatment.Conclusions
Participants who postpone the thoughts of consequences, belittle the treatment and avoid unnecessary interference represent a challenge to health care practitioners.Practical implications
Practitioners should explore aspects such as thoughts of consequences, view of treatment and the feeling of interference to be able to better understand illness behaviour, adjust their communication and hopefully improve adherence. 相似文献6.
Johanna Granhagen Jungner Elisabet Tiselius Klas Blomgren Kim Lützén Pernilla Pergert 《Patient education and counseling》2019,102(4):656-662
Objectives
The objective of this study was to explore interpreters’ perceived strategies in the interaction in interpreter-mediated consultations between healthcare personnel and patients/families with limited Swedish proficiency in pediatric oncology care.Methods
This study had an inductive approach using an exploratory qualitative design. A total of eleven semi-structured interviews were performed with interpreters who had experience interpreting in pediatric oncology care.Results
The interpreters' perceived strategies were divided into four generic categories; strategies for maintaining a professional role, strategies for facilitating communication, strategies for promoting collaboration, and strategies for improving the framework of interpreting provision. These four generic categories were then merged into the single main category of carrying the bilingual conversation.Conclusions
The interpreters stretch their discretionary power in order to carry the bilingual conversation by using strategies clearly outside of their assignment.Practical implications
The study contributes to the understanding of the interpreter-mediated consultation in pediatric oncology care, and this can be used to improve the care of patients and families in pediatric oncology care with limited knowledge of a country’s majority language. 相似文献7.
8.
Objective
Patient satisfaction had been the focus of many scientific studies worldwide. However, very few studies published had addressed the definition of the concept of patient satisfaction. Therefore this present concept analysis is to explore the attributes of the concept in the broader healthcare context.Methods
The Rodgers method, an inductive method of concept analysis, was selected to guide this concept analysis.Results
The attributes of patient satisfaction in the healthcare context identified were provider attitude, technical competence, accessibility, and efficacy. Perception in relation to expectation, patient demographics and personality, and market competition were regarded as prerequisites of patient satisfaction. Consequences of patient satisfaction identified in this analysis were: patient compliance, clinical outcomes, loyalty and referrals.Conclusion
As healthcare is becoming an increasingly competitive marketplace, studying patient experience could certainly help practitioners to better encompass patient perspectives in service delivery and improve patient satisfaction.Practice implications
To ensure the validity of patient satisfaction measurement and subsequently improve healthcare quality, practitioners should involve patients in identifying important factors relevant to each attributes of patient satisfaction. 相似文献9.
10.
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11.
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12.
Mariëtte N. Verkissen Kathleen Leemans Lieve Van den Block Luc Deliens Joachim Cohen 《Patient education and counseling》2019,102(4):768-775
Objective
To explore how individuals with cancer and bereaved relatives evaluate information provision by specialist palliative care services (PCSs).Methods
A cross-sectional survey was conducted within four multidisciplinary palliative homecare teams (HCTs), 17 hospital-based palliative care units (PCUs) and 13 hospital-based mobile palliative support teams (PSTs) in Belgium. During four measurement periods, structured questionnaires were administered to people being guided by PCSs and relatives of patients who had died while under the care of PCSs.Results
In total, 628 patients (80%) and 980 relatives (55%) responded; 73–82% and 75–77% respectively reported having received the right amount of information. Compared with those receiving care within a PCU, those being supported by a PST were more likely to report suboptimal information provision and decision-making. Relatives of those who had died while under the guidance of a PST were also more likely to report suboptimal information provision than their PCU counterparts.Conclusion
Although information provision to cancer patients and relatives being supported by PCSs is generally evaluated positively, evaluations depend on the type of service.Practice implications
Information provided within PCUs offering highly personalised, continuous care appears to both groups more satisfactory than that provided by palliative care teams mainly supporting care staff. 相似文献13.
Objectives
The aim of this study was to investigate the link between perceived dimensions of patient centred care and the satisfaction of adolescents and young adults within the UK, USA, Australian, Italian, and Chinese healthcare systems.Methods
One thousand and thirty-four participants (212 from China,206 from Australia,208 from UK, 202 from USA, and 206 from Italy) answered a self-report questionnaire assessing the perceived dimensions of patient centred care. Factor analysis (PFA) was conducted on the data to identify relevant dimensions. One-way ANOVAs were run to identify differences between country samples related to perceived dimensions of patient centredness, and a multi-level multiple regression model was computed to assess the link between satisfaction and dimensions of patient centred care.Results
Countries’ mean scores on ‘Satisfaction with Care’ (PF1) and on ‘Psychosocial Context’ (PF2) were statistically significant by inspecting the ANOVAs (p?<?.05). Satisfaction with care was predicted by PF2 and clinical utilization.Conclusion
An online survey collected meaningful data on perceptions of healthcare received by respondents from five countries. This initial international study highlights important associations worthy of closer investigation.Practice implications
Healthcare providers should assess comprehensively the psychosocial context of young patients during consultations. 相似文献14.
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15.
Saraswathi Vedam Kathrin Stoll Daphne N. McRae Mo Korchinski Raquel Velasquez Jessie Wang Sarah Partridge Lorna McRae Ruth Elwood Martin Ganga Jolicoeur 《Patient education and counseling》2019,102(3):586-594
Objective
The Changing Childbirth in British Columbia study explored women’s preferences and experiences of maternity care, including women’s role in decision-making.Methods
Following content validation by community members, we administered a cross-sectional online survey exploring novel topics, including drivers for interventions, and experiences of autonomy, respect, or mistreatment during maternity care. Using the Mothers Autonomy in Decision-Making (MADM) scale as an outcome measure in a mixed-effects analysis, we examined differential experiences by socio-demographic and prenatal risk profile, type of care provider, interventions received, and nature of communication with care providers.Results
A geographically representative sample of Canadian women (n?=?2051) reported on 3400 pregnancies. Most women (95.2%) preferred to be the lead decision-maker during care. Patients of physicians had significantly lower autonomy (MADM) scores than midwifery clients as did women who felt pressured to accept interventions. Women who had a difference in opinion with their provider, and those who felt their provider seemed rushed reported the lowest MADM scores.Conclusion
Women’s autonomy is significantly altered by model of maternity care, the nature of interactions with care providers, and women’s ability for self-determination.Practice Implications
If health professionals acquire skills in person-centred decision-making experience of autonomy among pregnant women may improve. 相似文献16.
Objective
Information overload can negatively impact positive health behaviors such as cancer screening. The 8-item Cancer Information Overload (CIO) scale appears to be the only validated measure of health-related information overload. The present study assesses the validity of the CIO scale when modified for use in patients with atrial fibrillation (AF) residing in Australia.Methods
We conducted a secondary analysis of data from a study of adult Australian patients with AF (N?=?386) in which a modified version of the CIO scale was used. In the present study, we examined the construct (convergent and divergent) validity and performed an exploratory factor analysis for the modified scale.Results
All items on the modified-CIO scale appear to load onto a single factor. As predicted, higher education levels (rs=-.24, p?<?.001) and higher oral anticoagulant knowledge (rs=-.17, p?=?.001) were significantly associated with lower modified-CIO scores; no other demographic characteristics were significantly associated with CIO scores.Conclusion
When adapted to the AF context, the modified-CIO scale appears to be a valid measure of information overload.Practice Implications
A valid scale is required to measure information overload accurately. Knowledge of the interplay between information overload and various health behaviors help focus future efforts to support patient empowerment. 相似文献17.
Marita S. Fønhus Therese K. Dalsbø Marit Johansen Atle Fretheim Helge Skirbekk Signe Flottorp 《Patient education and counseling》2019,102(3):474-485
Objective
To assess the effectiveness of patient-mediated interventions on healthcare professionals' performance.Methods
We conducted a systematic Cochrane review according to established guidelines. We searched predefined databases in 2016 and 2017. Two review authors independently assessed studies for inclusion, extracted data, assessed risk of bias, performed meta-analyses, and assessed the certainty of the evidence (GRADE).Results
We included 25 randomised studies with a total of 12 268 patients. We found that patient-reported health information interventions and patient education interventions probably improve healthcare professionals' adherence to recommended clinical practice (moderate certainty evidence). We also found that patient information interventions may improve healthcare professionals' adherence to recommended clinical practice (low certainty evidence). Patient decision aids may make little or no difference to the number of healthcare professionals’ adhering to recommended clinical practice (low-certainty evidence).Conclusion
Our findings strengthen the belief that patient-mediated interventions have the potential to improve professional practice, especially patient-reported health information interventions and patient education interventions.Practice implications
Our findings show that patient-reported health information interventions and patient education interventions are relevant approaches to improve professional practice. Thus, it seems reasonable to conclude that these types of patient-mediated interventions can contribute to improving the quality of healthcare services. 相似文献18.
Marleen Kunneman Michael R. Gionfriddo Freddy J.K. Toloza Fania R. Gärtner Gabriela Spencer-Bonilla Ian G. Hargraves Patricia J. Erwin Victor M. Montori 《Patient education and counseling》2019,102(3):452-466
Objective
To assess the extent to which evaluations of shared decision making (SDM) assess the extent and quality of humanistic communication (i.e., respect, compassion, empathy).Methods
We systematically searched Web of Science and Scopus for prospective studies published between 2012 and February 2018 that evaluated SDM in actual clinical decisions using validated SDM measures. Two reviewers working independently and in duplicate extracted all statements from eligible studies and all items from SDM measurement instruments that referred to humanistic patient-clinician communication.Results
Of the 154 eligible studies, 14 (9%) included ≥1 statements regarding humanistic communication, either in framing the study (N?=?2), measuring impact (e.g., empathy, respect, interpersonal skills; N?=?9), as patients’/clinicians’ accounts of SDM (N?=?2), in interpreting study results (N?=?3), and in discussing implications of study findings (N?=?3). Of the 192 items within the 11 SDM measurement instruments deployed in the included studies, 7 (3.6%) items assessed humanistic communication.Conclusion
Assessments of the quality of SDM focus narrowly on SDM technique and rarely assess humanistic aspects of patient-clinician communication.Practice implications
Considering SDM as merely a technique may reduce SDM’s patient-centeredness and undermine its’ contribution to patient care. 相似文献19.
Michael Anthony Fajardo Guy Balthazaar Alexandra Zalums Lyndal Trevena Carissa Bonner 《Patient education and counseling》2019,102(3):467-473
Objective
The study aim was to identify all freely available online diabetes risk calculators and to evaluate their suitability for patients with low health literacy.Methods
Online diabetes risk calculators were identified by an environmental scan. The Patient Education Material Assessment Tool for Printable Materials was used to determine understandability and actionability scores. A high-risk profile was used to compare the risk results obtained with each calculator.Results
Thirty-five risk calculators were identified; 51% had no described model, 23% reported absolute risk and 31% used visual aids. The estimated risk for the same profile ranged from low to very high. The mean understandability score was 79% (SD?=?19%) and the mean actionability score was 42% (SD?=?30%).Conclusions
Online diabetes risk calculators are generally understandable, but not very actionable, and may not be completely suitable for use by patients with low health literacy. The estimated risk is highly variable depending on the underlying model used for the calculation.Practice Implications
Patients and healthcare providers need to exercise caution when selecting a diabetes risk calculator. 相似文献20.
Scott A. Davis Delesha M. Carpenter Susan J. Blalock Donald L. Budenz Charles Lee Kelly W. Muir Alan L. Robin Betsy Sleath 《Patient education and counseling》2019,102(5):937-943