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1.

Objective

To examine the effectiveness of a three-day training programme on knowledge, confidence and fidelity to Motivational Interviewing (MI) delivery in an undergraduate occupational therapy and physiotherapy cohort (n?=?25).

Methods

Training outcomes were assessed pre-training, post-training and following a subsequent clinical placement. The Motivational Interviewing Knowledge and Attitudes Test (MIKAT) and an 8-item survey assessed knowledge, attitudes and confidence respectively. MI fidelity was evaluated by a simulated patient interview rated with the Motivational Interviewing Treatment Integrity scale (MITI). Analysis was by one-way repeated measures ANOVA.

Results

Self-report measurements indicated increased confidence but no effect on knowledge or attitude. MITI analysis showed superior performance in all four global criteria and an increased frequency of MI adherent behaviours post-training. Positive changes were maintained following clinical placement. MITI summary scores indicated an improvement in question to reflection ratio in line with beginner competency.

Conclusion(s)

Participation in a three-day MI training programme significantly improved student confidence and MI skilfulness.

Practice Implications

Where feasible, MI training should be embedded within the curriculum. Further research is needed elucidate the best practices to incorporate teaching this skill set within the curriculum in order to best prepare students to counsel clients in behaviour change in their applied settings.  相似文献   

2.

Objective

To determine the reliability of the Newest Vital Sign (NVS) administered via telephone by examining test-retest properties of the measure.

Methods

Data were obtained from a randomized controlled trial promoting opioid safe use. Participants were 18 or older and English-speaking. NVS assessment occurred in-person at baseline and in-person or via telephone at follow-up. Intraclass correlation coefficients (ICCs) were used to assess the test-retest reliability using raw NVS scores by mode of administration of the second NVS assessment. Kappa statistics were used to examine test-retest agreement based on categorized NVS score. Internal consistency was measured with Cronbach’s alpha.

Results

Data from 216 patients (70 completing follow-up in-person and 146 via telephone) were included. Reliability was high (ICCs: in-person?=?0.81, phone?=?0.70). Agreement was lower for three category NVS score (Kappas: in-person?=?0.58, 95% CI [0.39-0.77]; phone?=?0.52, 95% CI [0.39-0.65]) compared to two category NVS (Kappas: in-person?=?0.65, 95% CI [0.46-0.85]; phone?=?0.64, 95% CI [0.51-0.78]). Correlations decreased as time between administrations increased. Internal consistency was moderately high (baseline NVS in-person (α?=?0.76), follow-up NVS in-person (α?=?0.76), and phone follow-up (α?=?0.78).

Conclusion

The test-retest properties of the NVS are similar by mode of administration.

Practice implications

This data suggests the NVS measure is reliably administered by telephone.  相似文献   

3.
4.

Objective

To identify how and why infertility patients’ communication with health care providers relates to their continuity of care within infertility treatment.

Method

A grounded theory analysis was conducted for 25 in-depth interviews across three coding phases, where we remained open to all themes present in the data, narrowed to most prominent themes, and found the connections between the themes.

Results

Based on our identified themes, we created a conceptual model that explains why infertility patients (dis)continued care with one or more clinician. Through this model, we describe two infertility identity transitions for patients: Transition 1: “Infertility as Temporary” to “Infertility as Enduring”; and Transition 2: “Infertility as Enduring” to “Infertility as Integrated.”

Conclusion

The study explains how and why patients’ view of their infertility affects their communication, and thus their continuity of care, with clinicians.

Practice implications

To provide patient-centered care within infertility treatment, providers can recognize how patients’ view of their infertility, and thus their needs, goals, and expectations, shift throughout their infertility experience.  相似文献   

5.

Purpose

To screen novel candidate biomarkers in primary colorectal cancer (CRC), and indentify their clinical valuation in progress of colorectal cancer.

Methods

By using antibody microarray, 274 target proteins in tissue samples from primary colorectal cancer patients were detected. Among differently expressed proteins in CRC tissues, As promising candidate biomarker, RANTES/CCL5 was validated by enzyme-linked immunosorbentassay and immunohistochemistry (IHC), and the clinical significance of CCL5 was analyzed.

Results

Totally, 25 differentially expressed proteins were indentified between colorectal cancers and matched normal mucosa. CCL5 expression was significantly associated with adverse pathological progress, apt to lymph node metastasis and higher T stage.

Conclusions

CCL5 may contribute to promoting tumor growth, and CCL5 is a promising target that may help in understanding the pathogenesis of CRC.  相似文献   

6.

Objective

To determine the effectiveness of an online video intervention in improving self-efficacy and eye drop application technique in glaucoma patients.

Methods

We randomized ninety-two patients with primary open-angle glaucoma, all who self-administer their eye drops, to either watch the 4-minute Meducation® eye drop technique video in the intervention group, or a nutrition video in the control group. We assessed five eye drop technique steps using objective video recordings at baseline, immediately after watching the video, and 1 month later. We used linear regression models to determine whether the intervention group had better self-efficacy and technique than the control group.

Results

Adjusted for baseline technique and other covariates, eye drop technique averaged 0.73 steps better in intervention patients than controls immediately after the video (p?=?0.003) and 0.63 steps better at 1 month (p?=?0.01). Adjusted for baseline self-efficacy, intervention patients had better eye drop technique self-efficacy than controls immediately after the video (p?=?0.02) and at 1 month (p?=?0.02).

Conclusion

A short educational video can significantly improve glaucoma patients’ short-term self-efficacy and eye drop technique.

Practice implications

Videos may provide an inexpensive, convenient way to deliver eye drop technique education in any provider’s office or online.  相似文献   

7.

Objectives

The study’s goals were to characterize decisional conflict and preparedness for making the decision about having CPM among breast cancer patients considering CPM who do not carry cancer-predisposing mutation and to evaluate correlates of decisional conflict and preparedness.

Methods

93 women considering CPM completed a survey of decisional conflict and preparedness for the CPM decision, knowledge, perceived risk, self-efficacy, reasons for CPM, input from others and discussion with the doctor about CPM, and cancer worry.

Results

Between 8% and 27% of women endorsed elevated decisional conflict. Most women were satisfied with preparatory information that they were provided. Knowledge was low. Top reasons for choosing CPM were the desire for peace of mind, lowering the chance of another breast cancer, and improving survival.

Conclusions

Decisional conflict is elevated in a subset of patients considering CPM. A more well-informed decision may be fostered by a comprehensive discussion about CPM with the patient’s clinician, fostering self-efficacy in managing cancer worry, and helping patients understand their motivations for CPM.

Practice implications

Clinicians working with breast cancer patients considering CPM should discuss the CPM decision, foster self-efficacy in managing cancer worry, and help patients understand their motivations for the surgery.  相似文献   

8.

Objective

Patient education on high-risk medications such as warfarin is important, and they require quick follow-up after initiation to maximize efficacy and safety. In our Anticoagulation Clinic, two 60-minute new patient appointments are available each day, contributing to prolonged lead-time. We instituted standardized warfarin video education to shorten in-clinic-room visit time, to potentially increase new patient appointments.

Methods

Patients viewed the video in the waiting area with a goal to decrease visit times by 15?min (25%), before pharmacists completed their visit. Data collected included time spent in the clinic room, education comprehension, and patient feedback.

Results

Ninety patient visits were evaluated in one pre-intervention and two post-intervention phases. Patients who received video education spent less time in the clinic room versus those who had not (52.4 vs 39.4?min, p?=?0.001), and two-thirds of all post-intervention visits achieved 25% reduction in visit time. There were no significant differences in education comprehension and patient satisfaction.

Conclusion

Video education significantly decreased in-clinic-room visit time, and most patients achieved a goal of 25% reduction in time spent, without a change in comprehension or patient satisfaction.

Practice implications

Implementation of video education can reduce clinic times in many patients without significantly impacting patient satisfaction.  相似文献   

9.

Objective

To investigate the effect of including an online decision aid (DA) during prostate cancer treatment counseling on decisional regret and information satisfaction in a one-year follow-up.

Methods

Within a cluster RCT, 18 Dutch hospitals were randomized to DA counseling or care-as-usual, patients (n?=?382) initially completed questionnaires directly after treatment decision making. Six and twelve months later regret (Decisional Regret Scale) and information satisfaction (SCIP-B) were assessed. Anxious and depressive symptoms (HADS) was included as possible covariate.

Results

After 12 months, 43 participants (15%) regretted their treatment choice and 105 participants (36%) were dissatisfied with the information that was received at the time of decision-making, regardless of being exposed to the DA. Anxious and depressive symptoms at follow-up were associated with regret and information dissatisfaction.

Conclusion

No long-term benefical effects emerged from DA usage compared to patients who underwent standard counseling.

Practice implications

During PCa treatment counseling, healthcare providers should be aware of anxious and depressive symptoms.  相似文献   

10.

Objectives

The objective of this study was to explore interpreters’ perceived strategies in the interaction in interpreter-mediated consultations between healthcare personnel and patients/families with limited Swedish proficiency in pediatric oncology care.

Methods

This study had an inductive approach using an exploratory qualitative design. A total of eleven semi-structured interviews were performed with interpreters who had experience interpreting in pediatric oncology care.

Results

The interpreters' perceived strategies were divided into four generic categories; strategies for maintaining a professional role, strategies for facilitating communication, strategies for promoting collaboration, and strategies for improving the framework of interpreting provision. These four generic categories were then merged into the single main category of carrying the bilingual conversation.

Conclusions

The interpreters stretch their discretionary power in order to carry the bilingual conversation by using strategies clearly outside of their assignment.

Practical implications

The study contributes to the understanding of the interpreter-mediated consultation in pediatric oncology care, and this can be used to improve the care of patients and families in pediatric oncology care with limited knowledge of a country’s majority language.  相似文献   

11.

Objective

Patient satisfaction had been the focus of many scientific studies worldwide. However, very few studies published had addressed the definition of the concept of patient satisfaction. Therefore this present concept analysis is to explore the attributes of the concept in the broader healthcare context.

Methods

The Rodgers method, an inductive method of concept analysis, was selected to guide this concept analysis.

Results

The attributes of patient satisfaction in the healthcare context identified were provider attitude, technical competence, accessibility, and efficacy. Perception in relation to expectation, patient demographics and personality, and market competition were regarded as prerequisites of patient satisfaction. Consequences of patient satisfaction identified in this analysis were: patient compliance, clinical outcomes, loyalty and referrals.

Conclusion

As healthcare is becoming an increasingly competitive marketplace, studying patient experience could certainly help practitioners to better encompass patient perspectives in service delivery and improve patient satisfaction.

Practice implications

To ensure the validity of patient satisfaction measurement and subsequently improve healthcare quality, practitioners should involve patients in identifying important factors relevant to each attributes of patient satisfaction.  相似文献   

12.
13.

Objective

The study aim was to identify all freely available online diabetes risk calculators and to evaluate their suitability for patients with low health literacy.

Methods

Online diabetes risk calculators were identified by an environmental scan. The Patient Education Material Assessment Tool for Printable Materials was used to determine understandability and actionability scores. A high-risk profile was used to compare the risk results obtained with each calculator.

Results

Thirty-five risk calculators were identified; 51% had no described model, 23% reported absolute risk and 31% used visual aids. The estimated risk for the same profile ranged from low to very high. The mean understandability score was 79% (SD?=?19%) and the mean actionability score was 42% (SD?=?30%).

Conclusions

Online diabetes risk calculators are generally understandable, but not very actionable, and may not be completely suitable for use by patients with low health literacy. The estimated risk is highly variable depending on the underlying model used for the calculation.

Practice Implications

Patients and healthcare providers need to exercise caution when selecting a diabetes risk calculator.  相似文献   

14.

Objective

To examine whether the use of persuasive messages in which cancer patients’ attitudes and perceived social norms were either simultaneously or exclusively targeted can positively change patients’ attitudes, perceived social norms and the intention to express concerns in consultations.

Methods

Two online experiments were conducted. The first experiment had a pre-test and post-test measurements design with 4 conditions (attitudes message, social norms message, combined message, control message). The second experiment had a pre-test and post-test measurements design with 2 conditions (message and no message group).

Results

The results of the first study showed small positive changes for patients who could potentially change, but there were no differences in effects between conditions. A second study was conducted to determine whether these effects could be attributed to exposure to the message or to the pre-test questionnaire. There were no differences between the conditions.

Conclusion

The results indicate that paying attention to the expression of concerns by patients might increase patients’ intention to express further concerns.

Practice implications

Providers might be able to support patients’ in their sharing of concerns through simple communication strategies such as explicitly mentioning that the expression of concerns is possible during a consultation.  相似文献   

15.
16.

Objective

Our aim was to gather community stakeholder input to inform the development of a digital system linking depression screening to decision support.

Methods

Views and feature requirements were identified through (1) focus groups with patients and consumers with depression, and interviews with primary care clinicians and (2) usability sessions where patients and consumers used the current version of encounter decision aid (eDA) in a primary care waiting room. Qualitative data were analyzed using the framework method.

Results

We conducted six focus groups with 15 participants, seven clinician interviews and 10 usability sessions. Patients were comfortable completing the Patient Health Questionnaire (PHQ-9) and receiving the electronic eDA in clinic. They felt this would allow patients to prepare for their visit and instill a sense of agency. Participants were comfortable receiving the PHQ-9 results and a subsequent eDA on a tablet in the waiting room.

Conclusion

Patients with and without depression, as well as clinicians, viewed linking the PHQ-9, results, and eDA positively. Patients were comfortable doing this in the clinic waiting room.

Practice implications

Linking depression decision support to screening was viewed positively by patients and clinicians, and could help overcome barriers to shared decision-making implementation in this population.  相似文献   

17.

Objective

To examine breast cancer patients’ reasons to seek a second opinion (SO) and the underlying variables. To find out more about the outcome of the SO, the perceived helpfulness and the effect on the physician-patient relationship.

Methods

In 2017, 4626 newly diagnosed breast cancer patients from 86 hospitals in Germany completed a postoperative mail survey (response rate?=?89.04%). Data from 419 SO-seeking patients was obtained and analyzed by conducting logistic regression and non-parametric group comparisons.

Results

Reasons to seek an SO were mostly unrelated to the physician-patient relationship. Reasons related to the physician-patient-relationship were associated with a lower education level. The SO mostly (72.2%) equaled the first opinion. A different treatment plan recommendation (25%) reportedly affected the patients’ relationship with their primary physician. Patients who received a different diagnosis reported more fear of progression. Most patients found the SO helpful.

Conclusion

The reasons to seek an SO are primarily unrelated to the physician-patient relationship. However, less educated patients seem to have different reasons to seek an SO. These reasons were reportedly associated with the physician-patient relationship.

Practice implications

Physicians may need to explicitly ascertain the patient’s needs within the physician-patient communication to avoid inequalities based on patient education.  相似文献   

18.

Aim

The value of patient-centredness, of which effective physician–patient communication is one key element, has been established within medicine. However, research shows social differences in medical communication according to the patient’s social background. This study examines the role of the patient’s ethnicity, educational background and language proficiency in relation to physician-patient interaction in 31 countries.

Method

More than fifty thousand patients were given a standardized questionnaire to gain insights into the professional behaviour of their family physician and their own expectations and actions.

Results

While no effect of ethnicity was found, there was a significant effect of patients’ language proficiency and educational level. Patients with lower language proficiencies were more likely to experience more negative interactions with their physicians. Second-generation migrants who did not fill in the questionnaire in an official language were more negative about the patient–physician interaction. Patients who had a greater chance of having a positive patient–physician interaction were more likely to be higher educated.

Conclusion

Despite the shift towards patient-centred care in medicine, physician–patient communication is still determined by the patient’s educational background and language proficiency.

Practice Implication

GPs should primarily be trained to tailor their communication styles to match patients’ backgrounds.  相似文献   

19.

Objective

To provide an overview of information and participation preferences and needs of non-Western ethnic minority cancer patients living in Western countries.

Methods

A systematic literature review was conducted using the databases PsycINFO, PubMed, CINAHL, and EMBASE. Thematic analysis was carried out to synthesize data, allowing for identification of important themes and synthesis of both qualitative and quantitative studies.

Results

Forty-four papers were included. Non- Western ethnic minority cancer patients/survivors have high information preferences and needs regarding topics ranging from diagnosis to treatment and from prevention to the healthcare system. Younger, female, and unmarried patients/survivors, and patients with better language proficiency reported higher information preferences. Latin-American and African-American patients/survivors primarily prefer shared or active participation. Asian and Middle-Eastern patients/survivors prefer primarily passive participation. Younger patients, and those with a higher level of education and acculturation were more likely to prefer active or shared participation.

Conclusion

Further (quantitative) research on factors associated with patients’ preferences is needed in order to better understand the underlying reasons of information and participation preferences and needs of diverse non-Western ethnic minority cancer patients.

Practice implications

To better fulfil ethnic minority patients’/survivors’ preferences and needs healthcare providers should elaborate upon these and tailor their information- provision accordingly.  相似文献   

20.
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