Patient Education and Counseling - Articles in Press

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

Yuefang Zhou, Elaine Cameron, Gillian Forbes, Gerry Humphris — 2012-02-03

Abstract: Objective: To develop and validate the St Andrews Behavioural Interaction Coding Scheme (SABICS): a tool to record nurse–child interactive behaviours.Methods: The SABICS was developed primarily from observation of video recorded interactions; and refined through an iterative process of applying the scheme to new data sets. Its practical applicability was assessed via implementation of the scheme on specialised behavioural coding software. Reliability was calculated using Cohen's Kappa. Discriminant validity was assessed using logistic regression.Results: The SABICS contains 48 codes. Fifty-five nurse–child interactions were successfully coded through administering the scheme on The Observer XT8.0 system. Two visualization results of interaction patterns demonstrated the scheme's capability of capturing complex interaction processes. Cohen's Kappa was 0.66 (inter-coder) and 0.88 and 0.78 (two intra-coders). The frequency of nurse behaviours, such as “instruction” (OR=1.32, p=0.027) and “praise” (OR=2.04, p=0.027), predicted a child receiving the intervention.Conclusions: The SABICS is a unique system to record interactions between dental nurses and 3–5 years old children. It records and displays complex nurse–child interactive behaviours. It is easily administered and demonstrates reasonable psychometric properties.Practice implications: The SABICS has potential for other paediatric settings. Its development procedure may be helpful for other similar coding scheme development.

Training health professionals in shared decision-making: An international environmental scan - Corrected Proof

2012-02-03

Abstract: Objective: To identify and analyze training programs in shared decision-making (SDM) for health professionals.Methods: We conducted an environmental scan looking for programs that train health professionals in SDM. Pairs of reviewers independently analyzed the programs identified using a standardized data extraction sheet. The developers of the programs validated the data extracted.Results: We identified 54 programs conducted between 1996 and 2011 in 14 countries and 10 languages. Thirty-four programs targeted licensed health professionals, 10 targeted pre-licensure health professionals, and 10 targeted both. Most targeted only the medical profession (n=32); six targeted more than one health profession. The five most frequently mentioned teaching methods were case-based discussion, small group educational session, role play, printed educational material, and audit and feedback. Thirty-six programs reported having evaluated their impacts but evaluation data was available only for 17.Conclusions: Health professional training programs in SDM vary widely in how and what they deliver, and evidence of their effectiveness is sparse.Practice implications: This study suggests there is a need for international consensus on ways to address the variability in SDM training programs. We need agreed criteria for certifying the programs and for determining the most effective types of training.

Patients’ understanding of prescription instructions in a semi-urban setting in Cameroon - Corrected Proof

Lawrence Mbuagbaw, Eunice Ndongmanji — 2012-02-03

Abstract: Objective: This cross-sectional study investigates the factors associated with patient comprehension of frequently used prescription patterns and explores patients’ preferences for the various methods.Methods: We interviewed two hundred and four consenting patients selected consecutively from the waiting rooms of the St. Elizabeth Catholic Hospital-Shisong in the North West Region of Cameroon. We recorded socio-demographic data and their understanding and preference for four prescription modalities: pictograms, written out, symbols and Latin abbreviations. We studied the relationship between these variables in a logistic multivariate analysis.Results: Understanding was best with symbols (89.7%) and worst when Latin abbreviations (26.9%) were used. Higher levels of education were associated with better understanding of Latin abbreviations (OR 18.87; 95% CI 2.44–142.86), written out prescriptions (OR 58.82; 95% CI 23.25–333.33), symbols (OR 1.47; 95% CI 4.25–50.00) and pictograms (OR 52.63; 92% CI 1.85–142.86) after controlling for confounding. Participants mostly preferred pictograms (40.7%) and written-out prescriptions (30.9%).Conclusion: Latin abbreviations were the most difficult to understand and should no longer be used. Symbols are more easily understood.Practice implications: Latin abbreviations should be discouraged. Symbols are better, especially for patients with low levels of education. Prescribing using pictograms and plain text may facilitate understanding in this setting.

Buddha in room eight - Corrected Proof

Robert D. Hoffman — 2012-02-01

Internship. A traumatic period.

How well are we meeting haematological cancer survivors’ preferences for involvement in treatment decision making? - Corrected Proof

2012-02-01

Abstract: Objective: This study aimed to examine preferred and perceived roles of haematological cancer survivors in treatment decision making.Methods: Participants were within three years of diagnosis and registered with a cancer registry in one Australian state. 732 eligible survivors were invited to complete a paper and pencil survey.Results: 268 survivors completed the survey (37% response rate). The majority of participants (46%) preferred a passive role in decision making. Thirty percent of participants preferred to make the decision in collaboration with the doctor, whereas 26% preferred an active role in decision making. Just over half of respondents (56%) reported an exact match between their preferred and perceived roles. Where discordance between preferred and perceived roles were identified, survivors were more likely to report having been more passively than actively involved compared to their preferred roles.Conclusion: There is considerable variation in haematological cancer survivors’ preferred and perceived roles in treatment decision making.Practice implications: This study highlights the need to improve clinical communication to ensure that patient experiences align with their preferences for involvement in treatment decision making.

The effect of an educational programme consisting of group and individual arthritis education for patients with polyarthritis—A randomised controlled trial - Corrected Proof

Kjersti Grønning, Johan F. Skomsvoll, Toril Rannestad, Aslak Steinsbekk — 2012-01-25

Abstract: Objective: The aim of this study was to investigate the effect of an educational programme for patients with polyarthritis compared to usual care.Methods: Patients with rheumatoid arthritis, psoriatic arthritis and unspecified polyarthritis were randomised to the intervention (n=71) or usual care (n=70). The intervention consisted of three group educational sessions followed by one individual educational session. The primary outcomes were a patient's global well-being and arthritis self-efficacy. Secondary outcomes were patient activation, physical and psychological health status, educational needs and disease activity.Results: After four months the intervention group had significantly better global well-being, 95% CI (2.3–14.1), p=0.01, and self-efficacy, 95% CI (0.2–8.1), p=0.04, than the control group. There were also trends for improved disease activity, and a statistically significant improvement in patient activation and pain in the intervention group.Conclusion: This patient educational programme consisting of group sessions and nurse-delivered individual education has statistically significant benefits for global well-being and maintaining a level of self-efficacy in managing other symptoms in patients with polyarthritis.Practice implications: This educational programme allows patients to learn from each other in addition to addressing individual educational needs.

Different perspectives on communication quality and emotional functioning during routine oncology consultations - Corrected Proof

Hanna Fagerlind, Åsa Kettis, Ida Bergström, Bengt Glimelius, Lena Ring — 2012-01-20

Abstract: Objective: To determine quality of communication in routine oncology consultations from patient, physician, and observer perspectives, and to determine agreement of emotional function content in consultations from these three perspectives.Methods: In total, 69 consultations were included. Perceived quality of communication and whether or not emotional functioning had been discussed was evaluated with patient- and physician-reported questionnaires. Observer perspective was evaluated by content analysis of audio records of the consultations. Agreement between perspectives was analyzed and means compared using linear mixed models.Results: The patients’ ratings of communication quality differed significantly from those of both the physician and observer. Observer and physician scores did not differ significantly. Physicians rated emotional functioning as discussed more often than was reported from patient and observer perspectives.Conclusion: The patients’ view of the quality of communication differed from that of the physician and observer. Whether emotional functioning was discussed or not was also perceived differently by patients, physicians, and observer.Practice implications: The underpinnings and implications of these results need to be further explored regarding how to move toward a higher degree of shared understanding, where different perspectives are more in alignment, and how to develop more valid methods for evaluating communication.

Postoperative information needs and communication barriers of esophageal cancer patients - Corrected Proof

2012-01-16

Abstract: Objective: Given the poor prognosis of esophageal cancer and the impact of surgery on health-related quality of life (HRQL), addressing patients’ postoperative information needs is important. This study aimed to examine (1) the content and type of patients’ information needs and (2) patient perceived facilitators and barriers to patient participation.Methods: Interviews were conducted with 20 purposefully selected esophageal cancer patients. Open and structured questions were alternated. The transcribed interviews were analysed inductively and deductively, using MAXqda.Results: Patients’ post-operative information needs concerned HRQL, medical care and prognosis, covering several sub-domains. Different types of needs were identified, e.g., requests for information about cause, course and self-management. Barriers to patient participation mostly reflected beliefs and skills, and could be categorized into agenda and communication barriers. Facilitators of patient participation reflected physician, patient and interaction characteristics, companion support and pre-visit preparation. Many patients saw merit in pre-visit preparation interventions; few endorsed skill-building interventions.Conclusion: This study listed the postoperative information needs of esophageal cancer patients. Moreover, it gained insight into patient-perceived barriers and facilitators of patient participation.Practice implications: The findings demonstrate what information physicians should have available and informs interventions to support patients in meeting their information needs.

Health literacy and cancer prevention: Two new instruments to assess comprehension - Corrected Proof

2012-01-16

Abstract: Objectives: Ability to understand spoken health information is an important facet of health literacy, but to date, no instrument has been available to quantify patients’ ability in this area. We sought to develop a test to assess comprehension of spoken health messages related to cancer prevention and screening to fill this gap, and a complementary test of comprehension of written health messages.Methods: We used the Sentence Verification Technique to write items based on realistic health messages about cancer prevention and screening, including media messages, clinical encounters and clinical print materials. Items were reviewed, revised, and pre-tested. Adults aged 40–70 participated in a pilot administration in Georgia, Hawaii, and Massachusetts.Results: The Cancer Message Literacy Test-Listening is self-administered via touchscreen laptop computer. No reading is required. It takes approximately 1 hour. The Cancer Message Literacy Test-Reading is self-administered on paper. It takes approximately 10min.Conclusions: These two new tests will allow researchers to assess comprehension of spoken health messages, to examine the relationship between listening and reading literacy, and to explore the impact of each form of literacy on health-related outcomes.Practice implications: Researchers and clinicians now have a means of measuring comprehension of spoken health information.

Using visual displays to communicate risk of cancer to women from diverse race/ethnic backgrounds - Corrected Proof

2012-01-13

Abstract: Objective: This study evaluated how well women from diverse race/ethnic groups were able to take a quantitative cancer risk statistic verbally provided to them and report it in a visual format.Methods: Cross-sectional survey was administered in English, Spanish or Chinese, to women aged 50–80 (n=1160), recruited from primary care practices. The survey contained breast, colorectal or cervical cancer questions regarding screening and prevention. Women were told cancer-specific lifetime risk then shown a visual display of risk and asked to indicate the specific lifetime risk. Correct indication of risk was the main outcome.Results: Correct responses on icon arrays were 46% for breast, 55% for colon, and 44% for cervical; only 25% correctly responded to a magnifying glass graphic. Compared to Whites, African American and Latina women were significantly less likely to use the icon arrays correctly. Higher education and higher numeracy were associated with correct responses. Lower education was associated with lower numeracy.Conclusions: Race/ethnic differences were associated with women's ability to take a quantitative cancer risk statistic verbally provided to them and report it in a visual format.Practice implications: Systematically considering the complexity of intersecting factors such as race/ethnicity, educational level, poverty, and numeracy in most health communications is needed.

Factors that influence parents’ experiences with results disclosure after newborn screening identifies genetic carrier status for cystic fibrosis or sickle cell hemoglobinopathy - Corrected Proof

2012-01-13

Abstract: Objective: Newborn screening (NBS) identifies genetic carriers for sickle cell hemoglobinopathy and cystic fibrosis. We aimed to identify factors during initial NBS carrier results disclosure by primary care providers (PCPs) that influenced parents’ experiences and reactions.Methods: Open-ended responses from telephone interviews with 270 parents of carriers were analyzed using mixed-methods. Conventional content analysis identified influential factors; chi-square tests analyzed relationships between factors and parent-reported reactions.Results: Parents reported positive (35%) or negative (31%) reactions to results disclosure. Parents’ experiences were influenced by specific factors: content messages (72%), PCP traits (47%), and aspects of the setting (30%). Including at least one of five specific content messages was associated (p<0.05) with positive parental reactions; omitting at least one of four specific content messages was associated (p<0.05) with negative parental reactions. Parents reported positive reactions when PCPs avoided jargon or were perceived as calm. Parents reported negative reactions to jargon usage and results disclosure by voicemail.Conclusion: Parents identified aspects of PCP communication which influenced their reactions and results disclosure experiences.Practice implications: Our findings suggest ways PCPs may improve communication of carrier results. PCPs should provide specific content messages and consider how their actions, characteristics, and setting can influence parental reactions.

Visit with a veteran: A lesson in open listening - Corrected Proof

Catherine M. Reynolds — 2012-01-13

A call light went off while I happened to be standing outside a patient room on a medical/surgical unit so I ducked in to ask what was needed. The older gentleman in the bed near the window said very precisely, “I need some assistance. I am a disabled veteran. I get medication delivered to my home from the VA. If I am not there, the post office will leave a card but if I do not pick it up from the post office, they will send it back. I need you to call the post office so they do not send it back.” I was happy to help and a quick Google search gave us the number. I wrote it down for him, as he preferred to talk to them himself.

Obese patients overestimate physicians’ attitudes of respect - Corrected Proof

2012-01-12

Abstract: Objective: To evaluate whether obese patients overestimate or underestimate the level of respect that their physicians hold toward them.Methods: We performed a cross-sectional analysis of data from questionnaires and audio-recordings of visits between primary care physicians and their patients. Using multilevel logistic regression, we evaluated the association between patient BMI and accurate estimation of physician respect. Physician respectfulness was also rated independently by assessing the visit audiotapes.Results: Thirty-nine primary care physicians and 199 of their patients were included in the analysis. The mean patient BMI was 32.8kg/m2 (SD 8.2). For each 5kg/m2 increase in BMI, the odds of overestimating physician respect significantly increased [OR 1.32, 95%CI 1.04–1.68, p=0.02]. Few patients underestimated physician respect. There were no differences in ratings of physician respectfulness by independent evaluators of the audiotapes.Conclusion: We consider our results preliminary. Patients were significantly more likely to overestimate physician respect as BMI increased, which was not accounted for by increased respectful treatment by the physician.Practice implications: Among patients who overestimate physician respect, the authenticity of the patient–physician relationship should be questioned.

Perception of cancer recurrence risk: More information is better - Corrected Proof

2012-01-10

Abstract: Objective: Breast cancer is the most common cancer among women worldwide. Given the advances in extending survival, the number of recently diagnosed breast cancer patients and longer-term breast cancer survivors is growing. The goals of this study were to better understand (1) perceptions of provider cancer recurrence risk communication, (2) perceived risk of breast cancer recurrence in cancer patients and survivors, and (3) accuracy of perceived risk.Methods: A survey was conducted on women with a prior breast cancer (n=141).Results: Approximately 40% of women perceived that providers had not talked about their breast cancer recurrence risk; although only 1 person reported not wanting a physician to talk to her about her risk. Women were largely inaccurate in their assessments of risk. Greater worry, living in a rural area, and longer time since diagnosis were associated with greater inaccuracy. Women tended to think about distal recurrence of cancer as often of local recurrence.Conclusions: Perceived risk of breast cancer recurrence was inaccurate, and patients desired more communication about recurrence risk.Patients implications: Consistent with findings from other studies, greater efforts are needed to improve the communication of cancer recurrence risk to patients. Attention should be paid to those from rural areas and to distal cancer recurrence in women with a previous history of breast cancer.

Training medical students to conduct motivational interviewing: A randomized controlled trial - Corrected Proof

2012-01-06

Abstract: Objective: To examine the effectiveness of motivational interviewing (MI) training among medical students.Methods: All students (n=131) (year 5) at Lausanne Medical School, Switzerland were randomized into an experimental or a control group. After a training in basic communication skills (control condition), an 8-h MI training was completed by 84.8% students in the exprimental group. One week later, students in both groups were invited to meet with two standardized patients. MI skills were coded by blinded research assistants using the Motivational Interviewing Treatment Integrity 3.0.Results: Superior MI performance was shown for trained versus control students, as demonstrated by higher scores for “Empathy” [p<0.001] and “MI Spirit” [p<0.001]. Scores were similar between groups for “Direction”, indicating that students in both groups invited the patient to talk about behavior change. Behavior counts assessment demonstrated better performance in MI in trained versus untrained students regarding occurences of MI-adherent behavior [p<0.001], MI non-adherent behavior [p<0.001], Closed questions [p<0.001], Open questions [p=0.001], simple reflections [p=0.03], and Complex reflections [p<0.001]. Occurrences were similar between groups regarding “Giving information”.Conclusion: An 8-h training workshop was associated with improved MI performance.Practice implications: These findings lend support for the implementation of MI training in medical schools.

Self-management abilities, physical health and depressive symptoms among patients with cardiovascular diseases, chronic obstructive pulmonary disease, and diabetes - Corrected Proof

Jane Murray Cramm, Anna Petra Nieboer — 2012-01-06

Abstract: Objective: This study aimed to identify the predictive role of direct resources (educational level and marital status) and self-management abilities on physical health and depressive symptoms in patients with cardiovascular diseases (CVD), diabetes, or chronic obstructive pulmonary disease (COPD).Methods: Our cross-sectional questionnaire-based study included 1570 CVD patients, 917 COPD patients, and 412 patients with diabetes.Results: Physical health and depressive symptoms of COPD patients was lower than those of CVD and diabetic patients. Correlation analyses indicated that self-management abilities were strong indicators for physical health and depressive symptoms (all p<0.001). This relationship was strongest for depressive symptoms. Self-management abilities were related to educational level in all groups (all p<0.001). Regression analyses revealed that self-management abilities were strong predictors of physical health and depressive symptoms in all three patient groups (all p<0.001).Conclusion: This research showed that self-management abilities are strong predictors of physical health and depressive symptoms.Practice implications: Interventions that improve self-management abilities may counteract a decline in physical health and depressive symptoms. Such interventions may be important tools in the prevention of the loss of self-management abilities, because they may motivate people who are not yet experiencing serious problems.

The lesson of Monsieur Nouma: Effects of a culturally sensitive communication tool to improve health-seeking behavior in rural Cameroon - Corrected Proof

2012-01-03

Abstract: Objective: To test the effect of patient counseling using educational tools, on rates of return for follow-up in newly diagnosed hypertensive and/or diabetic patients in a rural African context.Methods: Free screening for hypertension and elevated blood glucose was offered in primary health care centers in central Cameroon during 9 campaigns of 3 days each. Individuals with untreated hypertension and/or diabetes were divided into 2 groups: a control group receiving counseling according to routine procedures, and an intervention group receiving counseling with different educational tools to explain the diagnosis and its implications to the patient.Results: Prevalence of hypertension and/or diabetes in the screened population was 41%. At 3 months from screening, rates of return visits were higher in the intervention group than in the control group: 55/169 (32%) vs. 15/92 (16%), OR 2.4; 95%CI 1.3–4.7; p<0.001.Conclusion: Screening may identify untreated individuals efficiently. Rates of return visits after screening, although low in both groups, could be doubled by a short communication intervention.Practice implications: This study suggests that modest communication interventions, e.g., the application of educational tools, may bring important benefits and increase the effectiveness of public health measures to combat chronic diseases in settings of limited resources.

Current challenges of behavior change talk for medical professionals and trainees - Corrected Proof

Anna Chisholm, Jo Hart, Vanessa Lam, Sarah Peters — 2011-12-28

Abstract: Objective: To explore medical professionals’ and trainees’ experiences and views of behavior change talk in various health care settings to develop current understanding of the challenges that underlie this phenomenon.Methods: Qualitative, semi-structured interviews were conducted with medical professionals and trainees (n=29). Grounded theory principles informed sampling, data collection and analysis. To achieve maximum variance, participants with different levels of experience were purposively sampled from a range of primary and secondary care settings. Analysis was iterative, involving a constant comparative approach allowing emergent ideas to be tested in subsequent interviews until thematic saturation was reached.Results: Three emergent themes described reasons for not engaging in behavior change talk with patients: (1) ‘personal challenges’; (2) ‘somebody else's responsibility’ and (3) ‘prioritizing the doctor–patient relationship’.Conclusion: Despite increasingly being recognized as a core aspect of medical practice and education, medical professionals and trainees remain unprepared to discuss health-related behavior change with patients and unclear of their roles within contemporary health care.Practice implications: Formal training in theory-based behavior change techniques is likely to help empower doctors and mitigate many of the barriers found, particularly in relation to socially and emotionally uncomfortable topics that are perceived to threaten the doctor–patient relationship.

Developing a model of decision-making about complementary therapy use for patients with cancer: A qualitative study - Corrected Proof

Maggie Evans, Debbie Sharp, Ali Shaw — 2011-12-26

Abstract: Objective: To improve our understanding of patient participation in health care consultations and decision-making by exploring a consultation that lies at the interface between mainstream care and complementary therapies.Methods: Thirty-four holistic consultations were observed at centres offering complementary therapies for cancer, followed by interviews with patients and focus groups with professionals.Results: A model of decision-making about complementary therapy use emerged from the data: ‘Advice: Assessor led decision’, ‘Confirmation: Joint decision’, ‘Access: Patient-led decision’ and ‘Informed: Patient-led decision’. Decision-making style was contingent on identifiable communication strategies in the preceding information-sharing and discussion phases of the consultation.Conclusion: This study confirms the importance of gauging patients’ preferences for level of participation in decision-making. Models of consultations are generally based on the assumption that a greater degree of patient participation is a good thing that access to information and decision-making power is sought by all patients. Data from this study suggest that, in this context at least, this is not necessarily the case. The study also stresses the dynamic nature of the consultation, in which roles are fluid rather than fixed.Practice implications: Insight were gained into professionals’ communication strategies and patients’ role preferences in decision-making, which may be applicable more widely.

Bombecke K et al., “Medical students trained in communication skills show a decline in patient-centred attitudes: An observational study comparing two cohorts during clinical clerkships” [Patient Educ. Couns. 11 (2011) 310–318] - Corrected Proof

Jan Schildmann, Jochen Vollmann — 2011-12-26

We read with great interest the paper of Bombecke et al.’s observational study on communication skills training and medical students’ patient-centred attitudes . The results resemble in parts our own evaluation of a “breaking bad news” training published recently in this journal which showed no changes regarding the more patient-centred communication competences . As pointed out rightly by the authors such results should not cast general doubt on the value of evidence-based communication skills training . Rather the research of Bombecke et al. provides stimulus for further empirical research regarding the appropriate timing, teaching methods and evaluation of communication skills training in relation to a patient-centred approach in medicine.

Factors that affect HIV testing and counseling services among heterosexuals in Canada and the United Kingdom: An integrated review - Corrected Proof

Susan Kaai, Sandra Bullock, Ann N. Burchell, Carol Major — 2011-12-26

Abstract: Objective: To examine factors that affect the utilization of HIV testing and counseling (HTC) services among heterosexual populations in Canada and the UK.Methods: We conducted an integrated review of published and unpublished literature (1996–September 2010) using Scopus, OVID-EMBASE, CSA illumina, CINHAL, PROQuest, Web of Science, and Google.Results: Twenty-seven studies met the inclusion criteria. We identified and categorized the key factors into three broad categories depending on their source. Personal-related factors included socio-demographic characteristics, risk perception, illness, HIV-related stigma, level of HIV and testing knowledge, and culture. Provider-related factors included provider-recommended HIV testing, provision of culturally and linguistically appropriate services, and doctor–patient relationship. System-related factors included integrating HIV testing with other health care services, anonymity of testing services, suitability of testing venues, technical aspects of HIV testing, and funding for immigrant health services.Conclusion: The findings from our review indicate that HTC behaviors of heterosexuals in the Canada and the UK are likely influenced by several unchangeable (socio-demographic characteristics) and amenable factors. There is need to step-up research to confirm whether these associations are causal using stronger research designs.Practical implication: We have made several recommendations that could be used to improve existing services in Canada.

Uncovering and validating clinicians’ experiential knowledge when facing difficult conversations: A cross-cultural perspective - Corrected Proof

Giulia Lamiani, Serena Barello, David M. Browning, Elena Vegni, Elaine C. Meyer — 2011-12-26

Abstract: Objective: To explore clinicians’ experiential knowledge when conducting difficult conversations; and to verify if experiential knowledge is culturally based.Method: Data were collected in Italy and the United States during the Program to Enhance Relational and Communication Skills (PERCS) workshops. At the beginning of each workshop, during a whiteboard exercise, clinicians shared the strategies they had found helpful in difficult conversations. The strategies were analyzed in each country through content analysis. Upon completion of this primary analysis, the themes identified within each country were synthesized into second-order themes by means of aggregated concept analysis.Results: We conducted 14 Italian and 12 American PERCS-workshops enrolling a total of 304 clinicians. The suggestions that were similar across both countries were related to: organizational aspects and setting preparation; communication and relational skillfulness; clinician mindfulness; interpersonal qualities and sensibilities; and teamwork and care coordination. Additionally, US participants identified attention to cultural differences as a helpful strategy.Conclusion: Clinicians can access relational strategies, tied to their experience, that are typically unrecognized in medical education. The whiteboard exercise is an effective teaching tool to uncover and validate already-existing relational knowledge.Practice implications: Communication training programs can foster clinicians’ sense of preparation by building upon their already-existing knowledge.

Factors affecting frequency of communication about family health history with family members and doctors in a medically underserved population - Corrected Proof

2011-12-26

Abstract: Objective: Family history contributes to risk for many common chronic diseases. Little research has investigated patient factors affecting communication of this information.Methods: 1061 adult community health center patients were surveyed. We examined factors related to frequency of discussions about family health history (FHH) with family members and doctors.Results: Patients who talked frequently with family members about FHH were more likely to report a family history of cancer (p=.012) and heart disease (p<.001), seek health information frequently in newspapers (p<.001) and in general (p<.001), and be female (p<.001). Patients who talked frequently with doctors about FHH were more likely to report a family history of heart disease (p=.011), meet physical activity recommendations (p=.022), seek health information frequently in newspapers (p<.001) and in general (p<.001), be female (p<.001), and not have experienced racial discrimination in healthcare (p<.001).Conclusion: Patients with a family history of some diseases, those not meeting physical activity recommendations, and those who do not frequently seek health information may not have ongoing FHH discussions.Practice implications: Interventions are needed to encourage providers to update patients’ family histories systematically and assist patients in initiating FHH conversations in order to use this information for disease prevention and control.

Diabetes self-management in patients with low health literacy: Ordering findings from literature in a health literacy framework - Corrected Proof

Mirjam P. Fransen, Christian von Wagner, Marie-Louise Essink-Bot — 2011-12-26

Abstract: Objective: To review studies on the association between health literacy (HL), diabetes self-management and possible mediating variables.Methods: We systematically searched for empirical studies in PubMed. Findings were ordered by a HL framework that outlines routes between HL, sociocognitive determinants and health actions.Results: Of the 11 relevant studies, three reported a significant positive association between HL and specific diabetes self-management domains. Ten studies investigated the association between HL and knowledge (n=8), beliefs (n=2), self-efficacy (n=3) and/or social support (n=1). Significant associations were found between HL and knowledge (n=6), self-efficacy (n=1) and social support (n=1). Of the three studies evaluating the effect of these sociocognitive variables on diabetes self-management, only one found proof for a mediating variable (social support) in the pathway between HL and self-management.Conclusion: There is only limited evidence for a significant association between HL and diabetes self-management, and for the mediating role of sociocognitive variables in this pathway.Practice implications: Longitudinal studies, including HL, diabetes self-management and potential mediators, are needed to substantiate possible associations between these variables. Such research is essential to enable evidence-based development of interventions to increase adequate and sustainable self-management in diabetic patients with low HL.

Computerised decision aids: A systematic review of their effectiveness in facilitating high-quality decision-making in various health-related contexts - Corrected Proof

Joanne Sheehan, Kerry A. Sherman — 2011-12-20

Abstract: Objective: To systematically review existing empirical evidence regarding the effectiveness of computerised decision aids (CDAs) in enabling high-quality decision-making in preference-sensitive health-related contexts.Methods: Relevant studies were identified via Medline, CINAHL, and PsycINFO databases (1990–October 2010). Only randomised controlled trials with at least one decision quality or decision process variable outcome were included.Results: Of 1467 identified articles, 28 studies met all inclusion criteria, evaluating 26 unique CDAs. CDAs performed better than standard consultations/education regarding improved knowledge and lower decisional conflict, and were found not to increase anxiety. CDAs facilitated greater satisfaction with the decision-making process than standard education. The effects on risk perceptions, value congruence with the chosen option, preferred roles in decision-making and decisional self-efficacy need further evaluation. A paucity of CDAs adhered to decision theories.Conclusions: CDAs showed similar effects as non-computerised DAs on various outcomes. Further research into the potentially superior effects of CDAs on feeling informed, values-clarity, and decisional conflict is required.Practice implications: The more remarkable effects on knowledge and risk perceptions were reported when unique features of interactive computerised media were used. The potential benefit of tailored information, values-clarification, and integration of CDAs into shared decision-making consultations remains unresolved.

Communicating quality of care information to physicians: A study of eight presentation formats - Corrected Proof

Max Geraedts, Peter Hermeling, Werner de Cruppé — 2011-12-19

Abstract: Objective: Non-hospital based physicians usually counsel their patients which hospital to choose. Our aim was to determine which formats for presenting quality of care data are preferred by physicians.Methods: 300 randomly recruited non-hospital based physicians participated in a survey. We created eight presentation formats which varied in terms of information aggregation and usage of evaluative cues. Participants rated clarity, comprehensibility, information content, acceptance, and preference of the presentation formats. Additionally, we tested physicians’ comprehension of the formats.Results: Physicians’ ratings of the formats differed significantly (p<0.001). Formats combining numeric information and evaluative cues performed best in terms of information content, comprehensibility and preference. Comprehension of presentation formats also differed (p<0.001). Even though physicians’ accuracy of interpreting “Simple Star Rating” was best a majority of participants accepted only formats that contained detailed numerical information (p<0.001).Conclusion: In order to support physicians’ use of quality of care information in counseling patients, report cards should depict indicator values in a format that combines actual indicator values with evaluative cues.Practice implications: If authors of comparative hospital quality reports apply the results of our study in designing reports, the results may increase physicians’ use of comparative performance reports in their counseling of patients.

Attitudes and dilemmas of caregivers supporting people with intellectual disabilities who have diabetes - Corrected Proof

Mieke Cardol, Mieke Rijken, Henny van Schrojenstein Lantman-de Valk — 2011-12-19

Abstract: Objective: To explore how professional caregivers in communal living arrangements support people with a mild or moderate intellectual disability (ID) who have diabetes.Methods: A qualitative study, 13 caregivers participated in semi-structured interviews.Results: Professional caregiver support in diabetes care is almost solely directed towards administering medication and controlling food intake. Caregivers want to provide person-centered care but are hindered by a conflict between protecting a client's health and at the same time respecting autonomy. None of the caregivers had received training in supporting self-management; their knowledge about diabetes is limited. The few that engaged their client in self-management stressed the importance of a positive and collaborative approach.Conclusion: This study provides a first insight into the challenges that professional caregivers experience when a client with ID has diabetes. More education for caregivers seems needed. Self-management support is likely to benefit from consensus among caregivers about what comprises person-centered care and self-management in people with ID who have a chronic disease.Practice implications: Increasing caregivers’ awareness of the importance of supporting self-management in people with ID and a chronic disease is essential. Discussing practice examples in the light of existing knowledge about developing autonomy will contribute to their awareness.

To be or not to be: The patient's view of thrombophilia testing - Corrected Proof

2011-12-16

Abstract: Introduction: The literature on the psychological effects of thrombophilia testing is unclear. Little is known about the complex world of significance subjects construct around the test.Objective: The study explored the peculiar network of implicit meanings that may be linked to the experience of being tested.Materials and methods: The research was designed according to Interpretative Phenomenological Analysis (IPA). 19 patients were interviewed. Integral verbatim reports of the interviews were analyzed through an inductive process aimed at gaining a holistic understanding of the narratives.Results: Two main issues were identified, each with sub-issues: (1) the clinical problem: (1.1) unhealthy blood and (1.2) the family issue; (2) the test: (2.1) knowing for the sake of knowing; (2.2) knowing for the sake of doing; (2.3) not knowing.Conclusions: The thrombophilia test is part of a larger network of meanings, where information about the test and its results seem to be lost.Practice implication: The study suggests the importance of paying greater attention to the process of doctor–patient communication at the time of the test. The theme of being informed is important for patients, yet often they are not able to understand or retain the information they receive, increasing the risk of misunderstandings.

Homeopathy enables rheumatoid arthritis patients to cope with their chronic ill health: A qualitative study of patient's perceptions of the homeopathic consultation - Corrected Proof

Sarah B. Brien, Geraldine M. Leydon, George Lewith — 2011-12-16

Abstract: Objective: The role of the consultation in mediating improved clinical outcomes has been demonstrated in both conventional and complementary medicine but to date no depth study has explored how complementary medical consultations achieve such benefits. This study explored rheumatoid arthritis (RA) patients’ perceptions of the homeopathic consultation including any perceived benefit.Methods: Qualitative study nested within a placebo-controlled multi-centre trial assessing adjunctive homeopathic intervention for RA. In-depth face to face interviews (with 16 participants) were analysed using interpretative phenomenological analysis.Results: RA participants perceived homeopathic consultations helped them cope better through either enabling improved physical health, wellbeing and/or illness management. Four themes associated with improved coping were: receiving emotional support; exploring the illness; exploring self; and gaining advice. Exploring the wider narrative of their illness, enabled participants to address their individual needs and for some, this process of increased awareness changed their perception resulting in the perceived benefits.Conclusion: Homeopathic consultations enable RA patient to cope better.Practice implications: Homeopathic consultations may provide an additional resource for RA patients. Identifying and employing the “active ingredients” that confer benefit may be appropriate for other clinicians to maximise patient benefits from consultations.

Factors influencing treatment decision making and information preferences of prostate cancer patients on active surveillance - Corrected Proof

Barbara Joyce Davison, Erin Breckon — 2011-12-16

Abstract: Objective: To assess information and decision making preferences of patients on active surveillance (AS), and the factors influencing their decision.Methods: A cross-sectional sample of 180 patients on AS for <10 years completed a survey exploring the role men assumed with their physician in treatment decision making (TDM), factors influencing their decision to go on AS, and information preferences.Results: Thirty-five percent of patients reported assuming an active role in TDM, 38% a collaborative role and 27% a passive role. Results suggest that patients<60 years prefer to play an active role in TDM whereas, men>70 years prefer to play a passive role. Available treatment options, eating a ‘prostate friendly’ diet, and non-traditional therapies were identified as the top three information preferences. Patients with higher levels of anxiety wanted access to more information compared to those with lower levels of anxiety. The urologists’ recommendation was rated the most important factor influencing patients’ decisions to go on AS.Conclusion: The urologist's recommendation for treatment continues to have the most influence on the decision to go on AS. Our results suggest that age has an impact on the role patients wish to assume in TDM.Practice implications: Assessments of patients’ information and decision preferences, and levels of anxiety are suggested for all prostate cancer patients considering AS.

Assessing medical student competency in communication in the pre-clinical phase: Objective structured video exam and SP exam - Corrected Proof

2011-12-14

Abstract: Objective: The aim of our study was to present the structure, process and results of the objective structured video exam and One-Station standardized patient exam that have been used to assess second year medical students’ communication skills.Methods: Scores of 1137 students between the years 2007 and 2010 were analyzed. Means and standard deviations were calculated for scores and ratings. Internal consistency was assessed using Cronbach's alpha coefficient. To analyze reliability and generalizability, multivariate generalizability theory was employed.Results: Students’ total and item scores on the objective structured video exam (60.5–68.8) were lower than on the One-Station standardized patient exam (90.4–96.6). Internal consistencies of both exams were moderate. Generalizability analysis and D-study results showed that both the objective structured video exam and the One-Station standardized patient exam need improvement.Conclusion: Both exams need measures to improve them, such as increasing the number of video cases or stations, and further standardization of raters.Practice Implications: this study might encourage medical teachers to consider assessing validity and reliability of written and performance exams on the basis of generalizability theory, and to find out feasible actions to improve assessment procedures by conducting a D-study.

Effectiveness of a web-based, individually tailored decision aid for depression or acute low back pain: A randomized controlled trial - Corrected Proof

2011-12-12

Abstract: Objective: To evaluate the effectiveness of a web-based, individually tailored decision aid (Patient Dialogue) on depression or acute low back pain for insurees of a German sickness fund.Methods: Patient Dialogue (PD) was compared to the non-tailored Static Patient Information (SPI) in an online randomized controlled trial (RCT). The primary outcome was decisional conflict; secondary outcomes included knowledge, preparation for decision-making, preference for participation, involvement in decision-making, decision regret, and adherence.Results: Out of 2480 randomized participants, 657 (26.5%) provided analyzable data immediately after using the system. Three months later, data from 131 (5.3%) participants could be included in the analysis. The PD group reported a significantly lower overall decisional conflict than the SPI group (38.7 vs. 45.1; p=0.028 via multiple imputation estimator). The largest standardized effect (Cohen's d 0.56) resulted from the preparation for decision-making (PD 59.4 vs. SPI 46.8; p<0.001).Conclusion: PD may be an effective tool to reduce decisional conflict and prepare participants for treatment decision-making. However, the large dropout rate needs to be taken into account.Practice implications: This study shows how a health insurance fund can support shared decision-making and how a decision aid can be evaluated in a RCT under routine care conditions.

Implementation of complementary interventions in the Netherlands: Experiences of pioneers - Corrected Proof

Susan Hupkens — 2011-12-12

Abstract: Objective: Although many Dutch patients desire integration of complementary interventions in conventional healthcare, implementation is in its infancy in the Netherlands. The objective of this study was to describe the implementation process of complementary interventions in Dutch healthcare organizations.Methods: Data in this qualitative study were collected in two steps: by questionnaires and by interviews. In five organizations the project leader and a professional who provides the interventions participated in the study.Results: Main facilitators for implementation are: enthusiasm and support of colleagues; appreciation of patients; effectiveness of the interventions; positive publications in media; possibility to link the project to objectives of the organization; and accessibility of the interventions. Main barriers for implementation are: ignorance and skepticism of professionals; lack of research; lack of budget; lack of integration of the interventions in daily practice. Participants developed strategies to overcome barriers and to exploit facilitators.Conclusion: Professionals play a leading role in the implementation of complementary interventions in Dutch healthcare organizations. They use several methods to deal with facilitators and barriers.Practice implications: Organizations and professionals that aim to implement complementary interventions in their service may learn from experiences of pioneer organizations.

The effect of using standardized patients or peer role play on ratings of undergraduate communication training: A randomized controlled trial - Corrected Proof

2011-12-02

Abstract: Objectives: Considering the expense of standardized patients (SP) for training communication skills and the convenience of peer role playing (RP) there is a surprising lack of studies directly comparing the two methods.Methods: Fifth year medical students (N=103) were assigned to three groups receiving a training in counseling parents of sick children with RP (N=34) or SP (N=35) or to a control group (CG, N=34). We assessed self-efficacy, as well as objective performance in parent–physician communication using questionnaires and the Calgary-Cambridge-Observation-Guide Checklist in a six-station OSCE, respectively.Results: The training led to an increase in self-efficacy ratings and in the post-intervention OSCE score after RP (p<.021 and p<.001 respectively) and SP-training (p<.007 and p<.006 respectively) compared to controls. Surprisingly, this benefit was higher after RP than after SP-training (p<.021) due to significantly higher performance in the domain understanding of parents’ perspective (p<.001).Conclusion: Both RP and SP are valuable tools for training specific communication skills. RP offer a methodological advantage in fostering empathy for patient perspectives.Practice implications: Both peer-role-play and standardized patients hold specific benefits for communication training. Peer-role-play seems to foster a more empathic approach towards patients’ concerns justifying its prominent role in medical curricula.

Factors that influence Italian consumers’ understanding of over-the-counter medicines and risk perception - Corrected Proof

2011-11-28

Abstract: Objective: To evaluate information needs for safe self-medication we explored the Italian consumers’ functional health literacy, specific knowledge and risk awareness about over-the-counter (OTC) medicines.Methods: A survey was conducted in the health sections of six large super stores. Data were collected from a convenience sample of 1.206 adults aged 18 years and older through a self-administered questionnaire.Results: Around 42% confused the concept of “contraindications” with that of “side effects” and were unable to calculate simple dosages. Most respondents were aware of the OTC general potential for side effects but 64.3% did not know that people with high blood pressure should use painkillers with cautions and 14.0% and 20.0% were unaware of the risks of long-term use of laxatives and nasal decongestants respectively. Higher total scores were obtained from women, highly educated people and those citing package leaflets as information sources.Conclusion: The study, the first of this type in Italy, showed an incomplete awareness of several risk areas, with regard to drug interactions and misuse/abuse.Practice implications: The results of this study were the basis of a following intervention plan tailored to the observed consumer needs and including information tools for customers and courses for the retail pharmacists.

A critical review of advance directives in Germany: Attitudes, use and healthcare professionals’ compliance - Corrected Proof

2011-11-24

Abstract: Objective: Recent legal changes in Germany make non-compliance with advance directives (ADs) a criminal offence. This article assesses the evidence on attitudes towards, use of, and physician compliance with ADs in Germany.Methods: Critical review: studies on ADs, identified from a systematic review of culture and end-of-life care in Germany (11 electronic databases, 3 journals, reference lists, and grey literature), were included. An interpretative synthesis of findings revealed cross-cutting themes.Results: Thirty-two studies (1996–2009) were identified. Key themes were: awareness; utilization; compliance; and bindingness of ADs. There was a positive trend between awareness of ADs and study publication date. Use varied between patient groups (0.3–62%) and was low amongst the general population (2.5–10%). Fears about ADs’ purpose and possible abuse were identified. Physician discomfort in discussing ADs and non-compliance were reported. Physicians preferred legally binding ADs, though conflicting results were reported for patients’ desired level of bindingness.Conclusion: Although there is increasing awareness of ADs in Germany, there remains low use, poor communication, fears of abuse, some non-compliance and contradictory evidence regarding desired bindingness.Practical implications: Although legal changes will hopefully improve compliance, low awareness, communication difficulties and uncertainties surrounding ADs must be addressed if use is to increase.

A practitioner's guide to interpersonal communication theory: An overview and exploration of selected theories - Corrected Proof

Carma L. Bylund, Emily B. Peterson, Kenzie A. Cameron — 2011-11-23

Abstract: Objective: To provide a brief overview of selected interpersonal theories and models, and to present examples of their use in healthcare communication research.Results: Nine interpersonal communication theories and their application to healthcare communication are discussed.Conclusion: As healthcare communication interactions often occur at an interpersonal level, familiarity with theories of interpersonal communication may reinforce existing best practices and lead to the development of novel communication approaches with patients.Practice implications: This article serves as an introductory primer to theories of interpersonal communication that have been or could be applied to healthcare communication research. Understanding key constructs and general formulations of these theories may provide practitioners with additional theoretical frameworks to use when interacting with patients.

Verbal information about anesthesia before scheduled surgery – contents and patient satisfaction - Corrected Proof

Helena Puro, Päivi Pakarinen, Kari Korttila, Minna Tallgren — 2011-11-21

Abstract: Objective: The contents of information for patients before medical procedures are outlined by legislation and guidelines. The amount and form are less regulated. Our aim was to evaluate the contents of verbal information provided by anesthesiologists in a long-established preoperative clinic, and how satisfied patients are with it.Methods: A questionnaire based on legislation and the DISCERN quality criteria for information on treatment choices was sent to patients who recently had anesthesia for elective hysterectomy in our hospital (n=372), and to the anesthesiologists involved (n=24).Results: Preoperative information was regarded as sufficient by 82% of the patients and rated good by 65%. Information on the benefits of anesthesia, its risks, and effects on the quality of life was considered satisfactory by 74%, 49%, and 49%, respectively. Only 54% received enough information on lifestyle interventions to reduce their individual risks. Of the anesthesiologists, 33% had a policy to tell about risks on request only.Conclusion: Verbal information was highly appreciated by the patients, but only two-thirds rated its quality as good, and half were satisfied with the information concerning risks.Practice implications: More attention has to be focused on how to offer information on risks and self-help interventions to reduce them.

The importance of patient-centered care for various patient groups - Corrected Proof

Dolf de Boer, Diana Delnoij, Jany Rademakers — 2011-11-14

Abstract: Objectives: To assess differences in the importance ascribed to patient-centered care between various patient groups and demographic groups.Methods: Survey data collected using questionnaires were analyzed for patients that underwent hip or knee surgery (n=214), patients suffering from rheumatoid arthritis (n=343), spinal disk herniation (n=145), breast abnormalities (n=596) or congestive heart failure (n=118). A composite for patient-centered care priorities was constructed (α=0.82) and compared to the average importance over all healthcare aspects in the surveys.Results: All patient groups considered patient-centered care to be of above-average importance (p‘s<0.001). Small but significant differences were observed: patient-centered care was more important for patients suffering from congestive heart failure (p<0.001) and patients who were younger, female, well-educated and healthier (p‘s<0.05). Patients who had undergone hip or knee surgery considered patient-centered care more important than patients with spinal disk herniation did (p<0.05).Conclusion: Patient-centered care is important to all patient groups. Differential policies regarding patient-centered care for patient subgroups do not seem required.Practical implications: Given the importance attributed to patient-centered care, it is essential that elements of patient-centered care are included in surveys, indicators of quality of care, and the training of doctors and nurses.

Influence of race and socioeconomic status on engagement in pediatric primary care - Corrected Proof

2011-11-09

Abstract: Objective: To understand the association of race/ethnicity with engagement in pediatric primary care and examine how any racial/ethnic disparities are influenced by socioeconomic status.Methods: Visit videos and parent surveys were obtained for 405 children who visited for respiratory infections. Family and physician engagement in key visit tasks (relationship building, information exchange, and decision making) were coded. Two parallel regression models adjusting for covariates and clustering by physician were constructed: (1) race/ethnicity only and (2) race/ethnicity with SES (education and income).Results: With and without adjustment for SES, physicians seeing Asian families spoke 24% fewer relationship building utterances, compared to physicians seeing White, non-Latino families (p<0.05). Latino families gathered 24% less information than White, non-Latino families (p<0.05), but accounting for SES mitigates this association. Similarly, African American families were significantly less likely to be actively engaged in decision making (OR=0.32; p<0.05), compared to White, non-Latino families, but adjusting for SES mitigated this association.Conclusion: While engagement during pediatric visits differed by the family's race/ethnicity, many of these differences were eliminated by accounting for socioeconomic status.Practice implications: Effective targeting and evaluation of interventions to reduce health disparities through improving engagement must extend beyond race/ethnicity to consider socioeconomic status more broadly.

Binding phylacteries: Mind and body meet in the operating room - Corrected Proof

Zahi Arnon, Zeev Loberman, Eran Ben-Arye, Elad Schiff — 2011-10-31

The following narrative describes the experiences of a clinical psychologist whose role is to provide hypnotherapy and guided imagery to patients on a surgical service. Phylacteries: English name for Tefillin, a pair of small square black leather boxes containing scrolls of parchment inscribed with verses from the Torah (The Bible), which are worn by observant Jews during weekday morning prayers, on the left arm and on the head.

The impact of preoperative counseling on postoperative treatment adherence in bariatric surgery patients: A randomized controlled trial - Corrected Proof

Haldis Ø. Lier, Eva Biringer, Bjarte Stubhaug, Tone Tangen — 2011-10-31

Abstract: Objective: To assess if attendance to a preoperative counseling program improved weight loss or adherence to treatment guidelines in patients who underwent bariatric surgery.Methods: One-hundred-forty-one patients were included in the study. Sixty-nine percent chose to participate in the counseling groups. They were randomized to a Treatment group and a Control group. Thirty-one percent chose not to participate in the counseling. However, they gave their consent to assessment before and after surgery (Reference group).Results: One year after bariatric surgery, 88% had a weight loss of ≥50% EWL, 37% reported more than 30min of physical activity daily, 74% had 5–7 meals daily, and 87% took recommended vitamins. There were no differences in weight loss, eating habits, or physical exercise between the Treatment group, the Control group and the Reference group one year after surgery.Conclusion: Preoperative group counseling did not increase treatment adherence to recommended life-style changes.Practice implications: In accordance with findings in the present study, it is not reasonable to offer a preoperative counseling program for all patients undergoing bariatric surgery. Further research should focus on developing and evaluating programs for postsurgical follow-up, and identifying patients that are in need for more comprehensive treatment programs.

Development and validation of the high blood pressure-focused health literacy scale - Corrected Proof

2011-10-26

Abstract: Objective: While the role of health literacy in chronic disease management is well documented, few intervention studies have been reported. A major barrier to designing and implementing such interventions is the lack of valid health literacy tools. This study developed and tested a novel health literacy scale for individuals with high blood pressure (HBP).Methods: A two-step design process was used: In the construction phase, focus group studies and a literature review were conducted to generate a pool of items. The testing phase involved a psychometric evaluation and pilot-testing of the scale on hypertensive Korean Americans (n=386). The end product was a HBP-health literacy scale (HBP-HLS) with two essential domains, print literacy and functional health literacy.Results: Psychometric testing indicated that the scale was reliable (Kuder–Richardson-20 coefficient=0.98), valid (content validity index ≥0.8), and significantly correlated with theoretically selected variables (education, r=0.67, p<0.01; HBP knowledge, r=0.33, p<0.01).Conclusion: The HBP-HLS demonstrated its utility for evaluating HBP management interventions in the community setting.Practice implications: Utilizing the HBP-HLS should be considered as a potential tool for improving health literacy and evaluating intervention studies in the context of HBP management.

The provision of information and informed decision-making on prenatal screening for Down syndrome: A questionnaire- and register-based survey in a non-selected population - Corrected Proof

2011-10-26

Abstract: Objective: Evaluating the information provision procedure about prenatal screening for Down syndrome, using informed decision-making as a quality-indicator.Methods: Questionnaire- and register-based surveys. Midwives associated with 59 midwifery practices completed process data for 6435 pregnancies. Pregnant women (n=510) completed questionnaires on informed decision-making.Results: Midwives offered information to 98.5% of women; 62.6% of them wished to receive information, of these, 81.9% actually received information. Decision-relevant knowledge was adequate in 89.0% of responding women. Knowledge about Down syndrome was less adequate than knowledge about the screening program. Participants in the screening program had higher knowledge scores on Down syndrome and on the screening program than non-participants. Of the women who intended to participate (35.8%), 3.1% had inadequate knowledge. A total of 75.5% of women made an informed decision; 94.3% of women participating in the screening program, and 64.9% of women not participating.Conclusion: This quality assurance study showed high levels of informed decision-making and a relatively low participation rate in the national screening program for Down syndrome in the Netherlands. Knowledge of the Down syndrome condition needs to be improved.Practice implications: This evaluation may serve as a pilot study for quality monitoring studies at a national level.

Participation in medical research; a systematic review of the understanding and experience of children and adolescents - Corrected Proof

Joke Aurelia Maria Hunfeld, Jan Passchier — 2011-10-24

Abstract: Objective: To systematically review the state of knowledge regarding the understanding and experience of psychological burden and risk of children and adolescents who participate in medical research. Further to provide recommendations to maximize understanding and minimize the burden and risk.Methods: Studies were selected that focus on children and adolescents as source of information via PubMed and PsycINFO; search terms were medical research or trial or experiment, child or adolescent, non-therapeutic, therapeutic, psychology, consent or understanding, risk, burden or stress.Results: Of 413 abstracts identified, ten studies on understanding and eight on the experience of burden and risk met our selection criteria. Overall, understanding of the study purpose was reasonable, but low for the procedure. Understanding increased with age and appeared to be overestimated by the young participants. Research on experience of burden was scarce, but identified invasive procedures and procedures related to sexual development as the most burdensome. Only one study assessed psychological risks.Conclusion: Systematic evidence should be collected on the various aspects of medical procedures related to the experienced burden and risk. This will be useful in informing children and adolescents, parents and medical ethical committees.

Social support and online postpartum depression discussion groups: A content analysis - Corrected Proof

Marilyn Evans, Lorie Donelle, Laurie Hume-Loveland — 2011-10-24

Abstract: Objective: Social support has a positive influence on women's childbearing experience and is shown to be a preventive factor in postpartum depression. This study examined the perceived value and types of social supports that characterize the discussions of women who participate in postpartum depression online discussion groups.Methods: A directed content analysis was used to examine 512 messages posted on a postpartum depression online support group over six months.Results: The majority of the women's postings illustrated emotional support followed by informational and instrumental support.Conclusions: Online support groups provide women experiencing postpartum depression a safe place to connect with others and receive information, encouragement and hope.Practice implications: Education strategies are needed to address the many questions regarding PPD medical treatment. Recommending vetted links to PPD online support groups will create opportunities for women to share their experiences and obtain support.

Patient compliance with telephone triage recommendations: A meta-analytic review - Corrected Proof

Rebecca J. Purc-Stephenson, Christine Thrasher — 2011-10-17

Abstract: Objective: To systematically investigate the extent to which patients comply with triage advice from telenurses and to identify factors that potentially influence compliance.Methods: Findings from 13 studies identified through interdisciplinary research databases (1990–2010) were meta-analyzed. Separate pooled analyses compared patients’ compliance rates for emergency services and office care (13 outcomes), emergency services and self care (13 outcomes), and self care and office care (12 outcomes).Results: Overall patient compliance was 62%, but varied by intensity of care recommended with low compliance rates for advice to see a general practitioner. Reasons for noncompliance include patients reporting to have heard a different disposition, patients’ intentions and health beliefs.Conclusion: Patient compliance to triage recommendations was influenced by the interactive role of patient perceptions and the quality of provider communication, both of which were mediated by access to health services. Further research is needed to clarify whether noncompliance is attributable to poor communication by the nurse or patient misinterpretation.Practice implications: We highlight the need for communication-skills training in a telephone-consultation context that is patient centered, and specifically addresses building active listening and active advising skills and advantages to structuring the call.

Conceptualizations of patient empowerment among individuals seeking treatment for diabetes mellitus in an urban, public-sector clinic - Corrected Proof

Claire Ramsay Wan, Linda Vo, Catherine S. Barnes — 2011-10-17

Abstract: Objective: The patient empowerment paradigm has been promoted as a critical component of diabetes care. The present study explores how patients in an urban, public-sector clinic perceive patient empowerment as it applies to their treatment, interactions with clinicians, and self-care behaviors.Methods: Semi-structured interviews were conducted with 29 individuals and analyzed through an inductive approach.Results: Patient empowerment was described as taking responsibility for self-care behaviors. Participants reported they that must be internally driven to maintain their self-care regiment, and placed moral value on their performance. Some participants asked questions during healthcare encounters, but fewer reported setting the agenda or making meaningful decisions regarding their care.Conclusion: Gaps in individuals’ perception of empowerment were identified, along with barriers such as frustration, fatigue, financial concerns, transportation, and scheduling difficulties.Practice implications: Increasing patient empowerment in socially disadvantaged settings will require careful communication to elicit questions, present all available treatment choices, and encourage individuals to take responsibility without placing blame on them for instances of poor glycemic control.

The influence of health literacy level on an educational intervention to improve glaucoma medication adherence - Corrected Proof

2011-10-14

Abstract: Objective: To test an educational intervention targeted to health literacy level with the goal of improving glaucoma medication adherence.Methods: One hundred and twenty-seven veterans with glaucoma were randomized to glaucoma education or standard care. The intervention included a video scripted at a 4th, 7th, or 10th grade level, depending on the subject's literacy level. After six months, the number of days without glaucoma medicine (DWM) according to pharmacy records for the intervention and control groups was compared.Results: The number of DWM in the six months following enrollment was similar for control and intervention groups (intervention, n=67, DWM=63±198; standard care, n=60, DWM=65±198; p=0.708). For each subgroup of literacy (adequate, marginal, inadequate), subjects in the intervention group experienced less mean DWM than subjects in the control group and the effect size (ES) increased as literacy decreased: adequate literacy, ES 0.069; marginal, ES 0.183, inadequate, ES 0.363. Decreasing health literacy skills were associated with decreasing self-reported satisfaction with care (slope=0.017, SE=0.005, p=0.002).Conclusions: Patients with decreased health literacy skills may benefit from educational efforts tailored to address their health literacy level and learning style.Practice implications: Providers should consider health literacy skills when engaging in glaucoma education.

The Chinese version of the Diabetes Empowerment Scale—Short Form - Corrected Proof

Ann Tak-Ying Shiu, Kai-chow Choi, Rebecca Yee-Man Wong — 2011-10-13

The importance of developing the self-management ability of people with diabetes has been increasingly emphasized because of a paradigm shift from the biomedical paradigm that focuses mainly on physiological endpoints to the social science paradigm that encompasses the functioning and overall wellbeing as the focus of diabetes care and education . The key drivers contributing to the paradigm shift include the increasing penetration of diabetes empowerment , defined as diabetes-related psychosocial self-efficacy, and the adoption of the chronic care model to collaboratively plan the care with people with diabetes who are the ones to face the consequences of the impact of such care on their daily living . In such a shift, diabetes empowerment has become an important outcome measure in diabetes care .