共查询到20条相似文献，搜索用时 15 毫秒
1.
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.
Laura B. Attanasio Katy B. Kozhimannil Kristen H. Kjerulff 《Patient education and counseling》2018,101(6):1130-1136
Objective
To examine correlates of shared decision making during labor and delivery.Methods
Data were from a cohort of women who gave birth to their first baby in Pennsylvania, 2009–2011 (N?=?3006). We used logistic regression models to examine the association between labor induction and mode of delivery in relation to women’s perceptions of shared decision making, and to investigate race/ethnicity and SES as potential moderators.Results
Women who were Black and who did not have a college degree or private insurance were less likely to report high shared decision making, as well as women who underwent labor induction, instrumental vaginal or cesarean delivery. Models with interaction terms showed that the reduction in odds of shared decision making associated with cesarean delivery was greater for Black women than for White women.Conclusions
Women in marginalized social groups were less likely to report shared decision making during birth and Black women who delivered by cesarean had particularly low odds of shared decision making.Practice implications
Strategies designed to improve the quality of patient-provider communication, information sharing, and shared decision making must be attentive to the needs of vulnerable groups to ensure that such interventions reduce rather than widen disparities. 相似文献4.
Tsuyoshi Okuhara Hirono Ishikawa Masahumi Okada Mio Kato Takahiro Kiuchi 《Patient education and counseling》2018,101(3):406-413
Objective
In Japan, the human papillomavirus (HPV) vaccination rate has sharply fallen to nearly 0% due to sensational media reports of adverse events. Online anti-HPV-vaccination activists often warn readers of the vaccine’s dangers. Here, we aimed to examine frequently appearing contents on pro- and anti-HPV vaccination websites.Methods
We conducted online searches via two major search engines (Google Japan and Yahoo! Japan). Targeted websites were classified as “pro,” “anti,” or “neutral” according to their claims, with the author(s) classified as “health professionals,” “mass media,” or “laypersons.” We then conducted a text mining analysis.Results
Of the 270 sites analyzed, 16 contents were identified. The most frequently appearing contents on pro websites were vaccine side effects, preventable effect of vaccination, and cause of cervical cancer. The most frequently appearing contents on anti websites were vaccine side effects, vaccine toxicity, and girls who suffer from vaccine side effects. Main disseminators of each content according to the author’s expertise were also revealed.Conclusion
Pro-HPV vaccination websites should supplement deficient contents and respond to frequent contents on anti-HPV websites.Practice implications
Effective tactics are needed to better communicate susceptibility to cervical cancer, frequency of side effects, and responses to vaccine toxicity and conspiracy theories. 相似文献5.
Background
The effectiveness of patient decision aids (PtDA) is rarely evaluated in the “real world” where patients vary in their preferences related to decision support.Purpose
To determine how Canadian patients use and evaluate our widely available PtDA for early-stage prostate cancer treatment with its 8 components.Methods
Google Analytics and online tracking provided usage information. A Usability Assessment (UA) following the PtDA provided evaluation data; main outcomes [scale: 1 (strongly disagree) to 5 (strongly agree)] were (a) the aid was helpful, and (b) I would recommend it to other patients.Results
Usage data were from 993 users, and UAs from 168 of them. Mean “helpfulness” score was 4.1(5 max); mean “recommend” score was 4.2 (5 max). For each PtDA component, there was no significant difference on each main outcome, between those who used it and those who did not.Conclusion
Overall, patients who completed the UA rated the PtDA as helpful and would recommend it to other patients. The widely available PtDA accommodated expected variation in decision support desired, and helpfulness was not associated with variation in components used.Practice implication
The internet can be an effective medium for making appropriately designed decision support widely available to prostate cancer patients. 相似文献6.
Kristen E. Pecanac Roger. L. Brown Jay Steingrub Wendy Anderson Michael A. Matthay Douglas B. White 《Patient education and counseling》2018,101(11):1957-1965
Objective
To assess the psychometric properties of the 16-item Decisional Conflict Scale (DCS) in surrogate decision makers.Methods
With a sample of 472 surrogates from intensive care units in five academic medical centers across the United States, we performed the analysis in five phases to 1) model the congeneric structure with confirmatory factor analysis and assess 2) internal consistency reliability, 3) the unidimensional or global assessment, 4) factorial invariance across surrogate gender, and 5) individual item influence on the domains.Results
The congeneric model fit the data, with all factor loadings (0.577–0.955) statistically significant at p?<?0.05. All subdomains had acceptable internal consistency (0.751–0.981). The bifactor model supported the sub-domains or the global construct as appropriate measurement models. The DCS demonstrated invariance for use across surrogate genders. The most difficult item for surrogates to complete was “This decision is easy for me to make” [MNSQ Infit/Outfit: 2.37/3.27] and the easiest item was “I have enough advice to make a choice” [0.70/0.67].Conclusions
Overall, the DCS demonstrated good fit, and can be considered a valid and reliable tool to use with the surrogate population.Practice Implications
Measuring surrogate decisional conflict could be especially useful to determine how to improve the decision-making process. 相似文献7.
8.
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9.
Chloe Grimmett Karen Pickett Jonathan Shepherd Karen Welch Alejandra Recio-Saucedo Elke Streit Helen Seers Anne Armstrong Ramsey I. Cutress D. Gareth Evans Ellen Copson Bettina Meiser Diana Eccles Claire Foster 《Patient education and counseling》2018,101(5):779-788
Objective
Identify existing resources developed and/or evaluated empirically in the published literature designed to support women with breast cancer making decisions regarding genetic testing for BRCA1/2 mutations.Methods
Systematic review of seven electronic databases. Studies were included if they described or evaluated resources that were designed to support women with breast cancer in making a decision to have genetic counselling or testing for familial breast cancer. Outcome and process evaluations, using any type of study design, as well as articles reporting the development of decision aids, were eligible for inclusion.Results
Total of 9 publications, describing 6 resources were identified. Resources were effective at increasing knowledge or understanding of hereditary breast cancer. Satisfaction with resources was high. There was no evidence that any resource increased distress, worry or decisional conflict. Few resources included active functionalities for example, values-based exercises, to support decision-making.Conclusion
Tailored resources supporting decision-making may be helpful and valued by patients and increase knowledge of hereditary breast cancer, without causing additional distress.Practice implications
Clinicians should provide supportive written information to patients where it is available. However, there is a need for robustly developed decision tools to support decision-making around genetic testing in women with breast cancer. 相似文献10.
Maarten Vermorgen Aline De Vleminck Luc Deliens Dirk Houttekier Nele Spruytte Chantal Van Audenhove Joachim Cohen Kenneth Chambaere 《Patient education and counseling》2018,101(8):1378-1384
Objective
Deaths from chronic illness are often preceded by a potentially life-shortening end-of-life decision (ELD). Involving family in these ELDs may have psychosocial benefits for them and the dying person. This study aims to examine how often ELDs are discussed with relatives of the dying person and which characteristics determine their involvement in those ELDs.Methods
A questionnaire survey was conducted in 2013 among physicians attending a large, stratified and representative sample of deaths (n?=?6188) in Flanders.Results
In 72.3% of ELDs preceding death, family of the dying person were involved. Discussion of an ELD with family members was more likely when the decision was also discussed with the dying person, the ELD was made with the explicit intention to shorten life, specialized palliative care was provided or death occurred in an ICU.Conclusions
Involving family in end-of-life decision making appears to be related to the type of formal care services involved, communication with the dying person and the motives behind the decision.Practice implications
Our findings suggest a need to further expand a palliative care approach with a focus on both the dying person and their family within and across a variety of health care services. 相似文献11.
Objective
To explore the relationships between self-reported Empathy and the patient-centered communication patterns of physician trainees.Methods
“Eighty-four 3rd year medical students completed the Jefferson Scale of Empathy (JSE – student version) and had recordings of a single OSCE analyzed using the Roter Interactional Analysis System (RIAS). Correlation and regression were employed to explore the relationships among JSE total score, 3 JSE subscales, 10 composite codes of provider communication, and a summary ‘patient centered communication’ ratio, reflecting the balance of psychosocial and emotional to biomedical communication of the simulated patient and student.Results
Results indicate that controlling for other elements of student communication, the RIAS composite of codes reflecting ‘emotional responsiveness’ (characterized by empathy statements, legitimization, showing concern, partnership statements and medically relevant provider self-disclosure) was positively related to the JSE Total Score while student ‘question asking’ and ‘biomedical counseling’ were negatively related to the JSE Score. RIAS-coded communication variables accounted for 32.4% of the JSE Total score.Conclusion
The relationship between student expressions of emotional responsiveness and predicted self-reported empathy provides concurrent validation evidence for the JSE.Practice implications
Further research is needed in order to elaborate and further explore a Patient-Centeredness latent variable. 相似文献12.
Suad Ghaddar Jihyun Byun Janani Krishnaswami 《Patient education and counseling》2018,101(12):2233-2240
Objective
The Patient Protection and Affordable Care Act (ACA) has allowed millions of Americans to obtain coverage. However, many, especially minorities, remain uninsured. With mounting evidence supporting the importance of health insurance literacy (HIL), the purpose of this cross-sectional study is to examine the association between HIL and ACA knowledge.Methods
We conducted 681 in-person interviews with participants at a community health event along the Texas-Mexico border in 2015, after the conclusion of the ACA’s second enrollment period. To assess HIL, we used the Health Insurance Literacy Measure, reflecting consumers’ confidence to choose, compare, and use health insurance. We assessed ACA knowledge through the following question: “How much would you say you know about this health reform law?” Logistic regression was used to examine the association between HIL and ACA knowledge after controlling for several covariates.Results
Almost 70% of participants knew nothing/very little about the ACA. Multivariate analyses revealed that no/very little ACA knowledge was associated with low levels of confidence “choosing health insurance plans” (OR:0.55; 95%CI:0.40-0.75) (full sample) and “comparing plans” (OR:0.56; 95%CI:0.32-0.96) (U.S.-born sub-sample).Conclusion
No/little ACA knowledge is associated with lower levels of HIL.Practice Implications
Promoting HIL is an essential step towards improving healthcare access. 相似文献13.
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14.
Sherina Mohd-Sidik Mehrnoosh Akhtari-Zavare Ummavathy Periasamy Lekhraj Rampal Siti Irma Fadhilah Rozi Mahmud 《Patient education and counseling》2018,101(5):862-871
Objectives
The aim of this study was to implement and evaluate the outcomes of chemotherapy counselling based on the “Managing Patients on Chemotherapy” module on self-esteem and psychological affect (anxiety, depression) of cancer patients by pharmacists in ten selected government hospitals in Peninsular Malaysia.Methods
A randomized control trial was conducted among 2120 cancer patients from April 2016 to January 2017 in ten selected government hospitals in Peninsular Malaysia. Cancer patients were randomly assigned to intervention and control groups. The intervention group received chemotherapy counselling by pharmacists based on the “Managing Patients on Chemotherapy” module. The outcomes were assessed at baseline, 1st, 2nd and 3rd follow-ups after counselling. In the course of data analysis; independent sample t-test, chi-square and two-way repeated measures ANOVA were conducted.Results
Mean scores of self-esteem in the intervention group had significant difference in comparison with those of the control group in the 1st, 2nd and 3rd follow-ups after counselling (P?<?0.0001). Also, among those with depression and anxiety at baseline, there was reduction in depression and anxiety scores after the 1st, 2nd and 3rd follow-ups after counselling (p?<?0.05).Conclusion
Repetitive counselling by pharmacists based on the “Managing Patients on Chemotherapy” module had positive effect on improving self-esteem and psychological affect of cancer patients undergoing chemotherapy in Peninsular Malaysia.Practice implications
This module can be used for all Malaysian cancer patients undergoing chemotherapy to improving self-esteem and psychological affect. 相似文献15.
Demian Glujovsky Carlos E. Sueldo Andrea Coscia Paula De Carvalho Stella Lancuba Gustavo Martinez Agustín Ciapponi 《Patient education and counseling》2018,101(5):945-950
Objectives
To evaluate motivations to perform an elective single embryo transfer (e-SET).Methods
Cross-sectional surveys to reproductive medicine specialists and to infertile patients undergoing assisted reproductive treatments.Results
In the physician’s survey (n?=?278), we found that the main reasons for not offering e-SET were the physicians’ belief that patients prefer optimizing the pregnancy rates regardless of the potential complications (57.1%). Regarding the decision making process, 76.7% of physicians thought that patients and doctors should make these decisions together and 93.3% would like to have a more formal decision-aid to help with counseling. In the patients’ survey (n?=?100), 21.3% chose e-SET, while 33% mentioned that complications associated to multiple pregnancies were insufficiently discussed. Among those patients, none chose to have e-SET, while 30% of those who had a full discussion selected e-SET (p?=?0.05).Conclusions
Most physicians did not offer e-SET based on potential patients’ negative feelings. Also, almost 30% take important decisions without the patient’s participation. Patients that discussed more thoroughly this topic, more frequently selected e-SET. Almost all the physicians surveyed agreed that decision-aids could help in this important shared-decision process.Practice implications
Decision aids about e-SET vs DET are needed to help patients in the decision making process. 相似文献16.
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17.
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18.
Aaron T. Seaman Kimberly Dukes Richard M. Hoffman Alan J. Christensen Nicholas Kendell Andrew L. Sussman Miriam Veléz-Bermúdez Robert J. Volk Nitin A. Pagedar 《Patient education and counseling》2018,101(10):1741-1747
Objective
Shared decision making (SDM) is recommended when offering lung cancer screening (LCS)—which presents challenges with tobacco-related cancer survivors because they were excluded from clinical trials. Our objective was to characterize head and neck cancer (HNC) survivors’ knowledge, attitudes, and beliefs toward LCS and SDM.Methods
Between November 2017 and June 2018, we conducted semi-structured qualitative interviews with 19 HNC survivors, focusing on patients’ cancer and smoking history, receptivity to and perceptions of LCS, and decision-making preferencesResults
Participants were receptive to LCS, referencing their successful HNC outcomes. They perceived that LCS might reduce uncertainty and emphasized the potential benefits of early diagnosis. Some expressed concern over costs or overdiagnosis, but most minimized potential harms, including false positives and radiation exposure. Participants preferred in-person LCS discussions, often ideally with their cancer specialist.Conclusion and Practice Implications
HNC survivors may have overly optimistic expectations for LCS, and clinicians need to account for this in SDM discussions. Supporting these patients in making informed decisions will be challenging because we lack clinical data on the potential benefits and harms of LCS for cancer survivors. While some patients prefer discussing LCS with their cancer specialists, the ability of specialists to support high-quality decision making is uncertain. 相似文献19.
Geraldine M. Leydon Beth Stuart Rachael H. Summers Paul Little Stuart Ekberg Fiona Stevenson Carolyn A. Chew-Graham Lucy Brindle John Heritage Paul Drew Michael V. Moore 《Patient education and counseling》2018,101(8):1394-1402
Objectives
To establish: a) feasibility of training GPs in a communication intervention to solicit additional patient concerns early in the consultation, using specific lexical formulations (“do you have ‘any’ vs. ‘some’ other concerns?”) noting the impact on consultation length, and b) whether patients attend with multiple concerns and whether they voiced them in the consultation.Methods
A mixed-methods three arm RCT feasibility study to assess the feasibility of the communication intervention.Results
Intervention fidelity was high. GPs can be trained to solicit additional concerns early in the consultation (once patients have presented their first concern). Whilst feasible the particular lexical variation of ‘any’ vs ‘some’ seemed to have no bearing on the number of patient concerns elicited, on consultation length or on patient satisfaction. The level of missing questionnaire data was low, suggesting patients found completion of questionnaires acceptable.Conclusion
GPs can solicit for additional concerns without increasing consultation length, but the particular wording, specifically ‘any’ vs. ‘some’ may not be as important as the placement of the GP solicitation.Practice implications
GPs can solicit early for additional concerns and GPs can establish patients’ additional concerns in the opening of the consultation, which can help to plan and prioritise patients multiple concerns. 相似文献20.
Johanna Granhagen Jungner Elisabet Tiselius Marika Wenemark Klas Blomgren Kim Lützén Pernilla Pergert 《Patient education and counseling》2018,101(9):1661-1668