Patient preference and adherence最新文献

Introduction: Currently, telehealth, which encompasses digital tools such as video communication, mobile applications, and remote monitoring, enables professional remote education and medical care. This study aimed to assess the acceptance of telehealth care by women with Gestational Diabetes Mellitus (GDM) in routine care based on data from the Istel Care system.

Material and methods: This retrospective, multicenter observational study included 62 patients from three clinical centers: 44 from Krakow, 10 from Rzeszow, and 8 from Zabrze. Patients who consented to participate in the research and conduct home measurements as recommended received a glucometer, a blood pressure monitor, a scale, and a mobile application integrated with the telemedicine Istel Care System. Only the first visit was face-to-face, and the rest were online. After the study, patients completed a satisfaction questionnaire using the Istel Care System.

Results: Of the 62 participants, 58 completed the study, and 50 responded to the follow-up survey. Satisfaction was high across several areas, including convenience (8.7 ± 2.5), accessibility (9.0 ± 2.3), and ease of interpreting results (9.3 ± 1.7). Patients used the system 5-7 times daily, most often seeking information on gestational diabetes and dietary advice. The most valued feature was the ability to easily share measurements with their doctor (89.8%), while 76.9% reported improved communication with their healthcare provider. Reported challenges included technological barriers (45.7%) and concerns about data security (21.6%). Suggested improvements included measurement reminders and real-time feedback from professionals. Overall, the system was positively received, enhancing patient control and motivation for lifestyle changes.

Conclusion: The Istel Care telehealth system was well accepted and feasible for women with GDM in routine care, supporting effective communication and patient self-management.These findings encourage further evaluation of telehealth solutions in diabetes care under routine clinical conditions.

Background: Non-pharmacological therapies in traditional Chinese medicine (TCM) are gradually gaining popularity. However, there has been no systematic understanding about cancer patients' preferences regarding these treatments.

Objective: This review aims to clarify cancer patients' preferences for these therapies and the factors influencing them through systematic integration of evidence.

Methods: A systematic search was conducted among eight databases. The time period spanned from the inception of each database to April 7, 2025. The Mixed Methods Assessment Tool was employed to assess the quality of the studies that met inclusion criteria. The JBI Convergent Synthesis Method was used to transform the extracted quantitative data into qualitative data that was then synthesized with qualitative data. A socio-ecological model was applied to group factors that influence TCM choices.

Results: A total of 27 studies were included in this review, consisting of 13 quantitative and 14 qualitative studies. The factors that might affect cancer patients' preferences in favor of TCM non-pharmacological therapies are multifaceted, covering every level that exists within the socio-ecological model, including the individual (belief and past experiences), interpersonal (professional recommendations and family), healthcare system (service accessibility and cost), society (cultural origins and resources), and governmental (insurance and standards). The PROSPERO registration was dated April 6, 2025 (Registration Number: CRD420251026914).

Conclusion: Patients' preference for TCM non-pharmacological therapies is driven by cultural affinity and interpersonal care needs rather than objective clinical evidence. This reminds us that while respecting patient preferences is essential for achieving patient-centered care, we must also adhere to evidence-based science to ensure safety and effectiveness. Future research should prioritize non-pharmacological therapies other than acupuncture (eg, massage, qigong) to bridge the evidence gap regarding their safety and efficacy. One limitation of this review lies in the overemphasis on acupuncture among cited studies and the cultural homogeneity.

Purpose: Autonomous self-regulation is a proxy for adapting to long-term healthy behaviors and has a key impact on the prevention of chronic illnesses. The psychometric properties of the Treatment Self-Regulation Questionnaire-Persian Version (TSRQ-P) were assessed in this study to examine different types of self-regulation among Iranian type 2 diabetes patients.

Patients and methods: A preliminary draft of the TSRQ-P was prepared based on a standard translation/back-translation procedure and appraisal of the face and content validities by 15 allied health specialists. The internal consistency measure of Cronbach's alpha and Intraclass Correlation Coefficient (ICC) were estimated to verify the content validity and reliability of the TSRQ-P. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to check the scale's structural components.

Results: The calculated Cronbach's alpha= 0.893 and ICC= 0.982 deemed the scale to be appropriate, in terms of internal consistency and measurement invariance. The EFA and CFA outputs yielded two distinct factor structures for TSRQ-P [(N=189) (RMSEA=0.078, NFI=0.849, RFI=0.806, IFI=0.913, TLI=0.886, and CFI= 0.911)].

Conclusion: The TSRQ-P has robust psychometric features for application to Persian-speaking patients with type 2 diabetes. Owing to the cross-border cultural diversity of the subgroups of Persian-speaking populations, further psychometric scrutiny is recommended to prevent bias and sociolinguistic inconsistencies.

Purpose: To determine the prevalence of patient decision delay in aortic dissection and identify its associated factors, representing the first application of the Self-Regulatory Model as a guiding theoretical framework.

Patients and methods: A total of 386 patients with aortic dissection were enrolled in this single-center, cross-sectional study. Participants were recruited from the emergency department of a tertiary cardiovascular hospital in China, using a convenience sampling methodology. Data were collected using the Brief Illness Perception Questionnaire, the Perceived Barriers to Healthcare-Seeking Decision Scale, and the Social Support Rating Scale. Logistic regression analysis was performed to identify factors associated with patient decision delay.

Results: The prevalence of patient decision delay in this study was 67.88% (95% CI: 63.22% - 72.54%). Logistic regression analysis identified several potential factors associated with this delay, including education level, presence of bystanders at symptom onset, Stanford classification, and pain severity. Symptoms such as back pain, abdominal pain, profuse perspiration, and persistent unrelieved pain were also significant. Furthermore, perceived barriers and illness perception were found to be linked to decision delay.

Conclusion: Decision delay is a prevalent issue among aortic dissection patients, necessitating targeted interventions. The study confirms that patient decision delay is driven by clinical factors and, crucially, by modifiable factors within the Self-Regulatory Model, such as negative illness perceptions and heightened perceived barriers. Interventions targeting these cognitive and psychosocial barriers are imperative for improving outcomes.

Introduction: This study aimed to investigate the knowledge, attitude, and practice (KAP) of pregnant women and their spouses toward intraspinal delivery analgesia.

Methods: This cross-sectional study recruited pregnant women and their spouses at Qilu Hospital in 2023.

Results: A total of 628 valid questionnaires were included (465 pregnant women and 163 spouses). The mean KAP scores were 6.44 ± 6.04 (possible range: 0-18), 36.33 ± 5.87 (possible range: 10-50), and 15.71 ± 3.16 (possible range: 4-20), respectively. Pregnant women had higher knowledge, attitude, and practice scores than spouses (all P<0.05). SEM showed that knowledge positively influenced both attitude (β=0.425, 95% CI: 0.352-0.497, P<0.001) and practice (β=0.580, 95% CI: 0.517-0.644, P<0.001), and attitude positively influenced practice (β=0.612, 95% CI: 0.545-0.680, P<0.001).

Conclusion: Pregnant women in Shandong (China) have poor knowledge but positive attitudes and proactive practices toward intraspinal delivery analgesia during delivery. Compared with their spouses, pregnant women demonstrated better KAP toward intraspinal delivery analgesia. These findings highlight the need to provide education for spouses to support informed decision-making, while interpretations should consider the single-center scope and cultural context. Importantly, the results support integrating spouse-focused education into routine antenatal care.

Purpose: To adapt the Test of Adherence to Inhalers (TAI) questionnaire to Basque language and evaluate the psychometric properties.

Patients and methods: A cross-sectional observational study was carried out. We recruited Basque-speaking adults aged ≥18 years who attended the respiratory outpatient clinics in the last 5 years for follow-up with a diagnosis of asthma (n=249) or chronic obstructive pulmonary disease (COPD) (n=149). Patients were contacted by postal mail and reminders were sent to non-respondents. The TAI was translated into Basque and back-translated into Spanish. The comprehensibility and feasibility of Basque TAI were evaluated through cognitive debriefing interviews. We performed the descriptive of the questionnaire and assessed reliability by Cronbach's alpha, structure validity by confirmatory factor analysis (CFA) and known-groups validity by Wilcoxon and Kruskal-Wallis tests according to disease severity, exacerbations and Charlson Comorbidity Index (CCI).

Results: Mean TAI score were 44.82 (standard deviation (SD)=7.26) and 48.52 (SD=3.88) for patients with asthma and COPD, respectively. No floor effect was observed in any cohort. 38.14% of patients with asthma and 67.21% with COPD reported good adherence (maximum score), indicating a ceiling effect. The Cronbach's alphas were 0.881 and 0.836 for the asthma and COPD cohorts, respectively, demonstrating adequate reliability. In the CFA, each item loading was >0.4, suggesting that they fit into a single dimension. Mean TAI score was higher in patients with asthma experiencing exacerbations (p<0.05) and more severe asthma and COPD (p<0.0001) as compared to their counterparts, which demonstrates the known-groups validity. TAI score did not differ according to comorbidities.

Conclusion: The Basque TAI is valid, reliable and useful for measuring adherence to inhalers in patients with asthma and COPD in clinical and research settings.

Background: Low back pain (LBP) is a leading cause of disability worldwide, especially in LMICs like Iran, yet patient preferences for treatment remain unquantified, hindering patient-centered care. This study aimed to investigate and quantify Iranian patients' preferences for LBP treatment attributes using a discrete choice experiment (DCE).

Methods: A cross-sectional DCE was conducted involving 331 adult patients in Kermanshah city, western Iran, between July and December 2024. The treatment attributes include pain reduction, risk of recurrence, treatment cost, time required for recovery, and type of treatment. A total of 24 treatment choice sets were developed using a D-efficient design and divided into four blocks. Patient preferences were analyzed using conditional and mixed logit regression models.

Results: The study population (N=331) had a mean age of 38.51 years and was 51.06% female. The conditional logit model identified pain reduction as the most influential attribute affecting patient preferences (coefficient = 0.836; 95% Confidence Interval(CI): 0.629 1.042; P< 0.001). A significant preference was observed for non-surgical treatments (coefficient = 0.665; 95% CI: 0.561-0.767; P < 0.001), while higher treatment costs, particularly those exceeding 500 million IRR, were negatively associated with choice (coefficient = -0.751; 95% CI:-0.905 -0.595; P <0.001). The mixed logit model revealed significant heterogeneity in preferences, especially for pain reduction (Standard Deviation(SD) up to 1.352; 95% CI: 0.634 -2.071; P< 0.001), treatment type (SD = 1.827; 95% CI: 1.296-2.358;P< 0.001), and high treatment costs (SD = 1.477; 95% CI: 0.928-2.025; P< 0.001), indicating diverse patient valuations. In contrast, risk of recurrence and recovery time showed less variability across individuals.

Conclusion: This study showed strong preferences for pain reduction, affordability, and non-surgical treatments. Significant heterogeneity highlights diverse patient values and the need for individualized, patient-centered care. These findings inform clinical practice and health policy, supporting shared decision-making and improved access to effective, affordable, and non-invasive treatment options in low- and middle-income settings.

Introduction: This survey aimed to characterize the patient experience with disease and immunoglobulin (Ig) treatment including quality-of-life in those with a neurologist-confirmed diagnosis of Chronic Inflammatory Demyelinating Polyneuropathy (CIDP).

Methods: CIDP patients (n=42) from the United States (n=31) and Europe (n=11) with Ig treatment experience completed an online 20-minute questionnaire, followed by virtual 60-minute in-depth interviews. Interviews were recorded, transcribed verbatim, and analyzed using NVIVO 12 qualitative data analysis software.

Results: Patients reported substantial delays between initial symptoms and CIDP diagnosis (median 2 years, range 0-15 years), and a profound impact of disease across physical, social, and psychological domains. Physical impact included inability to perform everyday tasks such as household chores and need to utilize assistive devices (eg walkers, wheelchairs). Patients reported substantially reduced social and leisure activities, and associated emotional impact due to social isolation and loss of independence, especially loss of driving ability. The majority retired and/or went on disability within a year of CIDP diagnosis. Notwithstanding some delays in initiating Ig treatment, both Intravenous Immunoglobulin (IVIG) and Subcutaneous Immunoglobulin (SCIG) were generally perceived as highly effective with 69% of patients reporting vast improvements in physical function, including renewed strength, restored ability to walk and perform everyday tasks, and reduced pain. SCIG patients (24%) expressed a preference for SCIG due to its ease of use and minimal disruption to daily life. Overall, 36% of patients reported their physicians ceased their Ig therapy, reduced dose or dosing frequency upon CIDP symptom improvement, with 33% of those patients subsequently worsening, but recovering upon returning to the original dose. Patients expressed a desire for continuing Ig treatment due to fear of disrupting its benefits.

Conclusion: Patients reported substantial impact of CIDP across physical, social, emotional and employment-related domains. Patients reported being highly satisfied with Ig therapy and committed to continuing treatment.

Introduction: Goal-setting interviews in randomised controlled trials (RCTs), such as the Bangor Goal-Setting Interview (BGSI), provide personalised, measurable outcomes that are meaningful to participants because they reflect their unique needs. The PRACTIC (PReventing and Approaching Crises for frail community-dwelling patients Through Innovative Care) RCT (2023-2024) evaluates a biopsychosocial intervention to approach and prevent crises for frail community-dwelling patients. The PRACTIC Goal Setting Interview (PGSI), adapted from the BGSI, focuses on individual goal attainment and readiness to change and was chosen as the primary outcome in the PRACTIC RCT. This study aimed to translate and develop the PGSI, exploring its feasibility, content validity and interrater reliability.

Design and methods: This study used a convergent mixed-method design; quantitative and qualitative data were collected with equal priority, analysed separately, and compiled for the results and discussion. Two substudies are included: 1) translation and development of the BGSI towards the PGSI and 2) feasibility, content validity and interrater reliability of the PGSI. Substudy 1 comprised field notes from meetings with municipal staff (n=7) across two municipalities. Substudy 2 included data from 28 municipalities participating in the PRACTIC RCT; patient (n=126), next of kin (n=72), and data from focus groups with staff members (n=13) and data collectors (n=5), as well as individual interviews; patients (n=8) and next of kin (n=4).

Results: The PGSI was well received in the home care services and helped strengthen patient involvement. However, there were challenges in using the PGSI, such as time pressure and workload for the staff. After 12 weeks, participants with high motivation showed a significant increase in PGSI compared with those with low motivation (p = 0.010). Analyses also revealed strong positive correlations between participants and staff members assessments of goal attainment at 12 weeks (Spearman's ρ = 0.87-0.92, p < 0.001). The results indicate that the PGSI is a valid and reliable tool for improving patient care through structured goal setting and the active involvement of patients and their next of kin.

Conclusion: The PGSI appears to be a useful and feasible tool for goal setting in home care services. The tool strengthens patient engagement and goal attainment with high content validity and interrater reliability.

Trial registration: ClinicalTrials.gov identifier: NCT05651659. Registration date: 07.12.22.

Background: Medical travel is a global phenomenon with significant economic value. However, its impact is felt primarily in the patients' home countries. Therefore, it is essential to engage in patient experience-based reflection to ensure that policy improvements remain patient-centered. This includes drawing on patients' experiences both domestically and abroad when interacting with healthcare services especially hospitals.

Objective: This study aims to explore the experiences and emotional bonds that form between Indonesian patients and foreign healthcare providers.

Methods: This study conducted in-depth interviews with 15 patients who had sought medical treatment abroad, at least once in the past two years. Participants were recruited using the snowball sampling technique through patient networks.

Results: Most informants had sought treatment outside Indonesia, predominantly in Malaysia and Singapore, at least once a year. Three informants had engaged in medical travel for more than five years. The study identified seven key themes: 1) Disappointing Experiences in Indonesian Hospitals; 2) Lengthy Procedures; 3) Lack of Expertise in the Home Country; 4) Medical Outcome Considerations; 5) Cost; 6) Equipment; and 7) Relationships. The decision to seek care abroad was highly personal and often stemmed from negative experiences in Indonesian hospitals. Informants found their relationships with doctors and hospitals abroad to be particularly pleasant.

Conclusion: This study highlights that a combination of negative experiences in Indonesian hospitals and the perception that the quality of care in foreign hospitals is superior leads to repeated medical travel. Emotional bonds are formed between patients and their preferred doctors or hospitals overseas. Indonesian hospitals must develop a patient-centered service approach to improve healthcare retention.