Patient Education and Counseling最新文献

Objective: To examine patient-surgeon communication challenges in aesthetic surgery and identify effective strategies for expectation management and informed consent through narrative review of current literature.

Methods: A comprehensive narrative review was conducted using PubMed, PsycINFO, and communication databases (2010-2024). Search terms included "aesthetic surgery," "patient communication," "expectations," "informed consent," and "social media." Literature was analyzed thematically to identify key communication challenges, digital media influences, and evidence-based intervention strategies.

Results: This review identifies three primary themes and proposes an integrated framework combining traditional communication barriers with digital-era influences: (1) Communication barriers arise from the subjective nature of aesthetic goals and patients' difficulty articulating desires in clinical terms; (2) Social media significantly influences patient expectations, with recent surveys indicating that a substantial majority of facial plastic surgeons encounter patients requesting procedures to improve social media appearance-representing a significant increase from earlier years; (3) Evidence-based visual communication tools and structured decision aids demonstrate effectiveness in aligning expectations and improving satisfaction. Studies consistently show that unmet expectations account for 14.4 % of malpractice claims in plastic surgery versus 3.8 % in other medical specialties.

Conclusion: This review presents a comprehensive integrated communication framework specifically designed for the digital era of aesthetic surgery practice. Effective patient-surgeon communication now requires specialized approaches that address both traditional expectation management and unprecedented social media influences on patient goals.

Practice implications: Surgeons should implement structured communication protocols including visual outcome ranges, psychological expectation assessment, and explicit discussion of social media influences. Professional development programs must emphasize communication skills specific to aesthetic consultation, with particular attention to cultural competence and digital literacy.

Objective: Childhood, adolescent, and young adult cancer survivors (CAYACS) often report cancer-related knowledge gaps. Addressing their information needs is associated with better quality of life. We aimed to explore and synthesize evidence on CAYACS' cancer-related information needs and identify associated characteristics.

Methods: Peer-reviewed articles on information needs in adult CAYACS ≥ 5 years post-diagnosis were systematically searched in PubMed, PsycINFO, and Scopus. The quality of included publications was assessed using the Mixed Methods Appraisal Tool, and results were narratively synthesized.

Results: Twenty-one studies (n = 10 quantitative, n = 8 qualitative, n = 3 mixed-methods) with a total of 5624 participants (range: 14-1386 per study) were included. Between 51 % and 77 % of CAYACS had at least one information need. Needs were reported across 11 domains, including cancer-related health information (2 %-86 %), follow-up care and prevention (2 %-91 %), healthcare system interactions (9 %-36 %), living a healthy lifestyle (4 %-60 %), psychosocial well-being and support (12 %-40 %), sexual health (<1 %-32 %), finances (2 %-50 %), relationships (2 %-20 %), education and employment (<1 %-18 %), insurances (28 %-47 %), and peer support (7 %-35 %). The highest prevalences were observed in follow-up discussions on current health (92 %) and late effects (19 %-86 %). Female sex, older age at study, lower educational attainment, poorer mental and physical health, longer time since diagnosis/treatment, central nervous system tumor diagnosis, and lack of written information were associated with more information needs.

Conclusions and practice implications: Adult CAYACS report significant information needs years after treatment, particularly regarding cancer-related health information, follow-up care and prevention, and lifestyle. Addressing these needs with age-appropriate, individualized information may improve their quality of life. Electronic and mobile health tools are promising methods to provide such support.

Social media beauty filters increasingly shape how patients view themselves and what they request in clinical encounters. In the oculoplastics clinic, a patient asked the author, an ophthalmology resident, whether it would be possible to look like the filtered version of herself she saw on TikTok. Caliper measurements showed that while some requests - such as modest brow elevation, subtle lid adjustments, or slight canthal support - were surgically feasible, others, including narrowed interpupillary distance, shortened philtrum, or enlarged irises, reflected digital distortions that cannot be reproduced in human anatomy. The patient's question - "How do I get to me?" - highlighted the central dilemma: when the filtered image becomes the reference point, the unaltered self can feel counterfeit. A categorical refusal risks leaving patients alone with these unrealistic standards, while uncritical agreement risks reinforcing illusion. The more constructive approach involves reframing the discussion from the filter's output to the underlying goals: appearing more awake, less tired, or more confident. This reflection underscores the importance of communication in settings where patient expectations are shaped by digital media. By combining honesty about anatomical limits with empathy for the emotions behind requests, clinicians can help safeguard identity, set realistic expectations, and maintain trust in an era where technology increasingly distorts self-perception.

Objective: To understand the implementation of a diabetes peer mentorship program from the perspective of peer mentors using an implementation framework and equity lens.

Methods: This study was developed in collaboration with individuals with lived type 1 diabetes experience. Virtual semi-structured interviews with mentors from the "Peer-2-Peer" (P2P) mentorship program (by I Challenge Diabetes) were guided by Proctor's Conceptual Model for Implementation and PROGRESS+ . Transcripts were double-coded and categorized using inductive thematic analysis.

Results: Mentors reported high satisfaction with P2P, especially with its informal structure, relationships, and bidirectional benefits. The adaptable, needs-based mentoring approach addressed challenges and gaps in care such as disease acceptance, diabetes distress, managing glucose during exercise, and transitioning to adult care. Implementation strengths highlighted by mentors were equitable access through support for transportation, financial assistance, and family inclusion. The program's flexibility allowed mentors of different ages and professions to participate. Additionally, mentors expressed a desire for crisis training and the appointment of a designated program mentor. To promote outreach, mentors encouraged the development of partnerships with clinicians.

Conclusion: Mentors identified key factors for the implementation of a peer mentorship program tailored to diabetes self-managed support. The informal and flexible mentoring approach helped address care gaps, create satisfaction, and promote sustainability. This was enhanced through equitable access. Opportunities to further tailor the program were identified, with enhanced mentor training and appointing a designated program mentor as the most crucial. Collaboration with diabetes care clinics for outreach was also recommended.

Practice implications: The findings from this study could be used to improve the implementation of other peer mentorship programs, such as ensuring flexibility for when and how peer mentors provide support, encouraging networking, providing some financial support for participants, providing additional resources for crisis training and outreach by diabetes care clinics.

Objectives: To describe the structure and content of vascular multidisciplinary team (MDT) meetings and to assess the implementation of MDT meeting (MDTM) recommendations in clinical practice, including the frequency and reasons for deviations.

Methods: This prospective observational cohort study evaluated MDT meetings at a tertiary vascular center. The MDT-Metric for the Observation of Decision-making (MDT-MODe) tool was adapted for vascular surgery, and used to score health care professional contributions and the quality of information of topics discussed during MDTMs. After 1 year, medical records were reviewed to assess adherence to MDTM recommendations.

Results: Twelve MDTMs were evaluated, of which 6 MDTMs including 112 patients were used in the final analysis. Discussion lasted a median of 3 min and 38 s per patient. Imaging was reviewed in 97.1 % of cases, and comorbidities, psychosocial factors, and patient perspectives were discussed in 29.4 %, 11 %, and 8 %, respectively. At the outpatient clinic, MDTM recommendations were adjusted in 20 % of cases, rising to 43 % when interventions were advised. Treatment deviations were often due to frailty, patient preference, or changes in the patient's clinical condition.

Conclusion: This study found that vascular MDTMs focused primarily on procedural and diagnostic aspects, including imaging, whereas patient comorbidities, psychosocial factors, and preferences were discussed in the minority of cases. This approach may contribute to discrepancies between MDTM recommendations and their adherence. Further research is needed to confirm the impact of this strategy on decision-making and clinical outcomes.

Practice implications: The findings underscore the need to enhance vascular MDTMs by adopting a more holistic approach. Strategies such as including additional specialists, and allocating more time for complex cases, couldn better align MDTM recommendations with patient-specific needs. These improvements may enhance adherence to MDTM advice.

Objective: To examine how cognitive load and socio-emotional adaptation shape patient education experiences among older adults with multiple myeloma (MM) undergoing autologous stem cell transplantation (ASCT).

Method: Interpretative Phenomenological Analysis (IPA) was used to analyze 150 h of ethnographic observations of nurse-patient education sessions (N = 70), supplemented by retrospective and prospective participant interviews (N = 35) and clinician interviews (N = 7) conducted over 18 months. Socio-Emotional Adaptation (SEA) Theory and Cognitive Load Theory were used as sensitizing frameworks to guide coding, interpretation, and theoretical integration.

Results: Participants reported anxiety, information overload, and limited health literacy, which contributed to cognitive overload. Across ethnographic observations and clinician interviews, facilitators included tailored education, strong caregiver support, and clinician reinforcement of key concepts.

Conclusion: Cognitive and socio-emotional factors influence how people with MM engage with and process transplant education. Interventions designed to optimize information delivery while enhancing socio-emotional support can improve comprehension and confidence in managing treatment.

Practice implications: Integrating cognitive load reduction strategies and socio-emotional adaptation principles into patient education can enhance patient-centered learning experiences and improve readiness for complex treatments.

Objective: This study evaluated the cultural feasibility and impact of a decision coaching workshop for nurses in Japan, using the Ottawa Decision Support Framework (ODSF).

Methods: A pre-post study was conducted to evaluate a four-hour workshop based on the ODSF, integrating lectures, instructional videos, and role-play. Outcomes assessed include participants' perceptions of SDM-related concepts, decision-making skills, and confidence. Confidence was measured using a self-report Likert scale. Quantitative data were analyzed using paired t-tests, and qualitative feedback was thematically summarized.

Results: A total of 54 nurses participated in the workshop. Before the workshop, only 57.4% reported understanding SDM concepts, and many described challenges such as conflicting patient-family preferences and limited patient decision-making capacity. After the workshop, the understanding of ODSF increased by 87.0% , the ability to use decision-support tools by 72.2% , and self-assessment of SDM skills by 50.0% . Confidence in SDM involvement improved from 2.25 to 3.37 and confidence in self-assessment of SDM skills from 2.04 to 3.04 (both p < .001). Participants valued role-play and video demonstrations as particularly effective in enhancing cultural relevance, especially in family-centered decision-making contexts.

Conclusion: The workshop significantly improved SDM confidence among nurses. This decision coaching training is culturally feasible and may support patient- and family-centered care in Japanese healthcare settings.

Practice implications: Decision coaching adapted to family-centered decision-making may strengthen SDM training in collectivist cultures and contribute to more patient- and family-centered care internationally.