Journal of Clinical Psychology in Medical Settings最新文献

Psychological and relational processes, including empathy, are increasingly recognised as central to effective pain care. Fibromyalgia Syndrome (FMS), a complex chronic pain condition, poses significant challenges for both patients and healthcare professionals (HCPs) across medical settings. Patients with FMS often report lack of empathy from HCPs, negatively affecting healthcare experiences. Whilst empathic therapeutic relationships are linked to improved satisfaction and reduced pain in FMS, how empathy is conceptualised in practice remains underexplored. Using Q-methodology, 20 HCPs and 20 patients with FMS ranked 40 statements on clinical empathy based on agreement/disagreement. Four factors were identified, explaining 51% of the variance. Factor 1, 'Empathy is about truly connecting-the dominant healthcare professional view', included 75% of the HCPs and emphasised emotional aspects and partnership. The remaining factors captured heterogeneous patient perspectives: Factor 2, 'Empathy cannot be taught; it is something that you have', focussed on behavioural, outcome-oriented aspects; Factor 3, 'Empathy requires communication that goes both ways', prioritised behavioural and cognitive aspects; and Factor 4, 'Lack of empathy makes patients feel abandoned-the dominant patient view', reflected a strong importance of emotional validation and personalised care. These four factors were further mapped onto broader dimensions of affective engagement and reciprocity. HCPs and patients view empathy differently, highlighting the need for interventions grounded in shared understanding. Addressing these perspectives may facilitate better empathic interactions and improve psychologically informed healthcare for FMS.

Chronic pain and eating problems frequently co-occur, with disordered eating behaviors such as emotional eating, food restriction, and appetite fluctuation contributing to adverse outcomes. However, there are no validated screening tools specifically designed for assessing eating problems in chronic pain populations. This study aimed to validate two brief eating disorder measures, the Eating Attitudes Test-8 (EAT-8) and Eating Disorder Examination-Questionnaire-8 (EDE-Q8), for English-speaking adults presenting for chronic pain treatment. Participants included 173 adults seeking treatment at a pain evaluation service. Participants completed the EAT-8 and EDE-Q8 alongside self-report clinical measures. Demographic and clinical data were extracted from medical records. Statistical analyses assessed internal reliability, construct validity, and differences in eating disorder measures by BMI and eating disorder history. Both the EAT-8 and EDE-Q8 demonstrated acceptable internal reliability (McDonald's omega ≥ 0.7) and strong construct validity, with significant correlation between the two measures (r = 0.77). Scores varied significantly by BMI and eating disorder history, with higher scores observed among participants with obese BMI or a history of eating disorders. However, less than 20% of participants felt the measures fully captured their experiences, suggesting potential gaps in assessing eating problems specific to chronic pain. The EAT-8 and EDE-Q8 are valid and reliable tools for identifying disordered eating behaviors in chronic pain patients. However, these measures may not capture the full spectrum of eating problems unique to this population. Future research should refine screening tools to better assess eating behaviors as they relate to chronic pain.

Food allergy (FA) is a chronic condition that can markedly affect family quality of life (QoL). Children's food neophobia (FN) may increase dietary management difficulties and parental stress, while maternal personality traits can shape family adjustment. This study examined the associations between maternal neuroticism, child FN, and the perceived impact of FA on family QoL, also considering the influence of child age. Sixty-three Portuguese mothers of children with physician-diagnosed FA completed a sociodemographic and clinical questionnaire and validated self-report measures: the Food Neophobia Scale for Children, the NEO Five-Factor Inventory, and the Food Allergy Quality of Life Questionnaire - Parent Form (FAQLQ-PF). Preliminary correlations guided predictor selection, followed by multiple linear regression models (enter method) for each FAQLQ-PF subscale: Emotional Impact, Food Anxiety, and Dietary/Social Limitations. Higher maternal neuroticism, greater child FN, and older child age were significantly associated with a greater perceived impact of FA on family QoL. The models explained 35.5% of the variance in Emotional Impact, F (3, 58) = 12.19, p < .001; 35.5% in Food Anxiety, F (3, 58) = 12.19, p < .001; and 32.9% in Dietary/Social Limitations, F (3, 56) = 10.66, p < .001. These findings underscore the need to integrate psychological screening and tailored psychosocial support into allergy care, addressing both maternal emotional traits and child eating behaviors to promote adaptive family functioning.

Sleep-related deaths are a preventable cause of infant mortality. Pediatricians can promote infant safe sleep practices; however, communication barriers may arise, especially for patients of color. This study examined how patient race and ethnicity relate to the length and quality of safe sleep discussions with pediatric residents. Sixteen pediatric residents completed questionnaires on safe sleep knowledge and attitudes. Observations were conducted during 102 well-baby visits to measure time spent discussing safe sleep and frequency of effective communication skills used by residents. In descriptive analyses, residents spent less time discussing safe sleep with Black and other patients of color compared to White patients. In multivariate models, caregiver receptiveness, rather than client race and ethnicity, predicted time discussing infant safe sleep. However, when receptiveness was removed from the model, caregiver race and ethnicity did predict time discussing infant safe sleep such that providers spent less time talking to Black caregivers and caregivers of color. Race and ethnicity did not predict resident use of MI skills. Residents may experience communication challenges when discussing infant safe sleep, particularly with patients of color. Client receptiveness and race appear to be important variables with regard to patient-provider communication about infant safe sleep.

The way in which behavioral health providers (BHPs) in integrated primary care settings function and what is needed for their success has not been systematically examined. The present study used direct observation to capture integrated BHPs' clinical activities, workflows, and team interactions. Observations took place in seven integrated primary care clinics in a single health system. The model of integration combined components of the Primary Care Behavioral Health model and the Collaborative Care Model. A trained Research Service Professional (RSP) observed 13 BHPs each during one typical clinical day in an integrated primary care clinic. Data collection methods included surveys, process maps, time tracking, and field notes. We used quantitative and qualitative analysis to describe BHPs' activities. During the days observed, BHPs conducted 77 patient visits and many other activities, including supervising learners. BHPs' clinical time was divided among direct patient care (56%), administrative tasks (29%), and consultation with team members (15%). Process maps revealed similar workflows across BHPs/practices with differences in completing screening, rooming, and scheduling patients. BHPs supervising learners saw on average more patients per day than BHPs on their own (5.1 vs. 7.6). BHPs interacted with all practice team members, and most frequently with medical providers, social workers, care managers, and nurses. BHPs provide clinical care to primary care patients on a wide variety of concerns and spend time on other important team-based tasks. Recommendations for optimizing workflows, reimbursement models, and team-based care from these observations are provided.

Nursing and direct care staff face significant psychological and physical challenges, including high workloads, emotional labour, and staff shortages, which increase the risk of burnout and stress-related conditions. Resilience is a protective factor that mitigates these effects. This study evaluated the efficacy of a 28-day digital resilience training programme tailored to the needs of nursing and direct care staff. One hundred twenty participants working in German healthcare settings were randomly assigned to an experimental group or a waitlist control group. Experimental group participants received a programme consisting of twice-daily video-based exercises, reflections, and relaxation activities over four weeks. Outcomes were assessed at baseline (T1), post-intervention (T2), and three months follow-up (T3). Resilience (primary outcome) was measured using the Resilience Scale, and perceived stress (secondary outcome) was measured using the Perceived Stress Questionnaire (PSQ). Compared to the control group, experimental group participants demonstrated significant improvements in resilience from T1 to T3 (p < .001, d = 0.6) and substantial reductions in percieved stress (PSQ total score, p < .001, d = - 1.4). No significant changes were observed in the control group. The digital programme effectively enhanced resilience and reduced the perception of stress, aligning with prior research on resilience training in healthcare. Despite stress reduction showing a larger effect size, resilience remained the theoretically grounded primary outcome. The flexible, scalable design of the digital programme accommodates challenges like shift work, offering a practical solution for improving nurse staff's mental health. Clinical Trial Registration: German Clinical Trials Register (DRKS), Identifier: DRKS00030973.

Informed consent laws allow patients to decide what happens to their bodies within a medical setting, but medical practices within academic teaching hospitals do not always live up to ethical standards or align with the values and wishes of clinicians, patients, and families. Bioethics often helps to resolve these conflicts through collaboration and dialogue. However, when conflicts persist and are resistant to change, it may be necessary to pursue regulatory or legislative solutions. This paper discusses the role of bioethics in strengthening federal regulations on explicit consent for sensitive (pelvic, prostate, rectal, and breast) exams. Since psychologists within academic health centers may also wish to influence policy, this paper concludes with practical, achievable guidance for psychologists to gain an understanding of the public policymaking process, develop relationships with policymakers, and take steps to exert influence on the policymaking process.

While psychologists possess unique and valuable skills that can contribute to leadership within academic health centers (AHCs), there are common barriers within these institutions that impede psychologists' engagement in leadership. As a result, significant educational efforts and challenges to entrenched norms are often required to advocate for the field of psychology, particularly when working outside of centralized psychology departments. In the following article, four psychologist colleagues working in a centralized department of psychiatry at a single AHC share their recent experiences facing barriers to leadership roles. The authors describe the impact of historical context on the challenges they face, as well as the actions they have taken to support the advancement of psychologists. These actions include leveraging interdisciplinary support, learning from other fields, and developing a curriculum to enhance financial and business acumen in psychology trainees. The authors also review the importance of staying informed about state and federal policy changes that impact healthcare systems, so that psychologists can help lead in responding to these changes in value-consistent ways. By advocating for the unique contributions psychologists offer and addressing the structural barriers in many AHCs, psychologists can more effectively navigate and shape leadership pathways.

Infancy and toddlerhood are periods of rapid development which could be significantly compromised by the diagnosis of cancer and its treatment. The aim of this study was to describe health-related quality of life (HRQOL) in infants/toddlers diagnosed with cancer and their caregivers over time and identify whether treatment variables and caregiver HRQOL are associated with infant/toddler HRQOL. HRQOL was assessed by parent-proxy reports among infants/toddlers (N = 39) and their caregivers (N = 39) at three timepoints (baseline, 6 months, 12 months). Linear mixed models were used to investigate whether demographic and treatment variables, caregiver HRQOL, and caregiver distress was associated with infant/toddler and caregiver HRQOL over time. No statistically significant variables were found to be associated with caregiver HRQOL, including infant/toddler HRQOL, time since diagnosis, income, and intensity of treatment. However, caregiver distress and infant/toddler HRQOL were bidirectionally related to each other over time, whereby higher infant/toddler HRQOL was associated with lower caregiver distress, and vice versa. Infants/toddlers with cancer and their caregivers experience psychosocial challenges. Interventions targeting caregivers that emphasize the importance of the caregiver-child relationship, and self-care are important. Health care providers should screen caregivers to assess their well-being and provide appropriate supports when needed.

Psychologists working in medical and academic health settings bring unique skills that make them well-suited for policy advocacy. Their training in trust-building, translating evidence, and understanding context can be applied to influence policies that impact access, quality, and equity in healthcare. This article explains how clinical and counseling skills align with policy engagement and shows their relevance through examples such as Medicaid reform, telehealth parity, and racial equity impact assessments. It introduces conceptual frameworks and practical strategies to demonstrate how psychologists can participate in coalition building, communication, and policy evaluation. Training recommendations emphasize the importance of incorporating advocacy skills into graduate programs, offering mentorship, and providing ongoing professional development to equip psychologists for leadership in evolving healthcare systems. Advocacy is presented not just as a supplement to practice, but as a natural part of psychologists' professional identity. By embedding advocacy into education and practice, psychologists can promote health equity and help ensure policies are based on both scientific evidence and lived experience.