Patient Education and Counseling最新文献_第6页

How do physiotherapists include patients’ perspectives into their decision making – cross-sectional study using the Four Habit Coding Scheme 物理治疗师如何将患者的观点纳入他们的决策-使用四种习惯编码方案的横断面研究

IF 3.1 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2026-01-07 DOI: 10.1016/j.pec.2026.109478

Sijmen Hacquebord , Philip van der Wees , Jorn Veenstra , Veerle Siebinga , Edward Krupat , Henri Kiers , Thomas J. Hoogeboom

Objectives

Patient-centered communication together with evidence-based practice is seen as the underlying pillars of shared decision making (SDM). However, the application of patient-centered communication in physiotherapy practice has not yet been studied from an observer-based point of view. The purpose was to determine to what extent physiotherapists use patient-centered communication in the first physiotherapy consultations of people with shoulder problems, and to what extent patient-centered communication is related to the level of SDM.

Methods

In this secondary analysis, 100 audio-recorded initial physiotherapy consultations with people with shoulder problems, obtained through convenience sampling, were analyzed for the level of patient-centered communication using the Four Habit Coding Scheme (4HCS) (0–100, higher 4HCS scores indicate higher level of patient-centered communication). The relation between the level of patient-centered communication and the SDM was analysed in multiple steps.

Results

A total of 100 initial physical therapy consultations of 41 participating physical therapists were included. The mean 4HCS score was 45(range 18–90). The correlation between the 4HCS and the OPTION-5 scores was 0.610(CI95 % 0.470 – 0.720). The four categories in the relation between patient-centered communication and SDM show that the most consultations are in the group of low patient-centered communication and low SDM and that there are only two consultations in the low patient-centered communication and high SDM.

Conclusion

Our results show that there is room for improvement in the application of patient-centered communication in physiotherapy practice although physiotherapists do apply patient-centered communication more than SDM. Patient-centered communication does not guarantee the application of SDM, although a higher level of SDM does indicate a higher degree of patient-centered communication.

Practice implications

This study offers clinical guidance on how to improve the integration of patient’s perspective, values, and preferences in the decision making.

目的以患者为中心的沟通与循证实践被视为共同决策（SDM）的基础支柱。然而，以患者为中心的沟通在物理治疗实践中的应用尚未从观察者的角度进行研究。目的是确定物理治疗师在肩部问题患者的首次物理治疗咨询中使用以患者为中心的沟通的程度，以及以患者为中心的沟通在多大程度上与SDM水平相关。方法在本二次分析中，通过方便抽样获得100例肩部问题患者的初始物理治疗咨询录音，分析使用四种习惯编码方案（4HCS）的以患者为中心的沟通水平（0-100分，4HCS得分越高表明以患者为中心的沟通水平越高）。分多个步骤分析以患者为中心的沟通水平与SDM之间的关系。结果共纳入41名参与调查的物理治疗师的100次初次物理治疗咨询。平均4HCS评分为45分（范围18-90分）。4HCS与OPTION-5评分的相关性为0.610（CI95 % 0.470 - 0.720）。从以患者为中心的沟通与SDM关系的四类可以看出，就诊次数最多的是低以患者为中心的沟通和低SDM组，而低以患者为中心的沟通和高SDM组仅有2次就诊。结论以患者为中心的沟通方式在物理治疗实践中的应用仍有一定的提升空间，尽管物理治疗师确实比SDM更注重以患者为中心的沟通。以患者为中心的沟通并不能保证SDM的应用，但SDM水平越高，以患者为中心的沟通程度就越高。实践意义本研究为如何在决策过程中整合患者的观点、价值观和偏好提供了临床指导。

{"title":"How do physiotherapists include patients’ perspectives into their decision making – cross-sectional study using the Four Habit Coding Scheme","authors":"Sijmen Hacquebord , Philip van der Wees , Jorn Veenstra , Veerle Siebinga , Edward Krupat , Henri Kiers , Thomas J. Hoogeboom","doi":"10.1016/j.pec.2026.109478","DOIUrl":"10.1016/j.pec.2026.109478","url":null,"abstract":"<div><h3>Objectives</h3><div>Patient-centered communication together with evidence-based practice is seen as the underlying pillars of shared decision making (SDM). However, the application of patient-centered communication in physiotherapy practice has not yet been studied from an observer-based point of view. The purpose was to determine to what extent physiotherapists use patient-centered communication in the first physiotherapy consultations of people with shoulder problems, and to what extent patient-centered communication is related to the level of SDM.</div></div><div><h3>Methods</h3><div>In this secondary analysis, 100 audio-recorded initial physiotherapy consultations with people with shoulder problems, obtained through convenience sampling, were analyzed for the level of patient-centered communication using the Four Habit Coding Scheme (4HCS) (0–100, higher 4HCS scores indicate higher level of patient-centered communication). The relation between the level of patient-centered communication and the SDM was analysed in multiple steps.</div></div><div><h3>Results</h3><div>A total of 100 initial physical therapy consultations of 41 participating physical therapists were included. The mean 4HCS score was 45(range 18–90). The correlation between the 4HCS and the OPTION-5 scores was 0.610(CI95 % 0.470 – 0.720). The four categories in the relation between patient-centered communication and SDM show that the most consultations are in the group of low patient-centered communication and low SDM and that there are only two consultations in the low patient-centered communication and high SDM.</div></div><div><h3>Conclusion</h3><div>Our results show that there is room for improvement in the application of patient-centered communication in physiotherapy practice although physiotherapists do apply patient-centered communication more than SDM. Patient-centered communication does not guarantee the application of SDM, although a higher level of SDM does indicate a higher degree of patient-centered communication.</div><div>Practice implications</div><div>This study offers clinical guidance on how to improve the integration of patient’s perspective, values, and preferences in the decision making.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"145 ","pages":"Article 109478"},"PeriodicalIF":3.1,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Exploration of telehealth delivery modes and therapeutic alliance within an allied health student-led clinic. 探索远程医疗服务模式和联合健康学生主导诊所内的治疗联盟。

IF 3.1 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2026-01-06 DOI: 10.1016/j.pec.2026.109468

Briana Dahlia Ryan, Kristie Matthews, Katrina Long, Terry Haines

Objective

To examine the impact of different telehealth modes on therapeutic alliance between student health practitioners and patients in a student-led telehealth clinic, and to compare patient reports of therapeutic alliance with that previously published.

Methods

Telehealth sessions between student health practitioners and patients were delivered via video, telephone, or a combination. 299 (n) patient and student pairings reported therapeutic alliance using a modified Working Alliance Inventory for General Practice. Linear regressions and t-tests were conducted.

Results

The 299 pairings identified that therapeutic alliance can be developed and maintained in this context. Telephone based approaches yielded higher patient scores for the bond and goal domains. Students provided lower scores than patients across all domains and telehealth modes. Patients reported higher scores than those from a previously published study.

Conclusion

Telephone interactions may yield greater therapeutic alliance than video conference or mixed approaches. Therapeutic alliance can successfully be developed in the context of a student-led telehealth clinic.

Practical Implications

To consider how student-led clinics may become part of health service provision since patient ratings of students and general health practitioners is comparable.

目的探讨在学生主导的远程医疗诊所中，不同远程医疗模式对学生医疗从业者与患者治疗联盟的影响，并将患者的治疗联盟报告与先前发表的报告进行比较。方法通过视频、电话或两者结合的方式进行学生健康从业人员与患者之间的在线健康会话。299 (n)患者和学生配对使用改良的全科医生工作联盟清单报告治疗联盟。进行了线性回归和t检验。结果299组配对表明，在这种情况下，治疗联盟是可以发展和维持的。基于电话的方法在联系域和目标域获得了更高的患者分数。在所有领域和远程医疗模式中，学生的得分低于患者。患者报告的得分高于先前发表的研究。结论电话互动治疗比视频会议或混合方式治疗效果更好。治疗联盟可以在学生主导的远程保健诊所的背景下成功地发展。实际意义考虑学生主导的诊所如何成为医疗服务提供的一部分，因为学生和全科医生的患者评分是可比的。

{"title":"Exploration of telehealth delivery modes and therapeutic alliance within an allied health student-led clinic.","authors":"Briana Dahlia Ryan, Kristie Matthews, Katrina Long, Terry Haines","doi":"10.1016/j.pec.2026.109468","DOIUrl":"10.1016/j.pec.2026.109468","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the impact of different telehealth modes on therapeutic alliance between student health practitioners and patients in a student-led telehealth clinic, and to compare patient reports of therapeutic alliance with that previously published.</div></div><div><h3>Methods</h3><div>Telehealth sessions between student health practitioners and patients were delivered via video, telephone, or a combination. 299 (n) patient and student pairings reported therapeutic alliance using a modified Working Alliance Inventory for General Practice. Linear regressions and t-tests were conducted.</div></div><div><h3>Results</h3><div>The 299 pairings identified that therapeutic alliance can be developed and maintained in this context. Telephone based approaches yielded higher patient scores for the bond and goal domains. Students provided lower scores than patients across all domains and telehealth modes. Patients reported higher scores than those from a previously published study.</div></div><div><h3>Conclusion</h3><div>Telephone interactions may yield greater therapeutic alliance than video conference or mixed approaches. Therapeutic alliance can successfully be developed in the context of a student-led telehealth clinic.</div></div><div><h3>Practical Implications</h3><div>To consider how student-led clinics may become part of health service provision since patient ratings of students and general health practitioners is comparable.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"145 ","pages":"Article 109468"},"PeriodicalIF":3.1,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pilot study: Training bilingual Hmong caregivers using the pain assessment information visualization tool for effective communication in healthcare 试点研究：培训双语苗族护理人员使用疼痛评估信息可视化工具进行有效沟通

IF 3.1 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2026-01-05 DOI: 10.1016/j.pec.2026.109476

Maichou Lor , Betty Chewning , Linkai Wu

Objective

Pain in non-English-speaking Hmong patients may be under-detected and under-managed, in part due to challenges in patient-clinician communication. While family caregivers could address this deficiency, they lack symptom recognition and communication training. This study piloted a web-based communication training intervention to help Hmong bilingual caregivers document and communicate their care recipients’ pain information to clinicians using the Pain Assessment Information Visualization (InfoViz) tool and communication strategies.

Methods

We conducted a single-arm, pre-post pilot study of a web-based pain training communication intervention. In the intervention, caregivers use tools and practice communication strategies with video case studies. Qualitative interviews evaluated participants’ training experiences, and quantitative measures evaluated feasibility outcomes (satisfaction, time to completion, usability). Descriptive statistics analyzed feasibility outcomes and thematic analysis assessed qualitative feedback about the training.

Results

Thirty Hmong caregivers (mean age 32; 26 female) completed the training. They lived in the U.S. for an average of 29 years, with half having a healthcare background (n = 15). Among those who completed the training, 96 % reported being somewhat (n = 8) or extremely satisfied (n = 21) with the intervention. The average completion time was 56 min, primarily using a laptop. Caregivers reported learning new ways to describe pain in Hmong, valued tools for preparation, and felt empowered to support communication during medical visits.

Conclusions

Our intervention was feasible and acceptable, providing valuable tools and strategies to help Hmong caregivers support their loved ones with pain communication during medical visits. Future research should examine the intervention’s effectiveness and its impact on clinical outcomes.

Practice Implications

Providing Hmong caregivers with communication training could help overcome language and cultural barriers during pain-related primary care visits for non-English-speaking patients. Additional studies are needed to determine how such training can be integrated into clinical workflows and scaled for broader use.

目的：非英语苗族患者的疼痛可能未被发现和管理，部分原因是患者与临床沟通的挑战。虽然家庭照顾者可以解决这一缺陷，但他们缺乏症状识别和沟通培训。本研究试点了一种基于网络的沟通培训干预，以帮助苗族双语护理人员使用疼痛评估信息可视化（InfoViz）工具和沟通策略记录和沟通他们的护理对象的疼痛信息。方法：我们进行了一项基于网络的疼痛训练沟通干预的单臂、前后先导研究。在干预中，护理人员使用工具并通过视频案例研究练习沟通策略。定性访谈评估参与者的培训经验，定量测量评估可行性结果（满意度、完成时间、可用性）。描述性统计分析了可行性结果，专题分析评估了关于培训的定性反馈。结果30名苗族护理员完成培训，平均年龄32岁，女性26名。他们平均在美国生活了29年，其中一半有医疗保健背景（n = 15）。在完成培训的人中，96% %报告对干预有些满意（n = 8）或非常满意（n = 21）。平均完成时间为56 分钟，主要使用笔记本电脑。护理人员报告说，他们学习了用苗族语描述疼痛的新方法，有价值的准备工具，并感到有能力在医疗访问期间支持沟通。结论sour干预是可行和可接受的，为苗族照护者在就诊过程中支持亲人进行疼痛沟通提供了有价值的工具和策略。未来的研究应检查干预措施的有效性及其对临床结果的影响。实践意义：为苗族护理人员提供沟通培训可以帮助非英语患者在疼痛相关初级保健就诊时克服语言和文化障碍。需要进一步的研究来确定如何将此类培训整合到临床工作流程中并扩大应用范围。

{"title":"Pilot study: Training bilingual Hmong caregivers using the pain assessment information visualization tool for effective communication in healthcare","authors":"Maichou Lor , Betty Chewning , Linkai Wu","doi":"10.1016/j.pec.2026.109476","DOIUrl":"10.1016/j.pec.2026.109476","url":null,"abstract":"<div><h3>Objective</h3><div>Pain in non-English-speaking Hmong patients may be under-detected and under-managed, in part due to challenges in patient-clinician communication. While family caregivers could address this deficiency, they lack symptom recognition and communication training. This study piloted a web-based communication training intervention to help Hmong bilingual caregivers document and communicate their care recipients’ pain information to clinicians using the Pain Assessment Information Visualization (InfoViz) tool and communication strategies.</div></div><div><h3>Methods</h3><div>We conducted a single-arm, pre-post pilot study of a web-based pain training communication intervention. In the intervention, caregivers use tools and practice communication strategies with video case studies. Qualitative interviews evaluated participants’ training experiences, and quantitative measures evaluated feasibility outcomes (satisfaction, time to completion, usability). Descriptive statistics analyzed feasibility outcomes and thematic analysis assessed qualitative feedback about the training.</div></div><div><h3>Results</h3><div>Thirty Hmong caregivers (mean age 32; 26 female) completed the training. They lived in the U.S. for an average of 29 years, with half having a healthcare background (n = 15). Among those who completed the training, 96 % reported being somewhat (n = 8) or extremely satisfied (n = 21<strong>)</strong> with the intervention. The average completion time was 56 min, primarily using a laptop. Caregivers reported learning new ways to describe pain in Hmong, valued tools for preparation, and felt empowered to support communication during medical visits.</div></div><div><h3>Conclusions</h3><div>Our intervention was feasible and acceptable, providing valuable tools and strategies to help Hmong caregivers support their loved ones with pain communication during medical visits. Future research should examine the intervention’s effectiveness and its impact on clinical outcomes.</div></div><div><h3>Practice Implications</h3><div>Providing Hmong caregivers with communication training could help overcome language and cultural barriers during pain-related primary care visits for non-English-speaking patients. Additional studies are needed to determine how such training can be integrated into clinical workflows and scaled for broader use.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"145 ","pages":"Article 109476"},"PeriodicalIF":3.1,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The story beneath the scores: A mixed methods study of communication skills self-assessment 分数背后的故事：沟通技巧自我评估的混合方法研究

IF 3.1 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2026-01-05 DOI: 10.1016/j.pec.2026.109477

Ghaith Alfakhry , Ariel Lindorff , Abdul Karim Ismail , Osama Alrikabi Alsuccari , Omar Hamadah , Issam Jamous

Objectives

Communication skills are universally recognised as a core competency in clinical education. This study aimed to investigate the impact of self-assessment on the development of communication skills and to understand the underlying meanings of self-assessment scores at the Faculty of Dental Medicine, Damascus University, Syria.

Methods

Based on the well-established Calgary-Cambridge Guide, an assessment instrument was developed, translated, and cross-culturally validated for the Syrian Arabic context. The assessment approach comprised one consultation with each of six patients in a clinical setting. After each consultation, the student and patient completed an assessment form. Fifty-four final-year dental students completed all six sessions. A mixed-methods design was employed, beginning with a quantitative phase that investigated the psychometric properties of the assessment instrument and tested for change in communication performance. In the qualitative phase, semi-structured interviews were conducted with a purposive subsample (n = 12) based on quantitative findings. Thematic analysis explored the educational impact and factors influencing self-assessment.

Results

There was a significant improvement in patient assessments over time, with a large effect size (P < 0.001, Partial η² = 0.184). Qualitative results supported these findings, revealing increased self-awareness and self-control due to self-assessment. Subjective self-assessment practices, patient – dentist dynamics, and self-reflection all influenced self-assessment scoring.

Conclusions

This rigorous mixed-methods research makes an original and substantive contribution through in-depth exploration of meanings and intentions underlying self-assessment results. Although the findings warrants cautious generalisation, this research provides valuable recommendations for students, clinical educators, and curriculum developers to optimise self-assessment and use its data to improve communication performance.

Practical implications

This study highlights that using structured self-assessment can be an effective educational practice to improve communication skills and provides insight for educators into what self-assessment scores could mean.

目的临床教育普遍认为沟通能力是一种核心能力。本研究旨在探讨自评对沟通技巧发展的影响，并了解自评分数在叙利亚大马士革大学牙科医学院的潜在意义。方法基于完善的卡尔加里-剑桥指南，开发、翻译并跨文化验证了叙利亚阿拉伯语背景下的评估工具。评估方法包括在临床环境中对六名患者中的每一位进行一次咨询。每次咨询后，学生和病人都要填写一份评估表格。54名最后一年的牙科学生完成了所有六个疗程。采用混合方法设计，从定量阶段开始，调查评估工具的心理测量特性，并测试沟通表现的变化。在定性阶段，根据定量结果，采用有目的的子样本（n = 12）进行半结构化访谈。专题分析探讨了教育影响和影响自我评价的因素。结果随着时间的推移，患者的评估有了显著的改善，且效应量很大（P <； 0.001，偏η²= 0.184）。定性结果支持这些发现，表明自我评估提高了自我意识和自我控制能力。主观自我评估实践、患者-牙医动态和自我反思均影响自我评估评分。这项严谨的混合方法研究通过深入探索自我评估结果的意义和意图，做出了原创性和实质性的贡献。尽管研究结果需要谨慎的概括，但本研究为学生、临床教育者和课程开发者提供了有价值的建议，以优化自我评估并使用其数据来改善沟通表现。实践意义本研究强调，使用结构化自我评估可以是一种有效的教育实践，以提高沟通技巧，并为教育工作者提供了对自我评估分数可能意味着什么的见解。

{"title":"The story beneath the scores: A mixed methods study of communication skills self-assessment","authors":"Ghaith Alfakhry , Ariel Lindorff , Abdul Karim Ismail , Osama Alrikabi Alsuccari , Omar Hamadah , Issam Jamous","doi":"10.1016/j.pec.2026.109477","DOIUrl":"10.1016/j.pec.2026.109477","url":null,"abstract":"<div><h3>Objectives</h3><div>Communication skills are universally recognised as a core competency in clinical education. This study aimed to investigate the impact of self-assessment on the development of communication skills and to understand the underlying meanings of self-assessment scores at the Faculty of Dental Medicine, Damascus University, Syria.</div></div><div><h3>Methods</h3><div>Based on the well-established Calgary-Cambridge Guide, an assessment instrument was developed, translated, and cross-culturally validated for the Syrian Arabic context. The assessment approach comprised one consultation with each of six patients in a clinical setting. After each consultation, the student and patient completed an assessment form. Fifty-four final-year dental students completed all six sessions. A mixed-methods design was employed, beginning with a quantitative phase that investigated the psychometric properties of the assessment instrument and tested for change in communication performance. In the qualitative phase, semi-structured interviews were conducted with a purposive subsample (n = 12) based on quantitative findings. Thematic analysis explored the educational impact and factors influencing self-assessment.</div></div><div><h3>Results</h3><div>There was a significant improvement in patient assessments over time, with a large effect size (<em>P</em> < 0.001, Partial η² = 0.184). Qualitative results supported these findings, revealing increased self-awareness and self-control due to self-assessment. Subjective self-assessment practices, patient – dentist dynamics, and self-reflection all influenced self-assessment scoring.</div></div><div><h3>Conclusions</h3><div>This rigorous mixed-methods research makes an original and substantive contribution through in-depth exploration of meanings and intentions underlying self-assessment results. Although the findings warrants cautious generalisation, this research provides valuable recommendations for students, clinical educators, and curriculum developers to optimise self-assessment and use its data to improve communication performance.</div></div><div><h3>Practical implications</h3><div>This study highlights that using structured self-assessment can be an effective educational practice to improve communication skills and provides insight for educators into what self-assessment scores could mean.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"145 ","pages":"Article 109477"},"PeriodicalIF":3.1,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cancer progression and shared decision-making: Crossed 癌症进展和共同决策：交叉

IF 3.1 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2025-12-27 DOI: 10.1016/j.pec.2025.109464

Julia Kolly , Sophie Lelorain , Nicolas Penel , Pierre-Yves Dietrich , Lisa Laroussi-Libeault , Kristopher Lamore

Objective

When cancer progresses, changes of treatment are proposed and discussed with patients and their family caregivers (P&Cs). However, there has been insufficient research on these consultations. The objective of this study was to explore how decision-making in cancer progression consultations relates to shared decision-making (SDM) from the perspective of healthcare professionals (HCPS) and P&Cs.

Methods

A qualitative study was conducted based on 35 semi-structured interviews with HCPs (n = 20) and P&Cs (n = 10 patients and n = 5 family caregivers).

Results

Five themes emerged: (1) overview of the decision-making process; (2) a key consultation: discussing progression and treatment options; (3) the central role of the relationship between healthcare professional, patient, and family caregiver; (4) the perception of choice in cancer progression consultations; and (5) participants’ perceptions of the elements needed for decision-making. The findings revealed an imbalance in decision-making roles, with physicians primarily making treatment decisions in interdisciplinary meetings, before presenting them to P&Cs in consultation.

Conclusions

While cancer progression consultations meet the conditions for SDM, adjustments are needed to enhance the involvement of P&Cs, who often feel passive. Strengthening communication strategies and more actively integrating P&Cs could foster a more balanced, patient-centered approach.

Practice implications

Strengthening team cohesion and optimizing interdisciplinary collaboration, systematically involving nurses, and expanding SDM training to include HCPs can foster patient-centered care, enhance communication, and improve decision-making efficiency. An approach that actively integrates patients’ values and caregivers’ experiential knowledge, combined with a discussion of treatment options, can improve participation without prolonging consultation time.

目的：当癌症进展时，建议改变治疗方案，并与患者及其家庭护理人员进行讨论（P&Cs）。但是，对这些协商的研究并不充分。本研究的目的是从医疗保健专业人员（HCPS）和P&；Cs的角度探讨癌症进展咨询中的决策与共同决策（SDM）的关系。方法采用半结构化访谈法对35名HCPs （n = 20名）和P&；Cs （n = 10名患者和n = 5名家庭照顾者）进行定性研究。结果：(1)决策过程概述；(2)关键会诊：讨论进展和治疗方案；(3)医疗保健专业人员、患者和家庭照顾者之间的关系的核心作用；(4)癌症进展咨询的选择感知；(5)参与者对决策要素的认知。研究结果揭示了决策角色的不平衡，医生主要是在跨学科会议上做出治疗决定，然后再将这些决定提交给P&； c咨询。结论：虽然癌症进展咨询符合SDM的条件，但仍需调整以提高P&； c的参与度，他们往往感到被动。加强沟通策略和更积极地整合P&； c可以促进一种更加平衡、以患者为中心的方法。实践启示：加强团队凝聚力，优化跨学科合作，系统地让护士参与，将SDM培训扩大到医护人员中，可以促进以患者为中心的护理，加强沟通，提高决策效率。积极整合患者价值观和护理人员经验知识的方法，结合对治疗方案的讨论，可以在不延长咨询时间的情况下提高参与度。

{"title":"Cancer progression and shared decision-making: Crossed","authors":"Julia Kolly , Sophie Lelorain , Nicolas Penel , Pierre-Yves Dietrich , Lisa Laroussi-Libeault , Kristopher Lamore","doi":"10.1016/j.pec.2025.109464","DOIUrl":"10.1016/j.pec.2025.109464","url":null,"abstract":"<div><h3>Objective</h3><div>When cancer progresses, changes of treatment are proposed and discussed with patients and their family caregivers (P&Cs). However, there has been insufficient research on these consultations. The objective of this study was to explore how decision-making in cancer progression consultations relates to shared decision-making (SDM) from the perspective of healthcare professionals (HCPS) and P&Cs.</div></div><div><h3>Methods</h3><div>A qualitative study was conducted based on 35 semi-structured interviews with HCPs (n = 20) and P&Cs (n = 10 patients and n = 5 family caregivers).</div></div><div><h3>Results</h3><div>Five themes emerged: (1) overview of the decision-making process; (2) a key consultation: discussing progression and treatment options; (3) the central role of the relationship between healthcare professional, patient, and family caregiver; (4) the perception of choice in cancer progression consultations; and (5) participants’ perceptions of the elements needed for decision-making. The findings revealed an imbalance in decision-making roles, with physicians primarily making treatment decisions in interdisciplinary meetings, before presenting them to P&Cs in consultation.</div></div><div><h3>Conclusions</h3><div>While cancer progression consultations meet the conditions for SDM, adjustments are needed to enhance the involvement of P&Cs, who often feel passive. Strengthening communication strategies and more actively integrating P&Cs could foster a more balanced, patient-centered approach.</div></div><div><h3>Practice implications</h3><div>Strengthening team cohesion and optimizing interdisciplinary collaboration, systematically involving nurses, and expanding SDM training to include HCPs can foster patient-centered care, enhance communication, and improve decision-making efficiency. An approach that actively integrates patients’ values and caregivers’ experiential knowledge, combined with a discussion of treatment options, can improve participation without prolonging consultation time.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"145 ","pages":"Article 109464"},"PeriodicalIF":3.1,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Multi-methods development and validation of a tool for use in measuring serious illness communication competence: Assessment of clinical encounters – Communication tool (ACE-CT) 用于测量严重疾病沟通能力的工具的多方法开发和验证：临床遭遇评估-沟通工具（ACE-CT）

IF 3.1 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2025-12-23 DOI: 10.1016/j.pec.2025.109465

Anish K. Arora , Hsien Seow , Daryl Bainbridge , Kulamakan Kulasegaram , Tavis Apramian , Nadia Incardona , Leah Steinberg , Justin Sanders , Zhimeng Jia , Oren Levine , Jessica Simon , Karen Zhang , Zelda Freitas , Clare Fuller , Amanda Lee Roze des Ordons , Jill Dombroski , Jeff Myers

Objectives

The assessment of serious illness communication (SIC) competence has, to date, primarily utilized tools that are profession-specific and not explicitly designed using competency-based or person-centered frameworks. To address these gaps, we developed and validated a new tool, the Assessment of Clinical Encounters – Communication Tool (ACE-CT).

Methods

We convened a national panel of interprofessional SIC experts to develop and validate the ACE-CT using a three-phase multi-method approach. Phase 1 focused on item development through review of existing validated tools, and a Bayesian process in which panel members assessed item quality and item-domain correlation. Phase 2 involved item refinement and preliminary validation through stimulated recall interviews using a think-aloud technique. Phase 3 consisted of psychometric analyses for which panel members used the tool to assess video-recorded standardized patient encounters from interprofessional clinicians completing a SIC professional development intervention.

Results

In Phase 1, 37 relevant items from previously validated tools were identified, of which 11 items were removed due to redundance. Through the Bayesian process, 14 items were removed and 1 item was generated. Through Phase 2, 2 items were generated, 2 items were combined into 1, and remaining items were refined to optimize measurability and understandability. In Phase 3, reliability was demonstrated through evidence of high internal consistency and moderate reproducibility, both over time and across raters. The tool was found to be responsive and have sound construct validity through evidence of congruence, convergence and credibility. Raters found the tool to be intuitive, easy to complete, and that it accurately captured their perception of the quality of communication observed.

Conclusions

The ACE-CT provides a reliable and valid approach to assessing SIC competence among interprofessional clinicians.

Practical Implications

Through its person-centered orientation, the ACE-CT provides an opportunity to objectively assess elements of SIC that patients and families value.

到目前为止，对严重疾病沟通（SIC）能力的评估主要是使用专业特定的工具，而不是明确设计使用基于能力或以人为中心的框架。为了解决这些差距，我们开发并验证了一种新的工具，临床遭遇评估-沟通工具（ACE-CT）。方法：我们召集了一个全国性的跨专业SIC专家小组，使用三阶段多方法方法开发和验证ACE-CT。第一阶段通过审查现有的有效工具和贝叶斯过程来关注项目开发，其中小组成员评估项目质量和项目领域相关性。第二阶段涉及项目细化和初步验证，通过刺激回忆访谈，使用出声思考技术。第三阶段包括心理测量分析，小组成员使用该工具评估完成SIC专业发展干预的跨专业临床医生录制的标准化患者接触视频。结果在第1阶段，从先前验证的工具中识别出37个相关项目，其中11个项目因冗余而被删除。通过贝叶斯过程，移除14项，生成1项。通过第2阶段，生成了2个项目，将2个项目合并为1个，并对剩余的项目进行了细化，以优化可测量性和可理解性。在第3阶段，通过高内部一致性和中等可重复性的证据证明了可靠性，无论是在时间上还是在评分者之间。该工具被发现是响应性的，并通过一致性，收敛性和可信度的证据具有良好的结构效度。评分者发现这个工具很直观，很容易完成，而且它准确地捕捉了他们对所观察到的交流质量的看法。结论ACE-CT为评估跨专业临床医生的SIC能力提供了一种可靠有效的方法。通过其以人为本的取向，ACE-CT提供了一个客观评估患者和家属所重视的SIC因素的机会。

{"title":"Multi-methods development and validation of a tool for use in measuring serious illness communication competence: Assessment of clinical encounters – Communication tool (ACE-CT)","authors":"Anish K. Arora , Hsien Seow , Daryl Bainbridge , Kulamakan Kulasegaram , Tavis Apramian , Nadia Incardona , Leah Steinberg , Justin Sanders , Zhimeng Jia , Oren Levine , Jessica Simon , Karen Zhang , Zelda Freitas , Clare Fuller , Amanda Lee Roze des Ordons , Jill Dombroski , Jeff Myers","doi":"10.1016/j.pec.2025.109465","DOIUrl":"10.1016/j.pec.2025.109465","url":null,"abstract":"<div><h3>Objectives</h3><div>The assessment of serious illness communication (SIC) competence has, to date, primarily utilized tools that are profession-specific and not explicitly designed using competency-based or person-centered frameworks. To address these gaps, we developed and validated a new tool, the Assessment of Clinical Encounters – Communication Tool (ACE-CT).</div></div><div><h3>Methods</h3><div>We convened a national panel of interprofessional SIC experts to develop and validate the ACE-CT using a three-phase multi-method approach. Phase 1 focused on item development through review of existing validated tools, and a Bayesian process in which panel members assessed item quality and item-domain correlation. Phase 2 involved item refinement and preliminary validation through stimulated recall interviews using a think-aloud technique. Phase 3 consisted of psychometric analyses for which panel members used the tool to assess video-recorded standardized patient encounters from interprofessional clinicians completing a SIC professional development intervention.</div></div><div><h3>Results</h3><div>In Phase 1, 37 relevant items from previously validated tools were identified, of which 11 items were removed due to redundance. Through the Bayesian process, 14 items were removed and 1 item was generated. Through Phase 2, 2 items were generated, 2 items were combined into 1, and remaining items were refined to optimize measurability and understandability. In Phase 3, reliability was demonstrated through evidence of high internal consistency and moderate reproducibility, both over time and across raters. The tool was found to be responsive and have sound construct validity through evidence of congruence, convergence and credibility. Raters found the tool to be intuitive, easy to complete, and that it accurately captured their perception of the quality of communication observed.</div></div><div><h3>Conclusions</h3><div>The ACE-CT provides a reliable and valid approach to assessing SIC competence among interprofessional clinicians.</div></div><div><h3>Practical Implications</h3><div>Through its person-centered orientation, the ACE-CT provides an opportunity to objectively assess elements of SIC that patients and families value.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"144 ","pages":"Article 109465"},"PeriodicalIF":3.1,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Teach-back techniques in telehealth: A review and insights for future directions 远程医疗中的反教技术：回顾和对未来发展方向的见解

IF 3.1 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2025-12-19 DOI: 10.1016/j.pec.2025.109453

Faith A. Albertson , Wafa Alnakhi , Shanikque Barksdale , Shannon Stark Taylor , Shaniece Criss , Daniela B. Friedman , Karen A. Kemper , Lorie Donelle , Wanda Thompson , Phyllis MacGilvray , Nabil Natafgi

Background and objectives

The rapid expansion of telehealth during the COVID-19 pandemic has created new challenges in patient-provider communication due to the absence of in-person interactions and visual cues. Teach-back, a method where patients repeat information to confirm understanding, is a promising tool for improving communication in virtual care. This review evaluates the effectiveness of teach-back techniques in telehealth settings.

Methods

A search of four databases (CINAHL, EMBASE, PsycINFO, PubMed) was conducted, yielding 10 studies that met the inclusion criteria. The article inclusion/exclusion criteria consisted of the following: (1) telehealth services topic; (2) direction provision related to teach-back; and (3) English, peer-reviewed, empirical journal publication. Risk of bias in included studies was assessed using established tools for randomized controlled trials (RCTs), non-randomized controlled trials (NRCTs), and qualitative studies. Data synthesis followed the PICO framework, and thematic analysis was used to compare outcomes across studies.

Results

Included studies which varied in design, modality, and telehealth specialty. Teach-back was consistently associated with improved patient knowledge, confidence, and self-management, as well as clinical outcomes such as better glycemic control and medication adherence. Overall evidence quality was moderate, with common limitations including small sample sizes and brief follow-up periods.

Conclusions and practice implications

Teach-back is effective in enhancing patient understanding and outcomes in telehealth settings. However, variability in study design and implementation highlights the need for standardized protocols and additional research. Provider training in effective virtual teach-back strategies may enhance patient comprehension, strengthen communication, and advance health equity in telehealth delivery.

背景和目的在2019冠状病毒病大流行期间，远程医疗的迅速普及给医患沟通带来了新的挑战，因为缺乏面对面的互动和视觉线索。反馈是一种让患者重复信息以确认理解的方法，是一种很有希望改善虚拟护理中沟通的工具。本综述评估了远程医疗环境中反教技术的有效性。方法检索4个数据库（CINAHL、EMBASE、PsycINFO、PubMed），获得10篇符合纳入标准的研究。该条纳入/排除标准包括以下内容：(1)远程保健服务专题；（二）与反教有关的指导规定；(3)英文，同行评审，实证期刊发表。采用随机对照试验（rct）、非随机对照试验（NRCTs）和定性研究的既定工具评估纳入研究的偏倚风险。数据综合遵循PICO框架，并使用主题分析来比较各研究的结果。结果纳入了设计、方式和远程医疗专业不同的研究。反馈与提高患者的知识、信心和自我管理以及临床结果（如更好的血糖控制和药物依从性）一致相关。总体证据质量为中等，常见的局限性包括样本量小、随访时间短。结论和实践意义：在远程医疗环境中，背教可以有效地提高患者的理解和结果。然而，研究设计和实施的可变性突出了标准化方案和额外研究的必要性。提供者培训有效的虚拟教学反馈策略可以提高患者的理解，加强沟通，促进远程医疗服务中的卫生公平。

{"title":"Teach-back techniques in telehealth: A review and insights for future directions","authors":"Faith A. Albertson , Wafa Alnakhi , Shanikque Barksdale , Shannon Stark Taylor , Shaniece Criss , Daniela B. Friedman , Karen A. Kemper , Lorie Donelle , Wanda Thompson , Phyllis MacGilvray , Nabil Natafgi","doi":"10.1016/j.pec.2025.109453","DOIUrl":"10.1016/j.pec.2025.109453","url":null,"abstract":"<div><h3>Background and objectives</h3><div>The rapid expansion of telehealth during the COVID-19 pandemic has created new challenges in patient-provider communication due to the absence of in-person interactions and visual cues. Teach-back, a method where patients repeat information to confirm understanding, is a promising tool for improving communication in virtual care. This review evaluates the effectiveness of teach-back techniques in telehealth settings.</div></div><div><h3>Methods</h3><div>A search of four databases (CINAHL, EMBASE, PsycINFO, PubMed) was conducted, yielding 10 studies that met the inclusion criteria. The article inclusion/exclusion criteria consisted of the following: (1) telehealth services topic; (2) direction provision related to teach-back; and (3) English, peer-reviewed, empirical journal publication. Risk of bias in included studies was assessed using established tools for randomized controlled trials (RCTs), non-randomized controlled trials (NRCTs), and qualitative studies. Data synthesis followed the PICO framework, and thematic analysis was used to compare outcomes across studies.</div></div><div><h3>Results</h3><div>Included studies which varied in design, modality, and telehealth specialty. Teach-back was consistently associated with improved patient knowledge, confidence, and self-management, as well as clinical outcomes such as better glycemic control and medication adherence. Overall evidence quality was moderate, with common limitations including small sample sizes and brief follow-up periods.</div></div><div><h3>Conclusions and practice implications</h3><div>Teach-back is effective in enhancing patient understanding and outcomes in telehealth settings. However, variability in study design and implementation highlights the need for standardized protocols and additional research. Provider training in effective virtual teach-back strategies may enhance patient comprehension, strengthen communication, and advance health equity in telehealth delivery.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"144 ","pages":"Article 109453"},"PeriodicalIF":3.1,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medical providers and biogenetic messages about depression: A vignette experiment 关于抑郁症的医疗提供者和生物遗传学信息：一个小插曲实验。

IF 3.1 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2025-12-19 DOI: 10.1016/j.pec.2025.109463

Hans S. Schroder , Sarah Bommarito

Objectives

Healthcare providers play an important role in educating patients about the causes of their problems. Certain narratives, such as the chemical imbalance explanation of depression, are overly simplistic and may decrease hope for recovery and increase stigma by triggering cognitive biases about the perceived permanence of biological causes. However, no previous studies have surveyed medical providers on their use of biogenetic messaging (messages that imply a biological, chemical, or genetic cause) to patients, nor has any research studied the conditions under which these messages are more likely to be invoked.

Methods

In this online, pre-registered vignette experiment, we randomized 396 medical providers (physicians and medical students) to read one of two vignettes of a woman experiencing significant depressive symptoms: one in which her depression was precipitated by a significant loss (Trigger condition) and one in which no clear cause for depression was provided (No-trigger condition). We hypothesized that the no-trigger condition would lead to H1) more biogenetic language communicated to the patient and H2) more recommendations for medication and hospitalization. H3 predicted that pre-manipulation biogenetic beliefs would correlate with medication recommendations.

Results

In line with hypothesis H1, providers exposed to the “no-trigger” vignette were more likely to focus their conversation using biogenetic language. However, Hypotheses 2 and 3 were unsupported – participants in the “no-trigger” condition were no more likely to recommend medication or hospitalization (H2) and pre-manipulation beliefs did not correlate with treatment recommendations (H3). Exploratory analyses revealed that the tendency to use biogenetic language was correlated with efforts to reduce patient blame.

Conclusions

Healthcare providers are more likely to use biogenetic narratives when the cause of a patient’s depression is unclear.

Practice implications

Clinicians should be mindful of the lure of biogenetic messaging, especially when the cause of depression is unclear and they want to reduce blame.

目的：医疗保健提供者在教育患者了解其问题的原因方面发挥着重要作用。某些叙述，如对抑郁症的化学失衡解释，过于简单化，可能会降低康复的希望，并通过引发对生物原因的感知持久性的认知偏见而增加耻辱。然而，以前没有研究调查过医疗提供者对患者使用生物遗传信息（暗示生物、化学或遗传原因的信息）的情况，也没有研究过这些信息更有可能被调用的条件。方法：在这个预先注册的在线小故事实验中，我们随机安排396名医疗服务提供者（医生和医学生）阅读一名经历显著抑郁症状的女性的两篇小故事中的一篇：其中一篇是由重大损失导致的抑郁（触发条件），另一篇是没有明确的抑郁原因（无触发条件）。我们假设无触发条件将导致H1)更多的生物遗传学语言与患者沟通，H2)更多的药物和住院治疗建议。H3预测，操作前的生物遗传学信念将与药物建议相关。结果：与假设H1一致，暴露于“无触发”小插曲的提供者更有可能使用生物遗传学语言集中他们的谈话。然而，假设2和3是不支持的——“无触发”条件下的参与者不太可能推荐药物或住院治疗（H2），操作前的信念与治疗建议不相关（H3）。探索性分析显示，使用生物遗传学语言的倾向与减少患者责备的努力相关。结论：当患者抑郁的原因不明确时，医疗保健提供者更有可能使用生物遗传学叙述。实践启示：临床医生应该注意生物遗传信息的诱惑，特别是当抑郁症的原因尚不清楚，他们希望减少指责。

{"title":"Medical providers and biogenetic messages about depression: A vignette experiment","authors":"Hans S. Schroder , Sarah Bommarito","doi":"10.1016/j.pec.2025.109463","DOIUrl":"10.1016/j.pec.2025.109463","url":null,"abstract":"<div><h3>Objectives</h3><div>Healthcare providers play an important role in educating patients about the causes of their problems. Certain narratives, such as the chemical imbalance explanation of depression, are overly simplistic and may decrease hope for recovery and increase stigma by triggering cognitive biases about the perceived permanence of biological causes. However, no previous studies have surveyed medical providers on their use of biogenetic messaging (messages that imply a biological, chemical, or genetic cause) to patients, nor has any research studied the conditions under which these messages are more likely to be invoked.</div></div><div><h3>Methods</h3><div>In this online, pre-registered vignette experiment, we randomized 396 medical providers (physicians and medical students) to read one of two vignettes of a woman experiencing significant depressive symptoms: one in which her depression was precipitated by a significant loss (Trigger condition) and one in which no clear cause for depression was provided (No-trigger condition). We hypothesized that the no-trigger condition would lead to H1) more biogenetic language communicated to the patient and H2) more recommendations for medication and hospitalization. H3 predicted that pre-manipulation biogenetic beliefs would correlate with medication recommendations.</div></div><div><h3>Results</h3><div>In line with hypothesis H1, providers exposed to the “no-trigger” vignette were more likely to focus their conversation using biogenetic language. However, Hypotheses 2 and 3 were unsupported – participants in the “no-trigger” condition were no more likely to recommend medication or hospitalization (H2) and pre-manipulation beliefs did not correlate with treatment recommendations (H3). Exploratory analyses revealed that the tendency to use biogenetic language was correlated with efforts to reduce patient blame.</div></div><div><h3>Conclusions</h3><div>Healthcare providers are more likely to use biogenetic narratives when the cause of a patient’s depression is unclear.</div></div><div><h3>Practice implications</h3><div>Clinicians should be mindful of the lure of biogenetic messaging, especially when the cause of depression is unclear and they want to reduce blame.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"144 ","pages":"Article 109463"},"PeriodicalIF":3.1,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Decision‐making delays in endovascular treatment for acute ischemic stroke: A qualitative study of perspectives from family surrogates, physicians, and nurses 急性缺血性卒中血管内治疗的决策延迟：一项来自家庭代理人、医生和护士的定性研究

IF 3.1 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2025-12-18 DOI: 10.1016/j.pec.2025.109462

Yitao Zhou , Yangbin Zhou , Huijie Yang , Ganying Huang

Objective

To explore the reasons for decision-making delays in endovascular treatment (EVT) for acute ischemic stroke (AIS), from the perspectives of surrogate decision-makers, physicians, and nurses.

Methods

This descriptive qualitative study included semi-structured interviews conducted with surrogate decision-makers for patients undergoing endovascular thrombectomy for AIS, as well as the attending physicians and nurses. Participants were recruited using purposive sampling to ensure a diverse representation of perspectives. The data were analysed applying thematic analysis.

Results

Our analysis revealed three main themes and seven subthemes: (1) Theme 1, Dynamic decision-making influenced by multiple factors. Family-centered collaborative decision-making; The unique position of surrogate decision-makers; Economic pressure in decision-making. (2) Theme 2, Limited support. Unfamiliar illness and environment; The marginalized role of patients in decision-making processes. (3) Theme 3, Building “bridges” of trust. The importance of doctors; Be patient.

Conclusion

Decision-making delays in EVT stem from intertwined cultural, informational, and support-related factors influencing surrogate judgment in time-critical stroke care. Targeted improvements in rapid communication, role clarification, and decision support are essential to reduce treatment delays. These findings offer practical direction for designing strategies and policies to optimize surrogate decision-making and improve access to timely EVT.

Practice implications

Healthcare providers should target specific causes of surrogate decision-making delays including family-centered collaborative processes, insufficient support for surrogate decision-makers and trust gaps with medical staff when designing interventions. This study provides targeted references for clinical practices to shorten surrogate decision-making time. It also offers a reference basis for formulating policies to address key barriers in surrogate decision-making delays such as economic pressure and unclear decision-making roles.

目的从代理决策者、医生和护士的角度探讨急性缺血性卒中（AIS）血管内治疗（EVT）决策延迟的原因。方法本描述性定性研究包括对AIS血管内取栓患者的代理决策者、主治医生和护士进行半结构化访谈。参与者是通过有目的的抽样来招募的，以确保观点的多样化。采用专题分析对数据进行分析。结果分析揭示了3个主旋律和7个副旋律：(1)主旋律1：多因素影响下的动态决策。以家庭为中心的协同决策；代理决策者的独特地位；决策中的经济压力。(2)主题2，支持有限。不熟悉的疾病和环境；患者在决策过程中的边缘化作用。(3)主题三：搭建信任的“桥梁”。医生的重要性；要有耐心。结论EVT的决策延迟源于文化、信息和支持相关因素相互交织，影响时间关键型脑卒中护理的替代判断。有针对性地改进快速沟通、角色澄清和决策支持对于减少治疗延误至关重要。这些发现为制定优化替代决策的策略和政策提供了实践指导，并提高了及时获得EVT的机会。实践启示：在设计干预措施时，卫生保健提供者应针对代孕决策延迟的具体原因，包括以家庭为中心的协作过程、对代孕决策者的支持不足以及与医务人员的信任差距。本研究为临床缩短代孕决策时间提供了有针对性的参考。它还为制定政策以解决替代决策延迟的主要障碍（如经济压力和决策角色不明确）提供了参考依据。

{"title":"Decision‐making delays in endovascular treatment for acute ischemic stroke: A qualitative study of perspectives from family surrogates, physicians, and nurses","authors":"Yitao Zhou , Yangbin Zhou , Huijie Yang , Ganying Huang","doi":"10.1016/j.pec.2025.109462","DOIUrl":"10.1016/j.pec.2025.109462","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the reasons for decision-making delays in endovascular treatment (EVT) for acute ischemic stroke (AIS), from the perspectives of surrogate decision-makers, physicians, and nurses.</div></div><div><h3>Methods</h3><div>This descriptive qualitative study included semi-structured interviews conducted with surrogate decision-makers for patients undergoing endovascular thrombectomy for AIS, as well as the attending physicians and nurses. Participants were recruited using purposive sampling to ensure a diverse representation of perspectives. The data were analysed applying thematic analysis.</div></div><div><h3>Results</h3><div>Our analysis revealed three main themes and seven subthemes: (1) Theme 1, Dynamic decision-making influenced by multiple factors. Family-centered collaborative decision-making; The unique position of surrogate decision-makers; Economic pressure in decision-making. (2) Theme 2, Limited support. Unfamiliar illness and environment; The marginalized role of patients in decision-making processes. (3) Theme 3, Building “bridges” of trust. The importance of doctors; Be patient.</div></div><div><h3>Conclusion</h3><div>Decision-making delays in EVT stem from intertwined cultural, informational, and support-related factors influencing surrogate judgment in time-critical stroke care. Targeted improvements in rapid communication, role clarification, and decision support are essential to reduce treatment delays. These findings offer practical direction for designing strategies and policies to optimize surrogate decision-making and improve access to timely EVT.</div></div><div><h3>Practice implications</h3><div>Healthcare providers should target specific causes of surrogate decision-making delays including family-centered collaborative processes, insufficient support for surrogate decision-makers and trust gaps with medical staff when designing interventions. This study provides targeted references for clinical practices to shorten surrogate decision-making time. It also offers a reference basis for formulating policies to address key barriers in surrogate decision-making delays such as economic pressure and unclear decision-making roles.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"144 ","pages":"Article 109462"},"PeriodicalIF":3.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Identifying the psychosocial experience of lung transplant recipients across the transplant trajectory: A systematic review and narrative synthesis 在移植过程中识别肺移植受者的社会心理经验：系统回顾和叙事综合

IF 3.1 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2025-12-18 DOI: 10.1016/j.pec.2025.109461

Nicole Heneka , Daniel Chambers , Isabelle Schaefer , Peter Hopkins , Suzanne K. Chambers

Introduction

Patients who receive lung transplantation generally experience dramatically improved physical well-being. However, transplantation is associated with elevated psychosocial distress. Reduced quality of life related to distress may compromise the net benefit of lung transplantation. Patients’ concerns likely vary across the illness trajectory, however a comprehensive synthesis that spans the full lung transplant trajectory is absent from the current literature.

This review aimed to identify the psychosocial concerns reported by adult lung transplant candidates across the transplant trajectory.

Methods

A systematic review and narrative synthesis approach was used. A systematic search of seven databases was undertaken from database inception to 29 April 2024, with articles appraised using the Critical Appraisal Skills Programme tool. Data were extracted to align with the lung transplant trajectory stages. Psychosocial concerns were thematically synthesised to align with each stage of the transplant trajectory.

Results

In all, 19 articles were eligible for inclusion. Lung transplant candidates experience a range of psychosocial issues beginning before discussions about transplant are initiated and continuing across the trajectory. The transplant experience is characterised by high uncertainty and ambiguity around decision-making, treatment experience and outcomes; with high threat to life, identity and relationships. This occurs alongside high symptom burden from pre-existing morbidity of end-stage respiratory disease and lung transplantation itself.

Conclusion

Lung transplantation patients experience psychosocial concerns throughout the trajectory that evolve over time.

Practice Implications

Clinicians should ensure that patients are screened for psychosocial distress and needs regularly from commencement of transplant discussions, and offered tailored advice and support across the transplant trajectory.

接受肺移植的患者通常会显著改善身体健康状况。然而，移植与社会心理困扰升高有关。与痛苦相关的生活质量下降可能损害肺移植的净收益。患者的关注点可能因疾病轨迹而异，然而，目前文献中缺乏对整个肺移植轨迹的全面综合。本综述旨在确定成人肺移植候选人在移植过程中报告的社会心理问题。方法采用系统综述和叙事综合的方法。从数据库建立到2024年4月29日，对七个数据库进行了系统搜索，并使用关键评估技能计划工具对文章进行了评估。提取数据以与肺移植轨迹分期相一致。心理社会问题在主题上综合，以配合移植轨迹的每个阶段。结果19篇文献符合纳入标准。肺移植候选者在开始讨论移植之前就会经历一系列社会心理问题，并在整个过程中持续下去。移植经验的特点是决策、治疗经验和结果的高度不确定性和模糊性；对生命，身份和人际关系都有很大威胁。这与终末期呼吸系统疾病和肺移植本身先前存在的发病率所造成的高症状负担同时发生。结论肺移植患者在整个过程中都会出现社会心理问题。临床医生应确保从移植讨论开始定期筛查患者的心理社会困扰和需求，并在整个移植过程中提供量身定制的建议和支持。

{"title":"Identifying the psychosocial experience of lung transplant recipients across the transplant trajectory: A systematic review and narrative synthesis","authors":"Nicole Heneka , Daniel Chambers , Isabelle Schaefer , Peter Hopkins , Suzanne K. Chambers","doi":"10.1016/j.pec.2025.109461","DOIUrl":"10.1016/j.pec.2025.109461","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients who receive lung transplantation generally experience dramatically improved physical well-being. However, transplantation is associated with elevated psychosocial distress. Reduced quality of life related to distress may compromise the net benefit of lung transplantation. Patients’ concerns likely vary across the illness trajectory, however a comprehensive synthesis that spans the full lung transplant trajectory is absent from the current literature.</div><div>This review aimed to identify the psychosocial concerns reported by adult lung transplant candidates across the transplant trajectory.</div></div><div><h3>Methods</h3><div>A systematic review and narrative synthesis approach was used. A systematic search of seven databases was undertaken from database inception to 29 April 2024, with articles appraised using the Critical Appraisal Skills Programme tool. Data were extracted to align with the lung transplant trajectory stages. Psychosocial concerns were thematically synthesised to align with each stage of the transplant trajectory.</div></div><div><h3>Results</h3><div>In all, 19 articles were eligible for inclusion. Lung transplant candidates experience a range of psychosocial issues beginning before discussions about transplant are initiated and continuing across the trajectory. The transplant experience is characterised by high uncertainty and ambiguity around decision-making, treatment experience and outcomes; with high threat to life, identity and relationships. This occurs alongside high symptom burden from pre-existing morbidity of end-stage respiratory disease and lung transplantation itself.</div></div><div><h3>Conclusion</h3><div>Lung transplantation patients experience psychosocial concerns throughout the trajectory that evolve over time.</div></div><div><h3>Practice Implications</h3><div>Clinicians should ensure that patients are screened for psychosocial distress and needs regularly from commencement of transplant discussions, and offered tailored advice and support across the transplant trajectory.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"145 ","pages":"Article 109461"},"PeriodicalIF":3.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0