Patient preference and adherence最新文献

Objective: To evaluate the effectiveness of a continuity-of-care model based on empowerment theory in patients with upper urinary tract calculi undergoing postoperative double-J stent placement.

Methods: A retrospective study was conducted on 124 patients treated from February 2024 to April 2025. Patients were assigned to a control group (routine nursing, n = 62) or an Intervention group (empowerment-based continuity care, n = 62). Compliance behavior, self-care ability (ESCA), self-efficacy (GSES), quality of life (WHOQOL-BREF), postoperative complications, and nursing satisfaction (NSNS) were compared between groups.

Results: The Intervention group showed higher compliance (91.94% vs 79.03%, P < 0.05). Post-intervention ESCA, GSES, and WHOQOL-BREF scores improved in both groups, with greater gains in the Intervention group (P < 0.05). Complication incidence was lower in the Intervention group (4.84% vs 16.13%, P < 0.05), and nursing satisfaction was higher (95.16% vs 82.26%, P < 0.05).

Conclusion: Empowerment-based continuity care significantly enhances self-care ability, adherence behavior, self-efficacy, and quality of life in postoperative double-J stent patients, while reducing complications and improving nursing satisfaction. This model supports patient-centered care and promotes active patient participation.

Project: Construction of an Empowerment Theory Model for Risk Prediction of Elderly Patients with Double-J Stent (Project No. 20250979).

Background: Gastrointestinal endoscopy (GIE) is crucial for diagnosing digestive tract issues, yet discomfort remains a significant concern. This study aimed to investigate the knowledge, attitudes, and practices (KAP) of patients undergoing GIE in the Shanghai region regarding painless GIE.

Methods: We conducted a cross-sectional study at Longhua Hospital, Shanghai University of Traditional Chinese Medicine, from July 27, 2023, to November 28, 2023, using a questionnaire survey to collect data.

Results: A total of 472 valid questionnaires were collected. Among them, 273 (57.8%) were female, and 458 (97.0%) would receive painless GIE. The KAP scores were 7 (4-9) for knowledge, 41 (36.5-46) for attitudes, and 17 (16-20) for practices. Correlation analyses showed that knowledge (r = 0.202, p < 0.001) and attitude (r = 0.290, p < 0.001) were positively correlated with practice. However, the correlation between knowledge and attitude was insignificant. Notably, 47.5% of patients recognized painless GIE as a safe examination method, and 37.1% affirmed its effectiveness in reducing fear. Additionally, 38.8% of respondents would recommend painless GIE to those who need it, although 30.1% would hesitate to visit the hospital because of nausea or discomfort. Multivariate analysis showed that being medical personnel was independently associated with positive practice.

Conclusion: Patients undergoing GIE in the Shanghai region exhibit limited knowledge, suboptimal attitudes, and inadequate practices regarding painless GIE. It is imperative to devise and implement targeted educational interventions to enhance patient awareness and foster the adoption of painless endoscopy techniques within clinical settings. Given the global increase in demand for patient-centered endoscopy services, our results may also serve as a useful reference for other countries or regions with similar healthcare systems, sedation practices, or cultural contexts.

Purpose: Applying the Timing It Right (TIR) theoretical framework, we explored the evolving experiences and needs of caregivers supporting adult percutaneous endoscopic gastrostomy (PEG) patients during different cycles of PEG placement, within a Chinese cultural context.

Patients and methods: A descriptive phenomenological research design was used to select 12 family caregivers of PEG patients in a tertiary hospital in Guangzhou from December 2024 to June 2025 through purposive sampling combined with the maximum difference strategy. Based on the TIR framework, the PEG course was divided into five stages (diagnosis, stabilization, discharge preparation, adjustment, and adaptation). Semi-structured in depth interviews were conducted with caregivers at each stage. The Colaizzi 7-step method and NVivo V.17 software were used to analyze the data and extract themes.

Results: The themes of the experiences and needs of PEG caregivers at different stages were as follows: 1. Diagnostic stage: anxiety and worry, lack of disease awareness, and passivity in medical decision-making. 2. Stabilization stage: coping with the postoperative comfort management needs of patients and sense of treatment benefit. 3. Discharge readiness stage: caregiving skills training needs and resource accessibility concerns. 4. Adjustment stage: continuity of care needs, daily care challenges (wound care needs, gastrostomy tube adjustment period), and caregiver socioeconomic role reconstruction. 5. Adaptation period: rehabilitation expectations, reality conflicts, and self-efficacy enhancement.

Conclusion: The notable variations in the demands and experiences of PEG caregivers at various phases of caregiving highlighted how crucial it was to create a staged support system that was accurate and culturally sensitive to maximize healthcare resources and effectively empower caregivers.

Background: Heart failure management remains challenging due to limited self-care and prevalent depressive symptoms, with telehealth emerging as an effective approach to strengthen disease management and enhance patients' quality of life. However, studies that specifically explore models, intervention content, and the broader benefits of telehealth in HF management are still limited.

Purpose: This systematic review aimed to compare and synthesize different telehealth delivery models, intervention content, and associated outcomes in the management of patients with heart failure.

Methods: A systematic review was conducted in accordance with Cochrane and PRISMA guidelines. A comprehensive search was conducted across multiple databases, including PubMed, Scopus, EBSCOhost, Taylor & Francis, and Springer Nature, with a focus on randomised controlled trials (RCTs) published in English. The article selection process is based on title, abstract, full text, and eligibility criteria, including quality appraisal. Data analysis employed thematic synthesis and descriptive qualitative approaches to categorize interventions, content, and outcomes.

Results: The review included 28 studies, evaluating three main telehealth intervention models: (1) telemonitoring, (2) phone call support, and (3) smartphone and web-based applications. Intervention content included symptom and medication monitoring, patient education, empowerment for self-management, reminders and feedback, psychological and social support, and healthcare communication. The study outcomes were categorized into four themes, including clinical outcomes, physical and mental health outcomes, behavioral outcomes, and quality of life. Among these models, phone call support and reminder interventions were most often recommended as practical and feasible approaches, as they are easy to implement, and flexible.

Conclusion: This review highlights that while telehealth interventions consistently improve quality of life, their impact on mental health and long-term clinical outcomes remains variable. Integrating support models with phone calls and reminders into routine heart failure management may improve accessibility and continuity of care, particularly for patients requiring ongoing behavioral and emotional support.

Background and aim: Health literacy and discharge preparedness are critical for managing chronic conditions like epilepsy. However, few studies in China have explored the relationship between knowledge, attitudes, and practices (KAP) and discharge outcomes. This study aimed to assess health literacy and discharge preparedness among epilepsy patients and identify key KAP predictors.

Methods: A cross-sectional study was conducted from January and December 2023 at a tertiary brain hospital in China. A total of 331 adult epilepsy patients completed a structured questionnaire evaluating epilepsy-related KAP and discharge preparedness. Associations were analyzed using chi-square tests and multivariate regression.

Results: A total of 331 epilepsy patients were included, with an average age of 38.6 years. Overall, 62.2% of patients demonstrated moderate knowledge of epilepsy, but only 29.6% knew proper seizure first-aid measures. Positive attitudes toward disease management were present in 68.3% of respondents, though 18.4% reported feelings of social stigma. In terms of self-care practices, 61.6% reported regular medication adherence, while only 21.7% were adequately prepared to manage emergency seizures. The mean discharge preparedness score was 7.1 out of 10, with 44.7% scoring above the threshold for good readiness. Multivariate analysis revealed that better knowledge and practice scores were significantly associated with higher discharge preparedness (p < 0.01).

Conclusion: This study underscores the need to improve health literacy and discharge preparedness in patients with epilepsy, especially in a tertiary hospital setting. Tailored educational interventions focusing on enhancing KAP could significantly improve the long-term management of epilepsy and reduce hospital readmissions. The findings suggest that better patient education on self-management could be pivotal in improving both short-term and long-term outcomes for individuals with epilepsy.

Purpose: This study aimed to explore the factors influencing medication adherence and develop a medication nonadherence risk nomogram in a Chinese population with hyperlipidemia.

Methods: This prospective intervention study was conducted in Beijing from November 2020 to October 2021. Medication adherence was determined according to the 9-question scale and nonadherence patients were intervened by pharmacists and followed up for 3 months. Multivariate logistic regression was used to analyze the risk factors of medication nonadherence, and then a nomogram model was established. The concordance index (C-index), area under the curve (AUC) was used to evaluate the accuracy of the prediction model. The decision curve analysis (DCA) and clinical impact plot analysis were employed to further evaluate the clinical effectiveness of the nomogram.

Results: A total of 685 patients were included for analysis. The rate of medication nonadherence was 238 patients (34.75%). Post-intervention, the average score of medication adherence increased from 20.75±8.01 to 29.90±6.93 (p < 0.001). And the number of patients with TC, TG, LDL-C, and HDL-C reaching the standard was 264 (62.86%), 201 (47.43%), 318 (78.52%), and 377 (96.71%), respectively. Five predictors including the course of hyperlipidemia (OR=2.957, 95% CI 1.168-7.488), following the doctor's advice to visit (OR=2.757, 95% CI 1.389-5.472), use of medications empirically (OR=1.189, 95% CI 1.188-2.786), physical exercise (OR=0.399, 95% CI 0.205-0.776) and lifestyle compliance (OR=0.910, 95% CI 0.839-0.988) were identified to build the nomogram model. The AUC was 0.927 and C-index was 0.87.

Conclusion: Patients with hyperlipidemia displayed low medication adherence which pharmaceutical interventions can improve. We developed and validated a nomogram model to facilitate the individual medication nonadherence risk prediction in hyperlipidemia patients.

Limitation: First, using the cut-off value of 27 for adherence assessment in the adherence questionnaire, criterion validity was not enough good to validly screen a patient with nonadherence to medication. Second, our study may have unmeasured confounding variables, which could bias the results. Third, owing to the lack of external validation in this study, it may have some limitations in extrapolation. Fourth, the questionnaire was assessed by self-report measures.

Purpose: The hospital-home transition is a high-risk period for medication management in patients with type 2 diabetes mellitus (T2DM). While bivariate relationships among medication literacy, beliefs, self-efficacy, and adherence have been explored, the integrated mediating mechanisms during this phase remain unclear. This study examined these interrelationships, focusing on the serial mediation beliefs and self-efficacy between literacy and adherence.

Patients and methods: A cross-sectional study enrolled 315 T2DM patients at discharge from a tertiary hospital in Dongguan, China, between August 2022 and October 2023. Data were collected using validated scales, including the Chinese version of the Medication Literacy Questionnaire, the Beliefs about Medicines Questionnaire-Specific, the Self-efficacy for Appropriate Medication Use Scale, and the Morisky Medication Adherence Scale-8. Data analysis was performed using SPSS 26.0 and the PROCESS macro. The study received ethical approval, and all participants provided informed consent.

Results: Patients demonstrated moderate medication literacy (4.05±1.49) and medication adherence (6.35±1.27), held stronger necessity beliefs, and reported high self-efficacy (31.19±4.29). Significant correlations were observed between medication literacy, concern beliefs, self-efficacy, and medication adherence (all P < 0.01). Concern beliefs partially mediated the medication literacy - adherence relationship (indirect effect: 0.085, 28.43%), self-efficacy also served as a partial mediator (indirect effect: 0.128, 42.81%). Furthermore, concern beliefs and self-efficacy acted as serial mediators (total indirect effect: 0.168, 56.19%), revealing a clinical pathway where poor literacy increases concerns, which in turn reduces self-efficacy and medication adherence.

Conclusion: In conclusion, this study reveals that medication literacy influences adherence in T2DM patients through a sequential psychological pathway: by alleviating concern beliefs, which in turn strengthens self-efficacy. This serial mediation mechanism underscores that effective interventional strategies must extend beyond knowledge dissemination to concurrently address patients' specific concerns and bolster their management confidence, thereby offering a multi-faceted approach to improve adherence during the vulnerable hospital-home transition.

Background: Endocrine therapy is essential for breast cancer management but often causes long-term side effects that impair quality of life. Understanding patients' lived experiences and unmet needs is critical for optimizing supportive care.

Objective: To explore the symptom experiences, coping strategies, management challenges, and support needs of breast cancer patients undergoing endocrine therapy.

Methods: A descriptive qualitative design was conducted in this study from December 2024 to May 2025. A purposeful sampling with the maximum variation strategy was adopted to select patients undergoing endocrine therapy for breast cancer. Semi-structured interviews were conducted to explore their symptom experiences, self-management practices and support needs. The data were analyzed using NVivo 12.0 through Braun and Clark's thematic analysis, and rigor was ensured through triangulation, participant validation, and audit trails.

Results: A total of 20 female breast cancer patients receiving ≥6 months of endocrine therapy participated in this study. These data reveal four main themes and 13 sub-themes. Four themes emerged: (1) Substantial multidimensional disease burden, revealing synergistic physical symptoms and psychological distress driving social withdrawal; (2) Individual variations in symptom coping styles, categorizing strategies as adaptive (proactive lifestyle adjustments), defensive (avoidance), or creative (self-devised techniques); (3) Diverse symptom management dilemmas, including knowledge gaps, limited self-advocacy, inadequate social support, and diminished motivation; and (4) Personalized symptom management needs, emphasizing demands for tailored information, lifestyle guidance, psychological support, and digital health tools.

Conclusion: Patients endure significant multidimensional symptoms exacerbated by heterogeneous coping capabilities and systemic barriers. Findings underscore an urgent need for patient-centered interventions addressing education, psychological care, and digital solutions to optimize long-term endocrine therapy management.

Introduction: The degree to which patients are able to understand, cope with, and manage their illness and daily lives can be assessed using the Patient Enablement Instrument (PEI) questionnaire, a tool widely recognized as the gold standard for such evaluations. The primary objective of this study was to assess the level of agreement between patients and General Practitioners (GPs) in evaluating enablement following a consultation.

Patients and methods: A cross-sectional observational study was carried out using the PEI in urban area, (3,88% of patients without GP). Surveys were conducted with individuals over 18 years of age after their GP appointment. They were invited post-consultation to self-complete the PEI survey (range: 0-12) and sociodemographic questionnaire, following the written informed consent. Both patients and GPs completed the PEI. A minimum sample size of 108 participants was calculated, and a favourable opinion was obtained from the Ethics Committee of the Faculty of Medicine of the University of Porto (FMUP).

Results: The study included 16 physicians and 238 patients (65.1% women, median age 59). Patients reported higher levels of enablement than GPs (median 8 vs 6), with a mean bias of 0.89. The agreement between the patients and the GPs was poor (42%-46%), and the reliability of the total score across the six PEI items (intraclass correlation coefficient: 0.126) was low.

Conclusion: In this sample, GPs underestimated patients' perceived enablement levels. Enablement is multidimensional and depends on various clinical interactions and care processes. Factors influencing enablement and its impact on disease self-management and health outcomes should be explored in future research.

Purpose: To identify predictors of patient engagement in a care coordination program for individuals with work disabilities, using a continuum-based definition of engagement and the PROGRESS-Plus framework.

Patients and methods: This observational analysis used deidentified data from the Vermont RETAIN Phase II program, a cluster-randomized controlled trial testing the impact of early delivery of evidence-based stay-at-work (SAW) and return-to-work (RTW) strategies on employment outcomes of individuals with work-limiting physical or mental health conditions recruited from the primary care setting. We included 429 intervention participants with complete data on patient engagement and relevant predictors in this analysis. Based on care manager assessment, we categorized patient engagement into four ordinal levels (none, low, medium, and high). We conducted bivariable analyses to identify potential predictors of engagement, followed by multivariable ordinal logistic regression. Variables were defined according to the PROGRESS-Plus framework, encompassing sociodemographic, clinical, and work-related characteristics.

Results: Having an injury or illness-related absence from work significantly predicted higher odds of engagement (OR = 2.87, 95% CI: 1.81-4.56), while unemployment predicted lower engagement (OR = 0.43, 95% CI: 0.27-0.63) compared to employer-based job. Participants with a high school education or less (OR = 0.40, 95% Cl: 0.23-0.69), followed by college education (OR = 0.52, 95% Cl: 0.31-0.88) engaged less than those with post-graduate education. Also, poor or fair self-rated health (OR = 1.87, 95% Cl: 1.31-2.68) and age (OR = 1.02 per year, 95% CI: 1.01-1.04) significantly predicted higher engagement odds. Multivariate model diagnostics supported the proportional odds assumption (χ²(14) = 18.5, p = 0.183).

Conclusion: These findings highlight the importance of tailored work disability prevention strategies based on health, work, and educational profiles to optimize patient engagement.