Patient Education and Counseling最新文献

Background: Social Media-based Health Education (SMHE) provides an effective way to address health disparities and improve public health literacy. Despite its inherent advantages, Healthcare Workers (HCWs) in China have showed limited and transient interest in engaging with SMHE initiatives.

Objective: This study aims to examine healthcare workers' perceptions of SMHE, identifying current influencing factors, challenges, and proposing future directions for development.

Methods: A descriptive qualitative study was conducted from October 2021 to January 2022, involving healthcare workers (i.e., physicians, nurses, and hospital administrators) engaged in SMHE. Semi-structured in-depth interviews were undertaken with 30 HCWs, which were subsequently analyzed thematically.

Results: Thematic analysis yielded 165 initial codes, organized into 12 subcategories spanning three main themes: (1) HCWs' perceptions of SMHE, (2) drivers and barriers to HCWs' engagement with SMHE, and (3) strategies to overcome current challenges.

Conclusion: This study yielded three main conclusions. First, HCWs in China exhibit a noticeable optimism toward SMHE, but most of them still have certain concerns. Second, HCWs engagement with SMHE is motivated or requested by their organizations, rather than their own initiatives. The main barriers for HCWs engagement with SMHE include: lack of time, risk of reputational loss, conflicts of interest, patient welfare, and concerns about legal issues. Third, healthcare organizations, social media platforms, and governmental bodies, must collaboratively address these issues to ensure protection for health workers engaged with SMHE.

Practical value: This study finds that Chinese HCWs are willing to engage in SMHE provided they are moderately rewarded and assured of a secure environment.

Objectives: Care for people living with dementia predominantly takes place at home and is often characterized by multiple hospitalizations throughout the lengthy disease trajectory. Care transitions from the hospital often involve home health care. The purpose of this study was to explore communication challenges experienced by home health nurses to inform communication training needs for home-based dementia care.

Methods: Seven audio-recorded focus group discussions were held with home health nurses (n = 31) from a large home care agency serving rural and urban counties. Focus group transcripts were thematically analyzed.

Results: We identified the following themes highlighting communication challenges for home health nurses: addressing potential risk for harm or injury, patient vulnerability, care partner needs, shifting decision-making to surrogate, and discrepancy in home health goals and family needs. These themes identified specific care transition conversation topics and communication content imperative for dementia-specific staff training.

Conclusions: Topics for communication skills training to improve person-centered dementia care were identified. These findings inform the future development of a home health staff communication curriculum for dementia care. Advanced communication skills are necessary to ensure these conversations take place and are engaged with sensitivity.

Practice implications: Our study informs the development of communication training on key communication topics in nurse-delivered and home healthcare interventions aimed at improving dementia care.

Adolescents and young adults (AYAs) with cancer face unique challenges that can disrupt their identity development and psychological well-being. This letter emphasizes the need for enhanced research and policy reforms to integrate psychosocial support into AYA oncology care. It advocates for targeted communication skills training for healthcare professionals to foster person-centered interactions that address both the physical and emotional needs of AYA patients. Additionally, it explores the role of digital health technologies, such as telemedicine and mobile applications, in bridging care gaps, particularly in underserved or remote areas. By advancing these strategies,we can promote a more holistic and equitable approach to AYA cancer care globally.

Objective: To assess the impact of wearing a continuous glucose monitoring (CGM) device on student pharmacist counseling ability (primary), knowledge, confidence, and empathy (secondary).

Methods: Students from two institutions were randomized to wear a CGM device (intervention) vs not (control). All received CGM education via lecture and live demonstration. Intervention group students were provided a CGM device. After two weeks, all students completed a standardized patient (SP) encounter regarding CGM prescription counseling. Pre-post CGM-related knowledge, confidence, and empathy were assessed. Analysis of variance was used to compare between-group counseling score difference, and analysis of covariance was used to compare changes in pre-post knowledge, confidence, and empathy scores. Analyses were performed using Stata/BE17.0.

Results: Of 86 students enrolled, 63 consented and completed surveys (32 intervention, 31 control). The intervention group demonstrated higher average SP counseling score vs control (82.4 % vs 77.7 %, p = .046). The intervention group had greater change in confidence vs control from pre to post survey (+ 2.3 vs + 1.7, p = 0.03, range 1-5). No between-group differences were observed in knowledge or empathy.

Conclusion: The opportunity to wear a CGM device resulted in higher performance on CGM counseling and greater rise in CGM-related confidence. This study supports the use of resources to provide hands-on CGM training.

Practice implications: Hands-on education about new diabetes technology can help students prepare to care for and counsel patients.

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.

Objectives: To identify the components of therapeutic empathy based on a review of existing definitions.

Methods: A search for therapeutic empathy definitions was conducted in two stages. First, a list of empathy definitions from within healthcare contexts was compiled using existing systematic reviews and a database of empathy definitions. The components of those definitions were identified through thematic analysis. Then, forward and backward citation searching (snowballing) of the papers from which those definitions were retrieved was conducted. These papers were randomly sampled and integrated into the analysis until saturation was reached.

Results: The searches yielded 3948 definitions of therapeutic empathy. Saturation was reached after analysing 39 individual definitions. Six interrelated components of therapeutic empathy were identified: exploring, understanding, shared understanding, feeling, therapeutic action, and maintaining boundaries.

Conclusions: This study identified six prevailing components of therapeutic empathy that distinguish it from empathy in general. The findings provide a conceptual starting point that can help the field better focus its understanding and use of activities that relate to empathy in practice.

Practice implications: Future practice, research, and education can use the components generated in this study to more consistently define therapeutic empathy, thereby offering potential to improve patient and practitioner outcomes.

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.