What do clinicians derive from partnering with their patients?: A reliable and valid measure of “personal meaning in patient care”

Objective

Burnout is high among clinicians and may relate to loss of “meaning” in patient care. We sought to develop and validate a measure of “personal meaning” that practitioners derive from patient care.

Methods

As part of a larger study of well-being among genetics professionals, we conducted three focus groups of clinical genetics professionals: physicians, nurses and genetic counselors (N = 29). Participants were asked: “What gives you meaning in patient care?” Eight themes were identified, converted into Likert items, and included in a questionnaire. Next, we mailed the questionnaire to clinical geneticists, genetic counselors and genetic nurses (N = 480) randomly selected from mailing lists of their professional associations. Results were subjected to exploratory factor analysis. The survey also included validated scales of burnout and professional satisfaction, and a 1-item measure of gratitude, to assess predictive validity.

Results

214 eligible providers completed the survey out of an estimated 348 eligible (61% response rate). Factor analysis resulted in a unidimensional scale consisting of 6-items with an alpha of 0.82 and an eigen value of 3.2. Factor loadings ranged from 0.69–0.77. The mean total score was 18.1 (S.D. 3.7) out of a possible high score of 24. Higher meaning scores were associated with being female (p = 0.044), a nurse (p < 0.001), and in practice longer (p = 0.006). Meaning scores were inversely correlated with burnout (p < 0.001), and positively correlated with gratitude (p < 0.001) and professional satisfaction (p < 0.022).

Conclusion

The 6-item “personal meaning in patient care” scale demonstrates high reliability and predictive validity in a select group of health professionals. Future research should validate this scale in a broader population of clinicians.

Practice implications

The scale could be useful in identifying providers at risk of burnout, and in evaluating interventions designed to counteract burnout, enhance meaning and improve communication and partnership between providers and patients.     

Does motivational interviewing counseling time influence HIV-positive persons’ self-efficacy to practice safer sex?

Objective

This study examined the impact of motivational interviewing (MI) counseling time on self-efficacy to practice safer sex for people living with HIV/AIDS (PLWHA).

Methods

In 4 month intervals we followed a cohort of 490 PLWHA for 12 months.We conducted hierarchical linear regression models to examine changes in safer sex self-efficacy when participants received zero, low to moderate (5–131 min) and high (132–320 min) doses of MI time. We conducted a similar analysis using number of counseling sessions as the predictor variable.

Results

Participants with low to moderate doses of MI counseling had 0.26 higher self-efficacy scores than participants with zero MI time (p = 0.01). Also, they had 0.26 lower self-efficacy scores than participants with high amounts of MI time (p = 0.04). Participants with high doses of MI had a 0.5 higher self-efficacy score than participants with zero amount of MI time (p < 0.0001). Participants who received 3–4 counseling sessions had 0.41 greater self-efficacy scores than participants who did not receive any sessions (p < 0.0001) but did not differ from participants receiving 1–2 sessions.

Conclusion

MI time is a key to enhancing safer sex self-efficacy among PLWHA.

Practice implications

Safer sex self-efficacy improves the more MI counseling time and sessions PLWHA receive.     

Impaired quality of life among middle aged women: A multicentre Latin American study

Background

Several studies indicate that quality of life (QoL) is impaired in middle aged women. Assessment of QoL using a single validated tool in Latin American climacteric women has not been reported to date at large scale.

Objective

The Menopause Rating Scale (MRS) was used to assess QoL among middle aged Latin American women and determine factors associated with severe menopausal symptoms (QoL impairment).

Methods

In this cross-sectional study, 8373 healthy women aged 40–59 years, accompanying patients to healthcare centres in 18 cities of 12 Latin American countries, were asked to fill out the MRS and a questionnaire containing socio-demographic, female and partner data.

Results

Mean age of the entire sample was 49.1 ± 5.7 years (median 49), a 62.5% had 12 or less years of schooling, 48.8% were postmenopausal and 14.7% were on hormonal therapy (HT). Mean total MRS score (n = 8373) was 11.3 ± 8.5 (median 10); for the somatic subscale, 4.1 ± 3.4; the psychological subscale, 4.6 ± 3.8 and the urogenital subscale, 2.5 ± 2.7. The prevalence of women presenting moderate to severe total MRS scorings was high (>50%) in all countries, Chile and Uruguay being the ones with the highest percentages (80.8% and 67.4%, respectively). Logistic regression determined that impaired QoL (severe total MRS score ≥17) was associated with the use of alternatives therapies for menopause (OR: 1.47, 95% CI [1.22–1.76], p = 0.0001), the use of psychiatric drugs (OR: 1.57, 95% CI [1.29–1.90], p = 0.0001), attending a psychiatrist (OR: 1.66, 95% CI [1.41–1.96], p = 0.0001), being postmenopausal (OR: 1.48, 95% CI [1.29–1.69, p = 0.0001]), having 49 years or more (OR: 1.24, 95% CI [1.08–1.42], p = 0.001), living at high altitude (OR: 1.43, 95% CI [1.25–1.62, p = 0.0001]) and having a partner with erectile dysfunction (OR: 1.69, 95% CI [1.47–1.94, p = 0.0001]) or premature ejaculation (OR: 1.34, 95% CI [1.16–1.55, p = 0.0001]). Lower risk for impaired QoL was related to living in a country with a lower income (OR: 0.77, 95% CI [0.68–0.88], p = 0.0002), using HT (OR: 0.65, 95% CI [0.56–0.76], p = 0.0001) and engaging in healthy habits (OR: 0.59, 95% CI [0.50–0.69], p = 0.0001).

Conclusion

To the best of our knowledge this is the first and largest study assessing QoL in a Latin American climacteric series with a high prevalence of impairment related to individual female and male characteristics and the demography of the studied population.     

The effect of using standardized patients or peer role play on ratings of undergraduate communication training: a randomized controlled trial

Objectives

Considering the expense of standardized patients (SP) for training communication skills and the convenience of peer role playing (RP) there is a surprising lack of studies directly comparing the two methods.

Methods

Fifth year medical students (N = 103) were assigned to three groups receiving a training in counseling parents of sick children with RP (N = 34) or SP (N = 35) or to a control group (CG, N = 34). We assessed self-efficacy, as well as objective performance in parent–physician communication using questionnaires and the Calgary-Cambridge-Observation-Guide Checklist in a six-station OSCE, respectively.

Results

The training led to an increase in self-efficacy ratings and in the post-intervention OSCE score after RP (p < .021 and p < .001 respectively) and SP-training (p < .007 and p < .006 respectively) compared to controls. Surprisingly, this benefit was higher after RP than after SP-training (p < .021) due to significantly higher performance in the domain understanding of parents’ perspective (p < .001).

Conclusion

Both RP and SP are valuable tools for training specific communication skills. RP offer a methodological advantage in fostering empathy for patient perspectives.

Practice implications

Both peer-role-play and standardized patients hold specific benefits for communication training. Peer-role-play seems to foster a more empathic approach towards patients’ concerns justifying its prominent role in medical curricula.     

Motivational interviewing by HIV care providers is associated with patient intentions to reduce unsafe sexual behavior

Objective

Motivational interviewing (MI) can promote behavior change, but HIV care providers rarely have training in MI. Little is known about the use of MI-consistent behavior among untrained providers. This study examines the prevalence of such behaviors and their association with patient intentions to reduce high-risk sexual behavior.

Methods

Audio-recorded visits between HIV-infected patients and their healthcare providers were searched for counseling dialog regarding sexual behavior. The association of providers’ MI-consistence with patients’ statements about behavior change was assessed.

Results

Of 417 total encounters, 27 met inclusion criteria. The odds of patient commitment to change were higher when providers used more reflections (p = 0.017), used more MI consistent utterances (p = 0.044), demonstrated more empathy (p = 0.049), and spent more time discussing sexual behavior (p = 0.023). Patients gave more statements in favor of change (change talk) when providers used more reflections (p < 0.001) and more empathy (p < 0.001), even after adjusting for length of relevant dialog.

Conclusion

Untrained HIV providers do not consistently use MI techniques when counseling patients about sexual risk reduction. However, when they do, their patients are more likely to express intentions to reduce sexual risk behavior.

Practice implications

MI holds promise as one strategy to reduce transmission of HIV and other sexually transmitted infections.     

Patient knowledge of blood pressure target is associated with improved blood pressure control in chronic kidney disease

Objective

To describe patient hypertension knowledge and associations with blood pressure measurements.

Methods

Patients with chronic kidney disease (CKD) were asked about the impact of high blood pressure on kidneys and their target blood pressure goal. Systolic blood pressure was measured using automated sphygmomanometers.

Results

In 338 adults with hypertension and pre-dialysis CKD, the median [IQR] age was 59 [47,68] years, 45% [n = 152] were women, and 18% [n = 62] were non-white. Lower systolic blood pressure (SBP) was associated with female sex (SBP mmHg median [IQR] 132 [117,149] women vs. 137 [124,152] men; p = 0.04), less advanced CKD (SBP 134 [122,147] stages 1–2 vs. 132 [118,148] stage 3 vs. 140 [125,156] stages 4–5; p = 0.01), and patient ability to correctly identify SBP goal (SBP 134 [119,150] correct vs. 141 [125,154] incorrect; p = 0.05). In adjusted analysis, knowledge of blood pressure goal remained independently associated with lower SBP (−9.96 mmHg [−19.97, −1.95] in correct respondents vs. incorrect; p < 0.001).

Conclusion

Patient knowledge of goal blood pressure is independently associated with improved blood pressure control.

Practice implications

Interventions to improve patient knowledge of specific blood pressure targets may have an important role in optimizing blood pressure management.     

Patient and observer ratings of physician shared decision making behaviors in breast cancer consultations

Objective

Explore the validity of using patient reports to measure shared decision making (SDM).

Methods

178 patients diagnosed with breast cancer obtained SDM assistance in a university-based clinic. Trained observers rated physician SDM behaviors and surveyed patients. We calculated the frequency with which patients and observers reported maximum SDM behaviors for each survey item. We also calculated agreement frequency between patients and observers.

Results

Over 90% of patients rated doctors as reflecting SDM competencies. Patients reported doctors making recommendations more than soliciting their preferred choice (90% vs. 69%, p < 0.001). Patients heard benefits discussed “a lot” more often than they heard risks and side effects discussed “a lot” (81% vs. 58%, p < 0.001). Agreement between patients and observers was 75%. In cases of disagreement, patients more frequently perceived SDM behaviors than did observers (15% vs. 9%, p = 0.002), suggesting a possible agreement bias.

Conclusions

High agreement supports further investigation into using patients as efficient and effective raters of SDM. Patient ratings may be inflated by agreement bias.

Practice implications

Doctors presentations may be biased toward discussing benefits more than risks. Policy makers can solicit patient ratings of SDM as long as they are aware of possibly inflated ratings due to agreement bias.     

AASAP: a program to increase recruitment and retention in clinical trials

Objective

To evaluate a theory based, subject-centered, staff/subject communication program, AASAP (anticipate, acknowledge, standardize, accept, plan), to increase recruitment and retention in RCTs.

Methods

AASAP was evaluated with logistical regression by comparing rates of recruitment (at telephone screening, baseline assessment, initial intervention) and intervention retention (over 16 weeks) before (−AASAP) and after (+AASAP) it was introduced to a 3-arm RCT to reduce disease distress among highly distressed subjects with type 2 diabetes.

Results

Included were 250 subjects in −AASAP and 338 in +AASAP. Significant improvement in recruitment occurred at each of the 3 recruitment stages: agreed at screening (OR = 2.52; p < 0.001), attended baseline assessment (OR = 1.91; p < 0.001), attended initial intervention (OR = 1.46; p < 0.03). Higher education and shorter diabetes duration predicted better recruitment in −AASAP (OR = 2.23; p < 0.001), but not in +AASAP. AASAP also improved intervention retention over 16 weeks (OR = 3.46; p < 0.05).

Conclusion

AASAP is a structured program of subject/staff communication that helps improve external validity by enhancing both subject recruitment and retention.

Practical implications

AASAP can be taught to non-professional staff and can be adapted to a variety of health settings. It can also be used by clinicians to engage patients in programs of ongoing care.     

Physicians’ attitudes towards disclosure of prognostic information: A survey among a representative cross-section of 1605 Norwegian physicians

Objective

To investigate if attitudes towards disclosure of prognostic information vary by speciality, previous experience and demographic factors in a general physician population.

Methods

A postal survey among a representative sample of Norwegian physicians across all specialities (N = 1605), using a translated questionnaire previously used to study attitudes towards disclosing prognostic information among US internists.

Results

A response rate of 70% was obtained after one reminder. 85% of the responders agreed to the helpfulness of an optimistic attitude. A factor analysis revealed three meaningful factors: ‘Prognostic communication is stressful’, ‘Fearing loss of reputation’ and ‘Reinforcement of positive prospects’. In multivariable models significantly more female than male physicians found aspects of prognostication straining (β = 0.143, p < 0.001). Those more experienced in communication of prognostic information towards end of life were less likely to support using reinforcement of positive prospects (β = 0.067, p = 0.001).

Conclusion

After years of focusing on patient autonomy and open communication between patient and physician many Norwegian physicians display attitudes that might hide the true content of prognostic information from the patients.

Practice implications

Many physicians think they are inadequately trained in prognostication and communication of prognostic information, suggesting that increased education and training are needed if patients’ wishes for information on prognosis are to be met in an individualised manner.     

Evaluation of a psychoeducation program for Chinese clients with schizophrenia and their family caregivers

Objectives

To evaluate the effectiveness of a psychoeducation program for Chinese clients with schizophrenia and their family caregivers.

Methods

A randomized controlled trial was conducted. Seventy-three clients with a diagnosis of schizophrenia and their caregivers (n = 73) were recruited and randomized into a study (n = 36) and control group (n = 37). Ten psychoeducation sessions were provided to the study group. The outcomes were measured at the baseline, immediately after (post-1), six months (post-2), and 12 months after the intervention (post-3).

Results

There were significant treatment effects across time for all client outcomes: adherence to medication (p < 0.01), mental status (p < 0.01), and insight into illness (p < 0.01). However, no significant differences were found between groups at the post-3 measures for all client outcomes. For the caregivers, significant group differences were only detected in self-efficacy at the post-1 (p = 0.007) and post-2 (p < 0.001) measures, the level of satisfaction at the post-1 (p = 0.033) and post-2 (p < 0.021) measures, and the perception of family burden at the post-2 measures (p = 0.043).

Conclusion

A psychoeducation intervention had positive effects on Chinese clients and their caregivers. However, these effects might not be sustained 12 months after the intervention.

Practice implications

To substantiate its effects, psychoeducation should be an ongoing intervention, with its outcomes constantly evaluated.     

Beliefs about generic drugs among elderly adults in hospital-based primary care practices

Objective

This study aimed to characterize seniors’ beliefs about generic drugs, and examine potential correlates of these beliefs, including socioeconomic and health status variables, health literacy, and physician communication skills.

Methods

Older adults (≥65 years) were interviewed in two primary care practices of an inner-city, tertiary care hospital (n = 311). Beliefs about generics were measured using a scale that compared generic and brand name drugs across four domains. Beliefs were modeled with multivariable linear regression.

Results

Negative beliefs about generics were associated with non-white race (p < 0.0001), lower education (p = 0.008) and income (p = 0.001), and having Medicaid coverage (p = 0.001). Individuals with low health literacy and who reported that their physicians had poor communication skills were more likely to hold negative views (p < 0.0001 and p = 0.003, respectively). In multivariable analysis, black race (β = −2.30, p = 0.006) and inadequate health literacy (β = −2.17, p = 0.0004) remained strongly associated with negative views about generic drugs. Poor physician communication skills also predicted negative beliefs about generics but the association was not significant for all levels of communication skill.

Conclusion

Many low-income seniors mistrust generic medications, especially African-Americans and seniors with low health literacy.

Practice implications

Educational efforts to promote generic medications should account for patients’ health literacy and cultural backgrounds.     

Correlates of low dietary energy reporting in free-living elderly: the MEDIS study

Objectives

To evaluate the prevalence of low energy reporting (LER) and associations between LER and lifestyle, psychological and clinical parameters, in elderly people living in eastern Mediterranean islands.

Methods

1190 men and women, aged 65–100 years, participated in this cross-sectional study. Socio-demographic, clinical and lifestyle characteristics were recorded for the study participants. Among others, the ratio of energy intake to estimated basal metabolic rate (EI/BMR) was calculated and was used for the assessment of LER.

Results

Prevalence of LER was 47.7%. Lower EI/BMR (i.e., higher risk for LER) was associated with older age (p = 0.001), male sex (p < 0.001), higher body mass index (BMI; p = 0.04), lower adherence to the Mediterranean diet (p < 0.001) and non-current smoking (p = 0.007). The sex-specific analysis revealed that, lower EI/BMR values were associated with lower adherence to the Mediterranean diet and being non-current smoker in both men and women (p ≤ 0.05), as well as with older age (p = 0.01), higher BMI (p = 0.02) and hypercholesterolemia (p = 0.02), only in women.

Conclusion

In elderly, several clinical and lifestyle factors seem to be related to LER, and they should be taken into account in their nutritional assessment.     

Development of a novel coding scheme (SABICS) to record nurse-child interactive behaviours in a community dental preventive intervention

Objective

To develop and validate the St Andrews Behavioural Interaction Coding Scheme (SABICS): a tool to record nurse–child interactive behaviours.

Methods

The SABICS was developed primarily from observation of video recorded interactions; and refined through an iterative process of applying the scheme to new data sets. Its practical applicability was assessed via implementation of the scheme on specialised behavioural coding software. Reliability was calculated using Cohen's Kappa. Discriminant validity was assessed using logistic regression.

Results

The SABICS contains 48 codes. Fifty-five nurse–child interactions were successfully coded through administering the scheme on The Observer XT8.0 system. Two visualization results of interaction patterns demonstrated the scheme's capability of capturing complex interaction processes. Cohen's Kappa was 0.66 (inter-coder) and 0.88 and 0.78 (two intra-coders). The frequency of nurse behaviours, such as “instruction” (OR = 1.32, p = 0.027) and “praise” (OR = 2.04, p = 0.027), predicted a child receiving the intervention.

Conclusions

The SABICS is a unique system to record interactions between dental nurses and 3–5 years old children. It records and displays complex nurse–child interactive behaviours. It is easily administered and demonstrates reasonable psychometric properties.

Practice implications

The SABICS has potential for other paediatric settings. Its development procedure may be helpful for other similar coding scheme development.     

More hypothyroidism and less hyperthyroidism with sufficient iodine nutrition compared to mild iodine deficiency—A comparative population-based study of older people

Objective

To assess the occurrence of thyroid disorders and autoimmunity in a geriatric population with long-standing recommended iodine intake of natural origin compared to mild iodine deficiency.

Design and setting

Cross-sectional, comparative, population-based study in two areas with different iodine intakes due to different tap water iodine contents.

Participants

Residents of Randers (n = 212) or Skagen (n = 218), Denmark, aged 75–80 years.

Measures

Blood samples were collected for measuring thyrotropin (TSH), triiodothyronine, thyroxine, thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TGAb), thyroglobulin (TG); iodine excretion estimated from iodine and creatinine measured in spot urine samples; questionnaire on history of thyroid disease, medication and vitamin use; clinical examination of the neck.

Results

Median urinary iodine excretion was 50 μg/24 h in Randers and 177 μg/24 h in Skagen (p < 0.001). A history of thyroid disease was reported by 40 (9.3%) dominated by goitre (n = 22) in Randers and hypothyroidism and Graves Disease (n = 15) in Skagen (p < 0.001). We found visible goitre in 26% of Randers dwellers and none in Skagen (p < 0.001). Hyperthyroidism with TSH below the reference range was present in 26% of Randers and 6% of Skagen dwellers while 6% and 13%, respectively, were hypothyroid with TSH above the reference range (p < 0.001). More Randers than Skagen participants harboured a thyroid antibody (42% vs. 32%, p = 0.006).

Conclusions

Recommended iodine intake associated with more hypothyroidism, less hyperthyroidism and goiters, low TGAb prevalence and lower TG level in serum than did iodine deficiency. TPOAb was similar in the iodine replete and deficient geriatric populations.     

Sleep quality and aerobic training among menopausal women--a randomized controlled trial

Background

Menopause is associated with poor sleep quality and daytime sleepiness, which may lead to impaired quality of life and impaired functioning in daily activities.

Objective

To study whether exercise training improves sleep quality or decreases the amount of night time hot flushes among menopausal women with vasomotor symptoms.

Study design

A randomized controlled trial. Sedentary women (N = 176) aged 43–63 years with menopausal symptoms were randomized to a six-month unsupervised aerobic training intervention (50 min 4 times per week) or a control group. Both groups attended lectures on physical activity and health once a month.

Main outcome measures

Sleep quality and the amount of hot flushes disturbing sleep. The women reported daily via mobile phone whether hot flushes had disturbed their sleep and how they had slept (scale 1–5). Responses received by mobile phone over the 6-month period totaled on average 125 (5.2 per week) responses per participant.

Results

At baseline there was no difference between the groups in the demographic variables. Sleep quality improved significantly more in the intervention group than in the control group (OR 1.02; 95% CI = 1.0–1.05, p = 0.043). The odds for sleep improvement were 2% per week in the intervention group and a decrease of 0.5% per week in the control group. The amount of hot flushes related to sleep diminished (p = 0.004) by the end of the intervention.

Conclusions

Aerobic training for 6 months may improve sleep quality and reduce hot flushes among symptomatic menopausal women.     

Patients feeling severely affected by multiple sclerosis: How do patients want to communicate about end-of-life issues?

Objective

Investigate multiple sclerosis patients’ desire to communicate with their physicians about their disease progression and end-of-life issues.

Methods

Persons meeting the inclusion criteria of feeling severely affected by MS were invited via the German MS society to complete a needs questionnaire. Replies to questions on physician empathy and wishes about communication regarding disease progression and death and dying were quantitatively analyzed. Endpoints (point 1 + 2/4 + 5) of 5-point-likert scales are summarized under results.

Results

573 of 867 questionnaires meeting our criteria were analyzed. In response to a general question 64% (n = 358) indicated a wish for disease progression and death and dying to be addressed by their doctor. A majority (76%, n = 427) considered it important that progression of their disease be discussed, while 44% (n = 246) regard addressing death and dying as unimportant. No objective disease criteria could be identified to explain the wish for communicating end-of-life issues. Doctors who were retrospectively viewed as avoiding raising critical aspects of the illness were perceived as less empathetic (p < 0.001).

Conclusion

People with MS have a desire to talk about progression of their disease with their doctors.

Practice implications

Physicians should be empathetic in raising critical aspects of the patients’ illness individually.     

Weight's up? Predictors of weight-related communication during primary care visits with overweight adolescents

Objective

Physicians’ use of Motivational Interviewing (MI) techniques when discussing weight with adolescent patients is unknown.

Methods

We coded audio-recorded encounters between 49 primary care physicians and 180 overweight adolescent patients. During weight discussions, we used the MITI 3.0 to assess: Empathy, MI Spirit, open-ended questions, reflections, MI consistent behaviors (e.g., praising) and MI inconsistent behaviors (e.g., confronting). We examined associations of patient and physician characteristics with (1) MI techniques, (2) time discussing weight, and (3) encounter time.

Results

Physicians used more MI consistent techniques with female patients (p = 0.06) and with heavier patients (p = 0.02). Physicians with prior MI training also used more MI consistent techniques (p = 0.04) and asked more open-ended questions (p = 0.05). Pediatricians had a higher MI Spirit score than family physicians (p = 0.03). Older patient age was associated with physicians spending less time discussing weight-related topics (p = 0.04) and higher BMI percentile was associated with physicians spending more time discussing weight-related topics (p = 0.01). Increased use of MI inconsistent techniques was associated with longer encounters (p = 0.02).

Conclusion

Physicians’ weight discussions vary based on adolescent and physician characteristics. Importantly, not using MI lengthened encounter time.

Practice implications

Physicians might consider using MI techniques more and attempt to use these equally with all adolescents.     

Determinants of quality of life in Greek middle-age women: a population survey

Objectives

The aim of the present study was to evaluate how sociodemographic parameters, lifestyle indicators and intensity of climacteric symptoms affect the quality of life (QOL) of Greek community dwelling middle-aged women.

Study design

This population survey included 1140 middle-aged women aged 45–65 who represented 1% of the whole female population of this age group in Greece, stratified by residential area.

Main outcome measures

Participants were asked to complete a questionnaire concerning sociodemographic and anthropometric parameters, medical history, the Utian quality of life (QOL) scale and the Greene climacteric scale rating menopausal symptoms.

Results

In the univariate analysis, normal body mass index, married status, higher education, employment, good financial status, physical exercise and a high calcium diet were associated with higher total QOL scores (p-value < 0.001). Multivariate regression analysis showed that higher total QOL scores were predicted by being married (separated/divorced/widowed: beta = −3.17, p-value = 0.008), by physical exercise (beta = 4.84 and beta = 4.57 for 1–3 h and >3 h per week respectively, p-value < 0.001) and by a good financial status (beta = 7.05, p-value < 0.001), while a higher score in the Greene scale resulted in lower total QOL scores (beta = −0.77, p-value < 0.001). Women with a better QOL were more health conscious and more probable to have utilized the public health preventive resources.

Conclusions

Menopause as a life event has no effect on the QOL of Greek middle-aged women. On the contrary, the presence and intensity of climacteric symptoms have a negative impact on all aspects of QOL. Marital and financial status, as well as physical exercise, are also significant predictors of QOL.     

A comparison of two educational interventions for the cognitive empowerment of ambulatory orthopaedic surgery patients

Objective

The aim of this study was to compare the cognitive empowerment of ambulatory orthopaedic surgery patients when using Internet-based education (experiment) in contrast to face to face education conducted by a nurse (control).

Methods

Elective ambulatory orthopaedic surgery patients were randomized to either an experiment group (n = 72) receiving Internet-based education, or to a control group (n = 75) receiving face-to-face education with a nurse. The data were collected at three different time points: before the preoperative education session, after preoperative education and 2 weeks after the operation. Three structured instruments were used: the Knowledge Test, the Sufficiency of Knowledge and the Orthopaedic Patient Knowledge Instrument.

Results

Patients in both groups showed improvement in their knowledge. However, patients who received Internet-based education improved their knowledge level significantly more in the ethical (p = 0.005) and functional (p = 0.023) dimensions and also in total (p = 0.033) than those patients who underwent face-to-face education with a nurse. In addition, patients in the experiment group had higher scores in sufficiency of knowledge in the experiential (p = 0.050) and financial (p = 0.048) dimensions and, moreover, their scores in sufficiency of knowledge in the ethical dimension improved significantly more (p = 0.008) during the study period than patients in the control group.

Conclusion

Improvements in the patients’ level and sufficiency of knowledge within both groups indicates an increase in patients’ cognitive empowerment.

Practice implications

Internet-based education can be used in ambulatory orthopaedic surgery patient education for increasing patients’ cognitive empowerment.