Patient Education and Counseling最新文献

英文中文

The implementation of design methodologies for supporting shared decision making in healthcare services: A systematic review. 在医疗服务中实施支持共同决策的设计方法：系统综述。

IF 2.9 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2024-11-15 DOI: 10.1016/j.pec.2024.108551

Yeray Sañudo , Canan Akoglu , Judith A.C. Rietjens , Dirk Snelders , Anne M. Stiggelbout , Jorge Sierra-Pérez

Objectives

This systematic review examines how design methodologies support Shared Decision Making (SDM), identifies the most suitable for future use, explores types of methodologies used, challenges faced, and the impact on patients, clinicians, and care pathways.

Methods

Studies were searched on Medline, Web of Science, Scopus and grey literature (Google Scholar, CORDIS) up to July 2024, following PRISMA guidelines.

Results

were analysed to identify patient involvement, design strategies, SDM solutions, and their impact on care paths, professionals, and patients.

Results

Out of 2499 studies and 39 grey literature projects identified, 22 studies (reported in 35 publications) were selected, primarily from the USA and Europe (2015 onward). User-Centered Design predominated, involving health professionals more than patients. IPDAS standards were common. Evaluations showed improved patient experience and SDM role, with a potential increase in healthcare professionals' workload.

Conclusion

Although design methodologies are used in SDM implementation, improvement is needed. Service Design can enhance implementation by analysing the entire SDM process, while co-creative approaches develop patient-focused solutions that integrate smoothly into health professionals' workflows.

Practical implications

Introducing SDM in healthcare is complex, but design methodologies can help by analysing stakeholder needs, providing a broader care path view, and facilitating SDM implementation.

目标：本系统综述研究了设计方法如何支持共同决策（SDM），确定了最适合未来使用的方法，探讨了所用方法的类型、面临的挑战以及对患者、临床医生和护理路径的影响：按照 PRISMA 指南，在 Medline、Web of Science、Scopus 和灰色文献（Google Scholar、CORDIS）上检索了截至 2024 年 7 月的研究。结果：分析了患者参与、设计策略、SDM 解决方案及其对护理路径、专业人员和患者的影响：在已确定的 2499 项研究和 39 个灰色文献项目中，选取了 22 项研究（在 35 份出版物中报告），主要来自美国和欧洲（2015 年以后）。以用户为中心的设计占主导地位，医护人员的参与度高于患者。IPDAS 标准很常见。评估结果显示，患者体验和 SDM 作用得到改善，但医护人员的工作量可能会增加：尽管在 SDM 实施过程中使用了设计方法，但仍需改进。服务设计可以通过分析整个 SDM 流程来加强实施，而共同创造的方法则可以开发出以患者为中心的解决方案，顺利融入医疗专业人员的工作流程：在医疗保健中引入 SDM 非常复杂，但设计方法可以通过分析利益相关者的需求、提供更广泛的护理路径视角以及促进 SDM 的实施来提供帮助。

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引用次数: 0

Informal caregivers’ roles and needs regarding shared decision-making in severe aortic stenosis 非正规护理人员在重度主动脉瓣狭窄患者共同决策方面的角色和需求。

IF 2.9 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2024-11-15 DOI: 10.1016/j.pec.2024.108554

Judith J.A.M. van Beek-Peeters , Miriam C. Faes , Mirela Habibovic , Jop B.L. van der Meer , Ruth E. Pel-Littel , Martijn W.A. van Geldorp , Ben J.L. Van den Branden , Nardo J.M. van der Meer , Mirella M.N. Minkman

Objective

To provide insight into experiences, preferences and needs of informal caregivers (ICs) regarding shared decision-making (SDM) in severe aortic stenosis (AS) of patients ≥ 70 years, and the effect of the level of perceived SDM on ICs’ quality of life (QOL) and distress.

Methods

Multiple methods study consisting of a questionnaire at baseline and 3-month follow-up and focus groups.

Results

Ninety-nine ICs (67.6 ± 11.7 years) completed the baseline questionnaire, eighty-two ICs the follow-up questionnaire, ten ICs (70.6 ± 12.6 years) participated in two focus groups. ICs perceived that identifying them as discussion partners and addressing patients’ daily lives were least discussed with professionals (26.3 %; 59.6 %). Most ICs (63.9 %) preferred a collaborative decision-making (DM) role. The level of perceived SDM was positively associated with baseline QOL social relations (p = .038), and follow-up QOL psychological health (p = .048) and environment (p = .024). ICs experienced three roles in SDM: supporters in DM, stimulators in clarifying patient’s personal context, and DM partners.

Conclusion

ICs play valuable roles in SDM for severe AS, but feel professionals do not consistently identify them as discussion partners.

Practice implications

Professionals should involve ICs in SDM for discussing older patient’s QOL and personal context, which can inform personalized decisions regarding severe AS treatment.

目的深入了解非正规照顾者（ICs）对 70 岁以上重度主动脉瓣狭窄（AS）患者共同决策（SDM）的经验、偏好和需求，以及感知到的 SDM 水平对 ICs 生活质量（QOL）和痛苦的影响：方法：多方法研究，包括基线问卷调查、3 个月随访和焦点小组：99 名集成电路设计师（67.6 ± 11.7 岁）完成了基线问卷，82 名集成电路设计师完成了后续问卷，10 名集成电路设计师（70.6 ± 12.6 岁）参加了两个焦点小组。综合症患者认为，与专业人员讨论最少的是确定他们为讨论伙伴和解决患者的日常生活问题（26.3%；59.6%）。大多数集成电路（63.9%）倾向于合作决策（DM）角色。感知到的 SDM 水平与基线 QOL 社会关系（p = .038）、后续 QOL 心理健康（p = .048）和环境（p = .024）呈正相关。综合治疗师在 SDM 中扮演了三种角色：DM 的支持者、澄清患者个人背景的激励者和 DM 的合作伙伴：集成治疗师在重度 AS 的 SDM 中发挥着重要作用，但专业人员并未始终将他们视为讨论伙伴：专业人员应让 IC 参与 SDM，讨论老年患者的 QOL 和个人背景，这可以为有关严重 AS 治疗的个性化决策提供信息。

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引用次数: 0

Development and validation of the chronic condition physician-patient relationship scale (CC-PPR): A patient-informed measurement tool 慢性疾病医患关系量表（CC-PPR）的开发和验证：一种患者知情的测量工具

IF 2.9 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2024-11-14 DOI: 10.1016/j.pec.2024.108492

Jessica A. Eigeland , Nicola Sheeran , Liz Jones , Robyn L. Moffitt

Objective

Several tools exist to measure the physician-patient relationship; however few are specific to those with chronic physical health conditions, and none to date have been derived from the patient’s perspective. This research aimed to develop and validate a patient-informed tool for measuring the physician-patient relationship with patients who have a chronic physical health condition.

Methods

Study 1: An Australian sample of participants with a diagnosed chronic physical health condition and a self-reported good physician-patient relationship completed a three round Delphi poll to determine items of the chronic condition physician-patient relationship scale (CC-PPR). Fifty-two participants completed round one, 33 completed round two, and 24 completed all three rounds. Study 2: Exploratory and confirmatory factor analysis were conducted on a separate sample (N = 226) to explore the factor structure of the CC-PPR.

Results

The CC-PPR comprised 22 items within a single-factor structure which demonstrated high internal consistency (Cronbach’s α = 0.97) and sound convergent validity.

Discussion

The CC-PPR reliably measures observable, concrete, and specific physician behaviours that patients with chronic physical health conditions believe are critical in forming a good physician-patient relationship. The CC-PPR has potential application in research, educational, and self-assessment contexts, including for the evaluation and development of competence in post-graduate and professional settings.

目的有多种测量医患关系的工具；然而，针对那些患有慢性身体健康状况的人的研究很少，迄今为止也没有一个是从病人的角度出发的。本研究旨在开发并验证一种患者知情的工具，用于测量患有慢性身体健康状况的患者的医患关系。方法研究1：对澳大利亚确诊慢性身体健康状况和自我报告良好医患关系的参与者进行三轮德尔菲民意调查，确定慢性疾病医患关系量表（CC-PPR）的项目。52名参与者完成了第一轮，33名完成了第二轮，24名完成了所有三轮。研究2：对单独样本（N = 226）进行探索性和验证性因子分析，探讨CC-PPR的因子结构。结果CC-PPR在单因素结构中包含22个条目，具有较高的内部一致性（Cronbach’s α = 0.97）和较好的收敛效度。CC-PPR可靠地测量了可观察到的、具体的和特定的医生行为，慢性身体健康状况患者认为这些行为对于形成良好的医患关系至关重要。CC-PPR在研究、教育和自我评估环境中具有潜在的应用，包括在研究生和专业环境中评估和发展能力。

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引用次数: 0

Parental experiences of end-of-life decision making in Neonatal Intensive Care Unit: A systematic review and qualitative data synthesis 新生儿重症监护室中父母对临终决策的经验：系统回顾与定性数据综合。

IF 2.9 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2024-11-13 DOI: 10.1016/j.pec.2024.108546

Yanhui Ma, Junxiang Gao , Chongyang Zhang, Lihua Zhang, Ling Lu

Objective

This systematic review and meta-synthesis aimed to explore the experiences of parents making end-of-life decisions in Neonatal Intensive Care Unit (NICU).

Methods

We searched nine databases up to December 2023, including qualitative studies focused on parents’ experiences with end-of-life decisions in NICU. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tool for qualitative research. A thematic synthesis approach was used for data analysis.

Results

Nine studies were ultimately included. Four themes were identified: Roles in Decision-Making, Factors Influencing Decision-Making, Decision-Making Trade-offs, and Emotional Experience.

Conclusion

This meta-synthesis indicates that factors influencing parents' end-of-life decisions in NICU are complex and challenging. This provides evidence for the development of interventions for end-of-life decision-making, suggesting that these challenges should be carefully addressed to reduce the stress associated with this process.

Implications for practice

The findings will assist healthcare providers in considering the spectrum of parental perspectives in end of life decision making and provide guidance for the development of decision aids.

目的本系统综述和荟萃旨在探讨新生儿重症监护室（NICU）中父母做出临终决定的经验：我们检索了截至 2023 年 12 月的九个数据库，其中包括关注新生儿重症监护室中父母临终决定经验的定性研究。我们使用乔安娜-布里格斯研究所（Joanna Briggs Institute）的定性研究批判性评估工具对研究方法的质量进行了评估。数据分析采用专题综合法：最终纳入了九项研究。确定了四个主题：决策中的角色、影响决策的因素、决策权衡和情感体验：这项元综合研究表明，影响新生儿重症监护室中父母临终决策的因素非常复杂且具有挑战性。这为临终决策干预措施的开发提供了证据，表明应认真应对这些挑战，以减轻与此过程相关的压力：研究结果将有助于医疗服务提供者考虑父母在生命末期决策中的各种观点，并为决策辅助工具的开发提供指导。

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引用次数: 0

Erratum to “Nurse-led immunotreatment DEcision Coaching In people with Multiple Sclerosis (DECIMS) – A cluster-randomised controlled trial and mixed methods process evaluation” [Patient Educ Couns 125 (2024) 108293] 多发性硬化症患者免疫治疗决策指导（DECIMS）--分组随机对照试验和混合方法过程评估》的勘误 [Patient Educ Couns 125 (2024) 108293]。

IF 2.9 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2024-11-13 DOI: 10.1016/j.pec.2024.108363

A.C. Rahn , J. Peper , S. Köpke , G. Antony , K. Liethmann , E. Vettorazzi , C. Heesen

引用次数: 0

A qualitative study of type 2 diabetes mellitus outpatients' perspectives on readiness, acceptance and barriers of mobile apps for medication adherence 关于 2 型糖尿病门诊患者对移动应用程序在坚持用药方面的准备程度、接受程度和障碍的定性研究。

IF 2.9 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2024-11-12 DOI: 10.1016/j.pec.2024.108547

Cheng Jun Chong , Mohd Makmor-Bakry , Ernieda Hatah , Nor Asyikin Mohd Tahir , Norlaila Mustafa , Francis R. Capule , Andi Hermansyah

Objectives

This qualitative phenomenological study explored the perspectives of type 2 diabetes mellitus (T2DM) outpatients in adopting mobile apps for medication adherence management.

Methods

Through 25 semi-structured in-depth interviews, themes were identified using thematic analysis, guided by the Technology Readiness and Acceptance Model (TRAM).

Results

Anticipated convenience and benefits, openness to new technologies acted as drivers, while limited digital literacy and concerns about data privacy and security served as inhibitors of readiness to adopt health apps. Acceptance was influenced by elements related to medication, patient, healthcare professional, family and app aspects. The identified barriers were related to patient, smartphone and monetary factors. Patients perceived the need to adopt digital apps were for those with poor adherence, complex medication regimen and forgetfulness issues. However, concerns about effectively implementing this approach were noted as T2DM patients were predominantly late middle-aged adults who faced technical challenges, leading to combination approach between digital technology and conventional patient education and counselling.

Conclusion

The findings highlighted the factors influencing patient's readiness, acceptance, and barriers on effective utilisation of digital health solutions in managing adherence issues.

Practical implications

The elements of TRAM provide guidance for strategic actions to enhance digital health technology adoption among T2DM patients.

目的：本项定性现象学研究探讨了 2 型糖尿病（T2DM）门诊患者在采用移动应用程序进行服药依从性管理时的观点：本定性现象学研究探讨了 2 型糖尿病（T2DM）门诊患者在采用移动应用程序进行服药依从性管理时的观点：方法：通过 25 个半结构式深度访谈，在技术准备和接受模型（TRAM）的指导下，采用主题分析法确定主题：结果：预期的便利性和益处、对新技术的开放性是采用健康应用程序的驱动因素，而有限的数字素养以及对数据隐私和安全的担忧则是采用健康应用程序的阻碍因素。接受度受药物、患者、医疗保健专业人员、家庭和应用程序等相关因素的影响。已确定的障碍与患者、智能手机和金钱因素有关。患者认为需要采用数字应用程序的是那些依从性差、用药方案复杂和健忘的患者。然而，由于 T2DM 患者主要是中年后期的成年人，他们面临着技术上的挑战，因此人们对有效实施这种方法表示担忧，这导致了数字技术与传统的患者教育和咨询相结合的方法：研究结果强调了影响患者在有效利用数字医疗解决方案管理依从性问题方面的准备程度、接受程度和障碍因素：实践意义：TRAM 的要素为提高 T2DM 患者对数字医疗技术的采用率提供了战略行动指南。

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引用次数: 0

From "Medication shortcut" to "Dependence": A qualitative study of self-management paradox in Chinese patients with type 2 diabetes 从 "用药捷径 "到 "依赖"：中国 2 型糖尿病患者自我管理悖论的定性研究。

IF 2.9 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2024-11-09 DOI: 10.1016/j.pec.2024.108491

Xiang Qiu , Lei Hu , Dan Yang , Ziqing Zhang , Xiaoyu He , Yongjie Li , Ni Gong

Objective

The purpose of this study is to explore the process and internal mechanism of patients with diabetes falling into the vicious cycle of medication dependence from the perspective of patients' life.

Methods

Employing purposive sampling, 23 patients with type 2 diabetes were interviewed individually at a renowned tertiary hospital in South China. Subsequently, interview data underwent content analysis.

Results

Analysis of the collected data yielded three overarching themes: "disease limits me everywhere," "the medications make me feel my life again," and "difficult to get rid of the medication dependence."

Conclusions

Our study reveals the process and underlying causes of the vicious cycle of medication dependence among patients with type 2 diabetes. Diabetes patients, in the process of integrating self-management into their daily lives, often view medication as a shortcut to simplify life. They struggle between comprehensive management and dependence on medication, but influenced by immediate gratification and life rationality, they ultimately fall into an inescapable vicious cycle.

Practice Implications

This study can provide information for targeted interventions to enhance patients' comprehensive health management abilities, thereby breaking the vicious cycle.

研究目的本研究旨在从患者生活的角度探讨糖尿病患者陷入药物依赖恶性循环的过程和内在机制：方法：采用目的取样法，在华南某知名三甲医院对23名2型糖尿病患者进行了个别访谈。随后，对访谈数据进行了内容分析：结果：对收集到的数据进行分析后，得出了三大主题：结果：对收集到的数据进行分析后，得出了三个总的主题："疾病处处限制我"、"药物让我重新感受生活"、"难以摆脱药物依赖"：我们的研究揭示了 2 型糖尿病患者药物依赖恶性循环的过程和根本原因。糖尿病患者在将自我管理融入日常生活的过程中，往往将药物视为简化生活的捷径。他们在综合管理与药物依赖之间挣扎，但受眼前利益和生活理性的影响，最终陷入了无法摆脱的恶性循环：本研究可为有针对性的干预措施提供信息，以提高患者的综合健康管理能力，从而打破恶性循环。

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引用次数: 0

Double lesson 双重教训

IF 2.9 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2024-11-08 DOI: 10.1016/j.pec.2024.108490

Ami Schattner

A single patient, treated and followed over many years taught me invaluable clinical lessons, but mostly, the enduring value of mindful, reflective practice and gratification of long-term relationships.

多年来对一名病人的治疗和跟踪，让我学到了宝贵的临床经验，但更主要的是，让我认识到用心、反思实践的持久价值，以及长期关系带来的满足感。

引用次数: 0

Factors affecting U.S. adults’ comfort level in sharing social needs information with healthcare providers 影响美国成年人与医疗服务提供者分享社会需求信息的舒适度的因素。

IF 2.9 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2024-11-07 DOI: 10.1016/j.pec.2024.108493

Nikhil A. Ahuja , Mahima Gulabani , Nirmal A. Ahuja

Objective

This study examines various factors affecting U.S. adults’ comfort level in sharing information about their social needs with healthcare providers.

Methods

We used data from the 2022 Health Information National Trends Survey (cycle 6), a nationally representative survey of U.S. adults (n = 6252). The outcome variables were participants’ comfort level in sharing information about three social needs (food insecurity, transportation difficulties, and housing instability). Data were analyzed using weighted bivariate and multivariable logistic regression models.

Results

Participants who faced discrimination when getting medical care based on race/ethnicity were more likely to be uncomfortable in sharing information about food insecurity, housing instability, and transportation difficulties. Those who trusted the healthcare system “a lot” were less likely to be uncomfortable in sharing information about food insecurity and transportation difficulties. Patient-Centered Communication (PCC) and social isolation scores significantly affected participants’ comfort level in sharing information about social needs.

Conclusion

Various factors such as trust, discrimination, social isolation, and PCC were found to be significantly affecting US adults’ comfort level in sharing information about social needs.

Practice implications

Healthcare systems and policymakers should focus on developing approaches and strategies to enhance trust, reduce discrimination, improve patient-provider communication, and create supportive social environments.

研究目的本研究探讨了影响美国成年人与医疗服务提供者分享其社会需求信息的舒适度的各种因素：我们使用了 2022 年健康信息全国趋势调查（第 6 周期）的数据，这是一项对美国成年人（n = 6252）进行的具有全国代表性的调查。结果变量是参与者在分享有关三种社会需求（食品不安全、交通不便和住房不稳定）的信息时的舒适程度。数据采用加权双变量和多变量逻辑回归模型进行分析：结果：在接受医疗服务时因种族/族裔而受到歧视的受试者更有可能在分享有关食物无保障、住房不稳定和交通困难的信息时感到不自在。那些 "非常信任 "医疗系统的人在分享有关食物不安全和交通不便的信息时，不太可能感到不自在。以患者为中心的沟通（PCC）和社会隔离得分极大地影响了参与者在分享社会需求信息时的舒适度：结论：研究发现，信任、歧视、社会隔离和以病人为中心的沟通（PCC）等各种因素对美国成年人在分享社会需求信息时的舒适度有很大影响：实践启示：医疗保健系统和政策制定者应注重制定方法和策略，以增强信任、减少歧视、改善患者与医疗服务提供者之间的沟通，并营造支持性的社会环境。

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引用次数: 0

A-wristed developments: Adapting to disability A 级发展：适应残疾。

IF 2.9 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling

Pub Date : 2024-11-04 DOI: 10.1016/j.pec.2024.108489

Linda S. Kahn

引用次数: 0

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