Patient preference and adherence最新文献

Purpose: Connective tissue diseases (CTDs) predominantly affect women, creating complex self-care and psychosocial demands that extend to their spouses. Yet, how couple-level interactions shape outcomes-or how nurses can harness dyadic resources in care-remains poorly understood. This study aims to explain and deeply understand how couples co-construct resilience in managing CTDs, thereby elucidating the interactional mechanisms underlying the previously observed null effect of partner coping.

Patients and methods: A descriptive qualitative study was conducted and reported following the COREQ guidelines. Twelve couples (comprising women with CTDs and their husbands) were purposively sampled. Semi-structured joint interviews, lasting 60-90 minutes, were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis in NVivo 14. To ensure credibility, member checking and dual-coder consensus were employed.

Results: Three themes emerged: (1) emotional resonance from disease shock, involving shared disbelief, role imbalance, and contagion; (2) an evolution in dyadic coping from joint avoidance to a division of labor and finally to embodied support; and (3) the joint construction of resilience through meaning-making, trust-building rituals, and humorous future re-imagining. However, well-intentioned support was found to subvert patient autonomy, providing a key explanation for the null effect of positive dyadic coping observed in quantitative studies.

Conclusion: Resilience is a dynamic, dyadic construct, co-constructed in moment-to-moment interactions. This necessitates viewing the couple, not the individual, as the essential unit of care in CTDs management. Interventions must therefore be designed to preserve patient autonomy while cultivating authentic emotional disclosure and collaborative problem-solving.

Purpose: Antipsychotic (AP) medication adherence is important for the management of schizophrenia. This study thus aimed to evaluate prescriber- and patient-level characteristics and long-acting injectable (LAI) treatment use among patients with schizophrenia to determine the association between these factors and AP adherence.

Patients and methods: Adult patients with schizophrenia in the United States were identified from Komodo Research Data (01/01/2016-06/30/2023). Patients were required to have been initiated on an oral or LAI AP (index date) during the intake period (07/01/2021-06/30/2022), by a provider who prescribed APs to ≥6 patients with schizophrenia over the intake period (index prescriber). Providers were characterized using quartiles of the proportion of LAIs over all APs prescribed during the intake period (non-LAI prescribers; Q1: low, ≤8.5% LAIs; Q2-3: intermediate, >8.5% and <27% LAIs; Q4: high, ≥27% LAIs). Adherence to any AP (proportion of days covered ≥80%) was reported over the fixed 12-month follow-up period, and factors associated with adherence were evaluated using multivariate logistic regression.

Results: In total, 22,255 patients were included (mean age: 40.9; male: 66%; Medicaid: 76%). At index, 82% and 18% of patients were initiated on an oral AP or LAI, respectively, with 10%, 21%, 47%, and 22% of index APs prescribed by non-, low-, intermediate-, and high-LAI prescribers, respectively. Prescription of the index AP by an intermediate- or high- LAI prescriber was associated with 39% and 63% higher odds of adherence, respectively, relative to non-LAI prescribers (both p<0.001). Prescription of an LAI versus oral index AP was associated with 25% higher odds of adherence (p<0.001). Patients of all racial/ethnic minorities had lower odds of adherence relative to White patients (all p<0.050).

Conclusion: Adherence was higher among patients treated by high-LAI prescribers, indicating that familiarity with LAI treatment and awareness of adherence challenges may improve adherence rates among patients with schizophrenia.

Purpose: Breast cancer is the most commonly diagnosed cancer among women and a leading cause of cancer-related death. The increasing use of oral anticancer medications (OAMs) shifts responsibility for medication management to patients, often without adequate support. This study aimed to co-design an early-stage prototype intervention to support patients with breast cancer in managing OAMs, using a patient-centered, participatory design approach.

Patients and methods: We conducted three rounds of participatory design (PD) sessions with five patients receiving OAMs at a federally qualified health center's outpatient breast cancer clinic, in central Indiana. Eligible participants were 18 years old or older, diagnosedwith breast cancer, and currently taking OAMs. The PD process involved three stages: (1) Inspiration-patients identified key challenges in OAM management; (2) Ideation-patients co-developed potential solutions; and (3) Convergence-patients evaluated and selected preferred design concepts.

Results: Participants (median age: 66; range: 38-75) identified key challenges, including side-effect management, difficulty navigating resources, and lack of clear information. Ten solution ideas were generated and grouped into three categories: resource booklet, care navigation/support, and transportation assistance. Two priority prototypes emerged: (1) a physical breast cancer handbook, and (2) an interactive treatment navigation app. Participants favored the ease of use from the handbook while appreciated the mobile app's potential for bidirectional communication and peer support features.

Conclusion: This study highlights the value of engaging patients as co-designers in the early stages of intervention development. Both the physical handbook and interactive app show potential to support OAM adherence and management. While the two design concepts require further refinement before implementation and pilot testing, the findings offer valuable insight for potential interventions in the context of oral anticancer medications used for treating breast cancer.

Background: Irritable bowel syndrome (IBS) is associated with impaired health-related quality of life (HRQoL) and a high burden of comorbid mental health conditions, However, limited population-level evidence exists. Therefore, this study examined the relationship between anxiety, depression, and HRQoL among adult and elderly populations with IBS in the United States.

Methods: A cross-sectional observational analysis was conducted. Data were drawn from the 2017-2022 Medical Expenditure Panel Survey (MEPS). Adults aged ≥18 years with a diagnosis of IBS were included. HRQoL was assessed using the Veterans RAND 12-Item Health Survey, generating Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Adjusted multivariable linear regression models provides weighted national estimates for the associations between IBS groups (IBS only, IBS with anxiety, IBS with depression, and IBS with both) and HRQoL. Depression and anxiety were identified from MEPS using the ICD-10-CM codes. Subgroup analyses compared adults (18-64 years) and older adults (≥ 65 years).

Results: Among 595 adults with IBS, most were women (78%) and aged >65 years (39%). IBS with comorbid depression and/or anxiety was strongly associated with lower HRQoL. Participants with both depression and anxiety reported the poorest HRQoL (PCS mean = 38.84; MCS mean = 39.20). Regression analyses showed significant reductions in both PCS and MCS for individuals with comorbid psychiatric disorders compared with IBS only (all p<0.001). In age-stratified analyses, depression and anxiety were primarily associated with larger declines in mental HRQoL among younger adults, whereas in older adults these comorbidities were associated with reductions in both physical and mental HRQoL, with greater overall impairment in the presence of chronic comorbid conditions. Protective factors included employment, higher income, physical activity, and good self-rated health.

Conclusion: Comorbid depression and anxiety substantially reduce both physical and mental HRQoL among individuals with IBS, with distinct age-specific patterns. Younger adults are primarily affected in mental domains, whereas older adults experience broader impairment in in physical and mental domains. These findings suggest the need for integrated clinical approaches that address both IBS and mental health to improve overall HRQoL in IBS patients.

Purpose: Females play a central role in health-related decision-making for their families. This study aims to evaluate the satisfaction of female patients with pharmaceutical services in Jordan.

Patients and methods: This is an online cross-sectional survey study that was conducted in Jordan between February 13^th and April 04^th 2025. This study utilized the Arabic version of a previously developed questionnaire tool focused on patient satisfaction with pharmaceutical services. Multivariable logistic regression analysis was used to identify significant predictors of satisfaction level.

Results: A total of 637 females participated in this study. Overall, patients' satisfaction with pharmaceutical services was positive. Moreover, 36.1% expressed excellent satisfaction with pharmacy services overall. Some areas showed room for improvement, only 14.8% rated the pharmacists' frequency of checking on medication effectiveness as excellent, and 20.3% rated the pharmacists' interest in their health as excellent. Participants with monthly income of 1000-1500 Jordanian dinars were more than twice as likely to report higher satisfaction compared to those earning less than 500 (adjusted odds ratio (aOR) = 2.23, 95% confidence interval (CI): 1.25-3.99, p = 0.006). Visiting government center pharmacies (aOR = 0.44, 95% CI: 0.24-0.82, p = 0.009) or government hospitals (aOR = 0.42, 95% CI: 0.21-0.84; p = 0.014) was associated with significantly lower odds of satisfaction compared to those visiting community pharmacy.

Conclusion: This study indicates that female patients in Jordan have a positive overall satisfaction with pharmaceutical services. However, training Jordanian pharmacists on updated medication information, pharmaceutical services, communications, and follow-up with patients during their treatment is required to increase satisfaction with pharmacy services and patients' health specifically in governmental healthcare settings; which warrant targeted policy.

Purpose: This study aimed to examine the factors influencing the adherence of stroke patients to home-based exercise rehabilitation and to elucidate the potential driving mechanisms of temporal perspective on rehabilitation adherence.

Patients and methods: This study employed a sequential, explanatory, and mixed-methods design. In the quantitative phase, a questionnaire survey was conducted among 289 stroke patients from January 2025 to May 2025 using convenience sampling. In the qualitative phase, 16 stroke patients were selected from the quantitative sample through purposive and maximum variation sampling to explain and supplement the quantitative findings using semi-structured interviews.

Results: Quantitative analysis demonstrated a significant positive correlation between temporal perspective and rehabilitation adherence, with rehabilitation intention partially mediating this relationship. Behavioral advantage exerted a negative moderating effect on the intention-adherence pathway, whereas the moderating effect of self-regulation ability did not reach statistical significance. Qualitative analysis identified four main themes: consistency belief, time-bound potency, behavioral advantage, and self-regulation ability.

Conclusion: Temporal perspective is an important driver of adherence to home-based rehabilitation among stroke patients. As rehabilitation habits develop, behavioral patterns gradually shift from being "intention-driven" to becoming "automatic habits", thereby weakening the direct driving effect of intention. Given the potential presence of latent executive dysfunction in stroke patients, targeted assessment tools and intervention strategies should be developed to bridge the gap between intention and behavior.

Purpose: Patients' illness experiences and needs are central to pulmonary tuberculosis management and have important implications for treatment engagement and health outcomes. This study addresses this gap by systematically synthesizing qualitative evidence to provide a comprehensive understanding of pulmonary tuberculosis patients' illness experiences and unmet needs, guided by the Symptom Experience Model.

Methods: PubMed, Web of Science, Embase, PsycINFO, CINAHL, ProQuest, the Cochrane Library, CNKI, VIP, Wanfang, and SinoMed were searched from inception to December 2024 for qualitative or mixed-methods studies on the illness experience of pulmonary tuberculosis patients. Studies were screened and appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Meta-integration techniques were used for synthesis. The Symptom Experience Model provided the interpretive framework for analysis. This review followed PRISMA 2020 guidelines for reporting systematic reviews. The PROSPERO registration was dated July 24, 2024 (Registration Number: CRD42024572729).

Results: Twenty-one studies were included, comprising a total of 469 participants. A total of 36 themes were identified, grouped into nine descriptive categories and synthesized into two overarching findings. First, patients experience complex illness-related challenges, including physical symptoms, psychological distress, disrupted social roles, uncertainty about the future, and, in some cases, post-traumatic growth. Second, multiple unmet needs were identified, including inadequate health education, insufficient emotional support, stigma, barriers to healthcare access, and lack of socioeconomic support. While the Symptom Experience Model helped explain symptom perception and coping behaviors, it was less effective in addressing structural determinants such as poverty and systemic stigma.

Conclusion: Pulmonary tuberculosis causes profound suffering shaped by both individual responses and wider social contexts. Interventions should address emotional and cognitive processes, strengthen social support, and consider patients' lived realities. The Symptom Experience Model could be expanded to better reflect socioecological influences.

Background: Network analysis can identify the core symptoms reported by patients at each time point, providing a basis to develop precise symptom strategies for treatment. However, few studies have established symptom networks for breast cancer patients at various treatment stages.

Objective: The purpose of this study was to identify core symptoms that may be targeted for intervention in different chemotherapy phases for breast cancer patients.

Methods: A multicenter prospective longitudinal survey design was employed in this study. 467 breast cancer patients were recruited in the Breast Surgery Ward from November 2022 and October 2023. The Symptoms Assessment Scale for Breast Cancer Patients Receiving Chemotherapy was used to assess breast cancer patients' symptoms before chemotherapy (T0), after the first chemotherapy (T1), after three chemotherapy treatments (T2), and after the sixth chemotherapy treatment (T3). Symptom networks and node properties were explored using network analysis.

Results: At T0, difficulty sleeping was a symptom with the highest strength (r _s=2.43) and closeness (r _c=1.51). Depression was a symptom with the highest betweenness (r _b=2.47). At T1, decreased appetite was the symptom with the highest strength centrality (r _s=2.22). Pain was the symptom with the highest closeness centrality (r _c=1.48). Headache was a symptom with the highest betweenness centrality (r _b=1.68). Fatigue was the symptom with the highest strength, closeness, and betweenness at T2 and T3 (T2: r _s=1.67; r _c=2.11; r _b=2.30. T3: r _s=1.96; r _c=2.68; r _b=2.15). Except for betweenness centrality at T1, all other centrality measures showed CS coefficients above 0.25, indicating that the symptom networks were substantially stable.

Conclusion: The core symptoms that need to be targeted for intervention in various chemotherapy stages of breast cancer patients differ. Difficulty sleeping and depression should be addressed at T0; decreased appetite and pain were the core symptoms at T1; and fatigue was the most central symptom at T2 and T3 and should be controlled as a priority.

Background: Ocular redness (OR) is a common clinical presentation that can significantly impact patients' health-related quality of life (HRQoL), yet treatment options have historically been limited by side effects and efficacy concerns. Brimonidine tartrate 0.025% represents a newer therapeutic option, but real-world perspectives from healthcare professionals (HCPs) on its clinical utility remain understudied.

Methods: A cross-sectional exploratory qualitative interview study was conducted with 18 ophthalmologists purposively recruited from a sponsor-acquired list. Participants had experience prescribing or recommending brimonidine tartrate 0.025% and were interviewed across Spain, Portugal, Poland, the United States, and Greece. Semi-structured interviews explored current treatment landscapes, unmet needs, and experiences with brimonidine tartrate 0.025%. Transcripts were analysed using qualitative content analysis.

Results: Participants reported OR as highly prevalent in their practice, with dry eye disease being the most commonly cited underlying cause. HCPs described significant HRQoL impact on patients, including social embarrassment, workplace concerns, and emotional distress. Prior to brimonidine tartrate 0.025%, treatment options were limited, with traditional vasoconstrictors avoided due to rebound redness and tachyphylaxis. All participants reported brimonidine tartrate 0.025% as effective, with rapid onset and good tolerability. Key advantages included lack of rebound redness and suitability for various patient types.

Conclusion: This study with brimonidine tartrate 0.025% prescribers found it addresses a significant unmet need in OR management, providing effective relief with improved safety profile compared to traditional options. However, emphasis on proper diagnosis and use remains crucial.