Patient Education and Counseling最新文献

Background: Building rapport with young patients is crucial for fostering a sense of comfort that enhances their cooperation during clinical encounters and improves clinical outcomes. The available data on children with neurodevelopmental disabilities in community-based settings, including data on child-physician rapport, is limited.

Aims: To examine how children with neurodevelopmental disabilities perceive rapport with treating physicians compared to parents and treating physicians and to evaluate the relationship between the child-reported rapport and its impact on their cooperation.

Methods: One hundred two children with neurodevelopmental disabilities (M years = 9.63, SD = 2.42) completed the CHARM-C Questionnaire, which assessed their experience of rapport with their examining physicians following neurodevelopmental assessments. In parallel, their parents and physicians completed the CHARM-A Questionnaire, which assessed how they perceived the children's experience of rapport (a total of 306 questionnaires). The physicians also rated children's cooperation. The data were analyzed using correlation, regression, and mixed linear analyses.

Results: Children's perceptions of rapport were significantly less positive than those of parents (d = -0.60) and physicians (d = -0.45). A moderate partial correlation (r = .37) was found between children's and parents' perceptions. Neither children's nor parents' perceptions were correlated with physicians' perceptions. Children's perceptions of rapport were positively associated with greater cooperation (β = .28).

Discussion: Children with neurodevelopmental disabilities rated their rapport with physicians lower than parents and doctors. Their evaluations offer valuable insights, complementing caregivers' and professionals' perspectives. Training physicians to improve their assessments of children's needs during medical encounters is critically important.

Objective: This study aims to explore and enhance the expression of empathy in telehealth visits (e-empathy) with Black American Chronic Kidney Disease (CKD) patients, focusing on goals of care conversations. It seeks to address the intersection of CKD, telehealth advancements, palliative care discussions, and the impact of racism in healthcare for holistic understanding.

Methodology: A qualitative case study design was employed in Washington, DC, involving Black patients with CKD. Data collection included cognitive testing via semi-structured interviews and feedback from a Stakeholder Advisory Group (SAG). Thematic analysis was conducted using NVivo 20 software.

Results: Themes emerged regarding empathy definitions, telehealth understanding, factors influencing confidence, importance of patient stories, cultural awareness, handling upsetting conversations, prioritizing treatment preferences, end-of-life decisions, and definitions of mental health professionals.

Conclusion: The study highlights the significance of e-empathy in telehealth for Black CKD patients, emphasizing respect, trust, and effective communication. It underscores the need for culturally targeted guidance and acknowledges limitations such as self-selection bias and a small sample size. Future work should address healthcare disparities and improve palliative care discussions, including virtual advance directives.

Practice implications: Providers should prioritize e-empathy in telehealth visits with Black CKD patients, fostering trust and communication to improve patient outcomes during goals of care discussions.

Objective: This systematic review assessed the socioeconomic and demographic factors influencing interpersonal communication between family physicians and patients with chronic diseases.

Methods: We searched three databases (Embase, MEDLINE, and Cochrane) for published empirical studies reporting interpersonal communication between adults with chronic conditions and their family physicians. Gender, sex, race or ethnicity, low levels of literacy and/or health knowledge, and lower level of education or income were the factors of interest. Pairs of independent reviewers selected studies, extracted data, and appraised quality of the studies using MMAT-2018. We conducted descriptive and content analyses with a narrative synthesis.

Results: From 7579 identified deduped studies, we included 12 with a total of 22266 participants. Suboptimal interpersonal communication in several domains was more incident amongst ethnic minorities (p < 0.01) and individuals with lower language proficiency (p < 0.05).

Discussion and conclusion: Studies used sex and gender interchangeably. The classifications of racial and ethnic origin, income, and education levels were inconsistent. Our findings suggest that socioeconomic and demographic factors can affect deleteriously in-encounter interpersonal communication.

Practice implications: This review might help guide a communication curriculum for medical students and increase awareness of potential health inequalities pathways in clinical practice.

Registration number: CRD42023411895 (PROSPERO platform).

Objectives: Screening recommendations for gynecologic cancers (GC) associated with Lynch syndrome (LS) are diverse. The objectives of this study were to examine among women with LS: 1) psychosocial factors that influence thoughts and choices about GC screening, and 2) information and unmet healthcare access needs when making GC screening decisions.

Methods: This study used a qualitative design. Interviews were analyzed using thematic analysis. Participants were women with LS (N = 20) recruited from Toronto, Canada. Fourteen participants had or were participating in GC screening and six had never undergone screening, however were or would be eligible for screening in the future.

Results: Five main themes were identified: understanding level of risk, women's experiences of GC screening, interactions with the health care system, considerations about risk-reducing surgery, and improving LS care.

Conclusions: Participants had many unmet healthcare needs and lacked information about screening and pain management. Self-advocacy was an important strategy for managing care.

Practice implications: Psychoeducational interventions are important to manage uncertainty associated with LS, increasing social and informational support, and informing health care providers about best practices with this population.

Objective: The objective of this trial was to determine the feasibility, acceptability, and preliminary effectiveness of sharing audio recordings of primary care visits with older adults with multimorbidity.

Methods: We used a two-arm, randomized, controlled, feasibility trial with 3-month follow-up. Patients aged ≥ 65 years-with diabetes and hypertension-were recruited from academic primary care settings in New Hampshire, Tennessee, and Texas. Patients were randomized to receive online access to audio recordings of scheduled visits for three-months or care as usual (after visit summaries). Primary outcomes were acceptability and feasibility assessed using several indicators: acceptabilityrecruitment of 90 patients; recording use; and the Appropriateness of Intervention Measure (AIM; >3), feasibility- retention rate; protocol adherence; and the Feasibility of Intervention Measure (FIM; >3). Interviews were conducted with clinicians (n = 14) and patients (n = 19). Exploratory outcomes included patient activation, satisfaction, adherence, and quality of life.

Results: We met recruitment (n = 91) and retention (98 %) targets and exceeded feasibility (Median FIM 4; IQR 3 - 4) and acceptability (Median AIM 4; IQR 3 - 4) metrics. Fidelity to protocol was high (92 %), and 40 of 45 patients (85 %) accessed their recordings. Interviewees noted the benefits of visit recording, including greater recall, understanding, and family engagement. Recording had little perceived impact on the visit interaction, and concerns about visit recording were minimal. Exploratory outcomes revealed better PROMIS Mental Health Scores for patients receiving Audio compared to Usual Care at 3 months: 51.5 (SD 7.7) vs. 47.7 (SD 9.9), P = 0.04.

Conclusions: Sharing visit recordings online with older adults is feasible and acceptable. A larger trial is needed to determine the impact of sharing recordings on patient health outcomes.

Practice implications: Recording is a highly scalable approach to supporting older adults and their care partners in managing care. Advances in natural language processing may unlock further opportunities for this innovative strategy.

Objective: Exercise adherence and motivation can benefit from technology, but the specific factors influencing these improvements remain unclear. This scoping review aimed to outline the types and features of technology used in exercise prescription within healthcare, focusing on enhancing users' adherence to exercise.

Methods: A comprehensive systematic literature search was conducted from January 2000 to February 2023 across Web of Science, Google Scholar, and MEDLINE via PubMed. The review sought studies on technology-based exercise prescriptions for adults ≥ 18 years, evaluating features that enhance motivation or adherence.

Results: Out of 1724 articles reviewed, 45 met the criteria, demonstrating that mobile applications, exercise gaming, wearable trackers, and websites are commonly used technologies for prescribing exercise in healthcare setting. Common features, special features, and motivating features were found to be important in all technology-based exercise tools to enhance users' adherence and motivation.

Conclusion: This review provides a comprehensive overview of the technological types and approaches that can support and improve exercise adherence among health service users. The findings also emphasize on specific features that can address current gaps in technology-driven fitness interventions.

Practice implications: Healthcare professionals should make informed decisions when recommending these tools to health service users, since technology does play a significant role in promoting long-term adherence to exercise programs.

Objectives: To investigate patient perspectives on the gender of physiotherapists in stroke rehabilitation.

Methods: A cross-sectional study was conducted among a diverse group of patients with stroke (N = 143) who required manual assistance with transfer and ambulation. Participants were asked about their preferences for the gender of their physiotherapist and responses were categorized as male physiotherapist, female physiotherapist, or gender doesn't matter.

Results: A significant proportion of participants (24-38 %) showed a preference for gender-concordant physiotherapists (p < 0.01). Women had a higher preference for gender-concordant physiotherapists compared to men. Specifically, 3 to 4 out of 10 women (32-38 %) preferred physiotherapists of the same gender, while 5 to 6 out of 10 (51-57 %) indicated that the gender of the physiotherapist didn't matter to them (p < 0.01).

Conclusions: This study highlights the diverse perspectives on the importance of physiotherapist gender among patients with stroke. While gender preferences may influence patient comfort and engagement in therapy, these preferences are not universal and should be considered within a broader context of patient-centered care.

Practice implications: Rehabilitation programs should strive to be sensitive to patient preferences while balancing these preferences with the availability of skilled therapists and the operational constraints of clinical settings.

Objective: We investigated communication experiences of caregivers of children with medical complexity (CMC) during emergency care.

Methods: Fifteen caregivers of CMC participated in semi-structured interviews regarding communication while seeking care for their child in the emergency department (ED). Thematic analysis was applied using a previously established functional communication model as an a priori framework.

Results: Each of the previously established 8 core functions of communication were identified in this population. "Building relationships" manifested as clinicians soliciting caregiver input and responding to the needs of the caregiver. "Exchanging information" included clearly explaining next steps to caregivers. "Responding to emotions" acknowledged the inherent distress of seeking emergency care. "Providing validation" included recognizing caregivers as the expert of their own child. "Enabling self-management" manifested as identifying caregiver needs and directing toward resources. "Making decisions" manifested as involving caregivers in the decision-making process and recognizing caregiver decision fatigue. "Managing uncertainty" involved developing plans with caregivers. "Supporting hope" was the least commonly described function and manifested as emphasizing positive aspects of a child's condition. Many caregivers described negative communication experiences in which their concerns and insights were unheard or invalidated.

Conclusion: Caregivers of CMC described communication experiences and goals that align with 8 communication functions that were identified in other serious childhood illnesses with unique operationalizations.

Practice implications: This communication framework can support ED clinicians in better understanding the communication needs of caregivers of CMC during emergency care.

Objective: Racial disparities in clinical communication quality are well-established but most clinical communication assessment tools are created without the collaboration of racially-diverse patient populations. Our objective was to collaborate with Black and White cancer survivors, caregivers, and advocates to develop and validate a tool to assess physicians' patient-centered communication.

Methods: A panel of Black and White cancer survivors, caregivers, and advocates (n = 11) and researchers observed and discussed video-recorded patient-physician cancer clinical interactions to generate and refine a list of physician communication behaviors considered critical for high-quality patient-centered communication. Raters applied the 22-item scale (Patient-Informed Cancer Communication Scale; PICCS) assessing physicians' patient-centered communication to video-recorded interactions (n = 61) from a larger study. We determined constructs using scale development and factor analysis and validated the scale through correlation with existing scales.

Results: Factor analysis identified five factors: treatment options; clinical relationship; prognosis and goals of treatment; explanations; and context. Treatment options, prognosis and goals of treatment, and the full scale correlated with a validated patient active participation scale. Clinical relationship and context correlated with a validated physicians' patient-centered communication scale.

Conclusion: This community-engaged research produced a reliable and valid scale to assess physician patient-centered communication in the context of Black and White people with cancer.

Practice implications: With further validation work, this scale can be used to train and assess physician communication quality when discussing cancer treatment in diverse cancer patient populations.