Patient Education and Counseling最新文献_第7页

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。

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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。

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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。

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引用次数: 0

Improv in health professions education special interest group: Creating community and collaboration 改进卫生专业教育特别兴趣小组：创建社区和协作

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.2025.109450

Amy Zelenski , Ankit Mehta , Anne Graff LaDisa , Shannon Hanson , Sarah Shepherd

引用次数: 0

Expanding horizons: Introducing PEC Global 拓展视野：介绍PEC Global

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

Patient Education and Counseling

Pub Date : 2025-12-17 DOI: 10.1016/j.pec.2025.109460

Gabriela Lima de Melo Ghisi , Richard Street Jr, Kirsten McCaffery

引用次数: 0

This wasn’t the first time I had heard those words as a third-year medical student: “You have breast cancer” 这不是我第一次听到这句话，作为一个三年级的医学院学生：“你得了乳腺癌。”

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

Patient Education and Counseling

Pub Date : 2025-12-17 DOI: 10.1016/j.pec.2025.109452

Manasicha Wongpaiboon

引用次数: 0

Gender affirming and non-affirming language and the healthcare experiences of transgender and gender non-binary individuals: A systematic review 性别肯定和非肯定语言与跨性别和性别非二元个体的医疗保健经验：系统回顾

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

Patient Education and Counseling

Pub Date : 2025-12-09 DOI: 10.1016/j.pec.2025.109449

Vi Nguyen , Enny Das , Charlie Loopuijt

Objectives

Previous studies have identified the crucial role of provider-client communication in healthcare experiences, but there lacks a comprehensive overview regarding the experiences of transgender and gender non-binary (TGNB) individuals. This review aimed to gain insights into best practices and pitfalls in language and communication with TGNB individuals across various healthcare domains.

Methods

A systematic literature review was conducted using two databases (PubMed and CINAHL) and following the PRISMA and the Cochrane guidelines, with search terms such as “communication”, “patient-provider”, “transgender” and “non-binary”. The final sample comprised 22 peer-reviewed publications on language and communication with TGNB individuals in various healthcare domains (e.g., primary care, gender/reproductive care, nursing, pharmacy, mental health, genetic counseling, cancer screening). Using a narrative synthesis framework, we thematically analyzed the findings.

Results

We identified and categorized recurring patterns of language and communication into three themes: (1) personalized communication, (2) communication about the healthcare provider’s (HCP’s) knowledge, and (3) assumption-related discriminatory behaviors toward the client. These themes were central in studying provider-client interactions and TGNB clients’ healthcare experiences.

Conclusion

The literature review and synthesis showed that affirming interactions were characterized by HCPs’ ability to express interest and intention in caring for TGNB clients, communicate knowledge and expertise, and most importantly, address clients respectfully. The findings also revealed that TGNB individuals often faced critical shortcomings in healthcare, such as discrimination and HCPs’ lack of knowledge and awareness.

Practice implications

We argued that a cultural shift toward the person-centered framework is necessary across all healthcare domains to improve TGNB clients’ experiences. Within this framework, we highlighted two recommendations: following the client’s lead with language and allyship. Additionally, comprehensive and periodic trainings on transgender themes should be accessible to all medical staff. More broadly, the review shed light on what could be the root cause for discrimination in healthcare based on sex and gender.

先前的研究已经确定了提供者-客户沟通在医疗保健体验中的关键作用，但缺乏关于跨性别和性别非二元（TGNB）个体体验的全面概述。本综述旨在深入了解不同医疗保健领域中与TGNB个体的语言和沟通的最佳实践和陷阱。方法采用PubMed和CINAHL两个数据库，按照PRISMA和Cochrane指南进行系统文献综述，检索词为“communication”、“patient-provider”、“transgender”和“non-binary”。最后的样本包括22份同行评议的出版物，内容涉及不同医疗保健领域（如初级保健、性别/生殖保健、护理、药学、心理健康、遗传咨询、癌症筛查）中与TGNB个体的语言和交流。使用叙事综合框架，我们对研究结果进行了主题分析。结果我们将语言和沟通的重复模式识别并分类为三个主题：(1)个性化沟通；(2)关于医疗保健提供者（HCP）知识的沟通；(3)与假设相关的对客户的歧视行为。这些主题是研究提供者-客户交互和TGNB客户医疗保健体验的核心。结论文献综述和综合表明，肯定互动的特点是医护人员表达照顾TGNB患者的兴趣和意图，交流知识和专业知识，最重要的是尊重客户。研究结果还显示，TGNB个体在医疗保健方面经常面临严重缺陷，例如歧视和卫生保健提供者缺乏知识和意识。实践意义我们认为，为了改善TGNB客户的体验，所有医疗保健领域都需要向以人为中心的框架进行文化转变。在这个框架内，我们强调了两个建议：在语言和盟友关系上遵循客户的领导。此外，应向所有医务人员提供关于跨性别主题的全面和定期培训。更广泛地说，该审查揭示了医疗保健中基于性别和性别歧视的根本原因。

{"title":"Gender affirming and non-affirming language and the healthcare experiences of transgender and gender non-binary individuals: A systematic review","authors":"Vi Nguyen , Enny Das , Charlie Loopuijt","doi":"10.1016/j.pec.2025.109449","DOIUrl":"10.1016/j.pec.2025.109449","url":null,"abstract":"<div><h3>Objectives</h3><div>Previous studies have identified the crucial role of provider-client communication in healthcare experiences, but there lacks a comprehensive overview regarding the experiences of transgender and gender non-binary (TGNB) individuals. This review aimed to gain insights into best practices and pitfalls in language and communication with TGNB individuals across various healthcare domains.</div></div><div><h3>Methods</h3><div>A systematic literature review was conducted using two databases (PubMed and CINAHL) and following the PRISMA and the Cochrane guidelines, with search terms such as “communication”, “patient-provider”, “transgender” and “non-binary”. The final sample comprised 22 peer-reviewed publications on language and communication with TGNB individuals in various healthcare domains (e.g., primary care, gender/reproductive care, nursing, pharmacy, mental health, genetic counseling, cancer screening). Using a narrative synthesis framework, we thematically analyzed the findings.</div></div><div><h3>Results</h3><div>We identified and categorized recurring patterns of language and communication into three themes: (1) personalized communication, (2) communication about the healthcare provider’s (HCP’s) knowledge, and (3) assumption-related discriminatory behaviors toward the client. These themes were central in studying provider-client interactions and TGNB clients’ healthcare experiences.</div></div><div><h3>Conclusion</h3><div>The literature review and synthesis showed that affirming interactions were characterized by HCPs’ ability to express interest and intention in caring for TGNB clients, communicate knowledge and expertise, and most importantly, address clients respectfully. The findings also revealed that TGNB individuals often faced critical shortcomings in healthcare, such as discrimination and HCPs’ lack of knowledge and awareness.</div></div><div><h3>Practice implications</h3><div>We argued that a cultural shift toward the person-centered framework is necessary across all healthcare domains to improve TGNB clients’ experiences. Within this framework, we highlighted two recommendations: following the client’s lead with language and allyship. Additionally, comprehensive and periodic trainings on transgender themes should be accessible to all medical staff. More broadly, the review shed light on what could be the root cause for discrimination in healthcare based on sex and gender.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"144 ","pages":"Article 109449"},"PeriodicalIF":3.1,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738590","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

Participating in decision-making at the end of life: The self-reported ability of people with cancer across 11 countries 生命末期参与决策：11个国家癌症患者自我报告的能力。

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

Patient Education and Counseling

Pub Date : 2025-12-09 DOI: 10.1016/j.pec.2025.109446

Yassin Engelberts , Judith A.C. Rietjens , Laura A. Hartman , Claudia Fischer , Melanie Joshi , Vilma A. Tripodoro , Pilar Barnestein-Fonseca , Dröfn Birgisdóttir , Dagny Faksvåg Haugen , Antoine Elyn , Stephen Mason , Agnes van der Heide , Ida J. Korfage

Objectives

Uncertainty among healthcare providers about patients’ ability to make care decisions is a barrier to shared decision-making. We aimed to assess the self-reported decision-making ability of patients with cancer at the end of life.

Methods

Data from 11 countries of adults with a limited life expectancy and cancer as the primary diagnosis were used. Participants completed a questionnaire, including one item on decision-making ability and two on decision-making preferences. Correlations between self-reported ability and preferences were tested using Kendall’s tau. Associations between decision-making ability and patient characteristics were determined using mixed-effects ordinal regression models.

Results

The sample (n = 1076, 53 % identified as men) had a mean age of 69 years (SD: 11.5). Among them, 80 % reported being able to make decisions about their life and care most of the time, 14 % some of the time, 5 % only a little of the time, and 2 % never. Regarding preferences, 95 % preferred to be involved in decision-making and 44 % preferred the doctors to make the decisions. These preferences were weakly correlated with decision-making ability (Kendall’s tau: 0.13 and −0.11, respectively). Feeling able to make decisions was less likely for those institutionalized (versus living with relatives, OR: 0.26, 95 % CI: 0.12;0.55), those with tertiary education (versus primary/no education, OR: 0.43, 95 % CI: 0.22;0.85) and those without clear understanding of their health (versus those with understanding, OR: 0.29, 95 % CI: 0.16;0.52).

Conclusions

Although most patients felt able to make decisions about their care, two out of every ten did not. About five out of ten preferred their doctors to make decisions.

Practice implications

As almost all patients want to be involved in decisions, we suggest that providers discuss with patients how decisions will be made. This may enable providers to identify patients’ needs and adapt the decision-making process to their abilities and preferences.

目的：医疗保健提供者对患者做出护理决定的能力的不确定性是共同决策的障碍。我们的目的是评估癌症患者在生命末期自我报告的决策能力。方法：使用来自11个国家的数据，这些成年人的预期寿命有限，主要诊断为癌症。参与者完成了一份问卷，其中一项关于决策能力，两项关于决策偏好。自我报告的能力和偏好之间的相关性用肯德尔的tau来测试。采用混合效应有序回归模型确定决策能力与患者特征之间的关系。结果：样本（n = 1076,53 %确定为男性）平均年龄为69岁（SD: 11.5）。其中，80% %的人在大多数时候能够对自己的生活和关心做出决定，14% %的人在某些时候能够做出决定，5% %的人在很少的时候能够做出决定，2% %的人从来没有做出过决定。在偏好方面，95 %的人更喜欢参与决策，44 %的人更喜欢医生做决定。这些偏好与决策能力弱相关（肯德尔的tau分别为0.13和-0.11）。那些被收容的人（与与亲戚住在一起的人相比，OR: 0.26, 95 % CI: 0.12;0.55）、受过高等教育的人（与没有受过小学教育的人相比，OR: 0.43, 95 % CI: 0.22;0.85）和对自己的健康状况不清楚的人（与了解健康的人相比，OR: 0.29, 95 % CI: 0.16;0.52）感觉能够做出决定的可能性更小。结论：虽然大多数患者觉得自己能够对自己的护理做出决定，但十分之二的患者却不能。大约五成的人更喜欢医生做决定。实践启示：由于几乎所有患者都希望参与决策，我们建议提供者与患者讨论如何做出决策。这可能使提供者能够确定患者的需求，并使决策过程适应他们的能力和偏好。

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引用次数: 0

Adapting diabetes education for neurodiverse patients: A COM-B framework analysis of type 1 diabetes and attention deficit hyperactivity disorder 适应神经多样性患者的糖尿病教育：1型糖尿病和注意缺陷多动障碍的COM-B框架分析。

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

Patient Education and Counseling

Pub Date : 2025-12-09 DOI: 10.1016/j.pec.2025.109448

Elise Chivoret , Nader Perroud , Zoltan Pataky , Karim Gariani , Jorge César Correia

Objective

To highlight the unique challenges faced by individuals with co-occurring Type 1 Diabetes (T1D) and Attention Deficit Hyperactivity Disorder (ADHD), and to advocate for the adaptation of Therapeutic Patient Education (TPE) through tailored strategies and interdisciplinary care models.

Methods

Using the COM-B model (Capability, Opportunity, Motivation – Behavior) as an analytical framework, we explore how executive dysfunction in ADHD impacts diabetes self-management. Drawing on current literature, clinical insights, and behavioral theory, the article identifies barriers to effective care and proposes adaptations to TPE that better address cognitive and behavioral needs.

Results

Executive function deficits in ADHD impair psychological capability to perform essential diabetes management tasks, while limited access to mental health integration and inadequate caregiver involvement reduce environmental opportunity. Motivational challenges are compounded by repeated experiences of perceived “non-compliance.” Tailored education strategies, including simplified routines, technological supports, structured environments, and affirming communication can enhance engagement and outcomes. Interdisciplinary collaboration is critical to implementing these adaptations.

Conclusion

Current TPE models are not fully equipped to serve patients with both T1D and ADHD. Integrating cognitive screening, personalized education techniques, and cross-disciplinary expertise can close this gap. By embracing neurodiversity in chronic disease education, health systems can move toward more equitable and effective care for all.

目的：强调1型糖尿病（T1D）和注意缺陷多动障碍（ADHD）共存个体面临的独特挑战，并倡导通过量身定制的策略和跨学科的护理模式来适应治疗性患者教育（TPE）。方法：采用COM-B模型（能力、机会、动机-行为）作为分析框架，探讨ADHD执行功能障碍对糖尿病自我管理的影响。根据目前的文献、临床见解和行为理论，本文确定了有效治疗的障碍，并提出了更好地解决认知和行为需求的TPE适应方案。结果：ADHD的执行功能缺陷损害了执行基本糖尿病管理任务的心理能力，而心理健康整合的机会有限和照顾者参与不足减少了环境机会。动机上的挑战会因为反复的“不服从”经历而变得复杂。量身定制的教育策略，包括简化的课程、技术支持、结构化的环境和肯定的交流，可以提高参与度和成果。跨学科合作对于实施这些调整至关重要。结论：目前的TPE模型还不能完全满足T1D和ADHD患者的需求。整合认知筛查、个性化教育技术和跨学科专业知识可以缩小这一差距。通过将神经多样性纳入慢性病教育，卫生系统可以为所有人提供更公平和有效的护理。

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引用次数: 0

It is time to recognise shared decision-making as a complex intervention 是时候承认共同决策是一种复杂的干预了

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

Patient Education and Counseling

Pub Date : 2025-12-07 DOI: 10.1016/j.pec.2025.109447

Joanne E. Butterworth , Karen Mattick , Suzanne H. Richards

Objective

Shared decision-making (SDM) is a core component of personalised health care. Populations continue to diversify in their health and social care needs. We argue that established SDM models (focusing on the interaction between patient and practitioner) do not reflect the complexity of patient presentations nor the wider influences on patients’ health and health care encounters. The route from SDM to positive health and health service outcomes are currently obscured. For SDM to be utilised without limit, and for SDM to impact health care policy, it is best understood as a complex intervention.

Discussion

SDM as a complex intervention is characterised by multiple interacting components, influenced by agents acting at several levels of a socioecological model (personal-, interpersonal-, organisational-, societal-, policy- level). The components have non-linear pathways (from cause to effect) existing within and interacting with the context in which SDM is implemented. SDM components are tailorable: Tailoring can enable personalised care for individuals and effect changes in desired outcomes for specific populations and settings. The development of programme theory, for example utilising logic modelling, will be essential for articulating and planning the evaluation of these complex pathways. A standardised framework of SDM outcomes, spanning the socioecological model, would guide the assessment of SDM process and effect. Programme theory, logic modelling, and consistent assessment will together reveal the route to positive outcomes for patients, carers, practitioners and health services and, in turn, will impact policy.

Conclusion

It is time to recognise SDM as a complex intervention. Simplistic definitions should no longer be attempted. SDM should be conceptualised as being wider than the consultation itself with components that are defined by and tailored to the context of its adoption, implementation and sustainability, considering influences that span the socioecological model of the health care system.

目的共享决策（SDM）是个性化医疗服务的核心组成部分。人口的保健和社会保健需求继续多样化。我们认为，已建立的SDM模型（关注患者和医生之间的互动）不能反映患者表现的复杂性，也不能反映对患者健康和医疗保健遭遇的更广泛影响。从可持续发展机制到积极的健康和卫生服务成果的途径目前模糊不清。为了无限制地利用SDM，为了SDM影响卫生保健政策，最好将其理解为一种复杂的干预措施。sdm作为一种复杂的干预措施，其特点是具有多个相互作用的组成部分，受到社会生态模型中多个层面（个人、人际、组织、社会、政策层面）的行动者的影响。组件具有非线性路径（从原因到结果），存在于实现SDM的上下文中并与之交互。SDM组件是可定制的：定制可以为个人提供个性化护理，并对特定人群和环境的预期结果产生影响。程序理论的发展，例如利用逻辑建模，对于阐明和规划这些复杂途径的评估至关重要。一个标准化的SDM结果框架，跨越社会生态模型，将指导SDM过程和效果的评估。方案理论、逻辑建模和一致的评估将共同揭示为患者、护理人员、从业人员和卫生服务取得积极成果的途径，进而影响政策。结论是时候认识到SDM是一种复杂的干预措施了。不应再尝试简单化的定义。SDM应被定义为比咨询本身更广泛的概念，其组成部分由其采用、实施和可持续性的背景定义并量身定制，考虑到跨越卫生保健系统社会生态模式的影响。

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引用次数: 0