共查询到20条相似文献,搜索用时 31 毫秒
1.
2.
Sebastian Weeger 《Disability and rehabilitation》2017,39(5):468-476
Purpose The patient–physician relationship has effects on adherence and health outcomes in chronic diseases. This prospective study investigates the effect of the patient–physician relationship on patients’ health-related quality of life (HRQOL) in the context of cardiac rehabilitation. Methods Three hundred and thirty-eight German patients filled out questionnaires at the start and end of rehabilitation and at 6 months follow-up. Patient–physician relationship variables surveyed were patient involvement (perceived involvement in care scales), trust in the physician, patient satisfaction (PHYSAT) and physician’s communicative behaviour (KOVA). After adjusting for multiple confounders, hierarchical regression analyses were conducted to predict the influence of the patient–physician relationship on HRQOL after rehabilitation. We further examined clinical relevance using minimal clinically important differences (MCID). Results In the hierarchical regression analyses, 42.8–54.9% of the variance at the end of rehabilitation and 22.4–40.5% at follow-up were explained. The patient–physician variables patient satisfaction, physician’s emotionally supportive communication and effective and open communication accounted for 1.4–2.6% of the variance and proved statistically and clinically significant for HRQOL change. Further predictors for better HRQOL were higher income and less trait anger. Conclusion Aspects of the patient–physician relationship are significant predictors for patients’ HRQOL after rehabilitation. Rehabilitation physicians should emotionally support the patients and communicate in an effective and open manner to enhance HRQOL.
- Implications for rehabilitation
Aspects of the patient–physician relationship have effects on adherence and clinical outcomes in chronic diseases.
In this cardiac sample, the patient–physician relationship had an influence on patients’ health-related quality of life (HRQOL) after inpatient rehabilitation.
Rehabilitation physicians should emotionally support and encourage the patients and communicate with them in an effective and open manner to enhance patients’ HRQOL.
3.
Helena Granstam Bj?rneklett Christina Lindemalm Marja-Leena Ojutkangas Anders Berglund Henry Letocha Peter Strang Leif Bergkvist 《Supportive care in cancer》2012,20(12):3325-3334
Background
When diagnosed with breast cancer, most women’s lives change as well as their perspectives on and appreciation of life. The aim of the present study was to evaluate whether psychosocial support intervention could influence health-related quality of life (HRQOL) and fatigue during the first year after diagnosis.Material and methods
Of 382 patients with newly diagnosed breast cancer, 191 patients were randomized to an intervention group and 191 patients were randomized to a routine control group. The intervention group received support intervention that lasted 1?week on a residential basis, followed by 4?days of follow-up 2?months later. The support intervention included informative educational parts, relaxation training, mental visualization, and nonverbal communication. HRQOL was measured using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-BR23 questionnaires and fatigue with the Norwegian version of the fatigue scale at baseline and at 2, 6, and 12?months after intervention.Result
There was a time-dependent improvement in both functional and symptom scales between baseline and 12?months as measured by the EORTC QLQ-C30 and BR23 questionnaires and there was a decrease in fatigue between baseline and after 2?months with further improvement up to 12?months in both groups, but there were no differences between the intervention and control groups at any point in time.Conclusion
HRQOL improves and symptoms of fatigue decrease over time, but we could not see any additional effect from the rehabilitation program in this setting. 相似文献4.
William Collinge Janet Kahn Tracy Walton Leila Kozak Susan Bauer-Wu Kenneth Fletcher Paul Yarnold Robert Soltysik 《Supportive care in cancer》2013,21(5):1405-1414
Purpose
A randomized controlled trial was conducted to evaluate outcomes of a multimedia instructional program for family caregivers in simple touch-based techniques to provide comfort to cancer patients at home.Methods
A multilingual 78-min DVD and 66-page manual were produced for homebased instruction. Content addresses attitudes and communication about touch in cancer, psychological preparation for giving and receiving touch, safety precautions, massage techniques for comfort and relaxation, acupressure for specific cancer-related symptoms, and practice in the home setting. Materials were produced in English, Spanish, and Chinese versions. A community-based multiethnic sample of 97 adult patient/caregiver dyads was randomized to experimental (massage) or attention control (reading) groups for 4 weeks. Massage dyads received the program and instructions to practice at least three times per week, while control caregivers read to their patients for the same frequency. Self-report instruments assessed change in symptom severity, quality of life, perceived stress, and caregiver attitudes.Results
Significant reductions in all symptoms occurred for patients after both activities: 12–28 % reductions after reading vs. 29–44 % after massage. Massage caregivers showed significant gains in confidence, comfort, and self-efficacy using touch and massage as forms of caregiving.Conclusions
Multimedia instruction in touch and massage methods may offer family members a viable means of enhancing self-efficacy and satisfaction in caregiving while decreasing patient pain, depression, and other symptoms. Family members may be able to learn and apply safe and simple methods that increase patient comfort and reduce distress. 相似文献5.
Purpose
The aim of this study is to examine family members’ experiences of end-of-life decision-making processes in Norwegian intensive care units (ICUs) to ascertain the degree to which they felt included in the decision-making process and whether they received necessary information. Were they asked about the patient’s preferences, and how did they view their role as family members in the decision-making process?Methods
A constructivist interpretive approach to the grounded theory method of qualitative research was employed with interviews of 27 bereaved family members of former ICU patients 3–12 months after the patient’s death.Results
The core finding is that relatives want a more active role in end-of-life decision-making in order to communicate the patient’s wishes. However, many consider their role to be unclear, and few study participants experienced shared decision-making. The clinician’s expression “wait and see” hides and delays the communication of honest and clear information. When physicians finally address their decision, there is no time for family participation. Our results also indicate that nurses should be more involved in family–physician communication.Conclusions
Families are uncertain whether or how they can participate in the decision-making process. They need unambiguous communication and honest information to be able to take part in the decision-making process. We suggest that clinicians in Norwegian ICUs need more training in the knowledge and skills of effective communication with families of dying patients.6.
Sally Wheelwright Anne-Sophie Darlington Jane B. Hopkinson Deborah Fitzsimmons Alice White Colin D. Johnson 《Supportive care in cancer》2013,21(9):2625-2636
Purpose
Assessing the health-related quality of life (HRQOL) of cancer patients with cachexia is particularly important because treatments for cachexia are currently aimed at palliation and treatment efficacy must be measured in ways other than survival. The aim of this systematic review was to evaluate HRQOL assessment in cancer patients with cachexia.Methods
Using guidance from the Centre for Reviews and Dissemination, relevant databases were searched from January 1980 to January 2012 with terms relating to cancer, cachexia and HRQOL for papers including adult cancer patients with cachexia or documented weight loss at baseline.Results
We found one cachexia-specific instrument, the Functional Assessment of Anorexia/Cachexia Therapy, but the tool has not been fully validated, does not cover all the relevant domains and the consensus-based standards for the selection of health status measurement instruments checklist highlighted a number of weaknesses in the methodological quality of the validation study. Sixty-seven studies assessed HRQOL in cachectic or weight-losing cancer patients. Most used generic cancer HRQOL instruments, limiting the amount of useful information they provide. A modified version of the Efficace minimum data checklist demonstrated that the quality of reporting on HRQOL tool use was inadequate in many of the studies. A negative relationship between HRQOL and weight loss was found in 23 of the 27 studies which directly examined this.Conclusion
There is a pressing need for a well-designed HRQOL tool for use with this patient group in both clinical trials and clinical practice. 相似文献7.
Jacqueline de Leeuw Judith B. Prins Steven Teerenstra Matthias A. W. Merkx Henri A. M. Marres Theo van Achterberg 《Supportive care in cancer》2013,21(2):537-547
Purpose
The aim of this study was to compare conventional medical follow-up with follow-up containing additional nursing consultations regarding the psychosocial adjustment and health-related quality of life (HRQOL) of head and neck cancer patients.Methods
Using a quasi-experimental design, patients were enrolled consecutively into two groups. Experimental care covered six 30-min bimonthly nursing follow-up consultations during the first year posttreatment. Data were collected at posttreatment months 1 (baseline), 6, and 12 for both groups.Results
The intervention group was significantly worse at baseline, based on two of the seven adjustment scales and on the majority of HRQOL scales. However, their outcome at 6 and 12 months was consistent with that of the group which received conventional follow-up. Thus, the intervention group had a larger improvement in scores, and this was significant for one of the seven adjustment scales and 19 of the 33 HRQOL scales at 6 and 12 months, respectively. Most of the differences in HRQOL scales were clinically relevant at 6 months.Conclusion
These results suggest that nurse-led consultations for patients with head and neck cancer have a positive effect, primarily with respect to HRQOL. Nurse-led follow-up leads to a similar psychosocial adjustment as conventional follow-up, even among patients who showed worse performance at the start of follow-up. Thus, nurse-led follow-up may be a cost-effective way to improve follow-up care for this patient group. 相似文献8.
Rees SE Allerød C Murley D Zhao Y Smith BW Kjaergaard S Thorgaard P Andreassen S 《Journal of clinical monitoring and computing》2006,20(6):421-429
Objective
To present a decision support system for optimising mechanical ventilation in patients residing in the intensive care unit.Methods
Mathematical models of oxygen transport, carbon dioxide transport and lung mechanics are combined with penalty functions describing clinical preference toward the goals and side-effects of mechanical ventilation in a decision theoretic approach. Penalties are quantified for risk of lung barotrauma, acidosis or alkalosis, oxygen toxicity or absorption atelectasis, and hypoxaemia.Results
The system is presented with an example of its use in a post-surgical patient. The mathematical models describe the patient’s data, and the system suggests an optimal ventilator strategy in line with clinical practice.Conclusions
The system illustrates how mathematical models combined with decision theory can aid in the difficult compromises necessary when deciding on ventilator settings. 相似文献9.
Judy Huei-yu Wang Inez F. Adams Rena J. Pasick Scarlett L. Gomez Laura Allen Grace X. Ma Michael X. Lee Ellen Huang 《Supportive care in cancer》2013,21(12):3315-3325
Purpose
Asian Americans have consistently reported poorer communication with physicians compared with non-Hispanic Whites (NHW). This qualitative study sought to elucidate the similarities and differences in communication with physicians between Chinese and NHW breast cancer survivors.Methods
Forty-four Chinese and 28 NHW women with early stage breast cancer (stage 0-IIa) from the Greater Bay Area Cancer Registry participated in focus group discussions or individual interviews. We oversampled Chinese women because little is known about their cancer care experiences. In both interview formats, questions explored patients' experiences and feelings when communicating with physicians about their diagnosis, treatment, and follow-up care.Results
Physician empathy at the time of diagnosis was important to both ethnic groups; however, during treatment and follow-up care, physicians' ability to treat cancer and alleviate physical symptoms was a higher priority. NHW and US-born Chinese survivors were more likely to assert their needs, whereas Chinese immigrants accepted physician advice even when it did not alleviate physical problems (e.g., pain). Patients viewed all physicians as the primary source for information about cancer care. Many Chinese immigrants sought additional information from primary care physicians and stressed optimal communication over language concordance.Conclusions
Physician empathy and precise information were important for cancer patients. Cultural differences such as the Western emphasis on individual autonomy vs. Chinese emphasis on respect and hierarchy can be the basis for the varied approaches to physician communication we observed. Interventions based on cultural understanding can foster more effective communication between immigrant patients and physicians ultimately improving patient outcomes. 相似文献10.
Jane R. Schubart Lisa Toran Megan Whitehead Benjamin H. Levi Michael J. Green 《Supportive care in cancer》2013,21(2):637-641
Purpose
This study aimed to determine the extent to which patients with advanced cancer agree with their physicians regarding their cancer diagnoses prior to engaging in advance care planning (ACP) and whether variables such as age and level of education correlate with the degree of patient–physician concordance.Methods
One hundred and fifty patients with a diagnosis of cancer and an estimated life expectancy of 18 months or less completed questionnaires about their cancer diagnoses prior to creating an advance directive. A review of the patients’ medical records was performed and the physician-designated diagnosis was identified for each patient. Patient–physician agreement on diagnosis was coded based on predetermined study criteria. Concordance rates were expressed in percentages.Results
The majority of patients (62.2 %) were in exact agreement with their physicians; 24.3 % were in partial agreement with the patient missing part of the diagnosis, and 9.5 % were in partial agreement with the physician missing part of the diagnosis; 4.1 % did not agree with their physicians on diagnosis. Age and education level did not correlate with patient–physician concordance rates.Conclusions
The majority of patients with advanced cancer correctly identified their cancer diagnosis. However, almost 40 % were not in full agreement with their physicians regarding diagnosis, a situation that has bearing on efforts to engage in meaningful shared decision making as well as advance care planning. 相似文献11.
Nicks BA Ayello EA Woo K Nitzki-George D Sibbald RG 《International journal of emergency medicine》2010,3(4):399-407
Background
As millions of emergency department (ED) visits each year include wound care, emergency care providers must remain experts in acute wound management. The variety of acute wounds presenting to the ED challenge the physician to select the most appropriate management to facilitate healing. A complete wound history along with anatomic and specific medical considerations for each patient provides the basis of decision making for wound management. It is essential to apply an evidence‐based approach and consider each wound individually in order to create the optimal conditions for wound healing.Aims
A comprehensive evidence‐based approach to acute wound management is an essential skill set for any emergency physician or acute care practitioner. This review provides an overview of current evidence and addresses frequent pitfalls.Methods
A systematic review of the literature for acute wound management was performed.Results
A structured MEDLINE search was performed regarding acute wound management including established wound care guidelines. The data obtained provided the framework for evidence‐based recommendations and current best practices for wound care.Conclusion
Acute wound management varies based on the wound location and characteristics. No single approach can be applied to all wounds; however, a systematic approach to acute wound care integrated with current best practices provides the framework for exceptional wound management. 相似文献12.
13.
14.
Virginia Sun Marcia Grant Carmit K. McMullen Andrea Altschuler M. Jane Mohler Mark C. Hornbrook Lisa J. Herrinton Robert S. Krouse 《Supportive care in cancer》2014,22(6):1563-1570
Purpose
The journey from diagnosis through treatment to survivorship can be challenging for colorectal cancer (CRC) survivors with permanent ostomies. Memories of both the positive and negative health-care interactions can persist years after the initial diagnosis and treatment. The purpose of this paper is to describe the health-care experiences of long-term (>5 years) CRC survivors with ostomies.Methods
Thirty-three CRC survivors with ostomies who were members of Kaiser Permanente, an integrated care organization, in Oregon, southwestern Washington and northern California participated in eight focus groups. Discussions from the focus groups were recorded, transcribed, and analyzed for potential categories and themes.Results
Health-care-related themes described CRC survivors’ experiences with diagnosis, treatment decision-making, initial experiences with ostomy, and survivorship. Participants discussed both positive and negative health-care-related experiences, including the need for continued access to trained nurses for ostomy self-care, access to peer support, and resources related to managing persistent, debilitating symptoms.Conclusions
Long-term CRC survivors with ostomies have both positive and negative health-care experiences, regardless of health-related quality of life (HRQOL) and gender. Long-term support mechanisms and quality survivorship care that CRC survivors with ostomies can access are needed to promote positive adjustments and improved HRQOL.Structured abstract
The current literature in CRC survivorship suggests that HRQOL concerns can persist years after treatment completion. The coordination of care to manage persistent late- and long-term effects are still lacking for CRC survivors living with an ostomy. Findings from this qualitative analysis will aid in the development of support strategies that foster more positive adjustments for CRC survivors living with an ostomy and support their ongoing ostomy-related needs. 相似文献15.
Kevin Klifto Christopher Klifto James Slover 《Current reviews in musculoskeletal medicine》2017,10(2):253-257
Purpose of review
The Shared Decision Making (SDM) model, a collaborative decision making process between the physician and patient to make an informed clinical decision that enhances the chance of treatment success as defined by each patient’s preferences and values, has become a new and promising tool in the healthcare process; however, minimal data exists on its application in the orthopedic surgical specialty. Increasing evidence has demonstrated that this once novel idea can be implemented successfully in the orthopedic setting to improve patient outcomes.Recent findings
SDM can be applied without significant increases in the office length. Patients report that a physician that takes the time to listen to them is among the most important factors in their care. When time was focused on the SDM process, there was a direct correlation between the time spent with a patient and patient satisfaction. Patients exposed to a decision aid prior to surgery gained a greater knowledge from baseline to make a higher quality decision that was consistent with their values. Involving family members preoperatively can help all patients adhere to postoperative regimens. Exposing patients to a decision aid can reduce expensive elective surgeries, in favor of non-operative management. Incorporating patient goals into the decision-making process has increased satisfaction, compliance, and outcomes.Summary
SDM is a two-way exchange of information that attempts to correct the inequality of power between the patient and physician. Decision-aids are helpful tools that facilitate the decision-making process. Treatment decisions are consistent with patient preferences and values when there may be no “best” therapy. A good patient–physician relationship is essential during the process to reduce decisional conflict and increase overall patient outcomes.16.
William J Meurer Jennifer J Majersik Shirley M Frederiksen Allison M Kade Annette M Sandretto Phillip A Scott 《BMC emergency medicine》2011,11(1):1-12
Background
Only 1-3% of ischemic stroke patients receive thrombolytic therapy. Provider barriers to adhering with guidelines recommending tPA delivery in acute stroke are not well known. The main objective of this study was to describe barriers to thrombolytic use in acute stroke care.Methods
Twenty-four hospitals were randomly selected and matched into 12 pairs. Barrier assessment occurred at intervention sites only, and utilized focus groups and structured interviews. A pre-specified taxonomy was employed to characterize barriers. Two investigators independently assigned themes to transcribed responses. Seven facilitators (three emergency physicians, two nurses, and two study coordinators) conducted focus groups and interviews of emergency physicians (65), nurses (62), neurologists (15), radiologists (12), hospital administrators (12), and three others (hospitalists and pharmacist).Results
The following themes represented the most important external barriers: environmental and patient factors. Important barriers internal to the clinician included familiarity with and motivation to adhere to the guidelines, lack of self-efficacy and outcome expectancy. The following themes were not substantial barriers: lack of awareness of the existence of acute stroke guidelines, presence of conflicting guidelines, and lack of agreement with the guidelines.Conclusions
Healthcare providers perceive environmental and patient-related factors as the primary barriers to adherence with acute stroke treatment guidelines. Interventions focused on increasing physician familiarity with and motivation to follow guidelines may be of highest yield in improving adherence. Improving self-efficacy in performing guideline concordant care may also be useful.Trial Registration
ClinicalTrials.gov identifier: NCT00349479 相似文献17.
Nicolas Nesseler Anne Defontaine Yoann Launey Jeff Morcet Yannick Mallédant Philippe Seguin 《Intensive care medicine》2013,39(5):881-888
Purpose
In septic shock, short-term outcomes are frequently reported, while long-term outcomes are not. The aim of this study was to evaluate mortality and health-related quality of life (HRQOL) in survivors 6 months after an episode of septic shock.Methods
This single-centre observational study was conducted in an intensive care unit in a university hospital. All patients with septic shock were included. Mortality was assessed 6 months after the onset of septic shock, and a comparison between patients who survived and those who died was performed. HRQOL was assessed using the MOS SF-36 questionnaire prior to hospital admission (baseline) and at 6 months in survivors. HRQOL at baseline and at 6 months were compared to the general French population, and HRQOL at baseline was compared to 6-month HRQOL.Results
Ninety-six patients were included. Six-month mortality was 45 %. Survivors were significantly younger, had significantly lower lactate levels and SAPS II scores, required less renal support, received less frequent administration of corticosteroids, and had a longer length of hospital stay. At baseline (n = 39) and 6 months (n = 46), all of the components of the SF-36 questionnaire were significantly lower than those in the general population. Compared to baseline (n = 23), the Physical Component Score (CS) improved significantly at 6 months, the Mental CS did not differ.Conclusions
Mortality 6 months after septic shock was high. HRQOL at baseline was impaired when compared to that of the general population. Although improvements were noted at 6 months, HRQOL remained lower than that in the general population. 相似文献18.
Background
Emergency missions can also be necessary for patients in the terminal phase of a progressive incurable disease. The emergency physician, accustomed to acting under strict procedures and whose training focuses on the restoration and stabilization of acutely threatened vital functions, can face severe difficulties when treating incurably ill patients in the terminal phase. This study investigates the number of such cases, patient symptoms and the events occurring during life-threatening emergencies of terminally ill patients.Method
All cases of emergency events involving terminally ill patients were analyzed prospectively. In addition to the standardized protocol (following DIVI/Mind?2) an enquiry sheet was used, which contained an 8-item checklist specifically for terminally ill patients, to be filled out by the responding physician.Results
The total number of patients in the terminal phase identified by the emergency physician was 55 (0.72% of total cases) and of these patients 30 (55%) were tumor patients. The most frequent complaint observed was dyspnea (30?patients, 55%), followed by relatives of the patients experiencing the stress of caring for a terminally ill person (19?patients, 35%). The leading symptom of 6?patients (11%) was pain. Only 17?cases (30.9%) required transport of the patient to hospital for further treatment.Conclusion
Every emergency physician can be confronted with an emergency involving a patient with a progressive incurable disease. The condition of each patient must be assessed for each medical decision. Not only medical, but also psychosocial, ethical and legal aspects have to be considered. 相似文献19.
Philippe Le Conte David Riochet Eric Batard Christelle Volteau Bruno Giraudeau Idriss Arnaudet Laetitia Labastire Jacques Levraut Frédéric Thys Dominique Lauque Claude Piva Jeannot Schmidt David Trewick Gilles Potel 《Intensive care medicine》2010,36(5):765-772
Purpose
To describe the characteristics of patients who die in emergency departments and the decisions to withhold or withdraw life support.Methods
We undertook a 4-month prospective survey in 174 emergency departments in France and Belgium to describe patients who died and the decisions to limit life-support therapies.Results
Of 2,512 patients enrolled, 92 (3.7%) were excluded prior to analysis because of missing data; 1,196 were men and 1,224 were women (mean age 77.3 ± 15 years). Of patients, 1,970 (81.4%) had chronic underlying diseases, and 1,114 (46%) had a previous functional limitation. Principal acute presenting disorders were cardiovascular, neurological, and respiratory. Life-support therapy was initiated in 1,781 patients (73.6%). Palliative care was undertaken for 1,373 patients (56.7%). A decision to withhold or withdraw life-sustaining treatments was taken for 1,907 patients (78.8%) and mostly concerned patients over 80 years old, with underlying metastatic cancer or previous functional limitation. Decisions were discussed with family or relatives in 58.4% of cases. The decision was made by a single ED physician in 379 cases (19.9%), and by at least two ED physicians in 1,528 cases (80.1%).Conclusions
Death occurring in emergency departments mainly concerned elderly patients with multiple chronic diseases and was frequently preceded by a decision to withdraw and/or withhold life-support therapies. Training of future ED physicians must be aimed at improving the level of care of dying patients, with particular emphasis on collegial decision-taking and institution of palliative care. 相似文献20.
Kojiro Shimozuma Yasuo Ohashi Ayano Takeuchi Toshihiko Aranishi Satoshi Morita Katsumasa Kuroi Shozo Ohsumi Haruhiko Makino Noriyuki Katsumata Masaru Kuranami Kimito Suemasu Toru Watanabe Frederick H. Hausheer 《Supportive care in cancer》2012,20(12):3355-3364