Patient Education and Counseling - Articles in Press

Genetic counselors’ attitudes towards individuals with schizophrenia: Desire for social distance and endorsement of stereotypes - Corrected Proof

Holly Feret, Laura Conway, Jehannine C. Austin — 2010-03-08

Abstract: Objective: Psychiatric disorders are profoundly stigmatized conditions. Many groups of healthcare professionals harbor negative attitudes towards affected individuals, which may interfere with the healthcare relationship, but genetic counselors’ attitudes towards individuals with psychiatric disorders have not been investigated. Thus, we conducted an exploratory study to assess genetic counselors’ desire for social distance from individuals with schizophrenia, and the degree to which stereotypes about people with schizophrenia were endorsed.Methods: Members of the National Society of Genetic Counselors were invited to complete an online survey, which included scales measuring: desire for social distance from individuals with schizophrenia, and endorsement of positive and negative stereotypes about these individuals.Results: In total, 142 surveys were completed. Genetic counselors expressed greater desire for social distance from an individual with schizophrenia in more intimate proposed relationship scenarios, and felt negative stereotypes about affected individuals were more typifying than positive stereotypes. Experience with psychiatric disorders did not significantly affect desired social distance or stereotypical attitudes.Conclusions: Genetic counselors express some negative attitudes towards individuals with schizophrenia, which may impede the counselor/client relationship. Future research in this area is suggested.Practice implications: Efforts should be made to promote positive attitudes, which would improve the ability of genetic counselors to provide optimal service for individuals with schizophrenia and their families.

New directions in eHealth communication: Opportunities and challenges - Corrected Proof

Gary L. Kreps, Linda Neuhauser — 2010-03-04

Abstract: Objective: This article reviews key communication issues involved in the design of effective and humane eHealth applications to help guide strategic development and implementation of health information technologies.Background: There is a communication revolution brewing in the delivery of health care and the promotion of health fueled by the growth of powerful new health information technologies.Conclusion: The development, adoption, and implementation of a broad range of new eHealth applications (such as online health information websites, interactive electronic health records, health decision support programs, tailored health education programs, health care system portals, mobile health communication programs, and advanced telehealth applications) holds tremendous promise to increase consumer and provider access to relevant health information, enhance the quality of care, reduce health care errors, increase collaboration, and encourage the adoption of healthy behaviors.Practice implications: With the growth of new and exciting health information technology opportunities, however, comes the daunting responsibility to design interoperable, easy to use, engaging, and accessible eHealth applications that communicate the right information needed to guide health care and health promotion for diverse audiences.

Effectiveness of self-management interventions on mortality, hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure: A systematic review - Corrected Proof

Joanne B. Ditewig, Helene Blok, Jeroen Havers, Haske van Veenendaal — 2010-03-04

Abstract: Objective: This review examined the effectiveness of self-management interventions compared to usual care on mortality, all-cause hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure.Methods: A systematic review was performed. MEDLINE, EMBASE, CINAHL and the Cochrane Library were searched between 1996 and 2009. Randomized controlled trials were selected evaluating self-management interventions designed for patients with chronic heart failure. Outcomes of interest are mortality, all-cause hospital readmissions, chronic heart failure hospitalization rate and quality of life.Results: Nineteen randomized controlled trials were identified. The effectiveness of heart failure management programs initiating self-management interventions in patients with chronic heart failure indicate a positive effect, although not always significant, on reduction of numbers of all-cause hospital readmitted patients and due to chronic heart failure, decrease in mortality and increasing quality of life.Conclusion: This systematic review found that current available published studies show methodological shortcomings impairing validation of the effectiveness of self-management interventions on mortality, all-cause hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure.Practice implications: Further research should determine independent effects of self-management interventions and different combinations of interventions on clinical and patient reported outcomes.

From patient education to patient engagement: Implications for the field of patient education - Corrected Proof

2010-03-04

Abstract: Objective: Advances in health care require that individuals participate knowledgeably and actively in their health care to realize its full benefit. Implications of these changes for the behavior of individuals and for the practice of patient education are described.Methods: An “engagement behavior framework” (EBF) was compiled from literature reviews and key informant interviews. To assess the focus of research and interventions on the identified engagement behaviors, the EBF was used to code scientific sessions in professional conferences relevant to patient education in the US in 2006–2007.Results: Many specific behaviors constitute engagement. Professional conferences on patient education show only modest attention to the full range of relevant behaviors.Conclusion: People must make informed choices about insurance and clinicians, coordinate communications among providers and manage complex treatments on their own. Not doing so risks preventable illness, suboptimal outcomes and wasted resources.Practice Implications: Increased responsibilities of individuals, sick and well, to find and actively participate in high quality health care provides an opportunity for patient education researchers and clinicians to improve health outcomes by developing innovative strategies to support all individuals to effectively participate in their care to the extent possible.

A history of patient education by health professionals in Europe and North America: From authority to shared decision making education - Corrected Proof

Ciska Hoving, Adriaan Visser, Patricia Dolan Mullen, Bart van den Borne — 2010-03-02

Abstract: Objective: This paper describes the development of patient education from the 1960s until now and identifies future challenges to improve patient education.Results: Patient education developed from the health care professional deciding what the patient needed to know to a shared decision making design where physician and patient are equally influential on the decision making process. The development of patient education is described for primary and secondary health care, as well as the impact of biomedical advances, an ageing population and cultural diversity on patient education. Some of the challenges for future patient education are identified: training health professionals as well as patients, involvement of the patient's social environment and application of e-Health techniques to patient education.Conclusion: Patient education has made several developmental changes, has spread to different settings in health care and has now finally established itself as a valuable part of health care for patients. Nevertheless, both patients and health professionals still need to be provided with skills to optimize patient education. A good science-practice fit for future interventions to facilitate patient education is paramount.Practice implication: Lessons from the past of patient education are important for the growth and future development of patient education.

Reporting quality of nursing home care by an internet report card - Corrected Proof

Noémi C. Van Nie, Louk J.M. Hollands, Jan P.H. Hamers — 2010-03-02

Abstract: Objective: This study was designed to test an internet report card containing information about quality indicators (e.g., pressure ulcers, falls) as well as assessments of consumer satisfaction and of quality of care by the Netherlands Health Care Inspectorate in nursing homes.Methods: Employing a laboratory-type experimental design, 278 current and future consumers and representatives of nursing homes were asked to make quality assessments based on report cards of imaginary nursing homes. They were also asked their opinions of the report cards.Results: The participants were positive about the internet report card and considered it satisfactory. However, they did make some suggestions for improvement, such as using more understandable terminology. It also became evident that the information on the card must be complete; the omission of information resulted in more negative views of the nursing home.Conclusion: The results show that an internet report card can be a useful tool that enables consumers to assess the quality of nursing home care. Further research is needed to examine whether the report card will actually be used by consumers to make decisions regarding nursing home care.Practice implications: The internet report card is a practical tool that can empower consumers, as it facilitates comparisons between nursing homes.

Development and implementation of a patient reported outcome intervention (QLIC-ON PROfile) in clinical paediatric oncology practice - Corrected Proof

2010-03-02

Abstract: Objective: The use of patient reported outcomes (PRO) in routine clinical practice is becoming increasingly common, but there is limited knowledge about the development and implementation of PRO. The objective of the current paper is to provide a thorough description of the development and implementation of a PRO on health related quality of life (HRQOL) – the QLIC-ON PROfile – in clinical paediatric oncology practice.Methods: The development of the QLIC-ON PROfile is explained by elucidating important choices: the HRQOL instrument, the professional that uses the QLIC-ON PROfile, the optimal form of HRQOL feedback and whether or not a clinically important difference is reported. The description of the implementation of the QLIC-ON PROfile focuses on the education and commitment of the professional that uses the QLIC-ON PROfile. Study design and outcome measures are also elaborated on.Results: Important considerations regarding the development and implementation of PRO interventions are reported. These considerations have also resulted in educational material.Conclusion: Our study adds to current knowledge of PRO research. This paper can be used as a practical guide for researchers and other professionals, who are interested in setting up PRO interventions in any clinical setting.

“It helps me see with my heart”: How video informs patients’ rationale for decisions about future care in advanced dementia - Corrected Proof

Kristy S. Deep, Ashley Hunter, Kevin Murphy, Angelo Volandes — 2010-03-02

Abstract: Objective: To explore how a video of a patient with advanced dementia impacts the rationale for patients’ decisions about future care.Methods: Participants were read a verbal description of advanced dementia and asked their preferences for future care—either life-prolonging, limited, or comfort care—and the rationale for that choice. Participants then watched a video of a patient with advanced dementia and again stated their preferred level of care and the rationale. Thematic content analysis was utilized to develop common themes among the rationale of participants in each response category.Results: We interviewed 120 participants. The rationale of those who initially chose life-prolonging or limited care (47/120) emphasized lengthening life and cited an inherent good of medical treatment. Those who initially chose comfort care (60/120) focused on avoiding suffering and quality of life. Post-video, 107/120 participants chose comfort care and the rationale focused on the experience of the patient and family rather than treatment-centered considerations. Participants found great value in the video images.Conclusions: While pre-video reasoning reflects general beliefs about extending life and the inherent good of treatment, the post-video reasoning reveals more focus on the experience of the actual patient and family.Practice implications: Video may serve an important role in advanced care planning by enriching the understanding of the condition and allowing one to imagine a future health state.

Patient use of weight-management activities: A comparison of patient and physician assessments - Corrected Proof

Sara N. Bleich, Mary Margaret Huizinga, Mary Catherine Beach, Lisa A. Cooper — 2010-03-02

Abstract: Objective: Examine concordance between patient and physician assessments of patient self-reported use of weight-management activities.Methods: Analysis of baseline data from a randomized controlled trial of patient and physician interventions to improve patient–physician communication (41 physicians and 274 of their patients).Results: A majority of patients reported regular exercise (55.6%) and efforts to lose weight, such as eating less (63.1%) while physicians only perceived one-third of patients as engaging in those activities (exercise, 36.6%; weight loss, 33.3%). Kappa scores indicated small agreement between patient and physician assessments of patient self-reported use of exercise, mean kappa 0.28 (range 0.15 to 0.40) and no agreement between patient and physician assessments of patient self-reported efforts to lose weight, mean kappa −0.14 (range −0.26 to −0.01). Obese patients were more likely than non-obese patients to report trying to lose weight or exercising regularly (p<0.05), but physicians were less likely to perceive obese patients as engaging in those activities (p<0.05).Conclusions: Primary care physicians differed considerably from their patients, especially obese patients, in their assessments of patient use of weight-management activities.Practice implications: These results highlight the importance of improving patient–provider communication about weight-management activities, particularly among obese patients.

Effect of the evaluation of recall on the rate of information recalled by patients in Primary Care - Corrected Proof

2010-03-02

Abstract: Objective: To analyse whether asking the patient to restate the recommendations they receive before leaving the surgery improves the recall rate once the consultation is finished.Methods: Observational study in 37 Primary Care Consultant (PCC) in health centres of the city of Albacete. The final sample had 963 patients.Results: The mean rate of recommendations remembered after leaving the surgery was better in the group of patients that restated the recommendations before finishing the doctor–patient encounter than in the group where there was no restatement (p=0.000). The amount of recommendations showed a negative correlation with the recall rate (r=−0.215).Conclusion: Asking patients to repeat treatment recommendations is an effective method of improving the recall of these prescriptions at the end of doctor–patient encounter.Practical implications: The importance of communication between health-care professionals and patients justifies the performance of studies so that it can be improved and, according to the results of this study, it would be advisable to use the method proposed on a more regular basis by the PCC as a way of improving communication and recall of medical advice.

Reevaluation of the effect of mandatory interpreter legislation on use of professional interpreters for ED patients with language barriers - Corrected Proof

2010-03-02

Abstract: Objective: We sought to compare emergency department (ED) use of professional interpreters in 2008 to previously reported 2002 data.Methods: We surveyed consecutive adult patients for two 24-h periods at 4 Boston EDs in 2008. We used identical questions as in our 2002 study to assess English language barriers and to measure use and type of interpreter for those with language barriers.Results: We enrolled 498 patients (66% of eligible). Of these, 8% had a significant English language barrier, but any interpreter was used for only 69% of these patients; the corresponding data for 2002 were 11% and 89%, respectively. In 2008, compared to 2002, professional interpreter use was similar (18% vs. 15%; p=0.70), but a friend or family member interpreted more often (59% vs. 24%; p<0.001), and hospital staff less often (10% vs. 47%; p<0.001).Conclusion: We found that use of professional interpreters by Boston ED patients with language barriers remained low, despite publicity of the state mandatory interpreter law. However, a majority were comfortable with a friend or family member serving as the interpreter for the clinical encounter, a finding that may contribute to the limited usage of professional interpreters.

Smoking intentions and mood preceding lapse after completion of treatment to aid smoking cessation - Corrected Proof

Eleni Vangeli, John Stapleton, Robert West — 2010-03-02

Abstract: Objective: To examine the situation preceding “late” smoking relapse, particularly the availability of tobacco, mood and intentions at first lapse.Methods: A questionnaire was sent to 1439 adults identified as abstinent after treatment with a National Health Service stop-smoking clinic over the previous 3 years. Relapsers were asked where they had obtained their first cigarette, their mood and intentions immediately before first lapse.Results: 40% (n=556) responded, of whom 35.8% (n=199) had relapsed. At the time of first lapse, only 27.1% had made a decision to return to smoking while 48.9% intended to smoke only one or two cigarettes before stopping again. In 45.7% of cases, respondents bought cigarettes to smoke again. Prior to lapse the majority (53.8%) reported “really needing a cigarette”. Similarly 53.8% reported being miserable at the time, while only 16% were happy.Conclusion: The most common pattern of late lapse appears to be intending to suspend the quit attempt temporarily in circumstances of needing to smoke and of negative emotional state, and in many cases cigarettes are actually sought out.Practice implications: Promoting strong ‘not a puff’ rules, a non-smoker identity and identifying negative mood as a potential vulnerability are important components of relapse prevention intervention.

Toward a theory of patient and consumer activation - Corrected Proof

Judith H. Hibbard, Eldon Mahoney — 2010-02-26

Abstract: Objective: The purpose of this study is to begin the process of developing a theory of activation, to inform educational efforts and the design of interventions. Because the experience of positive emotions in daily life, tends to widen the individual's array of behavioral responses and increase their openness to new information, we examine how emotions relate to activation levels.Methods: A web survey was carried out in 2008 with a National sample of respondents between the ages of 25–75. The study achieved a 63% response rate with a final sample size of 843.Results: The findings indicate that activation is linked with the experience of positive and negative emotion in daily life. Those low in activation are weighted down by negative affect and negative self-perception.Conclusions: Bringing about change in activation, likely means breaking this cycle of negative self-perception and emotions.Practice implications: Experiencing success can start a positive upward cycle, just like failure produces the opposite. By encouraging small steps toward improving health, ones that are realistic, given the individuals level of activation, it is possible to start that positive cycle. Effective educational efforts should focus on improving self-efficacy and the individual's self-concept as a self-manager.

From patient compliance to empowerment and consumer's choice: Evolution or regression? An overview of patient education in French speaking European countries - Corrected Proof

Alain Deccache, Karin van Ballekom — 2010-02-26

Abstract: Objective: This paper presents a historical overview of patient education in French speaking (parts of) countries of Europe, as well as the emergence of new concepts in Health care and education. Further it describes the results of research and studies on current practice and political decisions and positions about patient education, based upon laws and regulations. The present trends will be discussed, and propose an overview of the next possible developmental steps.Methods: Articles, reports and policy documents about publications on patient education in French speaking (parts of) countries of Europe.Results: In the last years, in France, Belgium, Switzerland, Luxemburg, patient education has undergone a lot of changes whether in theories, models, policies or practice. These changes came with the emergence of concepts such as effectiveness of care, chronic disease follow-up, compliance, adherence, health promotion, empowerment, salutogenesis, resilience, patients’ rights, health care costs control, coaching, disease management, consumer choice, and participation. Each of these concepts seems to have been defined and implemented in various ways, according to settings or countries. Political and social choices seem to have oriented choices from humanistic approaches to pragmatic decisions, with ethical problems rising. Consensus on definitions are often hard to reach, especially among policy makers, health care teams, health managers, and patient organizations, even though these concepts do coexist in daily practice, sometimes in very conflictual ways.Conclusions: Hard or subtle, changes are happening in patient education and cannot be ignored.Practice implication: Many questions rise on the future of patient education, wondering how to anticipate next models of health care practice, and their ethical and social stakes. Clear positions need to be taken.

The loss of reason in patient decision aid research: Do checklists damage the quality of informed choice interventions? - Corrected Proof

Hilary L. Bekker — 2010-02-22

Abstract: Objective: To discuss whether using the International Patient Decision Aids Standards (IPDAS) Collaboration checklist as a gold standard to judge interventions’ quality is premature and potentially detrimental to the validity of resources designed to help patients make treatment choices.Methods: Conceptual review integrating the science behind individuals’ decision making with the demands of designing complex, healthcare interventions.Results: Patient decision aids are promoted as interventions to help professionals engage in shared and/or patient-centred care. The IPDAS domains were informed by experts’ opinions of best practice. Decision scientists study how individuals make decisions, what biases their choices and how best to support decisions. There is debate from decision scientists about which component parts are the active ingredients that help people make decisions.Conclusions: Interventions to help patients make choices have different purposes, component parts and outcomes to those facilitating professional–patient communications. The IPDAS checklist will change to respond to new evidence from the decision sciences.Practice implications: Adhering uncritically to the IPDAS checklist may reduce service variation but is not sufficient to ensure interventions enable good patient decision making. Developers must be encouraged to reason about the IPDAS checklist to identify those component parts that do (not) meet their intervention's purpose.

Monitoring quality of care in nursing homes and making information available for the general public: State of the art - Corrected Proof

Monique F.M.T. Du Moulin, Jolanda C.M. van Haastregt, Jan P.H. Hamers — 2010-02-22

Abstract: Objective: To improve quality of care, nursing homes need to assess and monitor their performance. This study aims to gain insight in the availability and contents of publicly accessible quality systems in northwestern Europe and the USA.Methods: This study employed a systematic search consisting of searching bibliographic sources from 2005 to September 2009, personal communication with experts, a conventional internet search, and hand-searching of references.Results: Ten out of the 14 included countries use a quality systems. There is a large variety in type and number of indicators assessed. In general more attention is paid to the assessment of structure and process indicators, compared to outcome indicators. The countries differ in the way the results are made available to the general public.Conclusion: It can be concluded that monitoring and publicizing data on quality of care in nursing homes is becoming increasingly widespread. However, the systems still need further development and refinement.Practice implications: The systems need to be further developed regarding validity and reliability. Furthermore, the uniformity of the systems should be increased, more attention must be paid to the assessment of patient satisfaction, and additional insight must be gained in the user-friendliness of the systems.

Helping patients choose: How to improve the design of comparative scorecards of hospital quality - Corrected Proof

Barbara Fasolo, Elena Reutskaja, Anna Dixon, Tammy Boyce — 2010-02-22

Abstract: Objective: To understand how the public understand comparative quality information as presented on NHS Choices, the Department of Health website in England. We explore what quality information people value, how they understand different measures of quality, and their preferences for different types of information.Method: Seven focus groups were conducted.Results: Participants’ preferences for types of information changed at different stages of the focus groups. Participants attempted to compare hospitals option-wise, building up an overall picture of the hospital's performance. Faced with abundance of conflicting criteria, participants attempted to make trade offs, but found it difficult. Older and less numerate participants used summative measures to overcome this difficulty. Some indicators were poorly understood and the multiplicity of formats and labels was confusing. Missing data were mistrusted.Conclusion: The presentation of information affects what information people value, how they understand and process it. The design of scorecards is crucial in order to support use of scorecards for informed patient choice.Practice implications: We offer guidelines for changing presentation of comparative quality information with the aim to improve its use by patients when choosing between hospitals, especially online.

Improving patient education by an in-service communication training for health care providers at a cancer ward: Communication climate, patient satisfaction and the need of lasting implementation - Corrected Proof

Adriaan Visser, Michel Wysmans — 2010-02-22

Abstract: Objective: To show the effects of an in-service communication training for health care providers at a cancer ward, to improve the quality and quantity of the patient education, and patient satisfaction with the care received.Methods: A 3-year in-service communication training was held at a cancer ward. Pre- and post-data were collected about the quality and quantity of the communication of nurses, physicians and other health care providers (HCPs) towards patients and colleagues (n=22) as well as the satisfaction of the patients with the quality of care (n=90).Results: The communication training raised significantly the quality and quantity of the communication towards patients and with colleagues. Also patient satisfaction with the quality of care increased. However, the long-term implementation of the benefits was proved disappointing.Conclusion: In-service communication training is an important means for the long-term improvement of the quality of patient education at nursing departments in hospitals. Lasting implementation of the benefits however requires attention to organizational obstacles, budgetary conditions, leadership factors at the ward, and the application of an organizationally oriented theoretical framework.Practice implications: Improvement of patient education at nursing wards does not only require educational means, organizational facilities and professional training, but can be improved too by in-service communication training, which increases the quality of the patient-centered care. An organizational oriented change-strategy is needed to ensure the implementation produces lasting effects.

Do antidepressant advertisements educate consumers and promote communication between patients with depression and their physicians? - Corrected Proof

Robert A. Bell, Laramie D. Taylor, Richard L. Kravitz — 2010-02-22

Abstract: Objective: To examine how online depression support group members respond to direct-to-consumer (DTC) antidepressant advertising.Methods: Survey of 148 depression forum members, administered via an online questionnaire.Results: Chronicity was high, as 79.1% had received a diagnosis of depression 3 or more years earlier. Respondents reported seeing advertisements for an average of 4.3 of seven brands investigated. A majority rated the information quality of these advertisements as “poor” or “fair.” Attitudes toward antidepressant advertisements were neutral (mean: 2.96 on a five-point scale). More than half (52.4%) visited official websites provided in these advertisements, 39.9% had talked with a doctor after seeing an advertisement, 20.3% made an advertisement-induced prescription request, and 25.7% said these advertisements reminded them to take their antidepressants. Amount of attention given to these advertisements correlated positively with belief in the brain chemical imbalance causal model, but belief in this model did not predict prescription requests.Conclusion: Awareness of DTC antidepressant advertisements is high among individuals with depression, but so is skepticism.Practice implications: Among members of an online support group, these advertisements encourage patient–doctor dialogue, prescription requests, and adherence, but might also reduce the acceptability of psychotherapy and encourage doctor switching in a small number of patients.

Multidimensional analysis of treatment adherence in patients with multiple chronic conditions. A cross-sectional study in a tertiary hospital - Corrected Proof

2010-02-18

Abstract: Objective: Determine treatment adherence in patients with multiple chronic conditions (MCC).Methods: A random patient sample ≥15 years, discharged from hospital with ≥1 chronic conditions (CC) was interviewed after 6–12 months. Analysis included variables in 5 dimensions (WHO): socio-demographics, disease, treatment, patient and health system characteristics. Morisky–Green adherence questionnaire was used. High chronic treatment complexity was defined as: >3 pills/day, >6 inhalations/day, >1 injection/day, pharmacological treatment plus diet or self-monitoring techniques.Results: 301 patients were interviewed (62±15 years, 59% males). Despite good treatment information perception (79%), only 3% followed the patient education programme. Poor adherents (82%) were older (64±14 years vs. 55±16 years), had more CC (3.25±2.02 vs. 2.62±2.72), a higher frequency of hypertension (44% vs. 15%), ischaemic heart diseases: (21% vs. 4%), hyperlipidaemia (19% vs. 6%), more pills/day (5.78±4.14 vs. 3.20±4.70) and more complex treatments (95% vs. 70%) (p<0.05). On multivariate analysis number of CC [3.68 (0.75–18.15)], pills/day [2.23 (1.02–4.84)], treatment complexity [4.00 (1.45–11.04)], and hypertension [2.57 (1.06–6.25)] were predictive of poor adherence (OR 95% CI p<0.05).Conclusion: The WHO conceptual framework allows the construction of poor adherence risk profiles in patients with MCC after hospital discharge.Practice implications: Predictive variables of poor adherence could help clinicians detect patients with MCC most likely to present poor adherence.

A randomized trial of pictorial versus prose-based medication information pamphlets - Corrected Proof

Andrew E. Thompson, Mark A. Goldszmidt, Alan J. Schwartz, Philip G. Bashook — 2010-02-15

Abstract: Objective: The goal of this study was to compare prose and pictorial-based information pamphlets about the medication methotrexate in the domains of free recall, cued recall, comprehension and utility.Methods: A single blind, randomized trial of picture versus prose-based information pamphlets including 100 participants aged 18–65 years of age, who had not completed high school, could read English, and had no prior knowledge about methotrexate. Superiority of pamphlet type was assessed using immediate free recall, cued recall and comprehension.Results: There were no differences between picture and prose pamphlets in free recall, cued recall, and comprehension either immediately or after a 1-week interval. Immediate free recall of important information was 17–26%; free recall fell even lower to 7–16% after 1 week. The pictorial pamphlet was preferred over the prose-based pamphlet.Conclusion: This study found no benefit in free recall, cued recall, or comprehension through the addition of pictograms to a simple prose-based medication pamphlet.Practice implications: In order for them to be effective in clinical practice, even simple medication information pamphlets that have been assessed for patients’ ability to comprehend them cannot be used as the sole means for conveying important medication-related information to patients.

Helping women make choices about mammography screening: An online randomized trial of a decision aid for 40-year-old women - Corrected Proof

E. Mathieu, A.L. Barratt, K. McGeechan, H.M. Davey, K. Howard, N. Houssami — 2010-02-12

Abstract: Objective: To evaluate the effect of a decision aid (DA) on women's knowledge of the benefits and harms of screening and on their ability to make an informed decision.Methods: An online randomized controlled trial among 321 women aged 38–45 years was conducted. Participants were randomized to either immediate or delayed access to the online DA which (i) explained the benefits and harms, (ii) included a values clarification exercise and a worksheet to support decision making. The primary outcome, knowledge of benefits and harms of screening, and secondary outcomes, informed choice (composite of knowledge, values and intention), anxiety and acceptability of the DA were measured using online questionnaires.Results: Women in the intervention group were more knowledgeable (mean score out of 10, 7.35 vs 6.27, p<0.001) and were more likely to have made a decision (82% vs 61% p<0.001). Of those who made a decision, women in the intervention group were less likely to start screening now (52% vs 65% p=0.05). There was no significant difference in the proportion of women who made an informed choice (71% intervention group vs 64% control group, p=0.24). The DA was helpful, balanced and clear, and did not make women anxious.Conclusions: The DA increased knowledge and reduced indecision, without increasing feelings of anxiety.Practice Implications: This decision aid is easy to access online and could be an inexpensive way of supporting women aged 40 who are considering whether to start screening now, or wait until they are 50. The results of this study demonstrate the potential of DAs to help inform women about both the benefits and risks of screening at this age and to support women and clinicians in this decision making process.

Heart failure patients with a lower educational level and better cognitive status benefit most from a self-management group programme - Corrected Proof

2010-02-12

Abstract: Objective: The Chronic Disease Self-Management Programme (CDSMP)was recently evaluated among patients with congestive heart failure (CHF) in a randomized controlled trial (n=317) with twelve months of follow-up after the start of the programme. That trial demonstrated short-term improvements in cardiac-specific quality of life. The current study assessed which of the patients participating in this trial benefited most from the CDSMP with respect to cardiac-specific quality of life.Methods: Subgroup analyses were conducted using mixed-effects linear regression models to assess the relationship between patient characteristics and the effects of the CDSMP on cardiac-specific quality of life.Results: In the short term, patients with better cognitive status benefited more from the CDSMP than their poorer functioning counterparts. In addition, lower educated patients benefited more from the CDSMP than their higher educated counterparts during total follow-up.Conclusion: Subgroup effects were found for cognitive status and educational level. Future research should be performed to validate current findings and further explore the conditions under which CHF patients may benefit more from the programme.Practice implications: These results indicate that lower educated patients, in particular, should be encouraged to participate in the CDSMP. In addition, healthcare practitioners are recommended to take into account potential cognitive impairments of patients.

Road to help-seeking among (dedicated) human service professionals with burnout - Corrected Proof

Katarina Putnik, Ad de Jong, Petra Verdonk — 2010-02-12

Abstract: Objective: Describe and interpret the process of help-seeking among human service professionals with burnout.Methods: Semi-structured interviews were conducted with 14 participants. Analysis was conducted using principles of grounded theory.Results: All participants were dedicated and responsible workers, selflessly giving themselves to their work. Work was demanding, and often included some form of organisational change. After a period of time the problems of ill health appeared, since persons were overstretching their resources. However, the symptoms were denied, since the image of the ideal worker has been internalised and persons expected maximum performance from themselves. They kept on working hard and delayed the help-seeking process. Eventually, help was sought for medical symptoms or by talking to the supervisors. If postponed for too long, persons experienced a breaking point.Conclusion: Human service professionals with burnout internalise the ideal image of their professional role. They strive to keep this ideal image at the cost of their own needs, taking a long time to seek help for the obstacles they encounter.Practice implications: More awareness raising is needed in order to recognise early burnout symptoms. Particularly crucial in this process are supervisors and doctors, who have an authority role over employees.

The effect of physical activity on weight loss is mediated by eating self-regulation - Corrected Proof

2010-02-12

Abstract: Objective: This study tested whether different forms of physical activity (PA) were associated with eating self-regulation during weight control, and if changes in eating behavior mediated the relationship between PA and weight loss, in overweight/obese women.Methods: 239 women (37.6±7.0 years; 31.3±4.1kg/m2) participated. The intervention group received a 12-month group behavioral treatment designed to increase autonomy and self-regulation for weight control. Controls received a health education program. Assessments included body weight, structured and lifestyle exercise/PA, and eating self-regulation.Results: Moderate+vigorous and lifestyle PA were associated with 12-month change in most eating variables (p<0.05) and with body weight change (p<0.01). Mediation analysis showed that flexible cognitive restraint and emotional eating fully mediated the relation between lifestyle PA and weight change (effect ratio: 0.63). About 34% of the effect of moderate+vigorous PA on weight change was explained by these same mediators (partial mediation).Conclusion: Exercise and PA may positively influence weight control through eating self-regulation. Flexible dietary control and reduced emotional overeating are mechanisms by which an active lifestyle can contribute to long-term weight management.Practice implications: Regular exercise and PA can contribute to improved eating behaviors during weight management. This could represent an important incentive for people seeking weight control.

Poetry therapy - Corrected Proof

Jack Coulehan — 2010-02-12

Many years ago I received an urgent Friday afternoon consult from the surgery service. “Incipient DTs,” the resident told me. “We’ve got this guy, status-post pancreatitis, post-op cholecystectomy, he's going down the tube.” It turned out that the patient was an irascible middle-aged man named Chuck Benderton who a day or so after surgery had gotten agitated and started to swear at his doctors. So they concluded that he was slipping into an alcohol withdrawal syndrome and snowed him with Serax and thiamine.

Outcome of parent–physician communication skills training for pediatric residents - Corrected Proof

2010-02-08

Abstract: Objective: Communication skills represent an essential component of clinical competence. In the field of pediatrics, communication between physicians and patients’ parents is characterized by particular difficulties. To investigate the effects of a parent–physician communication skills training program on OSCE performance and self-efficacy in a group control design.Methods: Parallel to their daily work in the outpatient department, intervention-group experienced clinicians in practice (n=14) participated in a communication training with standardized parents. Control-group physicians (n=14) did not receive any training beyond their daily work. Performance was assessed by independent video ratings of an OSCE. Both groups rated their self-efficacy prior to and following training.Results: Regarding OSCE performance, the intervention group demonstrated superior skills in building relationships with parents (p<.024) and tended to perform better in exploring parents’ problems (p<.081). The communication training program led to significant improvement in self-efficacy with respect to the specific training objectives in the intervention group (p<.046).Conclusion: Even in physicians with considerable experience, structured communication training with standardized parents leads to significant improvement in OSCE performance and self-efficacy.Practise implications: Briefness and tight structure make the presented communication training program applicable even for experienced physicians in daily clinical practice.

The physical examination in telecardiology and televascular consultations: A study using conversation analysis - Corrected Proof

Yannis Pappas, Clive Seale — 2010-02-08

Abstract: Objective: This paper describes communication in the physical examination phases of telemedicine consultations.Methods: Using the method of conversation analysis, we draw on 10 telemedicine consultations (five telecardiology and five televascular) between primary and tertiary care in the UK.Results: Physical examination is absent in telecardiology consultations. In televascular consultations the professionals try to compensate for the lack of physical proximity by getting involved in a form of collaboration that constitutes a novel environment for all. Separated from the patient by physical space, the specialist orchestrates the positioning of the patient, the camera and the primary care nurse's activity via the use of a video-link.Conclusion: Telemedicine offers primary care nurses a unique opportunity to engage in active collaboration with hospital specialists. The nurses’ examination skills are recruited because physical examination is conducted from distance and the specialist cannot touch the patient or see parts of the body with ease. We speculate that difficulties with the physical examination may have contributed to the relatively slow adoption of telemedicine.Practice implications: The analysis reveals some new communication practices that participants in telemedicine are called to adopt. This can be used to inform training interventions that focus both on patient and professional.

Coping with infertility online: An examination of self-help mechanisms in an online infertility support group - Corrected Proof

Sumaira H. Malik, Neil S. Coulson — 2010-02-08

Abstract: Objective: To examine communication within an online infertility support group.Methods: A content analysis of 3500 messages posted to infertility bulletin boards.Results: The most frequently used self-help mechanisms were support or empathy (45.5%) and sharing personal experiences (45.4%), followed by the provision of information and advice (15.9%), gratitude (12.5%), friendship (9.9%), chit-chat (9.4%), requests for information or advice (6.8%) and universality (4.8%), with negative statements (0.3%) and creative expressions (0.2%) being the least frequent categories.Conclusion: These findings suggest that online support groups can provide a viable alternative source of support for couples dealing with infertility.Practice implications: Health care professionals interested in developing online support interventions should look to tailor support resources to the specific needs of patients at different stages of the infertility journey.

Did I really want to know this? Pregnant women's reaction to detection of a soft marker during ultrasound screening - Corrected Proof

Annika Åhman, Karin Runestam, Anna Sarkadi — 2010-01-18

Abstract: Objective: To investigate women's expectations of routine ultrasound and experiences when soft markers were discovered: what the disclosure meant, how it affected them, how they experienced the information given and why they did or did not choose amniocentesis.Design: Semi-structured, in-depth interviews were conducted with 11 women 25–30 weeks into the pregnancy, 7–13 weeks after the discovery of a soft marker.Findings: Women lacked knowledge about the potential of the scan and detection of soft markers created strong emotional reactions that women thought could have been alleviated by prior information about potential findings. Information in connection with the scan was perceived as insufficient. Decision about amniocentesis was affected by attitudes to disability, anxiety about fetal loss due to the procedure, need for certainty by a diagnostic test, and partner's opinion.Conclusions: Women were shocked by the unexpected and sometimes unwanted information on elevated risk for a chromosomal aberration for which they lacked any preparation. Because this event often has long-lasting effects on the pregnancy, models of information that are efficient in promoting informed decisions are imperative.Practice implications: Both women and their partners need relevant information before and in connection with ultrasound scan to be able to make informed choices.

Telephone nurse counseling for medication adherence in ulcerative colitis: A preliminary study - Corrected Proof

Paul F. Cook, Suzie Emiliozzi, Dana El-Hajj, Mishcha M. McCabe — 2010-01-15

Abstract: Objective: Adherence is challenging in episodic chronic conditions that require medication during both symptomatic and quiescent periods, such as ulcerative colitis (UC). Adherence for these conditions is under-studied. This study was a preliminary test of telephone nurse counseling to address cognitive and emotional barriers to adherence in UC.Methods: 524 people taking mesalamine for UC were referred by their health care providers, and 278 (53%) enrolled. There were no demographic differences between program participants and nonparticipants. Participants reported multiple comorbidities and concomitant medications. All participants received telephone follow-up (M=2.1 calls) from a registered nurse who used cognitive-behavioral and motivational interviewing counseling techniques. Adherence measured by structured interview was compared to a population baseline using a binomial test.Results: Attrition was 51% over 6 months but was unrelated to adherence. Participants had better adherence than the expected population rate, with a significant dose–response effect. Reasons for nonadherence were primarily psychological or efficacy-related.Conclusion: Adherence following intervention was better than typical mesalamine adherence. Self-efficacy predicted adherence, but demographic and clinical variables did not. Adherent participants reported more adverse events.Practice implications: Attention to patients’ cognitive and emotional reactions may help to improve adherence in episodic chronic diseases such as UC.

Promoting engagement with a Stop Smoking Service via pro-active telephone calls - Corrected Proof

A. McEwen, L. Condliffe, A. Gilbert — 2010-01-14

Abstract: Objectives: What proportion of smokers in a deprived area of London, contacted by telephone, are interested in quitting and accept a referral for cessation support?Methods: Current smokers from records of general practitioners (GPs) were telephoned; if interested in quitting they were offered a referral to the local Stop Smoking Service (SSS) and smoking status was assessed after 6 months.Results: Over half of current smokers (53%) were interested in receiving help to stop and 39% accepted a referral to the SSS. Six months later 21% of those contacted reported not smoking. Over one-quarter (28%) of those referred set a quit date with the service and 39% of these were recorded as abstinent four weeks after their quit date.Conclusion: Calling smokers from GP lists appears to offer promise as a means of prompting quit attempts and ensuring that the chances of these quit attempts succeeding are maximized through attendance at NHS SSS.Practice implications: GP records need to be accurate and maintained. Smoking patients can be contacted by telephone, informed about the availability of local cessation services and referred directly.

Being a patient in your own department - Corrected Proof

Jette Ammentorp, Poul-Erik Kofoed — 2010-01-14

“I had just arrived at my job when my wife phoned. Our teenage daughter had been admitted to the hospital due to severe stomach pain. My wife seemed very upset and asked me to come to the hospital immediately. It was extremely inconvenient, but of course I cancelled all my appointments and drove as quickly as possible to the hospital.

Averting adverse events in communication skills training: A case series - Corrected Proof

Tomer Levin, Jennifer Horner, Carma Bylund, David Kissane — 2010-01-14

Abstract: Objective: To document cases of adverse or near adverse events in communication skills training (CST) and to identify risk factors and strategies to reduce the likelihood of their occurrence.Methods: Six physician CST cases meeting criteria for an adverse or near adverse collected from experienced facilitators are analyzed and discussed.Results: Three types of adverse CST events are described: traumatic personal experiences or losses evoked by training; perception that feedback is not empathic; and where trainees are referred for remedial CST as a risk management strategy.Conclusion: Early identification of risk factors and emotional cues of trainees is a key first step that facilitates implementation of remedial strategies to avert potential adverse events. Consideration of ways that physicians’ personal experiences impact communication and good feedback techniques are vital. The implications of physicians sent to CST for risk management purposes is a new scenario that deserves special consideration.Practice implications: To make CST safer and to optimize learning, early recognition of potential adverse events is essential. Specific feedback techniques should be mastered by all CST facilitators.

Somali prenatal education video use in a United States obstetric clinic: A formative evaluation of acceptability - Corrected Proof

Christopher C. DeStephano, Priscilla M. Flynn, Brian C. Brost — 2010-01-13

Abstract: Objective: Because of low health literacy and low priority in seeking prenatal information, health education videos were explored for acceptability by Somali refugee women in a clinical setting.Methods: Focus groups led to the development of six targeted Somali prenatal education videos. Topics include: preparation for pregnancy, nutrition and exercise, pregnancy myths/facts, the father's role, episiotomies, and caesarean sections. Somali participants were recruited to view programs, and completed an 8-item survey prior to regularly scheduled prenatal appointments. Following the clinical visit, providers completed a 4-item survey indicating the video's helpfulness in facilitating client–provider communication.Results: All study participants “strongly recommended” and rated the videos as “appropriate for Somali clients”, 57% indicated the information was “just the right amount,” and 60% found the videos “extremely helpful.” The primary language spoken at home was Somali (72.7%) and 54.5% indicated Somali as the preferred language to receive health information. Providers indicated 24% of appointments were “more interactive” with 72% finding videos “somewhat” or “extremely helpful.”Conclusion: Preliminary results from this pilot study suggest that a video format for prenatal education is acceptable to Somali clients with most clients preferring video health education materials presented in the Somali language.Practice implications: Culturally tailored health education video series for Somali women appear well for use in a clinic setting to facilitate client–provider communication.

Conceptualizing couples’ decision making in PGD: Emerging cognitive, emotional, and moral dimensions - Corrected Proof

Patricia E. Hershberger, Penny F. Pierce — 2010-01-11

Abstract: Objective: To illuminate and synthesize what is known about the underlying decision making processes surrounding couples’ preimplantation genetic diagnosis (PGD) use or disuse and to formulate an initial conceptual framework that can guide future research and practice.Methods: This systematic review targeted empirical studies published in English from 1990 to 2008 that examined the decision making process of couples or individual partners that had used, were eligible for, or had contemplated PGD. Sixteen studies met the eligibility requirements. To provide a more comprehensive review, empirical studies that examined healthcare professionals’ perceptions of couples’ decision making surrounding PGD use and key publications from a variety of disciplines supplemented the analysis.Results: The conceptual framework formulated from the review demonstrates that couples’ PGD decision making is composed of three iterative and dynamic dimensions: cognitive appraisals, emotional responses, and moral judgments.Conclusion: Couples think critically about uncertain and probabilistic information, grapple with conflicting emotions, and incorporate moral perspectives into their decision making about whether or not to use PGD.Practice implications: The quality of care and decisional support for couples who are contemplating PGD use can be improved by incorporating focused questions and discussion from each of the dimensions into counseling sessions.

Using the word ‘cancer’ in communication about an abnormal Pap test: Finding common ground with patient–provider communication - Corrected Proof

2010-01-08

Abstract: Objective: To investigate provider and patient views about communication regarding cervical cancer screening follow-up.Methods: Using qualitative analysis, we interviewed 20 providers and 10 patients from two urban clinics that serve low-income African American and Hispanic women. Semi-structured interviews and focus groups assessed familiarity with National Cancer Institute's Cancer Information Service (CIS) and reactions to a letter asking women with abnormal Pap test to telephone CIS. The letter suggested questions to ask prior to receiving follow-up.Results: No patient or provider was familiar with CIS. Providers but not patients expressed discomfort with use of the word ‘cancer’ in the letter and in CIS's name. Providers feared that reference to cancer would provoke fatalism and impede timely follow-up, whereas patients felt information about cancer risk was needed to prompt timely follow-up. Information providers found necessary to convey in order to accurately explain abnormal Pap tests surpassed patients’ literacy levels.Conclusion: Qualitative data suggest important gaps in perspective between providers and patients. There is a need to bridge the gap and overcome communication challenges to promote timely medical follow-up and have better health outcomes.Practice implications: Implications and strategies for improving patient–provider education and communication about abnormal Pap test are discussed.

The role of helplessness, outcome expectation for exercise and literacy in predicting disability and symptoms in older adults with arthritis - Corrected Proof

2010-01-08

Abstract: Objective: To examine the effect of outcome expectation for exercise (OEE), helplessness, and literacy on arthritis outcomes in 2 community-based lifestyle randomized controlled trials (RCTs) conducted in urban and rural communities with older adults with arthritis.Methods: Data from 391 participants in 2 RCTs were combined to examine associations of 2 psychosocial variables: helplessness and OEE, and literacy with arthritis outcomes. Arthritis outcomes namely, the Health Assessment Questionnaire-Disability Index (HAQ-DI) and arthritis symptoms pain, fatigue and stiffness Visual Analogue Scales (VAS), were measured at baseline and at the end of the interventions. Complete baseline and post-intervention data were analyzed using STATA version 9.Results: Disability after intervention was not predicted by helplessness, literacy, or OEE in the adjusted model. Arthritis symptoms after the intervention were all significantly predicted by helplessness at various magnitudes in adjusted models, but OEE and literacy were not significant predictors.Conclusion: When literacy, helplessness, and OEE were examined as predictors of arthritis outcomes in intervention trials, they did not predict disability. However, helplessness predicted symptoms of pain, fatigue, and stiffness, but literacy did not predict symptoms.Practice implications: Future sustainable interventions may include self-management components that address decreasing helplessness to improve arthritis outcomes.

Who's in charge? The role of responsibility attribution in self-management among people with chronic illness - Corrected Proof

Åsa Audulv, Kenneth Asplund, Karl-Gustaf Norbergh — 2010-01-08

Abstract: Objective: To explore how responsibility attribution influences self-management regimens among people with chronic illness.Methods: This qualitative content analysis included 26 interviews with people living with chronic illness.Results: The participants attributed responsibility to internal, external or a combination of these factors, meaning that they either assumed responsibility for self-management or considered other people or factors responsible. Internal responsibility was associated with a multifaceted self-management regimen, whereas external responsibility was related to “conventional” self-management such as taking medication, managing symptoms and lifestyle changes.Conclusion: How responsibility is attributed is vital for the way in which individuals perform self-management. In this study, those who attributed responsibility to external factors mainly performed recommended behaviours to control their illness. In contrast, to take charge of their illness and be an active participant in the care, individuals must take responsibility for themselves, i.e. internal responsibility.Practice implications: Health-care providers should acknowledge and support individuals’ wishes about various levels of responsibility as well as different kinds of patient–provider relationships.

Begin the BEGAN (The Brown Educational Guide to the Analysis of Narrative) – A framework for enhancing educational impact of faculty feedback to students’ reflective writing - Corrected Proof

Shmuel P. Reis, Hedy S. Wald, Alicia D. Monroe, Jeffrey M. Borkan — 2010-01-07

Abstract: Objective: The study aim was the development of a method to further enhance the educational benefit of medical students’ reflective writing. The setting is a Doctoring course at the Warren Alpert Medical School of Brown University, which includes reflective writing assignments, termed “field notes”, combining students’ reflective writing with ongoing individualized feedback from small group faculty.Methods: Three-year (2005–2008) iterative process with three stages of immersion, analysis, and revision that resulted in the analysis framework. An interdisciplinary team composed of the four authors with backgrounds in narrative medicine, qualitative research, psychology, and medical education analyzed 12 first and second year students’ selected field notes in iterative cycles. In each cycle, consultations with small group faculty and content experts were conducted to further validate the emergent framework.Results: This process culminated in the creation of the Brown Educational Guide to Analysis of Narrative (BEGAN) framework, a guide for crafting feedback to students’ reflective writing, and the integration of the BEGAN framework into the faculty and student manuals for the Doctoring Course in 2008–2009.Conclusions: We propose the BEGAN framework as a useful innovative tool that can be incorporated in reflective writing curricula in the field of health professions education. It is tailored to support the educational impact of the course through additional scaffolding of student writing, and the robust process it delineates for crafting of faculty feedback.Providing systematic feedback to enhance reflective writing may represent the path forward in fostering professional development through reflection in health professions education.Practice implications: The BEGAN can be incorporated in reflective writing curricula in the field of health professions education. It is a springboard for the necessary next steps of development and research into the acquisition of reflective and narrative competence in the emerging professional.

Everything you always wanted to know about HPV (but could not ask your doctor) - Corrected Proof

2010-01-07

Abstract: Objective To investigate specific information needs of people who search for information about the human papillomavirus (HPV) on the Internet.Methods We performed a qualitative analysis of the e-mail questions asked by the visitors of a website with evidence-based information about HPV. The website, hosted by Antwerp University, provided basic information on epidemiology and natural history of HPV in women and men, diagnostic and treatment options, screening, and vaccination. If visitors did not find an answer to their questions, they could mail their question to an e-mail address associated with the website.Results We received 713 questions posed by 527 e-mail correspondents. The following themes emerged as most important: transmission of HPV, the HPV vaccine, the natural history of the virus, the vicious circle (re-infection between partners), HPV detection in men and women, treatment of men and women, incubation time, pregnancy/fertility, genital warts (in)fidelity, and symptoms of HPV infection.Conclusion Both men and women are seeking health information on HPV on the Internet, often after being counseled by a health care provider.Practice implications Practitioners should be prepared for questions on the themes that concern people most. Practitioners may play a role in guidance towards reliable sources of information.

Can interactive skills-based seminars with standardized patients enhance clinicians’ prevention skills? Measuring the impact of a CME program - Corrected Proof

2010-01-06

Abstract: Objective: Communication skills are crucial for high-risk behavior screening and counseling. Practicing physicians have limited opportunities to improve these skills. This paper assesses the impact of a continuing medical education (CME) program for Student Health Center clinicians that targeted communication skills, screening practices and patient satisfaction.Methods: Program evaluation included pre- and post-objective structured clinical examinations (OSCE's), chart review, and provider and patient satisfaction surveys. Data were analyzed using paired t-tests and ranked sum tests.Results: OSCE scores (n=15) revealed significant improvements in communication skills overall (p=0.004) and within specific domains (data gathering: p=0.003; rapport building: p=0.01; patient education: p=0.02), but no change in case-specific knowledge (p=0.1). Participants (n=14) reported high satisfaction with program methods (mean=4.6/5) and content (mean=4.7/5), 70% planning to alter their clinical practice. Chart audits (pre=96, post=103) showed increased screening for smoking (RR 1.65, p=0.03), depressed mood (RR 1.40, p=0.04), anhedonia (RR 1.47, p=0.01), sexual activity (RR 1.73, p=0.002) and drinking (RR 1.77, p=0.04). Sampling of satisfaction among participants’ patients (pre n=689, post n=383) detected no increase in already high baseline satisfaction.Conclusion: This curriculum improved clinicians’ relevant skills and screening behavior.Practice implications: Skills-oriented CME can improve clinicians’ communication skills and screening and counseling practices.

The narrative-autobiographical approach in the group education of adolescents with diabetes: A qualitative research on its effects - Corrected Proof

2010-01-04

Abstract: Objective: To introduce a narrative-autobiographical approach in the care and education of adolescents with type-1 diabetes and observe the effects of this novel approach on adolescents’ self-awareness, concern for self-care, and well-being.Methods: Ninety-four adolescents with type-1 diabetes attending one 9-day summer camp in 2004, 2005, or 2006 participated in structured daily self-writing proposals on diabetes, integrated with daily interactive self-management education. After some months, we sent participants interview-like questionnaires, and two independent researchers performed a qualitative analysis of the 50 answers that were mailed back.Results: Writing about the discovery of diabetes was, for many, a stressful experience, but with a strong liberating effect. One relevant point was change, which occurred: (a) in the perception of self; (b) in the relationship with others; (c) in the relationship with the disease.Conclusions: The integration of autobiography in diabetes camps, by adding the value of sharing individual stories to the liberating power of self-writing, can allow the adolescents to overcome their feelings of diversity, and can initiate several changes reflecting increased self-efficacy, maturity, acceptance of the disease and responsibility in self-management.Practice implications: Self-writing is feasible and well accepted, and provides healthcare professionals a proper way to patient-centered care.

The role of HIV nursing consultants in the care of HIV-infected patients in Dutch hospital outpatient clinics - Corrected Proof

2010-01-04

Abstract: Objective: In the Netherlands HIV nursing consultants have participated in HIV-care since 1985; their profession has changed with developments in HIV-treatment over time. The study goal was to gather information about their role in HIV-care and to provide an useful example to other (HIV-)care settings over the world.Methods: Interviews were held with HIV nursing consultants from all AIDS treatment centres. Descriptive analyses and statistical tests to detect differences between centres categorized by care model (parallel/unstructured/alternating), were performed.Results: 58% centres perform substitution of care. HIV nursing consultants see almost all patients at least once a year and see all patients when treatment is started/altered. The frequency of consultations for HIV-patients in stable condition varies, 2–4 times a year. Substitution leads to a slight, non-significant decrease in number of consultations. Adherence support is provided at the start of and during treatment. Regular patient discussions are common. All respondents are acquainted with the guidelines. Detailed knowledge of the adherence issues is limited: 58.3% had read the adherence chapter.Conclusion: Substitution of care model is an appropriate and effective method for the management of HIV-infected patients.Practice implications: Further development of and research into this new role of HIV nurse consultants is appropriate.

The effect of conflicting medication information and physician support on medication adherence for chronically ill patients - Corrected Proof

2009-12-31

Abstract: Objective: This article explores the effect of conflicting information, defined as contradictory information about medication topics from different sources, on medication adherence in a sample of chronically ill patients. We specifically investigate whether conflicting information and physician support directly affect medication adherence or whether the effect is mediated by adherence self-efficacy and outcome expectations for medications.Methods: Vasculitis patients (n=228) completed two on-line questionnaires which contained measures of conflicting information, adherence self-efficacy, outcome expectations, physician support, and medication adherence. We conducted a mediation analysis using a bootstrapping approach to generate point estimates and 95% confidence intervals to test the significance of each mediated effect.Results: A majority of patients (51.3%) received conflicting medication information. Conflicting information had a direct negative effect on medication adherence, which was not mediated by self-efficacy or outcome expectations. Alternatively, self-efficacy mediated the positive effect of physician support on medication adherence.Conclusion: Patients who encounter conflicting medication information are less adherent to their medications. The presence of a supportive physician may counteract the negative effect of conflicting medication information.Practice implications: Physicians should initiate conversations about conflicting medication information with their patients. Consensus-based guidelines that address medication discrepancies may also reduce the availability of conflicting information.

Evaluating the implementation of peer counseling in a church-based dietary intervention for African Americans - Corrected Proof

2009-12-31

Abstract: Objective: Body & Soul, an evidence-based nutrition program for African Americans churches, is currently being disseminated nationally and free of charge by the National Cancer Institute. For dissemination feasibility, the peer counseling training is done via DVD rather than by live trainers. We describe implementation and process evaluation of the peer counseling component under real world conditions.Methods: The study sample included 11 churches (6 early intervention, 5 delayed intervention) in 6 states. Data sources included training observations, post-training debriefing sessions, coordinator interviews, and church participant surveys. Survey data analysis examined associations between exposure to peer counseling and change in dietary intake. Qualitative data were analyzed using the constant comparative method.Results: Eight of 11 churches initiated the peer counseling program. Recall of talking with a peer counselor was associated with significantly (p<.02) greater fruit and vegetable intake. Data indicate sub-optimal program execution after peer counselor training.Conclusion: Inconsistent implementation of the peer counseling intervention is likely to dilute program effectiveness in changing nutrition behaviors.Practice implications: Disseminating evidence-based programs may require added resources, training, quality control, and technical assistance for improving program uptake. Similar to earlier research phases, systematic efforts at the dissemination phase are needed for program success.

Development and validation of a low-literacy Chronic Obstructive Pulmonary Disease knowledge Questionnaire (COPD-Q) - Corrected Proof

2009-12-31

Abstract: Objective: The objective of this study was to develop a content valid, understandable, readable, and reliable Chronic Obstructive Pulmonary Disease knowledge Questionnaire (COPD-Q).Methods: Twenty-one questions were generated as potential items to include in the COPD-Q. Twenty-two content experts provided both qualitative and quantitative assessments of two COPD-Q drafts. Ten patient volunteers completed a field test to assess clarity of individual COPD-Q items. An additional 24 patient volunteers completed a pilot test to determine internal consistency and test–retest reliability of the COPD-Q. The Flesch Reading Ease (FRE) was used to assess reading grade level of the COPD-Q.Results: Thirteen items were rated as “essential” (content validity ratio=p<0.05) by content experts and composed the final COPD-Q. Internal consistency, using Cronbach's alpha, was 0.72. Test–retest reliability, using intraclass correlation coefficient, was 0.90. The FRE score of the COPD-Q was 74.7 (equivalent to a 5th grade reading level).Conclusion: The COPD-Q is a valid, readable and reliable knowledge assessment instrument for assessing COPD knowledge in patients who may have low health literacy skills.Practice implications: Health care providers can use the COPD-Q to tailor counseling efforts according to individual patient needs, and to assess the effectiveness of their educational interventions.

Do people with diabetes understand their clinical marker of long-term glycemic control (HbA1c levels) and does this predict diabetes self-care behaviours and HbA1c? - Corrected Proof

Emma Beard, Marie Clark, Steve Hurel, Debbie Cooke — 2009-12-25

Abstract: Objective: Research demonstrates that patients have a poor understanding of glycosylated haemoglobin A1c (HbA1c) and that this impacts on effective diabetes self-management. This study attempted to replicate these findings in a UK outpatient sample of people with diabetes.Method: 83 participants were recruited and asked to fill in a questionnaire assessing their understanding of HbA1c, diabetes self-care behaviours and diabetes-specific self-efficacy in relation to carrying out these self-care behaviours.Results: Only 26.5% of the participants were classified as having a good understanding of HbA1c. Correlational and univariate analyses indicated that this level of understanding was related to demographic variables, HbA1c levels and certain aspects of self-care and self-efficacy. A series of multiple regressions found that understanding was a significant predictor of HbA1c levels.Conclusion: The majority of participants seemed to have a poor understanding of HbA1c and this was related to aspects of their diabetes management, self-efficacy and HbA1c levels.Practical implications: These findings provide support for the application of programmes and initiatives aimed at improving patients understanding of clinical disease markers.

The role of counseling for obstetric fistula patients: Lessons learned from Eritrea - Corrected Proof

2009-12-25

Abstract: Objective: The goal of this study was to evaluate the first formal counseling program for obstetric fistula patients in Eritrea.Methods: To evaluate the impact of the counseling program, clients were interviewed both before pre-operative counseling and again after post-operative counseling. A questionnaire was used in the interviews to assess women's knowledge about fistula, self-esteem, and their behavioral intentions for health maintenance and social reintegration following surgical repair. In addition, two focus groups were conducted with a total of 19 clients assessing their experiences with the surgical care and counseling.Results: Data from the questionnaires revealed significant improvements in women's knowledge about fistula, self-esteem, and behavioral intentions following counseling. Focus group data also supported increased knowledge and self-esteem.Conclusion: Evaluation of the short-term impact of an initial formal counseling program for fistula patients in sub-Saharan Africa affirmed the positive effects that such a program has for fistula patients, with increased knowledge about the causes of fistula, fistula prevention and enhanced self-esteem.Practical implications: Culturally appropriate counseling can be incorporated into services for surgical repair of obstetric fistula in low-resource settings and has the potential to improve the physical and mental well-being of women undergoing fistula repair.

Impact of a brief intervention on patient communication and barriers to pain management: Results from a randomized controlled trial - Corrected Proof

Meredith Y. Smith, Katherine N. DuHamel, Jennifer Egert, Gary Winkel — 2009-12-25

Abstract: Objective: This study examined the impact of a brief pain communication/education intervention on patient outcomes in breast cancer. We hypothesized that our intervention would improve patient communication and reduce misconceptions (“Barriers”) concerning pain management, and that patients with lower Barriers, or who perceived their physician as being more facilitative and receptive, would report better outcomes.Methods: Female breast cancer patients with persistent pain (n=89) were randomly assigned to either a 30-min in-person pain education/communication intervention or control condition and followed for 12 weeks.Results: Intervention group patients reported a significant decrease in pain Barriers but not in other outcomes. Overall, patients with lower barrier scores reported less distress and better emotional well-being. Patients who scored higher in active communication (e.g., asking questions, giving information) reported fewer Barriers and better pain relief. Individuals who perceived their physicians as being more receptive reported better pain management while those who perceived their physicians as being both more receptive and facilitative were more satisfied with their health care.Conclusion: A brief education/communication intervention reduced patients’ Barriers to pain management but did not impact other patient outcomes.Practical Implications: Pain outcomes may be improved by addressing patients’ pain misconceptions and emphasizing a receptive and responsive communication style.