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1.
Ida J. Korfage Erik W. de Kwaadsteniet Arno van Voorst Anne M. Stiggelbout Marieke de Vries Arwen H. Pieterse 《Patient education and counseling》2018,101(2):310-317
Objectives
Implicit associations influence behaviour, but their impact on cancer screening intentions is unknown.Methods
We assessed implicit associations with cervical cancer screening using an evaluative priming task. Participants were shown primes (‘Pap test’, neutral or non-word) followed by positive or negative target words. The test is based on the assumption that response times are shorter if primes and targets are strongly associated in the participant's mind. The Dutch screening program targets women aged 30–60, 226 of them completed online assessments twice. Prior to the second assessment participants were randomized to reading versus not reading the leaflet about the cervical screening program.Results
After controlling for knowledge and screen history, response times for ‘Pap test’ no longer differed between positive and negative targets. Implicit associations were not correlated with explicit attitudes or screening intentions. Reading the screening leaflet resulted in improved knowledge levels (p < 0.001), but implicit associations, explicit attitudes, and screening intentions remained similar.Conclusion
Cervical cancer screening intentions were related to explicit attitudes, but not to implicit associations. The screening leaflet did not affect screening intentions.Practice implications
We recommend achieving a deepened interest in the screening program among risk groups, e.g. by adapting the information leaflet. 相似文献2.
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3.
Kristina Luhr Marie Holmefur Kersti Theander Ann Catrine Eldh 《Patient education and counseling》2018,101(6):1137-1142
Objective
Patient participation is facilitated by patients’ ability to take responsibility for and engage in health issues. Yet, there is limited research as to the promotion of these aspects of patient participation in long-term healthcare interactions. This paper describes patient participation as experienced by patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF); the aim was to describe if and how a self-management programme in primary healthcare influenced patient participation.Methods
Patients who had participated in a self-management programme were interviewed in nine focus groups (36 patients). Data was analysed using qualitative content analysis.Results
Patients described equality in personal interactions, opportunities to share and discuss, and a willingness to share and learn to facilitate patient participation in a self-management programme. Consequently, patient participation was promoted by a match between the individuals’ personal traits and the context.Conclusion
Features facilitating patient participation by means of sharing and assimilating knowledge and insights should be included in self-management programmes and in the care for patients with COPD and CHF.Practice implications
A self-management programme can complement regular primary care regarding enhanced understanding of one’s disease and support patient participation and the patient’s own resources in self-management. 相似文献4.
Noralie H. Geessink Eirik H. Ofstad Marcel G.M. Olde Rikkert Harry van Goor Jürgen Kasper Yvonne Schoon 《Patient education and counseling》2018,101(10):1767-1774
Objective
To identify determinants of older patients’ perceptions of involvement in decision-making on colorectal (CRC) or pancreatic cancer (PC) treatment, and to compare these with determinants of observers' perceptions.Methods
Patients’ perceptions of involvement were constructed by the 9-item SDM questionnaire (SDM-Q-9) and a Visual Analogue Scale for Involvement (VAS-I). Observers’ perceptions were constructed by the OPTION5, OPTION12, and MAPPIN’SDM. Convergent validities were calculated between the patient-sided and observer instruments using Spearman’s correlation coefficient. Linear regression was used to identify determinants per criterion.Results
58 CRC and 22 PC patients were included (mean age: 71.8?±?5.2 years, 45.0% female). No significant correlations were found between the patient-sided and observer instruments. Patients’ impression of involvement was influenced by patient characteristics such as quality of life and satisfaction, while observers’ perceptions mainly referred to encounter characteristics such as the mean duration of consultations and general communication skills.Conclusion
Due to evident differences in determinants, older CRC/PC patients’ and observers’ perceptions of involvement should both be collected in evaluating the quality of medical decision-making.Practice Implications
General communication skills should be integrated in SDM training interventions. New SDM measurement tools for patients are needed to sufficiently discriminate between the constructs of involvement and satisfaction. 相似文献5.
Michelle L. Litchman Erin Rothwell Linda S. Edelman 《Patient education and counseling》2018,101(3):518-523
Objective
The use of the diabetes online community (DOC) is growing across all age groups. The aim of this exploratory study was to describe why older adults participated in the DOC, and how DOC users interacted with their healthcare providers.Methods
Telephone interviews (N = 20) were conducted with older adult DOC users (born between 1946 and 1964) living in the United States. Interviews were analyzed using qualitative content analysis adhering to rigor and reproducibility standards.Results
Themes that emerged from the data related to DOC participation included: information to improve self-care, emotional support, belonging to a community, validation of information, cause for concern and interaction with healthcare providers. Participants used the DOC for day to day diabetes management advice and healthcare providers for medical information and care.Conclusion
Participants highly valued the DOC and regarded their participation as a way to increase knowledge to improve self-care and reciprocate emotional support with others for diabetes management. The DOC filled gaps in knowledge and support participants were not able to get elsewhere.Practice implications
The DOC serves as an important source of information and support for individuals with diabetes and may be a cost-effective strategy to augment standard diabetes care. 相似文献6.
Olga C. Damman Suzanne I. Vonk Maaike J. van den Haak Charlotte M.J. van Hooijdonk Danielle R.M. Timmermans 《Patient education and counseling》2018,101(8):1410-1418
Objective
To study how comprehension of cardiovascular disease (CVD) risk is influenced by: (1) infographics about qualitative risk information, with/without risk numbers; (2) which qualitative risk dimension is emphasized; (3) heart age vs. traditional risk format.Methods
For aim 1, a 2 (infographics versus text) x 2 (risk number versus no risk number) between-subjects design was used. For aim 2, three pieces of information were tested within-subjects. Aim 3 used a simple comparison group. Participants (45–65 yrs old) were recruited through an online access panel; low educated people were oversampled. They received hypothetical risk information (20%/61yrs). Primary outcomes: recall, risk appraisals, subjective/objective risk comprehension. Secondary outcomes: behavioral intentions, information evaluations.Results
Infographics of qualitative risk dimensions negatively affected recall, subjective risk comprehension and information evaluations. No effect of type of risk dimension was found on risk perception. Heart age influenced recall, comprehension, evaluations and affective risk appraisals.Conclusion
Infographics of hypothetical CVD risk information had detrimental effects on measures related to risk perception/comprehension, but effects were mainly seen in undereducated participants. Heart age influenced perceptions/comprehension of hypothetical risk in a way that seemed to support understanding.Practice implications
Heart age seems a fruitful risk communication approach in disease risk calculators. 相似文献7.
8.
Kimberly A. Fisher Andy S.L. Tan Daniel D. Matlock Barry Saver Kathleen M. Mazor Arwen H. Pieterse 《Patient education and counseling》2018,101(12):2195-2201
Objective
To examine situations where shared decision making (SDM) in practice does not achieve the goal of a patient-centered decision.Methods
We explore circumstances in which elements necessary to realize SDM – patient readiness to participate and understanding of the decision – are not present. We consider the influence of contextual factors on decision making.Results
Patients’ preference and readiness for participation in SDM are influenced by multiple interacting factors including the patient’s comprehension of the decision, their emotional state, the strength of their relationship with the clinician, and the nature of the decision. Uncertainty often inherent in information can lead to misconceptions and ill-formed opinions that impair patients’ understanding. In combination with cognitive biases, these factors may result in decisions that are incongruent with patients’ preferences. The impact of suboptimal understanding on decision making may be augmented by the context.Conclusions
There are circumstances in which basic elements required for SDM are not present and therefore the clinician may not achieve the goal of a patient-centered decision.Practice Implications
A flexible and tailored approach that draws on the full continuum of decision making models and communication strategies is required to achieve the goal of a patient-centered decision. 相似文献9.
10.
Objective
To assess whether mode of communication and patient centered communication (PCC) with physicians were associated with the likelihood of deaf smokers inquiring about lung cancer screening.Methods
An accessible health survey including questions about PCC, modes of communication, smoking status and lung cancer screening was administered in American Sign Language (HINTS-ASL) to a nationwide sample of deaf adults from February to August 2017. Of 703 deaf adults who answered the lung screening question, 188 were 55–80 years old.Results
The odds ratio of asking about a lung cancer screening test was higher for people with lung disease or used ASL (directly or through an interpreter) to communicate with their physicians. PCC was not associated with asking about a lung cancer screening test.Conclusion
Current or former smokers who are deaf and use ASL are at greater risk for poorer health outcomes if they do not have accessible communication with their physicians.Practice implications
Optimal language access through interpreters or directly in ASL is critical when discussing smoking cessation or lung cancer screening tests. Counseling and shared decision-making will help improve high-risk deaf patients' understanding and decision-making about lung cancer screening. A video in American Sign Language is available here. 相似文献11.
Objective
We examine whether patients have a preference for affective (i.e., focused on patient’s emotions) or cognitive (i.e., focused on the process that led to the error) apologies that are dependent on the apologizing physician’s gender. We hypothesize patients will prefer gender-congruent apologies (i.e., when females offer affective apologies and males offer cognitive apologies).Methods
We randomly assigned analogue patients (APs: participants instructed to imagine they were a patient) to read a scenario in which a female or male physician makes an error and provides a gender-congruent or incongruent apology. APs reported on their perceptions of the physician and legal intentions.Results
An apology-type and gender congruency effect was found such that APs preferred apologies congruent with the gender of the apologizing physician. An indirect effect of congruency on legal intentions through physician perceptions was confirmed (b = ?0.24, p = 0.02).Conclusion
Our results suggest that physician gender plays a role in patient reactions to different apology types.Practice implications
Apology trainings should incorporate how physician characteristics can influence how patients assess and respond to apologies. 相似文献12.
Shrinkhala Dawadi Janet Takefman Phyllis Zelkowitz 《Patient education and counseling》2018,101(10):1852-1858
Objectives
To examine the provision of information by health care providers (HCPs) to fertility patients about accessing psychological resources.Methods
This study utilized data from a cross-sectional survey of 659 male and female patients seeking fertility treatment at clinics in Toronto and Montreal. Regression analyses were used to assess if sociodemographic and treatment variables were associated with the receipt of information, the desire for information, the helpfulness of the information, and the likelihood that participants had sought counselling.Results
The majority of respondents (79.8%) said that their HCP had not given them information about accessing psychological resources. Of the patients who did not receive this information, most (60%) said that they wanted it. Regression analysis revealed that immigrants, women, and patients with higher perceived stress scores were significantly more likely to desire this information. Furthermore, having received this information was associated with increased odds of counselling seeking (odds ratio?=?3.31, p?=?0.013).Conclusion
Fertility patients demonstrated an unmet need for information about accessing psychological resources, and HCPs may play an integral role in bridging this information gap.Practice Implications
To improve the patient-centeredness of fertility care, HCPs should be proactive in informing all patients about how to access psychological resources. 相似文献13.
From facts to arguments: A study of the 2014 Swiss controversy over systematic mammography screening
Caroline Perrenoud Friedrich Stiefel Céline Bourquin 《Patient education and counseling》2018,101(6):1110-1115
Objective
The Swiss Medical Board (SMB) has recently revived the controversy over mammography screening by recommending to stop the introduction of new systematic mammography screening programs. This study aimed to examine the Swiss media coverage of the release of the SMB report.Methods
The dataset consisted of 25 newspaper and “medical magazine” articles, and TV/radio interviews. The analytic approach was based on argumentation theory.Results
Authority and community arguments were the most frequent types of arguments. With respect to authority arguments, stakeholders for instance challenged or supported the expertise of the SMB by referring to the competence of external figures of authority. Community arguments were based on common values such as life (saved thanks to systematic mammography screening) and money (costs associated with unnecessary care induced by systematic mammography screening).Conclusion
The efficiency of mammography screening which was the key issue of the debate appeared to be largely eluded, and the question of what women should do endures.Practice implications
While interpersonal and interprofessional communication has become a major topic of interest in the medical community, it appears that media communication on mammography screening is still rather ineffective. We call in particular for a more fact-based discussion. 相似文献14.
Objective
Patient-clinician communication (PCC) may generate or reduce healthcare disparities. This paper is based on the 2017 International Conference on Communication in Healthcare keynote address and reviews PCC literature as a research area for the National Institute on Minority Health and Health Disparities (NIMHD).Methods
A narrative review of selected evidence on disparities in PCC experienced by race and ethnic minorities, associations between PCC and poor health outcomes, and patient and clinician factors related to PCC.Results
Factors associated with poor quality PCC on the patient level include being a member of racial/ethnic minority, having limited English proficiency, and low health and digital literacy; on the clinician level, being less culturally competent, lacking communication skills to facilitate shared decision-making, and holding unconscious biases. Recommendations include offering patient- and/or clinician-targeted interventions to guard against unconscious biases and improve PCC, screening patients for health literacy and English proficiency, integrating PCC in performance processes, and leveraging health information technologies to address unconscious biases.Conclusion
EffectivePCC is a pathway to decrease health disparities and promote health equity.Practice implications
Standardized collection of social determinants of health in the Electronic Health Record is an importantfirst step in promoting more effective PCC. 相似文献15.
Daniel B. Azambuja Natalia M. Leguisamo Helena C. Gloria Antonio Nocchi Kalil Ernani Rhoden Jenifer Saffi 《Pathology, research and practice》2018,214(1):64-71
Objective
to evaluate the prognostic value of base excision repair proteins in sporadic colorectal cancer.Methods
Pre-treatment tumor samples from 72 patients with sporadic colorectal adenocarcinoma were assessed for APC, MPG, Polβ, XRCC1 and Fen1 expression by immunohistochemistry. The associations of molecular data were analyzed in relation to clinical features and TNM staging as a prognosis predictor and disease-free survival.Results
Higher levels of MPG, Polβ and XRCC1, but not Fen1, were associated with unfavorable pathological outcomes, such as poor cellular differentiation, advanced TNM stages, presence of lymphatic and perineural invasions and metastatic lymph nodes. MPG and Polβ overexpression were associated with right-sided CRC. However, only MPG high expression is associated with shorter disease-free survival in CRC patients.Conclusions
Our results suggest that increased expression of MPG, Polβ and XRCC1 are more likely to evolve to poor pathological outcomes, but only the elevated expression of MPG protein predicts recurrence. The BER proteins appear to be suitable candidates to refine the TNM current staging of colorectal cancer. 相似文献16.
María D. Esteban-Vasallo Ana López de Andrés Marianela Bayón José Luis Aréjula Rodrigo Jiménez-García 《Patient education and counseling》2018,101(7):1240-1247
Objective
To describe the population who self-reported perceiving information on vaccines provided by health professionals as inadequate, and to analyze factors associated.Methods
A Spanish nationwide representative health survey conducted in individuals ≥18 in 2015 (N?=?7 800) was used. Respondents were classified according to the question: ‘Do you think that health professionals inform adequately to patients about the advantages and risks of vaccines prior to their administration? (yes/no/non-responders). The association with socio-demographic and health-related characteristics and with opinions/attitudes regarding vaccines were analyzed.Results
33.7% of respondents felt not adequately informed. These individuals had lower influenza vaccination coverage (16.0% vs. 24.1%), and were more distrustful of vaccines in general (8.4% vs. 3.3%) as well as regarding on the influenza vaccine (11.9% vs. 7.6%). Inadequate information was associated with female gender (aOR:1.21,95%CI:1.08–1.35), autochthonous origin (aOR:1.54,95%CI:1.27-–1.87), household income ≤600€/month (aOR:1.45,95%CI:1.10–1.91), poor self-perceived health (aOR:3.17,95%CI:1.36–7.39), and a lower satisfaction with the National Health Service and nurses (aOR:0.92,95%CI:0.89–0.95 and aOR:0.85,95%CI:0.82–0.88).Conclusion
A large proportion of the population considers that the information provided regarding vaccines is inadequate. This perception is associated with negative attitudes towards vaccination.Practice implications
Further studies are required to deepen our understanding of the problem and to enhance communication provided by healthcare professionals. 相似文献17.
Catherine A. Grodensky Carol E. Golin Allison P. Pack Audrey Pettifor Michele Demers Cecelia Massa Gift Kamanga Kevin McKenna Amy Corneli 《Patient education and counseling》2018,101(6):1103-1109
Objective
Individuals diagnosed with acute HIV infection (AHI) are highly infectious and require immediate HIV prevention efforts to minimize their likelihood of transmitting HIV to others. We sought to explore the relevance of Motivational Interviewing (MI), an evidence-based counseling method, for Malawians with AHI.Methods
We designed a MI-based intervention called “Uphungu Wanga” to support risk reduction efforts immediately after AHI diagnosis. It was adapted from Options and SafeTalk interventions, and refined through formative research and input from Malawian team members and training participants. We conducted qualitative interviews with counselors and participants to explore the relevance of MI in this context.Results
Intervention adaptation required careful consideration of Malawian cultural context and the needs of people with AHI. Uphungu Wanga's content was relevant and key MI techniques of topic selection and goal setting were viewed positively by counselors and participants. However, rating levels of importance and confidence did not appear to help participants to explore behavior change as intended.Conclusion
Uphungu Wanga may have provided some added benefits beyond “brief education” standard of care counseling for Malawians with AHI.Practice implications
MI techniques of topic selection and goal setting may enhance prevention education and counseling for Malawians with AHI. 相似文献18.
19.
Kathleen M. Grant Lance Brendan Young Kimberly A. Tyler Jamie L. Simpson R. Dario Pulido Christine Timko 《Patient education and counseling》2018,101(1):79-84
Objective
A multisite field trial testing whether improved outcomes associated with intensive referral to mutual help groups (MHGs) could be maintained after the intervention was adapted for the circumstances and needs of rural veterans in treatment for substance use disorder (SUD).Methods
In three Veterans Affairs treatment programs in the Midwest, patients (N = 195) received standard referral (SR) or rural-adapted intensive referral (RAIR) and were measured at baseline and 6-month follow-up.Results
Both groups reported significant improvement at 6-months, but no significant differences between SR and RAIR groups in MHG participation, substance use, addiction severity, and posttraumatic stress symptoms. Inconsistent delivery of the intervention resulted in only one-third of the RAIR group receiving the full three sessions, but this group reported significantly greater 6-month abstinence from alcohol than those receiving no sessions.Conclusion
Further research should explore implementation problems and determine whether consistent delivery of the intervention enhances 12-step facilitation.Practice implications
The addition of rural-specific elements to the original intensive referral intervention has not been shown to increase its effectiveness among rural veterans. 相似文献20.
Annemiek J. Linn Liset van Dijk Julia C.M. van Weert Beniam G. Gebeyehu Ad. A. van Bodegraven Edith G. Smit 《Patient education and counseling》2018,101(8):1419-1426