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1.
Jessy A. Terpstra Rosalie van der Vaart Saskia Spillekom-van Koulil Arno van Dam Judith G.M. Rosmalen Hans Knoop Henriët van Middendorp Andrea W.M. Evers 《Patient education and counseling》2018,101(9):1702-1707
Objective
Online cognitive-behavioral therapy (iCBT) is effective in supporting patients’ self-management. Since iCBT differs from face-to-face CBT on several levels, proper training of therapists is essential. This paper describes the development and evaluation of a therapist training based on theoretical domains that are known to influence implementation behavior, for an iCBT for chronic pain.Methods
The training consists of 1.5?days and covers the implementation domains “knowledge”, “skills”, “motivation”, and “organization”, by focusing on the therapy’s rationale, iCBT skills, and implementation strategies. Using an evaluation questionnaire, implementation determinants (therapist characteristics, e-health attitude, and implementation domains) and iCBT acceptance were assessed among participants after training.Results
Twenty-two therapists participated, who generally showed positive e-health attitudes, positive implementation expectations, and high iCBT acceptance. Organizational aspects (e.g., policy regarding iCBT implementation) were rated neutrally.Conclusions
An iCBT therapist training was developed and initial evaluations among participants showed favorable implementation intentions.Practice implications
Therapists’ positive training evaluations are promising regarding the dissemination of iCBT in daily practice. Organizational support is vital and needs to be attended to when selecting organizations for iCBT implementation. 相似文献2.
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3.
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4.
5.
Objective
Patient education on high-risk medications such as warfarin is important, and they require quick follow-up after initiation to maximize efficacy and safety. In our Anticoagulation Clinic, two 60-minute new patient appointments are available each day, contributing to prolonged lead-time. We instituted standardized warfarin video education to shorten in-clinic-room visit time, to potentially increase new patient appointments.Methods
Patients viewed the video in the waiting area with a goal to decrease visit times by 15?min (25%), before pharmacists completed their visit. Data collected included time spent in the clinic room, education comprehension, and patient feedback.Results
Ninety patient visits were evaluated in one pre-intervention and two post-intervention phases. Patients who received video education spent less time in the clinic room versus those who had not (52.4 vs 39.4?min, p?=?0.001), and two-thirds of all post-intervention visits achieved 25% reduction in visit time. There were no significant differences in education comprehension and patient satisfaction.Conclusion
Video education significantly decreased in-clinic-room visit time, and most patients achieved a goal of 25% reduction in time spent, without a change in comprehension or patient satisfaction.Practice implications
Implementation of video education can reduce clinic times in many patients without significantly impacting patient satisfaction. 相似文献6.
Objective
To examine patient education knowledge, attitude/belief, and practices (KABP) among specialists who manage sudden sensorineural hearing loss (SSNHL).Methods
A cross-sectional study design was employed wherein semi-structured interviews were conducted at a 2017 otorhinolaryngology meeting. In this survey, we asked the respondents about their perspectives regarding the imparting of SSNHL patient education.Results
The sample consisted of 84 physicians from 23 cities in Sichuan province. Three quarters of the respondents felt SSNHL patient education was necessary. Notably, 67.9% of the respondents believed that patient education could improve treatment. Half of the respondents provided culturally tailored education (based on US guidelines) inclusive of traditional Chinese medicine (TCM) notions of lifestyle adjustments. Internet platforms were an emerging preference for education delivery mode. Only 47.4% of participants reported being satisfied with their current patient education offerings, and these activities were regarded as needing improvement.Conclusion
This study captured the perspectives of otorhinolaryngologists and otologists in China regarding the imparting of SSNHL patient education. The results of this survey should support Chinese physician’s implementation of SSNHL patient education.Practice implications
Findings obtained with the present survey may be employed to support the importance of SSNHL patient education in China. 相似文献7.
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8.
9.
Objective
This study investigated how health care provider communication of risk information, and women’s role in decision-making, influenced women’s preferences for mode of birth after a previous caesarean birth.Methods
Women (N?=?669) were randomised to one of eight conditions in a 2 (selectivity of risk information) × 2 (format of risk information) × 2 (role in decision making) experimental design. After exposure to a hypothetical decision scenario that varied information communicated by an obstetrician to a pregnant woman with a previous caesarean birth across the three factors, women were asked to decide their preferred hypothetical childbirth preference.Results
Women provided with selective information (incomplete/biased toward repeat caesarean) and relative risk formats (ratio of incidence being compared e.g. 2.5 times higher), perceived lower risk for caesarean and were significantly more likely to prefer repeat caesarean birth than those provided with non-selective information (complete/unbiased) and absolute risk formats (incidence rate e.g. 0.01 per 100). Role in decision-making did not significantly influence childbirth preferencesConclusions
Modifiable aspects of healthcare provider communication may influence women’s decision-making about childbirth preferencesPractice implications
Optimised communication about risks of all options may have an impact on over-use of repeat CS. 相似文献10.
Sandra Lakke Melle Foijer Lisa Dehner Wim Krijnen Hans Hobbelen 《Patient education and counseling》2019,102(2):253-265
Objective
Lower physical activity levels in older adults are associated with increased co-morbidities and disability. Physical therapists have a critical role in facilitating increases in physical activity. The communication they use may impact their effectiveness. This study investigates the additional value of therapist’s communication during physical therapy on older adults’ physical activity levels.Methods
Systematic review and meta-analysis. Clinical trials were identified in PubMed, CINAHL, Embase, PsycINFO, PEDro, Cochrane, up to July 2016. Communication was classified with the Behavior Change Taxonomy(BCT). Effect sizes were pooled using Cochrane’s Review-Manager. Strength of the evidence was analyzed using GRADE’s criteria.Results
Twelve studies were identified. Overall, communication techniques revealed an immediate and long-term effect(ES:0.19;0.24) on self-reported physical activity measures but not on performance-based, with moderate to high strength of evidence. Divided in BCT-categories, only ‘Generalisation of target behavior’, defined as communication aimed to help patients generalise an exercise from one situation to another at home, had a positive effect on self-reported activity(ES:0.34), with low strength of evidence.Conclusion
Adding a communication technique to physical therapy is effective on self-reported physical activity measures but not on performance-based measures.Practice implications
Add communication to exercise when treatment aims at perceived, but not performed, physical activity. 相似文献11.
Fabiola Molina Christine Dehlendorf Steven E. Gregorich Miriam Kuppermann 《Patient education and counseling》2019,102(3):595-601
Objective
To investigate women’s preferred approach to prenatal genetic testing decision making and assess concordance between preference and experience.Methods
We conducted a secondary analysis of data from two randomized trials conducted between 2007–2012. Survey items assessed participants’ preferred approach to decision making and whether they experienced a preference-concordant decision process. Logistic regression estimated relationships between patient characteristics and these outcomes.Results
56% of women preferred autonomous decision making, 39% preferred shared decision making, and 5% preferred a provider-driven approach. Only 57% experienced preference-concordant decision making. On bivariate analysis, black women, Spanish-speaking Latinas and women with less education were less likely to experience this outcome than white, more educated women. Numeracy and preferring a provider-driven approach fully mediated observed disparities in preference-concordant decision making for most participants, except for Spanish-speaking Latinas, who were still less likely to have experienced this outcome after accounting for these factors.Conclusion
Numeracy, preference for provider-driven decision processes, and language barriers were key drivers of disparities in preference-concordant decision making.Practice implications
Given the values-sensitive and quantitative nature of prenatal testing decisions, nuanced counseling and interventions to address language barriers, numeracy gaps, and decision-making preferences are needed to tailor counseling to patient’s backgrounds and desires. 相似文献12.
Jill Yamasaki 《Patient education and counseling》2018,101(5):830-835
Objective
This study examines a personal pet hospital visitation program dedicated to preserving the human-animal bond during chronic, critical, or terminal illness to understand the novel ways companion pets facilitate meaningful communication between patients, providers, and families in hospital settings.Methods
I thematically analyzed data collected through a variety of qualitative methods, including participant observation, informal and semi-structured interviews, and a review of organizational materials.Results
The presence of a patient’s personal pet prompted stories and behaviors characterized by (1) compassion, (2) connection, and (3) response between patients, providers, and family members.Conclusion
Personal pet hospital visits facilitate storied conversations, foster healing relationships, and offer alternative ways of knowing that can promote greater understandings of the patient’s psychosocial context for more personalized care and improved well-being.Practice implications
Patient-centered critical care requires meaningful consideration of a patient’s health, well-being, and comfort. When appropriate, the therapeutic benefits of companion animals and the deep personal bonds between patients and their pets should be acknowledged and provided as part of this care. 相似文献13.
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14.
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15.
Maarten Vermorgen Aline De Vleminck Luc Deliens Dirk Houttekier Nele Spruytte Chantal Van Audenhove Joachim Cohen Kenneth Chambaere 《Patient education and counseling》2018,101(8):1378-1384
Objective
Deaths from chronic illness are often preceded by a potentially life-shortening end-of-life decision (ELD). Involving family in these ELDs may have psychosocial benefits for them and the dying person. This study aims to examine how often ELDs are discussed with relatives of the dying person and which characteristics determine their involvement in those ELDs.Methods
A questionnaire survey was conducted in 2013 among physicians attending a large, stratified and representative sample of deaths (n?=?6188) in Flanders.Results
In 72.3% of ELDs preceding death, family of the dying person were involved. Discussion of an ELD with family members was more likely when the decision was also discussed with the dying person, the ELD was made with the explicit intention to shorten life, specialized palliative care was provided or death occurred in an ICU.Conclusions
Involving family in end-of-life decision making appears to be related to the type of formal care services involved, communication with the dying person and the motives behind the decision.Practice implications
Our findings suggest a need to further expand a palliative care approach with a focus on both the dying person and their family within and across a variety of health care services. 相似文献16.
17.
Kaitlyn Walsh Teaghan A.M. Pryor Kristin A. Reynolds John R. Walker 《Patient education and counseling》2019,102(1):99-105
Objective
The purpose of this study was to evaluate websites providing information on treatment for depression to the public, and to evaluate changes in the quality of website information over time.Methods
Websites (N?=?25) addressing depression treatment were identified through the use of the Google search engine and by suggestions from healthcare professionals. Each website was evaluated based on the extent to which it addressed content areas deemed important by the public identified in previous research, overall quality as determined by the DISCERN, and reading level.Results
Overall, the quality of depression websites varied greatly. The majority of websites did not adequately answer the public’s questions about treatment options, and presented higher quality information in the area of pharmacological treatments as compared to other treatment options. An average reading level of 10.0 was found across websites. Upon re-evaluation, only 14 of 25 websites added new content, and the majority of websites did not improve in their overall website quality (as measured by the DISCERN).Conclusion and Practice Implications
Websites could be improved by addressing important questions that consumers have concerning depression, as well as by creating higher quality content in the areas of psychological, neurotherapeutic, and alternative treatments. 相似文献18.
Patricia C. Cheung Julie A. Gazmararian Michael R. Kramer Carolyn D. Drews-Botsch Jean A. Welsh 《Patient education and counseling》2019,102(1):113-118
Objective
The Healthy Weight Counseling Maintenance of Certification (MOC) program integrates pediatrician training and clinic changes to promote use of evidence-based, diet and physical activity (PA) health messages and counseling strategies. This interrupted time series study assessed the impact of this MOC program on provision of weight-related counseling.Methods
We randomly selected 10–15 well-child visit charts at three time points before and three time points after 102 Georgia pediatricians began the MOC in 2012–2015. Linear binomial regression compared the frequency of behavior-change goal setting and health messaging documentation (fruit/vegetable consumption, sugar-sweetened beverage consumption, out-of-home food consumption, PA, and screen time) before and after MOC participation.Results
At baseline, pediatricians documented behavior-change goals with 44% of patients, with an additional 49% of patients having documented goals after their pediatrician started the MOC (99.5% confidence interval [CI]: 21–77%). Similarly, absolute increases in the proportion of patients with documentation for sugar-sweetened beverage consumption (adjusted prevalence difference [aPD]: 37%; 99.5% CI: 13–62%) and out-of-home eating were observed (aPD: 38%; 99.5% CI: 12–64%).Conclusion
The Healthy Weight Counseling MOC is associated with increased and sustained use of evidence-based health messages and counseling strategies.Practice implications
Continuing education and facilitation of system changes help improve physicians’ weight-related counseling. 相似文献19.
Objectives
The use of groups is common in healthcare. There is a paucity of research which captures patient experiences of group participation. The aims of this study were to explore the perceptions and experiences of people with traumatic brain injury (TBI) about their participation in inpatient occupational therapy rehabilitation groups.Method
A phenomenological approach guided the study. Patients with a TBI who were participating in an inpatient occupational therapy group program were recruited. Data were collected through semi-structured interviews and analysed using content analysis.Results
Fifteen participants consented to the study. Three themes emerged from the data; 1) feeling normal, comfortable and connected; 2) learning by doing, seeing and sharing and; 3) practicalities of groups. Participants highlighted that groups facilitated opportunities to practice skills and prepared them for the real world. Opportunities for interaction and support were also emphasised as positive by participants.Conclusion
Perceptions of patients about participation in groups were generally positive, and as such a consumer-focused approach to healthcare would support the use of occupational therapy groups in TBI rehabilitation.Practice implications
Recommendations from the perspectives of patients include consideration of the selection of group participants, and meeting individual needs and goals within a group setting. 相似文献20.
Carey Candrian Alexandra Tsantes Dan D. Matlock Channing Tate Jean S. Kutner 《Patient education and counseling》2018,101(11):2025-2030