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1.
To support and to be supported. A qualitative study of peer support centres in cancer care in Norway
Objective
To explore what peer supporters, patients and their relatives want and gain from peer support in cancer care.Methods
Focus group interviews with peer supporters, and in-depth interviews with peer supporters, patients and relatives (N = 38) and observations of daily activities in a Vardesenter (“Cairn Centre”).Results
Peer supporters helped cancer patients and relatives with coping in and outside the hospital in several ways: (1) conveying hope and providing ways to cope in situations where despair would often be prevalent, thus protecting against unhealthy stress; (2) being someone who had the same experiences of disease and treatment, and thus providing a framework for positive social comparisons; and (3) to be an important supplement to family and health care providers. To be working as a peer supporter was also found to be positive and important for the peer supporters themselves.Conclusion
The peer support program represented a valuable supplement to informal support from family and friends and healthcare providers, and gave the peer supporters a new role as “professionally unprofessional”.Practice implications
Organised peer support represents a feasible intervention to promote coping for cancer survivors. 相似文献2.
Marsha N. Wittink Patrick Walsh Sule Yilmaz Michael Mendoza Richard L. Street Benjamin P. Chapman Paul Duberstein 《Patient education and counseling》2018,101(2):214-220
Objective
Patients with multiple chronic conditions face many stressors (e.g. financial, safety, transportation stressors) that are rarely prioritized for discussion with the primary care provider (PCP). In this pilot randomized controlled trial we examined the effects of a novel technology-based intervention called Customized Care on stressor disclosure.Methods
The main outcomes were stressor disclosure, patient confidence and activation, as assessed by self-report and observational methods (transcribed and coded audio-recordings of the office visit).Results
Sixty patients were enrolled. Compared with care as usual, intervention patients were 6 times more likely to disclose stressors to the PCP (OR = 6.16, 95% CI [1.53, 24.81], p = 0.011) and reported greater stressor disclosure confidence (exp[B] = 1.06, 95% CI [1.01, 1.12], p = 0.028). No differences were found in patient activation or the length of the office visit.Conclusion
Customized Care improved the likelihood of stressor disclosure without affecting the length of the PCP visit.Practice implications
Brief technology-based interventions, like Customized Care could be made available through patient portals, or on smart phones, to prime patient-PCP discussion about difficult subjects, thereby improving the patient experience and efficiency of the visit. 相似文献3.
Jennifer Viberg Johansson Pär Segerdahl Ulrika Hösterey Ugander Mats G. Hansson Sophie Langenskiöld 《Patient education and counseling》2018,101(3):422-427
Objective
It is well known that research participants want to receive genetic risk information that is about high risks, serious diseases and potential preventive measures. The aim of this study was to explore, by qualitative means, something less well known: how do healthy research participants themselves make sense of genetic risk information?Method
A phenomenographic approach was chosen to explore research participants’ understanding and assessment of genetic risk. We conducted four focus-group (N = 16) interviews with participants in a research programme designed to identify biomarkers for cardiopulmonary disease.Results
Among the research participants, we found four ways of understanding genetic risk: as a binary concept, as an explanation, as revealing who I am (knowledge of oneself) and as affecting life ahead.Conclusion
Research participants tend to understand genetic risk as a binary concept. This does not necessarily imply a misunderstanding of, or an irrational approach to, genetic risk. Rather, it may have a heuristic function in decision-making.Practical implications
Risk communication may be enhanced by tailoring the communication to the participants’ own lay conceptions. For example, researchers and counselors should address risk in binary terms, maybe looking out for how individual participants search for threshold figures. 相似文献4.
Lee Ellington Margaret F. Clayton Maija Reblin Gary Donaldson Seth Latimer 《Patient education and counseling》2018,101(3):414-421
Objective
First, to describe communication of home hospice nurse visits to cancer patient-caregiver dyads. Second, to assess change in communication related to domains of care over the course of visits.Methods
Multi-site prospective observational longitudinal study of audio-recorded home hospice visits (N = 537 visits; 101 patient-caregiver dyads; 58 nurses). Communication was coded using the Roter Interaction Analysis System to describe content and process. Conversation representing three care domains (physical, psychosocial/daily life, and emotional) was calculated from RIAS categories across speakers and analyzed to assess change in communication over time.Results
On average, nurses spoke 54% of total utterances, caregivers 29%, and patients 17%. For all participants, the predominant conversational focus was on physical care. Linear mixed effects models indicated that combined participant emotional talk showed a small systematic decrease over time; however, the results for all domains indicated variability unexplained by time or speaker effects.Conclusions
Home hospice conversations are predominantly focused on physical care. Systematic change in communication versus responsiveness to the dynamic effects of patient death and family response over time are discussed.Practice implications
Communication strategies already in use by hospice nurses could be leveraged and expanded upon to better facilitate family competence and confidence. 相似文献5.
Tessie W. October Zoelle B. Dizon Debra L. Roter 《Patient education and counseling》2018,101(4):647-652
Objective
Apply turn analysis to family conferences in the pediatric intensive care unit.Methods
We analyzed 39 audio-recorded family conferences using the Roter Interaction Analysis System. A turn was defined as a continuous block of uninterrupted statements by a speaker.Results
Opening turns by the healthcare team (HCT) averaged 207 s, compared to 28 s for families. Turn density (number of statements/turn) was 6 for the HCT versus 2 for families (p < 0.0001). An average of 21 turns (26%) occurred between HCT members, resulting in substantial sections of dialogue excluding the family. Average HCT dialogue reflected a literacy demand of a 9th grade level, whereas family dialogue averaged a 5th grade level (p < 0.0001). More HCT turns were related to higher reading level demand (r = 0.34; p = 0.03) and lower levels of patient-centeredness (r = ?0.35, p = 0.03).Conclusion
The healthcare team can improve the communication experience for families by encouraging and facilitating family engagement in conference dialogue.Practice implications
Changing how the healthcare team engages with families during communication events is vital to improving the experience for families. Our data suggests simple adjustments, such as limiting medical jargon and inter-team turns may lead to increased family participation and more family-centered care. 相似文献6.
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7.
Paul R. Duberstein Michael Chen Benjamin P. Chapman Michael Hoerger Fahad Saeed Elizabeth Guancial Jennifer W. Mack 《Patient education and counseling》2018,101(1):113-118
Objective
Understanding socioeconomic disparities in the care of patients with incurable cancer is a high priority. We hypothesized that patients without a high school education are more likely to believe that they could be cured and we explored the role of fatalism.Methods
We studied 977 patients with advanced, incurable cancer. Two logistic regression analyses were conducted. Model One examined the effect of education on beliefs about curability. Model Two added fatalism.Results
The significant association between having less than a high school education and the belief that advanced cancer can be cured (OR = 2.55; 95% CI: 1.09–5.96) in Model One was attenuated by 39% and rendered nonsignificant in Model Two. Fatalism was associated with the belief that advanced cancer can be cured. Whites were less likely to believe they could be cured than Blacks and Asians/Pacific Islanders. Beliefs about curability were not associated with income or insurance status.Conclusions
People who do not complete high school are more likely to believe that their advanced cancer is curable, in part because they are more likely to hold fatalistic worldviews.Practice implications
Interventions to help oncologists care for patients with fatalistic beliefs could mitigate socioeconomic disparities in end-of-life care. 相似文献8.
Marieke J. de Jonge Martijn A.H. Oude Voshaar Anita M.P. Huis Mart A.F.J. van de Laar Marlies E.J.L. Hulscher Piet L.C.M. van Riel 《Patient education and counseling》2018,101(1):67-73
Objective
To develop a Disease and treatment associated Knowledge in RA item bank (DataK-RA) based on item response theory.Methods
Initial items were developed from a systematic review. Rheumatology professionals identified relevant content trough a RAND modified Delphi scoring procedure and consensus meeting. RA patients provided additional content trough a focus group. Patients and professionals rated readability, feasibility and comprehensiveness of resulting items. Cross-sectional data were collected to evaluate psychometric properties of the items.Results
Data of 473 patients were used for item reduction and calibration. Twenty items were discarded based on corrected item-total point biserial correlation <0.30. Confirmatory factor analysis with weighted least squares estimation on the polychoric correlation matrix suggested good fit for a unidimensional model for the remaining 42 items (CFI 0.97 TLI = 0.97, RMSEA = 0.02, WRMR = 0.97), supporting the proposed scoring procedure. Scores were highly reliable and normally distributed with minimal ceiling (1.8%) and no floor effects. 75% of tested hypotheses about the association of DataK-RA scores with related constructs were supported, indicating good construct validity.Conclusion
DataK-RA is a psychometrically sound item bank.Practice implications
DataK-RA provides health professionals and researchers with a tool to identify and target patients’ information needs or to assess effects of educational efforts. 相似文献9.
Monika Janda Nigel R Armfield Katie Page Gayle Kerr Suzanne Kurz Graeme Jackson Jason Currie Edward Weaver Anusch Yazdani Andreas Obermair 《Patient education and counseling》2018,101(3):504-510
Objective
To explore factors influencing how well-informed women felt about hysterectomy, influences on their decision making, and on them receiving a less-invasive alternative to open surgery.Methods
Online questionnaire, conducted in 2015–2016, of women who had received a hysterectomy in Australia, in the preceding two years.Results
Questionnaires were completed by 2319/6000 women (39% response). Most women (n = 2225; 96%) felt well-informed about hysterectomy. Women were more aware of the open abdominal approach (n = 1798; 77%), than of less-invasive vaginal (n = 1552; 67%), laparoscopic (n = 1540; 66%), laparoscopic-assisted (n = 1303; 56%), and robotic approaches (n = 289; 12%). Most women (n = 1435; 62%) reported their gynaecologist was the most influential information source. Women who received information about hysterectomy from a GP (OR = 1.47; 95% CI 1.15-1.90), or from a gynaecologist (OR = 1.3; 95% CI 1.06-1.58), were more likely to feel better informed (p < 0.01).Conclusion
This study is important because it helps clinicians, researchers and health policy makers to understand why many women still receive an open abdominal approach despite many learned societies recommending to avoid it if possible.Practice implications
Additional information, or education about avoiding open abdominal approach where possible may lead to a greater number of women receiving less-invasive types of hysterectomy in the future. 相似文献10.
Gwendolyn P. Quinn Rebecca D. Pentz Teresita Muñoz-Antonia Theresa A. Boyle Matthew B. Schabath Christie L. Pratt Andrea Shaffer Luisa F. Duarte Meghan Bowman-Curci Scott J. Antonia Alberto A. Chiappori Benjamin C. Creelan Jhanelle E. Gray Charles C. Williams Eric B. Haura 《Patient education and counseling》2018,101(4):703-710
11.
Introduction
Patients are increasingly accessing online health information and have become more participatory in their engagement with the advent of social media (SM). This study explored how patients’ use of SM impacted their interactions with healthcare professionals (HCPs).Methods
Focus groups (n = 5) were conducted with 36 patients with chronic conditions and on medication who used SM for health-related purposes. The discussions lasted 60–90 min, were audio-recorded, transcribed verbatim, and thematically analysed.Results
Participants did not interact with HCPs on SM and were not expecting to do so as they used SM exclusively for peer interactions. Most reported improvement in the patient-HCP relationship due to increased knowledge, better communication, and empowerment. Participants supplemented HCP-provided information with peer interactions on SM, and prepared themselves for consultations. They shared online health information with HCPs, during consultations, to validate it and to actively participate in the decision-making. Although some participants reported HCP support for their online activities, most perceived overt or tacit opposition.Conclusion
Participants perceived that their SM use positively impacted relationships with HCPs. They felt empowered and were more assertive in participating in decision-making.Practice implications
HCPs should be aware of patients’ activities and expectations, and support them in their online activities. 相似文献12.
13.
L.J. Graven G. Gordon J.Grant Keltner L. Abbott J. Bahorski 《Patient education and counseling》2018,101(2):266-275
Objective
The purpose of this study was to examine the preliminary effects of a coping partnership intervention comprised of social support and problem-solving on HF self-care maintenance, management, and confidence.Methods
A 3-group randomized controlled pilot study was conducted. The intervention group received 1 home visit, weekly (month 1), and biweekly (months 2 and 3) telephone calls. The attention group received telephone calls starting at week 2, following a similar pattern. The control group received usual care only. The Self-care of Heart Failure Index, was administered at baseline, 5, 9, and 13 weeks. Linear mixed modeling examined intervention effect on study outcomes.Results
A total of 66 participants completed the study. The participants were mean age 61 years; 54.2% male; 56% Non-Caucasian; and 43.9% New York Heart Association HF Class II. Significant treatment-by-time interaction effects were noted for self-care maintenance (F = 4.813; p = 0.010) and self-care confidence (F = 4.469; p = 0.014). There was no significant treatment-by-time interaction effect on self-care management.Conclusions
Coping partnership interventions that strengthen support and social problem- solving may improve self-care maintenance and confidence in individuals with HF.Practice implications
Clinicians should consider including these components in HF patient education and clinical follow-up. 相似文献14.
Veerle Duprez Dimitri Beeckman Sofie Verhaeghe Ann Van Hecke 《Patient education and counseling》2018,101(2):276-284
Objective
To explore nurses’ self-perceived behavior of supporting patients’ self-management, and its association with person-related and socio-structural factors.Methods
Correlational study in a sample of nurses from nine general hospitals, three community healthcare organizations, and six private community practices. Nurses with >50% of their patients living with a chronic condition were eligible to participate. Data were collected at two time-points. Self-management support behavior was measured by the SEPSS-36 instrument. The person-related and socio-structural associated factors were derived from behavioral theories and measured by validated questionnaires.Results
Nurses (N = 477) scored overall low on self-management support behavior. Nurses lacked mainly competencies in collaborative goalsetting, shared decision making and organizing follow-up. Factors predicting nurses’ behavior in supporting patients’ self-management were self-efficacy, priority, perceived supervisor support and training in self-management support. This model explained 51.7% of the variance in nurses’ behavior.Conclusion
To date, nurses do not optimally fulfil their role in supporting patients’ self-management. Self-management support is practiced from a narrow medical point of view and primarily consists of informing patients, which is the lowest level of patient participation.Practice implications
It is essential to better prepare and support nurses ? and by extend all healthcare professionals ? for the challenges of supporting patients’ self-management. 相似文献15.
Wolfgang Gaissmaier Helge Giese Mirta Galesic Rocio Garcia-Retamero Juergen Kasper Ingo Kleiter Sven G. Meuth Sascha Köpke Christoph Heesen 《Patient education and counseling》2018,101(1):74-78
Objective
A shared decision-making approach is suggested for multiple sclerosis (MS) patients. To properly evaluate benefits and risks of different treatment options accordingly, MS patients require sufficient numeracy – the ability to understand quantitative information. It is unknown whether MS affects numeracy. Therefore, we investigated whether patients’ numeracy was impaired compared to a probabilistic national sample.Methods
As part of the larger prospective, observational, multicenter study PERCEPT, we assessed numeracy for a clinical study sample of German MS patients (N = 725) with a standard test and compared them to a German probabilistic sample (N = 1001), controlling for age, sex, and education. Within patients, we assessed whether disease variables (disease duration, disability, annual relapse rate, cognitive impairment) predicted numeracy beyond these demographics.Results
MS patients showed a comparable level of numeracy as the probabilistic national sample (68.9% vs. 68.5% correct answers, P = 0.831). In both samples, numeracy was higher for men and the highly educated. Disease variables did not predict numeracy beyond demographics within patients, and predictability was generally low.Conclusion
This sample of MS patients understood quantitative information on the same level as the general population.Practice implications
There is no reason to withhold quantitative information from MS patients. 相似文献16.
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17.
Winny Setyonugroho Thomas Kropmans Ruth Murphy Peter Hayes Jan van Dalen Kieran M. Kennedy 《Patient education and counseling》2018,101(1):147-151
Background
Comparing outcome of clinical skills assessment is challenging. This study proposes reliable and valid comparison of communication skills (1) assessment as practiced in Objective Structured Clinical Examinations (2). The aim of the present study is to compare CS assessment, as standardized according to the MAAS Global, between stations in a single undergraduate medical year.Methods
An OSCE delivered in an Irish undergraduate curriculum was studied. We chose the MAAS-Global as an internationally recognized and validated instrument to calibrate the OSCE station items. The MAAS-Global proportion is the percentage of station checklist items that can be considered as ‘true’ CS. The reliability of the OSCE was calculated with G-Theory analysis and nested ANOVA was used to compare mean scores of all years.Results
MAAS-Global scores in psychiatry stations were significantly higher than those in other disciplines (p < 0.03) and above the initial pass mark of 50%. The higher students' scores in psychiatry stations were related to higher MAAS-Global proportions when compared to the general practice stations.Conclusion
Comparison of outcome measurements, using the MAAS Global as a standardization instrument, between interdisciplinary station checklists was valid and reliable.Practice implications
The MAAS-Global was used as a single validated instrument and is suggested as gold standard. 相似文献18.
Luqman Aribidesi Olayaki Isiaka Abdullateef Alagbonsi Hawau Olaide Abdulkadir Felix Oluwaseyi Idowu 《Journal of the Anatomical Society of India》2017,66(1):67-71
Introduction
Cryptorchidism has been associated with spermatotoxicity and oxidative stress while melatonin is a well-known anti-oxidant. This study investigated the possible ameliorative effect of melatonin on cryptorchidism-induced spermatotoxicity and oxidative stress.Methods
Thirty six male Wistar rats were randomised into sham-operated (n = 18) and bilaterally cryptorchid (n = 18) groups, each of which were subdivided into 3 oral treatment groups (n = 6 rats each) that received normal saline, low dose (4 mg/kg) and high dose (10 mg/kg) melatonin.Results
Cryptorchidism reduced sperm parameters, oestradiol, luteinising hormone, follicle stimulating hormone and glutathione peroxidase activity, but increased testosterone and lactate dehydrogenase activity. The cryptorchidism-induced spermatotoxicity and oxidative stress were ameliorated by low dose of melatonin but exacerbated by its high dose.Discussion
Melatonin’s effect on cryptorchidism-induced spermatotoxicity is dose-dependent. 相似文献19.
Rachael Glassey Moira O’Connor Angela Ives Christobel Saunders Sarah J. Hardcastle 《Patient education and counseling》2018,101(2):318-323
Objective
The objective of this study was to explore the influences on decision-making of younger women (<35) undergoing or considering bilateral prophylactic mastectomy (BPM).Methods
Qualitative interviews guided by interpretative phenomenological analysis (IPA) were conducted with forty-six women who had a strong family history of breast cancer (BC) who had either undergone (n = 26) or were considering (n = 20) BPM. Participants were recruited from Australia and New Zealand (NZ) via hospitals, a genetics clinic, a research cohort, a registry and online.Results
Four themes underpinning the influences on decision-making were identified: fear and anxiety, children, personal experiences with BC, health professional’s influence.Conclusions
The decision to undergo BPM for younger women ( < 35) was multifaceted, however, it appeared that fear and anxiety were the main influence. Younger women appear more anxious than previous research with older women. There appears to be few differences between those with confirmed BRCA1/2 mutations and those with no known mutation and this is clinically significant.Practice implications
These findings have important practice implications, particularly improving communication of risk statistics, especially to those with no known mutation. Health professionals need to take into account the way younger women perceive information given to them when discussing risk. 相似文献20.
Jin Hui Joo Seungyoung Hwang Joseph J. Gallo Debra L. Roter 《Patient education and counseling》2018,101(4):665-671