Patient Education and Counseling - Articles in Press

Nurse-led psychological interventions to improve diabetes control: Assessing competencies - Corrected Proof

2010-09-01

Abstract: Objective: To assess whether medical nurses can deliver motivational enhancement therapy (MET) and cognitive behavioural therapy (CBT) to a competent level and whether treatment fidelity is maintained.Methods: Training consisted of classroom teaching, written materials, a training caseload, and audio-visual feedback. We used the Motivational Interviewing Treatment Integrity (MITI), the Revised 12-item Cognitive Therapy Scale (CTS-R), and components of the Motivational Interviewing Skill Code (MISC) to assess competency and treatment fidelity. Two independent clinical psychologists who were blind to the allocation rated a random selection of 40 sessions.Results: Six nurses were trained in both interventions. For the MET the mean (SD) scores for empathy and spirit on the MITI scale were 5.1 (0.7) and 4.6 (1.0) respectively and for CBT the total mean (SD) CTS-R score was 52.1 (7.5), which was acceptable competency in both treatments. The two interventions were distinguishable.Conclusion: Results suggest that nurses can be trained to deliver diabetes-specific MET and CBT competently and maintain treatment fidelity.Practice implications: Findings of this study provide preliminary evidence to suggest that nurse-led psychological interventions could be incorporated into the traditional diabetes setting.

Determinants and outcomes of patient-centered care - Corrected Proof

Klea D. Bertakis, Rahman Azari — 2010-09-01

Abstract: Objective: This paper defines an interactional analysis instrument to characterize patient-centered care and identify associated variables.Methods: In this study, 509 new adult patients were randomized to care by family physicians and general internists. An adaption of the Davis Observation Code was used to measure a patient-centered practice style. The main outcome measures were visit-specific satisfaction and healthcare resource utilization.Results: In initial primary care visits, patient-centered practice style was positively associated with higher patient self-reported physical health status (p=0.0328), higher educational level (p=0.0050), and non-smoking status (p=0.0108); it was also observed more often in the interactions of family physicians compared to internists (p=0.0003). Controlling for patient sociodemographic variables, self-reported health status, pain, health risk behaviors (obesity, alcohol abuse, and smoking), and clinic assignment, patient satisfaction was not related to the provision of patient-centered care. Moreover, a higher average amount of patient-centered care recorded in visits throughout the one-year study period was significantly related to lower annual medical charges (p=0.0003).Conclusions: Patient-centered care was observed more often with family physician caring for healthier, more educated patients, and was associated with lower charges.Practice implications: Reduced annual medical care charges are an important outcome of patient-centered medical visits.

Systematic review of the effect of dental staff behaviour on child dental patient anxiety and behaviour - Corrected Proof

Yuefang Zhou, Elaine Cameron, Gillian Forbes, Gerry Humphris — 2010-09-01

Abstract: Objectives: To review the literature, of the past 30 years, on the effects of dental staff behaviour on the anxiety and behaviour of child dental patients; especially to determine staff behaviours that reduce anxiety and encourage cooperation of children.Methods: A systematic literature review was conducted using PubMed, Web of Science, The Cochrane Library, PsycINFO, Embase and CINAHL.Results: Initial search returned 31 publications of which 11 fulfilled the criteria for review. Among seven studies that measured anxiety, four used validated measures. Five observational studies coded behaviour using Weinstein et al.’s (1982) coding scheme . An empathic working style and appropriate level of physical contact accompanied by verbal reassurance was found to reduce fear-related behaviours in children. Findings regarding positive reinforcement and dentists’ experience increasing cooperative behaviour were inconsistent.Conclusions: Measures for anxiety and behaviour varied across studies. Relationships between certain dental staff behaviours and child anxiety/behaviour were reported. However, limited work was identified and research using improved sampling, measurement and statistical approach is required.Practice implications: Understanding what routine clinical behaviour of dental staff affects children's dental anxiety/behaviour will inform investigators of how children comply and help staff be aware the significance of their daily behaviour on treatment success.

Asking questions: The effect of a brief intervention in community health centers on patient activation - Corrected Proof

Darwin Deen, Wei-Hsin Lu, Dan Rothstein, Luz Santana, Marthe R. Gold — 2010-08-27

Abstract: Objective: To evaluate the impact of a patient activation intervention (PAI) focused on building question formulation skills that was delivered to patients in community health centers prior to their physician visit.Methods: Level of patient activation and patient preferred role were examined using the patient activation measure (PAM) and the patient preference for control (PPC) measure.Results: More of the 252 patients evaluated were at lower levels of activation (PAM levels 1 or 2) than U.S. population norms before the intervention. Paired-samples t-test revealed a statistically significant increase from pre-intervention to post-visit PAM scores. One-third of participants moved from lower levels of activation to higher levels (PAM levels 3 or 4) post-intervention. Patients preferring a more passive role had lower initial PAM scores and greater increases in their post-intervention PAM scores than did those who preferred a more active role.Conclusion: Patients exposed to the PAI demonstrated significant improvement on a measure of activation. The PAI may be useful in helping patients prepare for more effective encounters with their physicians.Practice implications: The PAI was feasible to deliver in the health center setting and may be a useful method for activating low-income, racial/ethnic minority patient populations.

Using freelisting to understand shared decision making in ADHD: Parents’ and pediatricians’ perspectives - Corrected Proof

2010-08-27

Abstract: Objective: To compare and contrast notions of ADHD among pediatricians and parents of affected children to understand the perspectives they bring to shared decision making (SDM).Methods: In this freelisting study, 60 parents of children with ADHD and 30 primary care pediatricians listed words reflecting their understanding of (1) Attention Deficit Hyperactivity Disorder (ADHD), (2) getting/offering help for ADHD, (3) talking to doctors/families about ADHD, and (4) “mental health.” Smith's salience score established terms that were salient and cultural consensus analysis identified variation within subgroups of participants.Results: Parents’ terms reflected ADHD's effects on the child and family, while clinicians often mentioned school. Lists suggested differing needs and goals for clinicians and subgroups of parents in SDM: “time” for clinicians, “learning” and “understanding” for non-college educated parents, and “comfort” and “relief” for college educated parents. Neither parents nor clinicians framed ADHD in the same way as “mental health.”Conclusion: Parents and clinicians, who conceptualize ADHD differently, should negotiate a shared understanding of ADHD as a basis for SDM. Treatment discussions should be tailored to encompass families’ varied emotional and educational needs.Practice implications: Fostering SDM in primary care is consonant with notions of ADHD as distinct from mental health.

Informed decision-making in prenatal screening for Down's syndrome: What knowledge is relevant? - Corrected Proof

2010-08-27

Abstract: Objective: To determine the content of decision-relevant knowledge needed for informed decision-making about (non-) participation in prenatal screening for Down's syndrome (DS), in order to develop a knowledge questionnaire for routine application in large-scale programme evaluations.Methods: A generic list of content domains for knowledge about screening was extracted from the literature. Items reflecting specific knowledge domains were constructed. An expert group of professionals and pregnant women expressed whether domains and items represented decision-relevant information.Results: All presented domains were scored as (very) important. Options when receiving an ‘increased probability for DS’ test result, the meaning of this result, the aim of the screening, and voluntary nature of the test were scored as most important. The condition being screened for, prevalence, and the screening procedure were scored as relatively less important, with a high amount of expert consensus.Conclusion: A knowledge measure for prenatal screening for DS was developed, based on domains and items acquired by expert consensus.Practice implications: This measure of decision-relevant knowledge can be used in routine, large-scale evaluations of the procedure for offering information about prenatal screening for DS.

The effects of a pedometer-based behavioral modification program with telephone support on physical activity and sedentary behavior in type 2 diabetes patients - Corrected Proof

2010-08-26

Abstract: Objective: Effectiveness of a behavioral modification program on physical activity (PA) and sedentary behavior in diabetes patients.Methods: Ninety-two patients were randomly assigned to an intervention or control group. The 24-weeks intervention consisted of a face-to-face session, pedometer and seven telephone follow-ups. Mean selection criteria were 35–75 years; 25–35kg/m2; ≤12% HbA1c, treated for type 2 diabetes; no PA limitations. PA and sedentary behavior were measured by pedometer, accelerometer and questionnaire over the short- (24 weeks) and intermediate- (1 year) term.Results: The intervention group increased their steps/day by 2744, their total PA by 23min/day (p<0.001) and decreased their sedentary behavior by 23min/day (p<0.05) post-intervention. After 1 year the intervention group still had an increase of 1872 steps/day, 11min/day total PA and a decrease of 12min/day in sedentary behavior (p<0.001).Conclusion: This pedometer-based behavioral modification program with telephone support showed lasting positive effects on steps/day, PA and sedentary behavior.Practice implications: This study tested a convenient way to increase PA among type 2 diabetes patients.

A qualitative study of caregivers’ expectations and communication desires during medical consultation for sick children in Uganda - Corrected Proof

2010-08-26

Abstract: Objective: Little data exist on patients’ expectations and communication desires during medical consultation in Non-Western settings. We conducted a qualitative study to compare expectations and communication desires of sick children's caregivers at Mulago Hospital, Uganda, to those of patients in Western countries.Methods: Three Focus Group Interviews and three Key Informant Interviews were conducted with 24 caregivers of sick children in Mulago Hospital Kampala, Uganda. An interview guide adapted from the Calgary-Cambridge Guide was used to conduct focus group and Key Informant Interviews. Two investigators worked independently to review transcripts and analyse them for content and emerging themes.Results: Caregivers of sick children in Mulago Hospital expect attending doctors to build a relationship with them, by demonstrating the verbal and nonverbal skills outlined in the CCG including maintaining eye contact, using appropriate gestures and voice during communication, and being nonjudgmental.Conclusion: The communication needs and expectations of caregivers of sick children in Mulago Hospital are similar to those of patients and caregivers in Western countries.Practice implications: The CCG can be used as a training guide to enhance the communication skills of current and future doctors in Mulago Hospital.

Risky feelings: Why a 6% risk of cancer does not always feel like 6% - Corrected Proof

Brian J. Zikmund-Fisher, Angela Fagerlin, Peter A. Ubel — 2010-08-26

Abstract: Objective: Emotion plays a strong role in the perception of risk information but is frequently underemphasized in the decision-making and communication literature. We sought to discuss and put into context several lines of research that have explored the links between emotion and risk perceptions.Methods: In this article, we provide a focused, “state of the science” review of research revealing the ways that emotion, or affect, influences people's cancer-related decisions. We identify illustrative experimental research studies that demonstrate the role of affect in people's estimates of cancer risk, their decisions between different cancer treatments, their perceptions of the chance of cancer recurrence, and their reactions to different methods of presenting risk information.Results: These studies show that people have strong affective reactions to cancer risk information and that the way risk information is presented often determines the emotional gist people take away from such communications.Conclusion: Cancer researchers, educators and oncologists need to be aware that emotions are often more influential in decision making about cancer treatments and prevention behaviors than factual knowledge is.Practice implications: Anticipating and assessing affective reactions is an essential step in the evaluation and improvement of cancer risk communications.

Using plausible group sizes to communicate information about medical risks - Corrected Proof

Rocio Garcia-Retamero, Mirta Galesic — 2010-08-23

Abstract: Objective: To make informed health decisions, patients must understand and recall risks, which often involve ratios with large denominators. Grasping the meaning of such numbers may be difficult, because of limited exposure to large groups of people in either our evolutionary history or daily life.Methods: In an experiment (n=98), we investigated whether medical risks are easier to understand and recall if their representation is based on small, evolutionarily plausible groups of people, and whether this representation especially helps patients with low numeracy.Results: Participants—especially those with low numeracy—often disregarded and incorrectly recalled denominators of ratios representing medical risks when the denominators involved were large. Risks were easier to understand and recall if their representation was based on smaller, evolutionarily plausible groups of people.Conclusions: Our results extend previous literature on the role of numeracy in understanding health-relevant risk communications by showing the importance of using plausible group sizes to communicate these risks to people with low numeracy. Our results also support the notion that problems in risk perception occur because of inappropriate presentation formats rather than cognitive biases.Practice implications: Our findings suggest suitable ways to communicate quantitative medical data—especially to people with low numeracy.

A usability study of a computerized decision aid to help patients with, early stage papillary thyroid carcinoma in, decision-making on adjuvant radioactive iodine treatment - Corrected Proof

2010-08-23

Abstract: Objective: We tested the usability of a patient-directed decision aid (DA), intended for patients with early stage papillary thyroid carcinoma (PTC) deciding to accept or reject adjuvant radioactive iodine (RAI) treatment. This decision is complicated by uncertainty of the medical evidence relating to potential treatment benefits.Methods: The DA was tested by 12 thyroid cancer survivors, 7 thyroid specialty physicians, and 30 lay individuals with no history of thyroid cancer. The participants completed the System Usability Scale for human–computer interaction questionnaire. The medical knowledge of lay participants was assessed before and after DA exposure. Qualitative participant feedback was obtained by thinking aloud during DA use, as well as from interviews.Results: Participants generally found the usability of the DA acceptable. The DA significantly increased medical knowledge. In spite of some physicians’ concerns about disclosure of treatment controversy and evidence uncertainty, it was found to be acceptable to non-physicians.Conclusion: A computerized DA on RAI treatment is acceptable to physicians and non-physicians and can improve medical knowledge.Practice implications: In counseling patients about complex medical decisions, disclosure of uncertainty related to medical evidence may be acceptably conveyed using a DA.

HIV patients’ willingness to share personal health information electronically - Corrected Proof

Paul A. Teixeira, Peter Gordon, Eli Camhi, Suzanne Bakken — 2010-08-19

Abstract: Objective: To assess the attitudes of persons living with HIV/AIDS (PLWH) towards having their personal health information (PHI) stored and shared electronically.Methods: PLWH (n=93) in New York City completed surveys using audio computer-assisted self-interview (ACASI) that assessed willingness to share their PHI with various people and entities via a secure electronic network. The survey also included questions on satisfaction with and trust of health care providers, current health, HIV-associated stigma, and frequency of internet access. Data were analyzed with descriptive and multivariate statistical methods.Results: The majority (84%) of individuals were willing to share their PHI with clinicians involved in their care. Fewer individuals (39%) were as willing to share with non-clinical staff. Willingness to share PHI was positively associated with trust and respect of clinicians.Conclusion: PLWH accepted clinicians’ need for access to accurate information. Patients’ trust in their primary care providers highlights the importance of the clinician–patient relationship which can be used to engage patients support for health information exchange initiatives.Practice implications: As electronic storage and sharing of PHI is increasing, clinicians and PLWH should discuss patients’ attitudes towards sharing PHI electronically.

Bringing gender sensitivity into healthcare practice: A systematic review - Corrected Proof

2010-08-19

Abstract: Objective: Despite the body of literature on gender dimensions and disparities between the sexes in health, practical improvements will not be realized effectively as long as we lack an overview of the ways how to implement these ideas. This systematic review provides a content analysis of literature on the implementation of gender sensitivity in health care.Methods Literature was identified from CINAHL, PsycINFO, Medline, EBSCO and Cochrane (1998–2008) and the reference lists of relevant articles. The quality and relevance of 752 articles were assessed and finally 11 original studies were included.Results: Our results demonstrate that the implementation of gender sensitivity includes tailoring opportunities and barriers related to the professional, organizational and the policy level. As gender disparities are embedded in healthcare, a multiple track approach to implement gender sensitivity is needed to change gendered healthcare systems.Conclusion: Conventional approaches, taking into account one barrier and/or opportunity, fail to prevent gender inequality in health care. For gender-sensitive health care we need to change systems and structures, but also to enhance understanding, raise awareness and develop skills among health professionals.Practice implications: To bring gender sensitivity into healthcare practice, interventions should address a range of factors.

A nationwide survey of standardized patients: Who they are, what they do, and how they experience their work - Corrected Proof

Keiko Abe, Debra Roter, Lori H. Erby, Nobutaro Ban — 2010-08-19

Abstract: Objective: Standardized or simulated patients are widely used in medical training, however, little is known about these individuals and their work experience. The current study was designed to describe the SP workforce and gain insight into the routine tasks, challenges and rewards associated with their work.Methods: Using the full 2005 membership list (n=450) of Association of Standardized Patient Educators (ASPE), one SP educator for each medical school across all states was identified, representing a total of 87 different medical schools. Fifty-seven (65%) of the SP educators approached agreed to participate in the study and distribute surveys to 10 SPs in each program.Results: 255 (45%) of the distributed surveys were returned representing the experience of SPs in 57 medical schools across all 6 ASPE geographic regions. Specifics in regard to work scheduling and compensation are reported with some regional differences noted in pay. On the whole, SPs were highly satisfied with their work, but roughly half reported some difficulty with elements of case mastery and providing feedback to learners.Conclusion: SP satisfaction is high but challenges in case mastery and feedback tasks are evident.Practice implications: Meeting training needs can enhance the utility and effectiveness of this workforce.

The effect of spousal communication on contraceptive use in Central Terai, Nepal - Corrected Proof

Kang Yue, Carolyn O’Donnell, Paul L. Sparks — 2010-08-18

Abstract: Objective: Family planning has several social and health benefits; it can reduce maternal mortality and the number of unplanned pregnancies, as well as increase educational and economic opportunities . Utilizing quantitative data from an endline household survey (July 2009) and data from focus group discussions, the Centre for Development and Population Activities (CEDPA) seeks to determine whether spousal communication increases contraceptive use among married women of child-bearing age in Nepal's Central Terai region.Methods: Quantitative household survey and qualitative focus group discussions.Results: Women who discuss family planning with their husbands (OR=7.254), perceive husband approval on family planning (OR=5.558) and have born a son (OR=2.239) are more likely to use a modern contraceptive method. Qualitative data show that several other considerations can be motivating factors for contraceptive uptake.Conclusion: While results do not explain the direction of causality, it is clear that spousal discussion and partner approval are significant in a woman's decision to use modern contraceptives in the Central Terai region of Nepal.Practice implications: More research needs to be conducted on the effect of spousal communication and contraceptive use, in particular, the role of frequency, quality, and content of spousal communication, as well as individual motivations.

“There is nothing to worry about”: Gynecologists’ counseling on mammography - Corrected Proof

Odette Wegwarth, Gerd Gigerenzer — 2010-08-18

Abstract: Objective: In Germany, approximately 10 million women between the ages of 50 and 69 are eligible for biennial mammography screening. Mammography is at the center of much controversy, however, which means gynecologists must provide women considering mammography with sufficient and transparent information. The present study analyzed the information gynecologists share with a person seeking advice about the benefit and harms of mammography screening.Method: To receive realistic data, we called 20 gynecologists practicing in different large cities across Germany and took telephone counseling sessions on the benefit and harms of mammography.Results: The majority of gynecologists described mammography as safe and scientifically well grounded. Harms were rarely mentioned or described as negligible. A minority of gynecologists provided numerical information; when they did, they often quantified the benefit using relative risk reduction and harms using absolute risk increase.Conclusion: A sample of German gynecologists was not able to correctly and transparently communicate the benefit and harms of mammography screening to a patient.Practice implication: Gynecologists should be taught how to understand and transparently explain medical risk information in simple terms.

Breaking through - Corrected Proof

Katharine C. Barnes — 2010-08-16

She, the first year medical student in blue-gray scrubs with a ponytail and an eager expression, was assigned to the ob intern, a non-descript twenty-something with dry sallow skin below his eyes, wearing a white coat loose around the shoulders. She followed him down a hall that looked like the hall she came in through and much like every other hall on every floor of the hospital, brown linoleum, no windows, gurneys pushed out of the way and abandoned, and numbered doors. He paused outside a closed door and shuffled through some papers. She waited. “This will work,” he said and knocked.

Medical students’ self-assessment of performance: Results from three meta-analyses - Corrected Proof

Danielle Blanch-Hartigan — 2010-08-16

Abstract: Objective: Self-assessment is an important component of medical education. Meta-analyses were conducted to better understand accuracy of self-assessment and direction of inaccuracy.Methods: Three meta-analyses were conducted on results from 35 published articles on medical student self-assessment, one for each of the theoretically distinct ways of measuring accuracy of self-reported ability (correlational, paired comparison, and independent means comparison). Characteristics that potentially influence self-assessment accuracy, including gender, year in medical school, and type of self-assessment, were examined.Results: Students are moderately able to self-assess performance and are more accurate later in medical school. Students as a whole do not significantly over- or underestimate, but are more likely to overestimate on communication-based, standardized patient encounters than objective, knowledge-based performance measures. Female students underestimate their performance more than male students, but gender analyses are often unreported.Conclusion: A deeper understanding of the causes and consequences of over- and underestimation is impossible without measurement and reporting of the direction of inaccuracy.Practice implications: To improve our understanding of self-assessment and increase its effectiveness as a teaching tool, research should report self-assessment as both a correlation and a paired comparison, and conduct analyses of important moderators that can influence self-assessment accuracy.

Delivery styles and formats for different stroke information topics: Patient and carer preferences - Corrected Proof

Sally Eames, Tammy Hoffmann, Linda Worrall, Stephen Read — 2010-08-16

Abstract: Objective: To identify the preferences of patients with stroke and their carers for format and delivery style, of different categories of stroke information, and whether these preferences changed over time.Methods: A semi-structured questionnaire, designed to explore preferences for four topic categories was administered to 34 acute stroke unit patients and 18 carers prior to discharge and again, 3 months after discharge to 27 of these patients and 16 of these carers.Results: Overall format preferences were a combination of face-to-face, written and telephone for both patients and carers prior to discharge. This combination continued for carers following discharge, while patients preferred face-to-face, written and alternative formats of online and audiovisual at this time. Patients and carers most frequently preferred delivery styles appeared to be a mix of active and passive delivery styles, across all topics. Access to a telephone hotline was a popular delivery style.Conclusion: Patient and carer preferences varied, supporting the need to offer a variety of formats and delivery styles at each point of contact.Practice implications: By focusing on specific formats and delivery styles for different topics, health professionals may maximise the access to, and relevance of, stroke information for patients and their carers.

The impact of financial incentives on physician empathy: A study from the perspective of patients with private and statutory health insurance - Corrected Proof

2010-08-16

Abstract: Objective: We hypothesized that patients’ ratings of physician empathy (PE) would be higher among those with private health insurance (PHI, referring to financial incentive) than among patients with statutory health insurance (SHI).Methods: A postal survey was administered to 710 cancer patients. PE was assessed using the Consultation-and-Relational-Empathy measure. T-tests were conducted to analyse whether PHI and SHI-patients differ in their ratings of PE and variables relating to contact time with the physician. Structural-equation-modelling (SEM) verified mediating effects.Results: PHI-patients rated physician empathy higher. SEM revealed that PHI-status has a strong significant effect on frequency of talking with the physician, which has a strong significant effect (1) on PE and (2) has a moderate effect on patients’ perception of medical staff stress, thereby also affecting patients’ ratings of PE.Conclusions: Our findings suggest that PHI-status is one necessary precondition for physicians spending more time with the patient. Spending more time with the PHI-patient has two major effects: it results in a more positive perception of PE and positively impacts PHI-patients’ perception of medical staff stress, which in turn, again influences PE.Practical implications: Health policy should discuss these findings in terms of equality in receiving high-quality care.

Chronic condition self-management: Expectations of responsibility - Corrected Proof

Sharon Lawn, John McMillan, Mariastella Pulvirenti — 2010-08-12

Abstract: Objective: While self-management may be beneficial for many patients it assumes and encourages a particular conception of responsibility and self-management that may not fit with all patients’ experience of their chronic conditions and their management. It therefore warrants further examination.Methods: We examine the concept of self-management and responsibility from a range of standpoints, focusing on the Australian context.Results: Attempts to meet people's needs run the risk of imposing specific conceptions of how people should live their lives. While self-management appears to be consistent with placing patients’ needs, values and priorities at the heart of healthcare, ill-defined assumptions about responsibility may confound these goals.Conclusions: Reflection on social determinants of health, the context in which patients seek self-management support from health services, and how their needs and preferences are listened to by health professionals, is critical for the collaborative self-management partnership between them to be effectively realized.Practice implications: Providing services without reflecting on the meaning of self-management for the person with chronic conditions creates unintended assumptions about responsibility, engagement and care provision which may serve to alienate and further stigmatise some patients. Often, these are the very patients with complex needs who need such service support the most.

Development of an ICF-based patient education program - Corrected Proof

Silvia Neubert, Carla Sabariego, Marita Stier-Jarmer, Alarcos Cieza — 2010-08-12

Abstract: Objective: To describe the development of an ICF-based patient education program, to present the results of its pilot test and to present the adaptations and final version of the program.Methods: The education program was developed in five steps: (1) definition of relevant areas of functioning, (2) development of strategies to enhance self-efficacy in these areas, (3) development of material and instructions, (4) definition of modules and setting and (5) performance of a pilot test targeting acceptability and feasibility of the program.Results: Eleven stroke patients were enrolled in the pilot test. The intervention was well accepted on the part of participants. The developed patient education program is structured in three modules. Module 1 targets to increase patients’ understanding of their current level of functioning. Module 2 targets to identify concrete problems and corresponding solutions regarding limited areas. Module 3 is a refresher session.Conclusion: Feasibility and acceptability of the intervention were verified and a final version of the patient education program was developed. The effectiveness of the program will be evaluated in a randomized controlled trial.Practice implications: Due to the universality of the ICF and availability of ICF tools, it is possible to adapt the intervention to different chronic conditions.

Effect of a group-based rehabilitation programme on glycaemic control and cardiovascular risk factors in type 2 diabetes patients: The Copenhagen Type 2 Diabetes Rehabilitation Project - Corrected Proof

Eva Soelberg Vadstrup, Anne Frølich, Hans Perrild, Eva Borg, Michael Røder — 2010-08-11

Abstract: Objective: To compare the effectiveness of a group-based rehabilitation programme with an individual counselling programme at improving glycaemic control and cardiovascular risk factors among patients with type 2 diabetes.Methods: We randomised 143 adult type 2 diabetes patients to either a 6-month multidisciplinary group-based rehabilitation programme or a 6-month individual counselling programme. Outcome measures included glycated haemoglobin (HbA1c), blood pressure, lipid profile, weight, and waist circumference.Results: Mean HbA1c decreased 0.3%-point (95% confidence interval [CI]=−0.5, −0.1) in the rehabilitation group and 0.6%-point (95% CI=−0.8, −0.4) among individual counselling participants (p<0.05). Within both groups, equal reductions occurred in body weight, waist circumference, systolic blood pressure and diastolic blood pressure, but no significant between-group differences between occurred for any of the cardiovascular outcomes. The group-based rehabilitation programme consumed twice as many personnel resources.Conclusion: The group-based rehabilitation programme resulted in changes in glycaemic control and cardiovascular risk factor reduction that were equivalent or inferior to those of an individual counselling programme.Practice implications: The group-based rehabilitation programme, tested in the current design, did not offer additionally improved outcomes and consumed more personnel resources than the individual counselling programme; its broad implementation is not supported by this study.Trial registration Clinicaltrials.gov NCT00284609.

“I wish I’d told them”: A qualitative study examining the unmet psychosexual needs of prostate cancer patients during follow-up after treatment - Corrected Proof

2010-08-11

Abstract: Objective: To gain insight into patients’ experiences of follow-up care after treatment for prostate cancer and identify unmet psychosexual needs.Methods: Semi-structured interviews were conducted with a purposive sample of 35 patients aged 59–82 from three UK regions. Partners were included in 18 interviews. Data were analyzed using constant comparison.Results: (1) Psychosexual problems gained importance over time, (2) men felt they were rarely invited to discuss psychosexual side effects within follow-up appointments and lack of rapport with health care professionals made it difficult to raise problems themselves, (3) problems were sometimes concealed or accepted and professionals’ attempts to explore potential difficulties were resisted by some, and (4) older patients were too embarrassed to raise psychosexual concerns as they felt they would be considered ‘too old’ to be worried about the loss of sexual function.Conclusion: Men with prostate cancer, even the very elderly, have psychosexual issues for variable times after diagnosis. These are not currently always addressed at the appropriate time for the patient.Practice implications: Assessments of psychosexual problems should take place throughout the follow-up period, and not only at the time of initial treatment. Further research examining greater willingness or reluctance to engage with psychosexual interventions may be particularly helpful in designing future interventions.

Comparing the use of evidence and culture in targeted colorectal cancer communication for African Americans - Corrected Proof

2010-08-11

Abstract: Objective: This study examined the effects (affective reactions, cognitive reactions and processing, perceived benefits and barriers and intent to screen) of targeted peripheral+evidential (PE) and peripheral+evidential+socio-cultural (PE+SC) colorectal cancer communications.Methods: This study was a two-arm randomized control study of cancer communication effects on affective, cognitive processing, and behavioral outcomes over a 22-week intervention. There were 771 African American participants, 45–75 years, participating in the baseline survey related to CRC screening. Three follow-up interviews that assessed intervention effects on affective response to the publications, cognitive processing, and intent to obtain CRC screening were completed.Results: There were no statistically significant differences between PE and PE+SC intervention groups for affect, cognitive processing or intent to screen. However, there were significant interactions effects on outcome variables.Conclusions: The advantages and disadvantages of PE+SC targeted cancer communications and implications of sex differences are considered.Practice implications: While there do not appear to be significant differences in behavioral outcomes when using PE and PE+SC strategies, there appear to be subtle differences in affective and cognitive processing outcomes related to medical suspicion and ethnic identity, particularly as it relates to gender.

Knowledge, satisfaction with information, decisional conflict and psychological morbidity amongst women diagnosed with ductal carcinoma in situ (DCIS) - Corrected Proof

Simone De Morgan, Sally Redman, Catherine D’Este, Kris Rogers — 2010-08-10

Abstract: Objective: To assess knowledge, satisfaction with information, decisional conflict and psychological morbidity amongst women diagnosed with ductal carcinoma in situ (DCIS) and to explore the factors associated with less knowledge and greater confusion about DCIS.Methods: A cross-sectional survey of women diagnosed with DCIS in Australia (N=144).Results: This study found misunderstanding and confusion amongst women diagnosed with DCIS and a desire for more information about their breast disease. Approximately half of participants worried about their breast disease metastasizing; approximately half expressed high decisional conflict; 12% were anxious and 2% were depressed. Logistic regression analysis demonstrated that worry about dying from the breast disease was significantly associated with not knowing that DCIS could not metastasize (OR 3.9; 95% CI 1.03–14.25); and confusion about whether DCIS could metastasize was significantly associated with dissatisfaction with information (OR 12.5; 95% CI 3.8–40.2).Conclusion: Good communication about how DCIS differs from invasive breast cancer is essential to alleviating the confusion and worry amongst women with DCIS.Practice implications: Recommendations about how best to communicate a diagnosis of DCIS, including the uncertainties, are needed to guide health professionals to promote better understanding about DCIS and increase the well-being of women with DCIS.

Expanding the reach of decision and communication aids in a breast care center: A quality improvement study - Corrected Proof

2010-08-10

Abstract: Objective: One academically based breast cancer clinic implements decision and communication aids as part of routine clinical care. This quality improvement study aimed to expand reach of these supportive materials and services with budget-neutral program changes.Methods: We used program theory and continuous quality improvement to design changes to our program. We calculated reach as the number of new patient visits for which we administered decision and communication aids. We compared reach before and after the program changes.Results: Program changes included: reassigning program outreach tasks from over-committed to under-utilized personnel; deploying personnel in floating rather than fixed schedules; and creating a waitlist so service delivery was dynamically reallocated from overbooked to underbooked personnel. Before these changes, we reached 208 visitors with decision aids, and 142 visitors with communication aids. Changes were associated with expanded reach, culminating in program year 2008 with the delivery of 936 decision aids and 285 communication aids.Conclusions: We observed over a fourfold increase in decision aid reach and a twofold increase in communication aid reach. We attribute increases to recent program changes.Practice implications: This study illustrates how program theory and quality improvement methods can contribute to expanded reach of decision and communication aids.

Patients’ reaction to the disclosure of rare dreaded adverse events - Corrected Proof

Liana Fraenkel, Ellen Peters — 2010-08-09

Abstract: Background: Physicians must frequently inform their patients of the risks of rare, but serious, adverse events (AEs).Objective: To examine how patients react to the disclosure of rare AEs.Methods: Outpatients viewed a video of a physician describing a medication associated with a rare AE. Subjects then rated their worry, perceived chance of developing the AE, and willingness to take the medication.Results: Non-White men were more likely to perceive a greater chance of developing the AE compared to White men [Adjusted odds ratio (95% CI)=3.37 (1.09–10.45)]; White women were more likely to be worried [2.00 (0.95–4.24)] and to perceive a greater chance of developing the [6.22 (2.50–15.50)], perceive a greater chance of developing the AE [6.27 (2.43–16.15)], and be less willing to take the medication [0.23 (0.09–0.59)], compared to White men.Conclusions: Gender and ethnicity influence how patients react to disclosure of rare, but serious, AEs.Practice implications: An improved understanding of patients’ risk perceptions is required to inform the development of best practices to improve risk communication.

Technicalities: Getting and staying connected to people living with HIV/AIDS in the southern United States - Corrected Proof

Leah Farrell Carnahan, Stefania Fabbri, Karen Ingersoll — 2010-08-05

We read with interest the article by Konkle-Parker, Erlen, and Dubbert in which the authors describe feasibility of conducting a remote telephone-delivered HIV medication adherence intervention study in the southern United States . We are most interested in Konkle-Parker et al.’s discussion of the feasibility of using telephones as a format for intervention delivery. In this study, the two intervention sessions conducted in-clinic were more often completed than the six intervention sessions by telephone. Participants were often unreachable for their telephone intervention sessions despite researchers’ request that participants provide three telephone numbers and the fact that researchers made up to nine call attempts and sent letters in attempt to complete the scheduled telephone intervention sessions.

An exploration of patient decision-making for autologous breast reconstructive surgery following a mastectomy - Corrected Proof

Shelima Begum, Elizabeth A. Grunfeld, Mark Ho-Asjoe, Jian Farhadi — 2010-08-05

Abstract: Objective: The aim of this study was to examine patients’ experiences of the decision to undergo breast reconstructive surgery following mastectomy.Method: 21 Women, who had undergone reconstruction, took part in a semi-structured qualitative interview, which examined the participants’ experience of the decision-making process. The recorded interviews were transcribed verbatim and analyzed using “framework analysis”.Results: Women who underwent immediate reconstruction spoke of the convenience of undergoing only one operation with regards to juggling work and childcare arrangements. For women who underwent delayed reconstructive surgery the reasons centre on dissatisfaction with wearing prosthesis. Others spoke of no choice, as immediate reconstruction was not offered as an option. However both groups did report similar influential factors and received and used similar informational content and informational sources in order to make their decision.Conclusion: The study outlines the different motivations for undergoing immediate or delayed breast reconstruction and highlights that there is not always a choice offered to patients.Practice implications: Future patients who are considering breast reconstruction should be provided with the relevant information to make a well informed decision and may benefit from different methods of information delivery that could include decision aids such as informational booklets, photographs, and videos.

Language barriers and patient-centered breast cancer care - Corrected Proof

Leah S. Karliner, E. Shelley Hwang, Dana Nickleach, Celia P. Kaplan — 2010-08-04

Abstract: Objective: Provision of high quality patient-centered care is fundamental to eliminating healthcare disparities in breast cancer. We investigated physicians’ experiences communicating with limited English proficient (LEP) breast cancer patients.Methods: Survey of a random sample of California oncologists and surgeons.Results: Of 301 respondents who reported treating LEP patients, 46% were oncologists, 75% male, 68% in private practice, and on average 33% of their patients had breast cancer. Only 40% reported at least sometimes using professional interpretation services. Although 75% felt they were usually able to communicate effectively with LEP patients, more than half reported difficulty discussing treatment options and prognosis, and 56% acknowledged having less-patient-centered treatment discussions with LEP breast cancer patients. In multivariate analysis, use of professional interpreters was associated with 53% lower odds of reporting less-patient-centered treatment discussions (OR 0.47; 95% CI 0.26–0.85).Conclusion: California surgeons and oncologists caring for breast cancer patients report substantial communication challenges when faced with a language barrier. Although use of professional interpreters is associated with more patient-centered communication, there is a low rate of professional interpreter utilization.Practice implications: Future research and policy should focus on increasing access to and reimbursement for professional interpreter services.

Evaluating an intervention to increase cancer knowledge in racially diverse communities in South Carolina - Corrected Proof

2010-08-02

Abstract: Objective: To conduct a cancer education intervention with racially diverse communities in South Carolina.Methods: The study was conducted at eight different sites in six counties in SC. The intervention included a 3-h general cancer knowledge and 30-min prostate cancer knowledge component. Pre- and post-intervention surveys were administered. Maximum scores were 31, 10 and 5 for the general cancer knowledge, prostate cancer knowledge and perceived self-efficacy in patient–physician interaction instruments, respectively. Analyses were completed using SPSS 16.0, SAS 9.1.3, and R v2.6.1.Results: The study sample consisted of 164 predominantly African American participants. Most of the participants who reported age were 50+ years (62.5%). Among those who reported income, 46.1% had an annual household income <$40,000. The mean general cancer knowledge pre-test score was 26.2 (standard deviation (SD) 3.7) with a mean post-intervention increase of 2.15 points (p<0.01). The mean pre-test prostate cancer knowledge score was 7.3 (SD 2.0) with a post-intervention increase of 0.48 points (p<0.01). Perceived self-efficacy in patient–physician interaction scores had a ceiling effect.Conclusion: General cancer knowledge and prostate cancer knowledge scores increased following the intervention.Practice Implications: The intervention was successful in the short-term. It could be continued by community members.

Identifying patient information needs about cancer clinical trials using a Question Prompt List - Corrected Proof

2010-08-02

Abstract: Objective: Question Prompt Lists (QPLs) have demonstrated significant promise in facilitating communication in general, surgical and palliative oncology settings yet have not been tested in the oncology clinical trial setting. We aimed to develop a targeted QPL for Clinical Trials (QPL-CT).Methods: Breast, lung, and genitourinary cancer patients who either had (trial experienced) or had not (trial naive) participated in a clinical trial joined focus groups to help develop and explore the acceptability of a QPL-CT. Clinicians also participated in separated focus groups. Focus groups were audio-recorded and transcribed. We explored patients’ trial information needs and views about the utility of the QPL-CT.Results: Patients focused on four trial information needs: understanding foundational information, conflict of interest issues and financial implications of trial participation. Of note, experienced patients need to personalize foundational information.Conclusion: Patient information needs varied considerably and were influenced by trial experience. Patients valued the QPL-CT as an aid to gathering new trial information and ensuring that their information needs were met.Practice implications: Physicians need to carefully elicit patient information needs and tailor trial information to meet these needs. The QPL-CT, may be of great benefit during clinical trial discussions.

Effective training strategies for teaching communication skills to physicians: An overview of systematic reviews - Corrected Proof

2010-07-30

Abstract: Objective: Physicians need good communication skills to communicate effectively with patients. The objective of this review was to identify effective training strategies for teaching communication skills to qualified physicians.Methods: PubMED, PsycINFO, CINAHL, and COCHRANE were searched in October 2008 and in March 2009. Two authors independently selected relevant reviews and assessed their methodological quality with AMSTAR. Summary tables were constructed for data-synthesis, and results were linked to outcome measures. As a result, conclusions about the effectiveness of communication skills training strategies for physicians could be drawn.Results: Twelve systematic reviews on communication skills training programmes for physicians were identified. Some focused on specific training strategies, whereas others emphasized a more general approach with mixed strategies. Training programmes were effective if they lasted for at least one day, were learner-centred, and focused on practising skills. The best training strategies within the programmes included role-play, feedback, and small group discussions.Conclusion: Training programmes should include active, practice-oriented strategies. Oral presentations on communication skills, modelling, and written information should only be used as supportive strategies.Practice implications: To be able to compare the effectiveness of training programmes more easily in the future, general agreement on outcome measures has to be established.

Perceived dominance in physicians: Are female physicians under scrutiny? - Corrected Proof

Marianne Schmid Mast, Judith A. Hall, Christina Klöckner Cronauer, Gaëtan Cousin — 2010-07-30

Abstract: Objective: This research aims at identifying how specific physician verbal and nonverbal behaviors are related to perceived dominance of female and male physicians.Method: Analogue patients (163 students) watched videotaped excerpts of eight physicians and indicated how dominant they perceived each physician to be.Results: Female physicians who spoke more, talked more while doing something else, spoke with louder voices, modulated their voices more, were oriented more toward the patients, sat at a smaller interpersonal distance, were more expansive, and had a more open arm position were perceived as more dominant. These relations were significantly more pronounced in female than in male physicians. With respect to verbal behavior, not agreeing with the patient, structuring the discussion, setting the agenda, and asking questions were related to being perceived as significantly more dominant in female than in male physicians.Conclusion: Patients interpret verbal and nonverbal female and male physicians’ cues differently. If a behavior contradicts gender stereotypes regarding women, this behavior is perceived as particularly dominant in female physicians.Practice implications: To provide optimal care, physicians need to be aware of the expectations their patients harbor toward them—especially expected behavior related to the gender of the physician.

A systematic review of motivational interviewing training for general health care practitioners - Corrected Proof

Lena Lindhe Söderlund, Michael B. Madson, Sune Rubak, Per Nilsen — 2010-07-27

Abstract: Objective: This article systematically reviews empirical studies that have evaluated different aspects of motivational interviewing (MI) training for general health care professionals.Methods: Studies were obtained from several databases. To be included, the MI training had to be provided specifically for general health care practitioners for use in their regular face-to-face counselling. The training outcomes had to be linked to the MI training.Results: Ten studies were found. The median length of the training was 9h. The most commonly addressed training elements were basic MI skills, the MI spirit, recognizing and reinforcing change talk, and rolling with resistance. Most studies involved follow-up training sessions. The study quality varied considerably. Five studies assessed training outcomes at a single point in time, which yields low internal validity. Four studies used random assignment of practitioners to the MI training and comparison conditions. The training generated positive outcomes overall and had a significant effect on many aspects of the participants’ daily practice, but the results must be interpreted with caution due to the inconsistent study quality.Conclusions: The generally favourable training outcomes suggest that MI can be used to improve client communication and counselling concerning lifestyle-related issues in general health care. However, the results must be interpreted with caution due to inconsistent methodological quality of the studies.Practice implications: This review suggests that MI training outcomes are generally favourable, but more high-quality research is needed to help identify the best practices for training in MI.

In Dante's ninth circle - Corrected Proof

William T. Branch — 2010-07-26

Struggling for an excuse, I explained to the man on the phone that I was cutting back on my practice. I had taken the call because it came from my hometown. Now the caller, Walter, played his trump card, “I was having dinner with an old friend of yours on Saturday. He told me I must get you to be the doctor for my brother.” Stuck, I suggested a compromise. I would arrange for his semi-comatose brother's transfer to our University Hospital where he would receive care from our hospitalist team. I would look in on him frequently and be available to advise the family.

Opinions of patients with type 2 diabetes about responsibility, setting targets and willingness to take medication. A cross-sectional survey - Corrected Proof

K.J. Gorter, G.H. Tuytel, J.R.J. de Leeuw, J.M. Bensing, G.E.H.M. Rutten — 2010-07-26

Abstract: Objective: To assess opinions and their determinants of patients with type 2 diabetes about responsibility for managing their diabetes, setting treatment targets and willingness taking medication.Methods: Questionnaire survey carried out in general practices and outpatient clinics across the Netherlands. Outcomes: opinions about responsibility, targets and medication. Multinomial logistic regression analysis.Results: Data of 994 consecutive persons were analysed (mean age 65 years; 54% males). Of these 62% agreed to take responsibility for their diabetes. In the opinion of 89% the setting of targets should be by or in cooperation with their physician or nurse and 40% were willing to take tablets until all targets were attained. Patients who perceived dysfunction by barriers to activity did not agree to take responsibility (OR 3.68; 1.65–8.19). Patients with complications preferred to set targets in cooperation with their physician or nurse (OR 1.98; 1.03–3.80). Males were more willing to take tablets until all targets were attained (OR 1.62; 1.17–2.25).Conclusion: Not all patients want to take responsibility for their diabetes or taking all necessary tablets, especially those with barriers to activity or complications.Practice implications: Doctors and nurses should ask for patients’ opinions about responsibility and treatment goals before starting education.

The effect of school-based cervical cancer education on perceptions towards human papillomavirus vaccination among Hong Kong Chinese adolescent girls - Corrected Proof

Tracy T.C. Kwan, Kar-fai Tam, Peter W.H. Lee, Karen K.L. Chan, Hextan Y.S. Ngan — 2010-07-23

Abstract: Objective: To evaluate the effects of school-based cervical cancer education on Hong Kong Chinese adolescent girls.Methods: Adolescent girls (n=953) in local secondary schools attended a tailored educational program on cervical cancer prevention. Self-administered questionnaires were used before and after the program to measure its effects on participants’ knowledge, attitude and perceived social norms towards human papillomavirus (HPV) vaccination and their intention to be HPV vaccinated.Results: Before the program, HPV vaccine acceptance was favorable but relevant knowledge was low. After the program, participants had greater knowledge and a more positive attitude (both p<0.001), with more girls anticipating family (41.6% before vs. 58.9% after) and peer support (32.8% before vs. 56.9% after). There were 11.3% more girls who indicated an intention to accept the vaccine afterward. More knowledge, a more positive attitude and perceived support from significant others predicted a stronger intention to be HPV vaccinated.Conclusion: The educational program had a positive impact on participants’ perceptions towards HPV vaccination and their intention to be vaccinated.Practice implications: School-based cervical cancer education is a viable means to meet the substantial educational needs of adolescents. Promotion of HPV vaccination should also include educating and influencing perceptions of families and peers.

Preferences for decision-making about contraception and general health care among reproductive age women at an abortion clinic - Corrected Proof

2010-07-22

Abstract: Objective: Studies suggest that not all patients desire shared decision making, and little is known about decision making around contraception. This study compared decision-making preferences for contraception to preferences for general health among reproductive-aged women.Methods: 257 women receiving abortion care in an urban hospital completed a survey which included questions adapted from the Problem-Solving Decision-Making Scale about their preferences for medical decision making.Results: Women were significantly more likely to desire autonomous decision making about contraception than about their general health care (50% vs. 19%, p<.001). No patient characteristics were associated with contraceptive decision-making preferences. Women with Medicaid insurance were more likely to desire autonomous decision making about contraception than about general health care (51% vs. 17%, p<.001).Conclusion: Women desire more autonomy in their contraceptive decisions than in their decisions about general health care.Practice implications: Health care providers should be attentive to the existence of variation in preferences in decision making across health domains. Contraceptive providers should proactively assess decisional preferences to ensure the most appropriate counseling is provided to each individual.

Implementation of Motivational Interviewing in a diabetes care management initiative in the Netherlands - Corrected Proof

Y.J.L. van Eijk-Hustings, L. Daemen, N.C. Schaper, H.J.M. Vrijhoef — 2010-07-21

Abstract: Objective: Motivational Interviewing (MI) is a counseling approach to support behavioural change. The objective of the present study was to examine the uptake of MI in daily practice by health care professionals in a care management initiative for patients with diabetes in the region of Maastricht, the Netherlands.Methods: MI was implemented by means of a training. Directly and six months after the training, the application of MI was measured objectively (MITI) and subjectively (questionnaire). In focus interviews, MI-trained professionals (n=10) and MI untrained professionals (n=10) were asked about facilitators and barriers for implementation. Additionally, data on patient characteristics (n=141) were collected.Results: Spirit of MI was present among professionals directly after the training and increased during follow-up. Mostly uncomplicated techniques were applied. Professionals stated the need for training and practice to be able to apply more complicated techniques.Conclusion: The applicability of MI in daily practice was found feasible, with various degrees of uptake. Relevant conditions to further improve the implementation of MI in daily practice were identified.Practice implications: In daily practice, a phased training in MI is recommended, with sufficient time and support by colleagues as essential conditions to profit most from the training sessions.

Development and pilot testing of a culturally sensitive multimedia program to improve breast cancer screening in Latina women - Corrected Proof

Mita Sanghavi Goel, Gaby Gracia, David W. Baker — 2010-07-20

Abstract: Objective: Our study goal was to assess the effects of a brief patient video on breast cancer knowledge and attitudes among Latina women at a community health center.Methods: We conducted pre- and post-testing of knowledge and attitudes in women aged 40 years or older with active screening referrals (n=91). We compared pre- and post-test knowledge and attitudes overall and by baseline values.Results: Mean knowledge increased from 5.8/10 to 6.9/10 (p<0.05), with the greatest increases in those with low baseline knowledge (p<.001). There were no changes in mean attitudes, which were high at baseline (3.8/5); however, among the 16 women with negative/neutral attitudes, 50% developed positive attitudes after watching the video (p<0.05). Baseline intention to complete screening was high at 98%.Conclusion: Although the overall effects were modest, the greatest improvements were in those with low baseline knowledge scores and negative/neutral baseline attitudes. Future testing should examine the effects in a community-based sample.Practice implications: A brief patient video has promise for influencing patient knowledge and perhaps attitudes while being amenable to integration into clinical flow.

Development of the Hepatitis C Self-Management Program - Corrected Proof

2010-07-20

Abstract: Objective: Chronic hepatitis C infection (HCV) is a major health problem that disproportionately affects people with limited resources. Many people with HCV are ineligible or refuse antiviral treatment, but less curative treatment options exist. These options include adhering to follow-up health visits, lifestyle changes, and avoiding hepatotoxins like alcohol. Herein, we describe a recently developed self-management program designed to assist HCV-infected patients with adherence and improve their health-related quality of life (HRQOL).Methods: The development of the Hepatitis C Self-Management Program (HCV-SMP) was informed by scientific literature, qualitative interviews with HCV-infected patients, self-management training, and feedback from HCV clinical experts.Results: The Hepatitis C Self-Management Program (HCV-SMP) is a multi-faceted program that employs cognitive-behavioral principles and is designed to provide HCV-infected people with knowledge and skills for improving their HRQOL. The program consists of six 2-h workshop sessions which are held weekly. The sessions consist of a variety of group activities, including disease-specific information dissemination, action planning, and problem-solving.Conclusion: The intervention teaches skills for adhering to challenging treatment recommendations using a validated theoretical model. A randomized trial will test the efficacy of this novel HCV self-management program for improving HRQOL in a difficult to reach population.

Moving beyond the language barrier: The communication strategies used by international medical graduates in intercultural medical encounters - Corrected Proof

Parul Jain, Janice L. Krieger — 2010-07-20

Abstract: Objective: To understand the communication strategies international medical graduates use in medical interactions to overcome language and cultural barriers.Methods: In-depth interviews were conducted with 12 international physicians completing their residency training in internal medicine in a large hospital in Midwestern Ohio. The interview explored (a) barriers participants encountered while communicating with their patients regarding language, affect, and culture, and (b) communication convergence strategies used to make the interaction meaningful.Results: International physicians use multiple convergence strategies when interacting with their patients to account for the intercultural and intergroup differences, including repeating information, changing speaking styles, and using non-verbal communication.Practice implications: Understanding barriers to communication faced by international physicians and recognizing accommodation strategies they employ in the interaction could help in training of future international doctors who come to the U.S. to practice medicine. Early intervention could reduce the time international physicians spend navigating through the system and trying to learn by experimenting with different strategies which will allow these physicians to devote more time to patient care. We recommend developing a training manual that is instructive of the socio-cultural practices of the region where international physician will start practicing medicine.

Translating patient education theory into practice: Developing material to address the cardiovascular education needs of people with rheumatoid arthritis - Corrected Proof

2010-07-20

Abstract: Objective: This paper describes the rationale and design of a theory-informed patient education programme addressing cardiovascular disease for people with rheumatoid arthritis (RA) to illustrate how theory can explicitly be translated into practice.Methods: A steering group of rheumatologists and psychologists was convened to design the programme. The Common Sense Model, the Theory of Planned Behaviour and the Stages of Change Model were used to underpin the topics and activities in the programme. User involvement was sought. The programme was formatted into a manual and the reading age of the materials was calculated.Results: A small group 8-week programme was designed. The structure of the patient education programme, including topics, underlying psychological theory as well as behaviour change techniques, is described.Conclusion: This patient education programme addresses a currently unmet educational need for patients with RA and uses theory to design, not just evaluate, the programme. This will allow both enhanced interpretation of the results when the programme is implemented and replication by other units if successful.Practice implications: The actual design and detail of education programmes merit wider dissemination to facilitate progress in the process of development and application.

Communication skills instruction: An analysis of self, peer-group, student instructors and faculty assessment - Corrected Proof

2010-07-20

Abstract: Objective: To explore the correlation of student and faculty assessments of, second-year dental students’ (D2s) communicative skills during simulated patient interviews.Methods: Eighty-two D2s, 14 student instructors and 8 faculty used a 5-point scale, (1=poor–5=excellent) to assess 12 specific communicative skills of D2s generating assessment sources of self, peer-group, student instructor, and faculty. Mean scores and comparisons between assessment sources were calculated. Spearman correlations evaluated relationships between specific skills and assessment sources.Results: Mean assessment score and standard error for peer-group (4.14±0.04), was higher than self (3.86±0.06, p<0.05) yet slightly higher than student instructor (4.07±0.04) and faculty (3.93±0.10). Regarding assessment sources, the degree of correlation from highest to lowest was peer-group and student instructor (ρ=0.46, p<0.0001), self and student instructor (ρ=0.35, p<0.002), self and peer-group (ρ=0.28, p<0.02). The correlations between student instructor and faculty, faculty and self, and faculty and peer-group were nonsignificant.Conclusion: Student assessments were different from faculty by mean score and correlation index. Future studies are needed to determine the nature of the differences found between student and faculty assessments.Practice implications: Peer, student instructor and faculty assessments of dental students’ communicative skills are not necessarily interchangeable but may offer uniquely different and valuable feedback to students.

“Mission Impossible”? Midwives’ experiences counseling pregnant women with gestational diabetes mellitus - Corrected Proof

Margareta Persson, Åsa Hörnsten, Anna Winkvist, Ingrid Mogren — 2010-07-15

Abstract: Objective: Since not all pregnancy-related complications require hospitalization midwives often provide these women with antenatal care and counseling. This study explored the experiences of midwives providing antenatal care and counseling to pregnant women with gestational diabetes mellitus (GDM).Methods: Twelve midwives participated in the interview study performed in the three northernmost counties in Sweden. Grounded theory was used for analysis.Results: The emerging core category was ‘Balancing fear of failure’. The unexpected disease increased the demands and the pressure. Three major conflicting situations were revealed. The midwives believed they were obligated to monitor and control the pregnancy, to initiate and motivate the necessary changes in lifestyle and provide empowering relationships with their patients. The fear of failure with these assignments made the midwives chose different strategies to manage the conflicting situations.Conclusions and practice implications: The midwives described conflicting encounters providing antenatal care to pregnant women with GDM. The fear of failing to fulfill the assignments caused by the GDM made the midwives chose strategies to handle the conflicting encounters. Similar conflicting situations might be present for other health care professionals promoting lifestyle changes. The challenges might be addressed with an organization focusing on support and coaching sessions.

Description and initial evaluation of an educational and psychosocial support model for adults with congenitally malformed hearts - Corrected Proof

Helén Rönning, Niels Erik Nielsen, Eva Swahn, Anna Strömberg — 2010-07-15

Abstract: Objective: Various programmes for adults with congenitally malformed hearts have been developed, but detailed descriptions of content, rationale and goals are often missing. The aim of this study was to describe and make an initial evaluation of a follow-up model for adults with congenitally malformed hearts, focusing on education and psychosocial support by a multidisciplinary team (EPS).Methods: The model is described in steps and evaluated with regards to perceptions of knowledge, anxiety and satisfaction.Results: The EPS model included a policlinic visit to the physician/nurse (medical consultation, computer-based and individual education face-to-face as well as psychosocial support) and a 1-month telephone follow-up. Fifty-five adults (mean age 34, 29 women) with the nine most common forms of congenitally malformed hearts participated in the EPS model as well as the 3-months follow-up. Knowledge about congenital heart malformation had increased in 40% of the participants at the 3-months follow-up.Conclusion: This study describes and evaluates a model that combines a multidisciplinary approach and computer-based education for follow-up of adults with congenitally malformed hearts. The EPS model was found to increase self-estimated knowledge, but further evaluations need to be conducted to prove patient-centred outcomes over time.Practice implications: The model is now ready to be implemented in adults with congenitally malformed hearts.

Patient correspondence after outpatient appointments: What format should it take? - Corrected Proof

Catherine E. Western, James W. Faux — 2010-07-09

In an increasingly patient-orientated health care service, there has been a great deal of interest in copying correspondence to patients after an outpatient appointment and this interest stems from the original NHS Cancer plan in 2000 . It is now accepted as best practice to at least offer copies of clinic letters to patients, not least because it demonstrates an open approach to patient management. In reality however, it is far from widespread practice, with anything from 8 to 87% of patients receiving copies of clinic letters in one review paper from 2007 .

Mediated decision support in prostate cancer screening: A randomized controlled trial of decision counseling - Corrected Proof

2010-07-09

Abstract: Objective: This randomized trial was conducted to assess the impact of a mediated decision support intervention on primary care patient prostate cancer screening knowledge, decisional conflict, informed decision making (IDM), and screening.Methods: Before a routine office visit, 313 male patients eligible for prostate cancer screening completed a baseline telephone survey and received a mailed brochure on prostate cancer screening. At the visit, participants were randomized to either an enhanced intervention (EI) or a standard intervention (SI) group. Before meeting with their physician, EI Group men had a nurse-led “decision counseling” session, while SI Group men completed a practice satisfaction survey. An endpoint survey was administered. Survey data, encounter audio-recordings, and chart audit data were used to assess study outcomes.Results: Knowledge increased in the EI Group (mean difference of +0.8 on a 10-point scale, p=0.001), but decisional conflict did not change (mean difference of −0.02 on a 4-point scale, p=0.620). The EI Group had higher IDM (rate ratio=1.30, p=0.029) and lower screening (odds ratio=0.67, p=0.102).Conclusion: Nurse-mediated decision counseling increased participant prostate cancer screening knowledge, and influenced informed decision making and screening.Practice implications: Nurses trained in decision counseling can facilitate shared decision making about screening.