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1.
Objective
Patient-centered care emphasizes the need to form a therapeutic and trusting relationship between patients and providers in which patients feel comfortable disclosing health-relevant and personal information. It is still unknown how many patients disclose their sexual orientation to providers, under what circumstances and what it is related to in terms of outcomes.Method
The present meta-analysis and review sought to identify the overall proportion of sexual orientation disclosure to healthcare providers, facilitators and barriers of disclosure, patient populations less likely to disclose, and the relationship between disclosure and outcomes. Thirty-five studies met the inclusion criteria yielding 38 independent proportions. Characteristics of patients, providers, location, and disclosure were extracted.Results
Sexual orientation disclosure proportions to healthcare providers ranged from .29 to .98. The random-effects pooled estimate was .63 (95% CI: .58, .68). Disclosure compared to nondisclosure was related to more positive direct and indirect health outcomes including higher satisfaction, more healthcare seeking and screenings and better self-reported health and psychological wellbeing.Conclusion
The overall proportion of disclosure to healthcare providers varied by patient, provider, location, and disclosure characteristics.Practice implications
These findings emphasize the need for future interventions directed at facilitating disclosure among populations identified as less likely to disclose. 相似文献2.
Vincent Kalumire Cubaka Michael Schriver Peter Vedsted Gregory Makoul Per Kallestrup 《Patient education and counseling》2018,101(9):1601-1610
Objective
To identify, adapt and validate a measure for providers’ communication and interpersonal skills in Rwanda.Methods
After selection, translation and piloting of the measure, structural validity, test-retest reliability, and differential item functioning were assessed.Results
Identification and adaptation: The 14-item Communication Assessment Tool (CAT) was selected and adapted.Validity and reliability testing
Content validation found all items highly relevant in the local context except two, which were retained upon understanding the reasoning applied by patients. Eleven providers and 291 patients were involved in the field-testing. Confirmatory factor analysis showed a good fit for the original one factor model. Test-retest reliability assessment revealed a mean quadratic weighted Kappa?=?0.81 (range: 0.69–0.89, N?=?57). The average proportion of excellent scores was 15.7% (SD: 24.7, range: 9.9–21.8%, N?=?180). Differential item functioning was not observed except for item 1, which focuses on greetings, for age groups (p?=?0.02, N?=?180).Conclusion
The Kinyarwanda version of CAT (K-CAT) is a reliable and valid patient-reported measure of providers’ communication and interpersonal skills. K-CAT was validated on nurses and its use on other types of providers may require further validation.Practice implication
K-CAT is expected to be a valuable feedback tool for providers in practice and in training. 相似文献3.
Alexander Jenson Debra L. Roter Harran Mkocha Beatriz Munoz Sheila West 《Patient education and counseling》2018,101(6):1075-1081
Objective
Prevention of Trachoma, the leading cause of infectious blindness, requires community treatment assistants (CTAs) to perform mass drug administration (MDA) of azithromycin. Previous research has shown that female CTAs have higher MDA coverage, but no studies have focused on the content of conversation. We hypothesize that female CTAs had more patient-centered communication and higher MDA coverage.Methods
In 2011, CTAs from 23 distribution sites undergoing MDA as part of the Partnership for Rapid Elimination of Trachoma were selected. CTA – villager interactions were audio recorded. Audio was analyzed using an adaptation of the Roter Interaction Analysis System. The outcome of interest was the proportion of adults receiving MDA in 2011 who returned in 2012.Results
58 CTAs and 3122 interactions were included. Sites with female CTAs had significantly higher patient-centeredness ratio (0.548 vs 0.400) when compared to sites with male CTAs. Sites with more patient-centered interactions had higher proportion of patients return (p?=?0.009).Conclusion
Female CTAs had higher proportion of patient-centered communication. Patient centered communication was associated with higher rates of return for MDA.Practice implications
Greater patient-centered connection with health care providers affects participation in public health efforts, even when those providers are lay health workers. 相似文献4.
Tanya L. Packer America Fracini Åsa Audulv Neda Alizadeh Betsie G.I. van Gaal Grace Warner George Kephart 《Patient education and counseling》2018,101(4):579-595
Objectives
To identify self-report, self-management measures for adults with chronic conditions, and describe their purpose, theoretical foundation, dimensionality (multi versus uni), and scope (generic versus condition specific).Methods
A search of four databases (8479 articles) resulted in a scoping review of 28 self-management measures.Results
Although authors identified tools as measures of self-management, wide variation in constructs measured, purpose, and theoretical foundations existed. Subscales on 13 multidimensional tools collectively measure domains of self-management relevant to clients, however no one tool’s subscales cover all domains.Conclusions
Viewing self-management as a complex, multidimensional whole, demonstrated that existing measures assess different, related aspects of self-management. Activities and social roles, though important to patients, are rarely measured. Measures with capacity to quantify and distinguish aspects of self-management may promote tailored patient care.Practice implications
In selecting tools for research or assessment, the reason for development, definitions, and theories underpinning the measure should be scrutinized. Our ability to measure self-management must be rigorously mapped to provide comprehensive and system-wide care for clients with chronic conditions. Viewing self-management as a complex whole will help practitioners to understand the patient perspective and their contribution in supporting each individual patient. 相似文献5.
Wei Wei Lee Maria L. Alkureishi J. Harry Isaacson Mark Mayer Richard M. Frankel Daniel A. London Kristen E. Wroblewski Vineet M. Arora 《Patient education and counseling》2018,101(12)
Objective
Despite rapid EHR adoption, few faculty receive training in how to implement patient-centered communication skills while using computers in exam rooms. We piloted a patient-centered EHR use training to address this issue.Methods
Faculty received four hours of training at Cleveland Clinic and a condensed 90-minute version at the University of Chicago. Both included a lecture and a Group-Objective Structured Clinical Exam (GOSCE) experience. Direct observations of 10 faculty in their clinical practices were performed pre- and post-workshop.Results
Thirty participants (94%) completed a post-workshop evaluation assessing knowledge, attitude, and skills. Faculty reported that training was important, relevant, and should be required for all providers; no differences were found between longer versus shorter training. Participants in the longer training reported higher GOSCE efficacy, however shorter workshop participants agreed more with the statement that they had gained new knowledge. Faculty improved their patient-centered EHR use skills in clinical practice on post- versus pre-workshop ratings using a validated direct-observation rating tool.Conclusion
A brief lecture and GOSCE can be effective in training busy faculty on patient-centered EHR use skills.Practice Implications
Faculty training on patient-centered EHR skills can enhance patient-doctor communication and promotes positive role modeling of these skills to learners. 相似文献6.
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7.
Karen Nieuwenhuijsen Carel T. Hulshof Judith K. Sluiter 《Patient education and counseling》2018,101(7):1291-1297
Objective
To study the influence of the presentation of results of a preventive medical examination on risk perception and willingness to seek help for work-related fatigue or being overweight.Methods
A factorial design experiment was conducted, presenting workers (n?=?82) with vignettes including eight scenarios of test results with and without an emphasis on the risk of a current or future health condition or a probe to seek help. Participants rated perceived risk and willingness to seek help (0–100 Visual Analogue Scale) as if these were their own results. Differences were tested with paired-sample t-tests.Results
In scenarios emphasizing the risk of a current or future disorder, participants perceived higher risk and were more willing to seek help (p-values?<?.00). Slightly higher willingness to seek help scores was observed in all scenarios that included probes (p?<?.00).Conclusion
Risk perception and willingness to seek help of workers participating in a preventive medical examination were higher when they were told that the test results indicate a risk of a current or future disorder and after being advised to seek help.Practice implications
Healthcare providers should take the potential effects on risk perception and help-seeking into account in preventive settings. 相似文献8.
Christina C. Wieczorek Peter Nowak Susan B. Frampton Jürgen M. Pelikan 《Patient education and counseling》2018,101(8):1508-1513
Objective
Present and discuss the development and basic structure of a multilevel approach to strengthen patient and family engaged care, “The New Haven Recommendations on partnering with patients, families and citizens to enhance performance and quality in health promoting hospitals and health services”.Methods
A generic literature review was conducted followed by a Delphi procedure to prepare the New Haven Recommendations. From systems theory perspective, three conceptual levels are used to map action areas to enhance patient and family engaged care.Results
The recommendations propose a multilevel approach to enable patient, family, (and citizen representatives’) involvement (a) within direct service provision; (b) among hospitals and health services; (c) in planning healthcare delivery systems and policy.Conclusion
The New Haven Recommendations provide a strategic tool and practical recommendations, which can be used for reflection on current practices or generating new ways of thinking about patient and family engaged care. They support the development of patient and family engaged care as core aspect of high quality healthcare, and can contribute to achieving the Ottawa Charter’s claim of reorienting health services.Practice implications
The potential benefit of the multilevel approach is to reorient the basic culture of healthcare towards patient- and health-centered care. 相似文献9.
Objective
Despite well-known beneficial effects, adherence to core elements of diabetes treatment is suboptimal. This study, conducted in the Netherlands, aimed to explore if and how treatment adherence success factors are applied in diabetes consultations, and to explore salient personal beliefs about type 2 diabetes treatment including both healthy lifestyle adaptations and pharmacotherapy.Methods
A qualitative study using semi-structured interviews among nine Dutch healthcare providers predominantly involved in diabetes management and 19 Dutch type 2 diabetes patients. Data was systematically analysed through deductive coding analysis using Nvivo.Results
Most patients visited their consultations unprepared. Patients did not or vaguely experience goal-setting in consultations, whereas healthcare providers indicated to set treatment goals. Shared-decision making was applied, however patients were rather passive collaborators as mostly healthcare providers were in charge of making treatment decisions. Despite suboptimal treatment adherence, many advantages and few disadvantages of treatment strategies were reported. Adherence self-efficacy was lower in situations outside daily routine.Conclusion
Treatment adherence success factors are not optimally applied, and in particular treatment adherence self-efficacy could be improved.Practice implications
The application of treatment adherence success factors in consultations could be improved, and personal beliefs should be addressed to improve treatment adherence and optimize counselling. 相似文献10.
Bronwyn Hemsley Megan Rollo Andrew Georgiou Susan Balandin Sophie Hill 《Patient education and counseling》2018,101(1):2-15
Objective
To integrate the findings of research on electronic personal health records (e-PHRs) for an understanding of their health literacy demands on both patients and providers.Methods
We sought peer-reviewed primary research in English addressing the health literacy demands of e-PHRs that are online and allow patients any degree of control or input to the record. A synthesis of three theoretical models was used to frame the analysis of 24 studies.Results
e-PHRs pose a wide range of health literacy demands on both patients and health service providers. Patient participation in e-PHRs relies not only on their level of education and computer literacy, and attitudes to sharing health information, but also upon their executive function, verbal expression, and understanding of spoken and written language.Conclusion
The multiple health literacy demands of e-PHRs must be considered when implementing population-wide initiatives for storing and sharing health information using these systems.Practice implications
The health literacy demands of e-PHRs are high and could potentially exclude many patients unless strategies are adopted to support their use of these systems. Developing strategies for all patients to meet or reduce the high health literacy demands of e-PHRs will be important in population-wide implementation. 相似文献11.
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12.
13.
Evelyn Y. Ho Joseph Acquah Cewin Chao Genevieve Leung Don C. Ng Maria T. Chao Abby Wang Shannon Ku Wanyi Chen Choi Kwun Yu Shuwen Xu Melissa Chen Jane Jih 《Patient education and counseling》2018,101(12):2202-2208
Objectives
Current cardiovascular disease (CVD) nutrition guidelines do not take into account Chinese medicine (CM) principles. We created a heart healthy integrative nutritional counseling (H2INC) curriculum consistent with CM principles and current nutrition guidelines.Methods
We conducted three phases of semi-structured interviews with key stakeholders (CM and biomedical providers and Chinese American (CAs) patients with CVD) followed by iterative development of H2INC. First, we interviewed licensed CM providers (n?=?9) and laypeople with CM foods expertise (n?=?1). Second, we interviewed biomedical providers (n?=?11) and licensed CM providers (n?=?3). Third, we conducted four focus groups with CAs (n?=?20) with CVD.Results
Stakeholders emphasized different principles for creating H2INC. Phase one emphasized alignment of CM diagnoses to biomedical CVD conditions. Phase two overlaid CM concepts like the nature of foods and constitution (hot/neutral/cool) with heart healthy nutrition recommendations such as MyPlate, and avoiding excess salt, fat, and sugars. Phase three demonstrated patient acceptability.Conclusion
By integrating CM foods principles with biomedical nutrition, this integrative approach yields culturally relevant health education for an underserved population.Practice Implications
Integrative nutritional counseling shows promise for CAs and could support biomedical providers with little knowledge about patients’ use of CM for CVD. 相似文献14.
Miriam Komaromy Erin Fanning Madden Andrea Zurawski Summers Kalishman Kristin Barker Patricia O’Sullivan Martin Jurado Sanjeev Arora 《Patient education and counseling》2018,101(3):524-531
Objective
Elicit patients’ perceptions of factors that facilitate their engagement in careMethods
In-depth interviews with 20 adult Medicaid patients who had complex health problems, frequent hospitalizations/emergency department use, and who were enrolled in an intensive, team-based care program designed to address medical, behavioral, and social needs.Results
Prior to engaging in the program, participants described weak relationships with primary care providers, frequent hospitalizations and emergency visits, poor adherence to medications and severe social barriers to care. After participating in the program, participants identified key factors that enabled them to develop trust and engage with care including: availability for extended intensive interactions, a non-judgmental approach, addressing patients' material needs, and providing social contact for isolated patients. After developing relationships with their care team, participants described changes such as sustained interactions with their primary care team and incremental improvements in health behaviors.Conclusion
These findings illuminate factors promoting “contingent engagement” for low socio-economic status patients with complex health problems, which allow them to become proactive in ways commensurate with their circumstances, and offers insights for designing interventions to improve patient outcomes.Practice implications
For these patients, engagement is contingent on healthcare providers’ efforts to develop trust and address patients’ material needs. 相似文献15.
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
Objective
Improving adherence is a challenge and multiple barriers are likely to explain non-adherence. These barriers differ per patient and over course of the regimen. Hence, personalized interventions tailored to the specific barriers are needed. In a theoretical and evidence-based Tailored Multimedia Intervention, technology (online preparatory assessment, text messaging) was used as an add-on to a tailored counseling session (learned during a communication skills training), with the expectation of synergistic effects.Methods
A cluster randomized controlled trial was conducted in six hospitals, eight nurses and 160 chronic patients. Patient satisfaction with communication, beliefs about medication, self-efficacy and medication adherence were assessed at initiation of the treatment and after six months.Results
Intervention effects were found for patient satisfaction with nurses’ affective communication and self-efficacy at the initiation of treatment. The effect on self-efficacy remained after six months.Conclusion
By combining tailored counseling with technology, this intervention resulted in positive changes in important prerequisites of medication adherence.Practical implications
Technology can contribute significantly to health care providers’ ability to tailor information to the patients’ needs. 相似文献16.
17.
Farina Kokab Sheila Greenfield Antje Lindenmeyer Manbinder Sidhu Lynda Tait Paramjit Gill 《Patient education and counseling》2018,101(4):619-630
Objective
The objective of this research was to synthesise qualitative literature about the perceived influence and experience of social support, in relation to cardiovascular disease (CVD) prevention in migrant Pakistani communities.Methods
Articles were systematically reviewed, critically appraised, and analysed using an adapted meta-ethnography approach.Results
Sixteen qualitative studies on health behaviours related to CVD prevention were included.Findings
include four sub-themes under two substantive thematic areas that focus on: 1) family dynamics and 2) community dynamics influenced by discrimination. For members of the Pakistani community, gendered family dynamics and discrimination from outside and within community networks influenced behaviour change.Conclusion
The authors of the synthesis developed multi-layered, contextualised interpretations of the care needs of an established multi-generational community. Future qualitative studies taking an intersectional approach to interpreting the role of social networks in migrant communities should take into account gender, identity, culture and faith.Practice implications
Health care providers should focus on cultural awareness and sensitivity during consultations. In particular, general practitioners can benefit from the insight they gain from patient experiences, allowing for more appropriate recommendations. 相似文献18.
Sarah Bauerle Bass Amy Jessop Muhamed Gashat Laurie Maurer Mohammed Alhajji Jon Forry 《Patient education and counseling》2018,101(11):1995-2004
Objective
This paper describes the development of a mobile health tool to facilitate Hepatitis C (HCV) treatment decision making in methadone patients.Methods
Using an iterative, formative evaluation framework, we used commercial marketing techniques to create 3D maps of survey data to develop culturally relevant messaging that was concept tested. The resulting tool was then user tested and results were used to modify the tool.Results
The “Take Charge, Get Cured” tool was developed with surveys (n?=?100), perceptual mapping analysis, concept testing (n?=?5), and user testing (n?=?10). “Think aloud” sessions were audio recorded and surveys given. Patients thought the goal of the tool was to encourage treatment and it was aimed to the needs of methadone patients. Means of 6.7–7 (on a 7 point scale) were observed for survey items related to ease of use, content, and satisfaction.Conclusion
The iterative development was essential to ensuring a culturally targeted tool, specific to the needs of HCV?+?methadone patients. There was a high level of acceptance for the tool.Practice Implications
Our study indicates that using a formative evaluation strategy is essential for development of highly targeted patient communication, especially in hard-to-reach populations. 相似文献19.
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20.
Una Stenberg Andre Vågan Maria Flink Vibeke Lynggaard Kari Fredriksen Karl Fredrik Westermann Frode Gallefoss 《Patient education and counseling》2018,101(6):1006-1035