Patient Education and Counseling (PATIENT EDUC COUNS)

Publications in this journal

• Article: Frameworks and guidelines for research-Three examples.

  Arnstein Finset
  Patient Education and Counseling 06/2013; 91(3):263-4.
• Article: Patient satisfaction with physician errors in detecting and identifying patient emotion cues.

  Danielle Blanch-Hartigan
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  ABSTRACT: OBJECTIVE: Previous research has examined physicians' ability to respond to or identify the type of emotion cues. Yet in physician-patient interactions, identification and response are preceded by the ability to detect whether an emotion cue has occurred. This research assesses consequences of emotion detection errors for patient satisfaction. METHODS: Participants responding to an online survey read one of six randomly assigned descriptions of a physician-patient interaction varying on: whether the patient presented an emotion cue; whether the physician detected an emotion cue; and whether the physician correctly identified the cue. Participants then rated satisfaction with the physician. RESULTS: Satisfaction was highest when the physician correctly detected the patient's emotion cue and lowest when the physician failed to detect the patient's emotion. Failing to detect the emotion cue had lower satisfaction than other emotion processing errors, including falsely detecting an emotion cue that was not there or incorrectly identifying the type of emotion. CONCLUSIONS: Emotion cue detection has implications for patient satisfaction distinct from emotion identification. PRACTICE IMPLICATIONS: Results suggest it may be better for physicians to incorrectly identify than miss an emotion. Training for healthcare providers should consider incorporating emotion detection.
  Patient Education and Counseling 05/2013;
• Article: Shared decision-making to improve attention-deficit hyperactivity disorder care.

  William B Brinkman, Jessica Hartl Majcher, Lauren M Poling, Gaoyan Shi, Mike Zender, Heidi Sucharew, Maria T Britto, Jeffery N Epstein
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  ABSTRACT: OBJECTIVE: To examine the effect of a shared decision-making intervention with parents of children newly diagnosed with attention-deficit/hyperactivity disorder. METHODS: Seven pediatricians participated in a pre/post open trial of decision aids for use before and during the office visit to discuss diagnosis and develop a treatment plan. Encounters pre- (n=21, control group) and post-intervention implementation (n=33, intervention group) were compared. We video-recorded encounters and surveyed parents. RESULTS: Compared to controls, intervention group parents were more involved in shared decision-making (31.2 vs. 43.8 on OPTION score, p<0.01), more knowledgeable (6.4 vs. 8.1 questions correct, p<0.01), and less conflicted about treatment options (16.2 vs. 10.7 on decisional conflict total score, p=0.06). Visit duration was unchanged (41.0 vs. 41.6min, p=0.75). There were no significant differences in the median number of follow-up visits (0 vs. 1 visits, p=0.08), or the proportion of children with medication titration (62% vs. 76%, p=0.28), or parent-completed behavior rating scale to assess treatment response (24% vs. 39%, p=0.36). CONCLUSIONS: Our intervention increased shared decision-making with parents. Parents were better informed about treatment options without increasing visit duration. PRACTICE IMPLICATIONS: Interventions are available to prepare parents for visits and enable physicians to elicit parent preferences and involvement in decision-making.
  Patient Education and Counseling 05/2013;
• Article: Online support group use and psychological health for individuals living with HIV/AIDS.

  Phoenix K H Mo, Neil S Coulson
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  ABSTRACT: OBJECTIVE: The Internet provides an opportunity for individuals with HIV/AIDS to obtain support and information in a timely and convenient manner. The present study examines the psychological effects of online support group use for individuals living with HIV/AIDS. METHODS: A total of 340 HIV positive online support group users completed an online survey. RESULTS: Results from structural equation modeling showed that individuals with higher levels of online support group participation had higher levels of empowering processes, which in turn, had higher levels of optimism toward life. Optimism was related to lower levels of loneliness and depression while loneliness was also related to higher levels of depression. CONCLUSION: The findings suggest that participants with higher levels of online support group participation had better psychological health than those with lower levels of participation. PRACTICE IMPLICATIONS: Findings suggest that the use of online support groups could be promoted to individuals with HIV/AIDS. Healthcare professionals should work to increase the motivation and confidence patients have in using online support groups. Health education should also be provided to patients with HIV/AIDS so to improve their skills and literacy in using online support groups.
  Patient Education and Counseling 05/2013;
• Article: Cartoon visual: A useful commutation tool between doctors and patients.

  Xiao-Wei Tang, Shu Huang, Zhi-Ning Fan
  Patient Education and Counseling 05/2013;
• Article: Acceptability of video recordings of consultations in HIV and genitourinary medicine (GUM).

  Daniel Bradshaw, Charlotte E Cohen, Sara Day, Sundhiya Mandalia, Nick Theobald
  Patient Education and Counseling 05/2013;
• Article: Do participation and personalization matter? A model-driven evaluation of an Internet-based patient education intervention for fibromyalgia patients.

  Luca Camerini, Anne-Linda Camerini, Peter J Schulz
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  ABSTRACT: OBJECTIVES: To evaluate the effectiveness of an Internet-based patient education intervention, which was designed upon principles of personalization and participatory design. METHODS: Fifteen months after the first release of the website, 209 fibromyalgia patients recruited through health professionals completed an online questionnaire to assess patients' use of the website, health knowledge, self-management behavior, and health outcomes. These constructs were combined into an a-priory model that was tested using a structural equation modeling approach. RESULTS: Results show that the usage of certain tools of the website - designed and personalized involving the end users - impacts patients' health knowledge, which in turn impacts self-management. Improvements in self-management ultimately lower the impact of Fibromyalgia Syndrome leading to better health outcomes. CONCLUSION: This study empirically confirmed that the adoption of a participatory approach to the design of eHealth interventions and the use of personalized contents enhance the overall effectiveness of systems. PRACTICE IMPLICATIONS: More time and effort should be invested in involving patients in the preliminary phases of the development of Internet-based patient education interventions and in the definition of models that can guide the systems' evaluation beyond technology-related variables such as usability, accessibility or adoption.
  Patient Education and Counseling 05/2013;
• Article: Communicating risk of hereditary breast and ovarian cancer with an interactive decision support tool.

  Douglas J Rupert, Linda B Squiers, Jeanette M Renaud, Nedra S Whitehead, Roger J Osborn, Robert D Furberg, Claudia M Squire, Janice P Tzeng
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  ABSTRACT: OBJECTIVE: Women with hereditary breast and ovarian cancer syndrome (HBOC) face a higher risk of earlier, more aggressive cancer. Because of HBOC's rarity, screening is recommended only for women with strong cancer family histories. However, most patients do not have accurate history available and struggle to understand genetic concepts. METHODS: Cancer in the Family, an online clinical decision support tool, calculated women's HBOC risk and promoted shared patient-provider decisions about screening. A pilot evaluation (n=9 providers, n=48 patients) assessed the tool's impact on knowledge, attitudes, and screening decisions. Patients used the tool before wellness exams and completed three surveys. Providers accessed the tool during exams, completed exam checklists, and completed four surveys. RESULTS: Patients entered complete family histories (67%), calculated personal risk (96%), and shared risk printouts with providers (65%). HBOC knowledge increased dramatically for patients and providers, and many patients (75%) perceived tool results as valid. The tool prompted patient-provider discussions about HBOC risk and cancer family history (88%). CONCLUSIONS: The tool was effective in increasing knowledge, collecting family history, and sparking patient-provider discussions about HBOC screening. PRACTICE IMPLICATIONS: Interactive tools can effectively communicate personalized risk and promote shared decisions, but they are not a substitute for patient-provider discussions.
  Patient Education and Counseling 05/2013;
• Article: Hedging, knowledge and interaction: Doctors' and clients' talk about medical information and client experiences in genetic counseling.

  Esa Lehtinen
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  ABSTRACT: OBJECTIVES: The article starts from the observation that professionals in genetic counseling deploy the strategy of 'hedging'. It shows how hedging is used in a particular sequential position: doctors' responses to clients' presentations of personal information during information delivery sequences. METHODS: The data consist of video-recorded sessions of genetic counseling. The methodology is based on ethnomethodological conversation analysis. The analysis identifies interactional patterns in the counseling sessions. RESULTS: In their responses doctors display an orientation to different access to different kinds of knowledge. In particular, the doctors tread carefully when commenting on the situation of a particular client vis-á-vis the symptoms and prognosis of genetic conditions. Furthermore, the article shows that the doctors' responses and hedging devices in them are fitted to the form and function of the clients' presentations of personal experience. CONCLUSION: While the focus of the article is narrow in that it concentrates on one type of an interactional sequence, its strength is that it shows how the doctor's talk can be intertwined with the client's contributions. PRACTICE IMPLICATIONS: The results make it possible for genetic counselors to identify an interactional task they recurrently face and reflect on alternative ways of responding to it.
  Patient Education and Counseling 05/2013;
• Article: Motivational interviewing by HIV care providers is associated with patient intentions to reduce unsafe sexual behavior.

  Tabor E Flickinger, Gary Rose, Ira B Wilson, Hannah Wolfe, Somnath Saha, Philip Todd Korthuis, Michele Massa, Stephen Berry, Michael Barton Laws, Victoria Sharp, Richard D Moore, Mary Catherine Beach
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  ABSTRACT: OBJECTIVE: Motivational interviewing (MI) can promote behavior change, but HIV care providers rarely have training in MI. Little is known about the use of MI-consistent behavior among untrained providers. This study examines the prevalence of such behaviors and their association with patient intentions to reduce high-risk sexual behavior. METHODS: Audio-recorded visits between HIV-infected patients and their healthcare providers were searched for counseling dialog regarding sexual behavior. The association of providers' MI-consistence with patients' statements about behavior change was assessed. RESULTS: Of 417 total encounters, 27 met inclusion criteria. The odds of patient commitment to change were higher when providers used more reflections (p=0.017), used more MI consistent utterances (p=0.044), demonstrated more empathy (p=0.049), and spent more time discussing sexual behavior (p=0.023). Patients gave more statements in favor of change (change talk) when providers used more reflections (p<0.001) and more empathy (p<0.001), even after adjusting for length of relevant dialog. CONCLUSION: Untrained HIV providers do not consistently use MI techniques when counseling patients about sexual risk reduction. However, when they do, their patients are more likely to express intentions to reduce sexual risk behavior. PRACTICE IMPLICATIONS: MI holds promise as one strategy to reduce transmission of HIV and other sexually transmitted infections.
  Patient Education and Counseling 05/2013;
• Article: Exploring telemonitoring and self-management by patients with chronic obstructive pulmonary disease: A qualitative study embedded in a randomized controlled trial.

  Peter Fairbrother, Hilary Pinnock, Janet Hanley, Lucy McCloughan, Aziz Sheikh, Claudia Pagliari, Brian McKinstry
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  ABSTRACT: OBJECTIVE: To explore patient and professional views on self-management in the context of telemonitoring in chronic obstructive pulmonary disease (COPD). METHODS: Semi-structured interviews with patients with COPD and healthcare professionals participating in a randomized controlled trial of telemonitoring in Lothian, Scotland, explored experiences of using telemonitoring, and dynamics in patient-practitioner relationships. Transcribed data were analyzed using the Framework approach. RESULTS: 38 patients (mean age 67.5 years) and 32 professionals provided 70 interviews. Patients considered that telemonitoring empowered self-management by enhancing their understanding of COPD and providing additional justification for their decisions to adjust treatment or seek professional advice. Professionals discussed telemonitoring as promoting compliance with medical advice and encouraged patients to exercise personal responsibility within clinical parameters, but expressed concerns about promoting the sick role and creating dependence on telemonitoring. CONCLUSION: Telemonitoring assisted many patients to embrace greater responsibility for their health but the model of service provision remained clinician-centered. A medical model of 'compliant self-management' may paradoxically have promoted dependence on professionals. PRACTICE IMPLICATIONS: Patients and professionals shared responsibility for meeting the central objective of prompt management of exacerbations of COPD. Care is needed, however, to minimize the risk in some patients, of telemonitoring increasing dependence on practitioner support.
  Patient Education and Counseling 05/2013;
• Article: Bridging the transition from cancer patient to survivor: Pilot study results of the Cancer Survivor Telephone Education and Personal Support (C-STEPS) program.

  Kathleen Garrett, Sonia Okuyama, Whitney Jones, Denise Barnes, Zung Tran, Lynn Spencer, Karl Lewis, Paul Maroni, Margaret Chesney, Al Marcus
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  ABSTRACT: OBJECTIVE: To develop a feasibility study of a theory-driven telephone counseling program to enhance psychosocial and physical well-being for cancer survivors after treatment. METHODS: Participants (n=66) were recruited from two Colorado hospitals with self-administered questionnaires at baseline and two weeks post-intervention. The one group, intervention only design included up to six thematic telephone counseling sessions over three months. Topics included nutrition, physical activity, stress management, and medical follow-up. Primary outcomes were cancer-specific distress, self-reported fruit and vegetable consumption and physical activity. RESULTS: Of 66 subjects, 46 completed at least one counseling module and the follow-up assessment (70% retention rate). Mean satisfaction was 9 out of 10, and all participants would recommend C-STEPS to other survivors. Cancer-specific distress (Impact of Event Scale - Intrusion subscale) decreased for entire study population (p<0.001) and stress management session participants (p<0.001). Fruit and vegetable consumption increased for nutrition and exercise session participants (p=0.02) and the entire sample (p=NS). Physical activity increased in the entire group (p=0.006) and for nutrition and exercise session participants (p=0.01). CONCLUSION AND PRACTICE IMPLICATIONS: C-STEPS is a feasible telephone counseling program that transcends geographic barriers, demonstrating the potential to decrease distress and promote coping and healthy lifestyles among cancer survivors.
  Patient Education and Counseling 05/2013;
• Article: A reflective practice intervention for professional development, reduced stress and improved patient care-A qualitative developmental evaluation.

  Gabriele Lutz, Christian Scheffer, Friedrich Edelhaeuser, Diethard Tauschel, Melanie Neumann
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  ABSTRACT: OBJECTIVE: Professional capabilities, such as empathy and patient-centeredness, decline during medical education. Reflective practice is advocated for teaching these capabilities. The Clinical Reflection Training (CRT) is a reflective practice intervention using the professional dilemmas faced by medical students during clinical practice. The aim of this study was to evaluate students' perceptions of the helpfulness of the CRT and its effects on their medical education. METHODS: Eighteen semi-structured interviews were conducted with medical students who had participated in the CRT. Content analysis was used to analyze the interview data. RESULTS: Medical students did not feel adequately prepared to manage the difficult personal and interpersonal problems frequently encountered in clinical practice. They reported that the CRT reduces stress, improves patient care and serves as a tool for professional development. CONCLUSION: The CRT may be a useful tool for developing professionalism during medical education, reducing stress and enhancing the quality of patient care. PRACTICE IMPLICATIONS: Providing students with reflective practice training that draws on their current personal clinical problems in order to improve their clinical work may be a productive investment in personal professional development, physician health, and quality improvement.
  Patient Education and Counseling 05/2013;
• Article: Shared decision making: Moving from theorization to applied research and hopefully to clinical practice.

  France Légaré
  Patient Education and Counseling 05/2013; 91(2):129-30.
• Article: Role of the Internet in patient education and counseling: A framework for health-care provider in developing China.

  Zhijun Xiao, Zhiling Li, Feng Xu
  Patient Education and Counseling 04/2013;
• Article: Cardiorespiratory fitness protects against stress-related symptoms of burnout and depression.

  Markus Gerber, Magnus Lindwall, Agneta Lindegård, Mats Börjesson, Ingibjörg H Jonsdottir
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  ABSTRACT: OBJECTIVE: To examine how cardiorespiratory fitness and self-perceived stress are associated with burnout and depression. To determine if any relationship between stress and burnout/depression is mitigated among participants with high fitness levels. METHODS: 197 participants (51% men, mean age=39.2 years) took part in the study. The Åstrand bicycle test was used to assess cardorespiratory fitness. Burnout was measured with the Shirom-Melamed Burnout Questionnaire (SMBQ), depressive symptoms with the Hospital Anxiety and Depression Scale (HAD-D). A gender-matched stratified sample was used to ensure that participants with varying stress levels were equally represented. RESULTS: Participants with moderate and high fitness reported fewer symptoms of burnout and depression than participants with low fitness. Individuals with high stress who also had moderate or high fitness levels reported lower scores on the SMBQ Tension subscale and the HAD-D than individuals with high stress, but low fitness levels. CONCLUSION: Better cardiovascular fitness seems to be associated with decreased symptoms of burnout and a better capacity to cope with stress. PRACTICAL IMPLICATIONS: Promoting and measuring cardiorespiratory fitness can motivate employees to adopt a more physically active lifestyle and thus strengthen their ability to cope with stress exposure and stress-related disorders.
  Patient Education and Counseling 04/2013;
• Article: Existing instruments for assessing physician communication skills: Are they valid in a computerized setting?

  Shiri Assis-Hassid, Tsipi Heart, Iris Reychav, Joseph S Pliskin, Shmuel Reis
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  ABSTRACT: OBJECTIVES: This study aims to highlight the differences in physicians' scores on two communication assessment tools: the SEGUE and an EMR-specific communication skills checklist. The first tool ignores the presence of the EMR in the exam room and the second, though not formally validated, rather focuses on it. METHODS: We use the Wilcoxon Signed Ranks Test to compare physicians' scores on each of the tools during 16 simulated medical encounters that were rated by two different raters. RESULTS: Results show a significant difference between physicians' scores on each tool (z=-3.519, p<0.05 for the first rater, and z=-3.521, p<0.05 for the second rater), while scores on the EMR-specific communication skills checklist were significantly and consistently lower. CONCLUSION: These results imply that current communication assessment tools that do not incorporate items that are relevant for communication tasks during EMR use may produce inaccurate results. PRACTICE IMPLICATIONS: We therefore suggest that a new instrument, possibly an extension of existing ones, should be developed and empirically validated.
  Patient Education and Counseling 04/2013;
• Article: Belief in numbers: When and why women disbelieve tailored breast cancer risk statistics.

  Laura D Scherer, Peter A Ubel, Jennifer McClure, Sarah M Greene, Sharon Hensley Alford, Lisa Holtzman, Nicole Exe, Angela Fagerlin
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  ABSTRACT: OBJECTIVE: To examine when and why women disbelieve tailored information about their risk of developing breast cancer. METHODS: 690 women participated in an online program to learn about medications that can reduce the risk of breast cancer. The program presented tailored information about each woman's personal breast cancer risk. Half of women were told how their risk numbers were calculated, whereas the rest were not. Later, they were asked whether they believed that the program was personalized, and whether they believed their risk numbers. If a woman did not believe her risk numbers, she was asked to explain why. RESULTS: Beliefs that the program was personalized were enhanced by explaining the risk calculation methods in more detail. Nonetheless, nearly 20% of women did not believe their personalized risk numbers. The most common reason for rejecting the risk estimate was a belief that it did not fully account for personal and family history. CONCLUSIONS: The benefits of tailored risk statistics may be attenuated by a tendency for people to be skeptical that these risk estimates apply to them personally. PRACTICE IMPLICATIONS: Decision aids may provide risk information that is not accepted by patients, but addressing the patients' personal circumstances may lead to greater acceptance.
  Patient Education and Counseling 04/2013;
• Article: A communication skills intervention for parents of pediatric surgery patients.

  Donald J Cegala, Deena J Chisolm, Benedict C Nwomeh
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  ABSTRACT: OBJECTIVE: It was hypothesized that parents exposed to a communication skills intervention would participate (e.g., ask questions, express concerns) in a pre-surgical consultation more than parents in the control group. METHODS: Sixty-five parents of prospective pediatric surgery patients were randomly assigned to either a communication skills intervention (booklet mailed prior to the consultation) or control group. Only initial consultation parents were included, no follow-ups. Audio-recordings of the medical consultations were obtained and the transcripts analyzed utilizing a content-coding system to determine patient participation. Also, parents were given a health literacy test (s-TOFHLA) and a post-interview questionnaire to gather demographic data. RESULTS: Intervention parents participated overall significantly more than control parents. Follow-up analyses revealed that intervention parents asked significantly more questions, and engaged in significantly more information verifying and expressing of concerns. There were no significant differences for parents' assertive statements or information provision. Other significant predictors of parents' participation were consultation length and parents' income. CONCLUSION: The intervention tested in this study promoted parents' participation in a pre-surgical consultation. As such, it has the potential to improve information exchange between parents and physicians with positive implications for informed consent. PRACTICE IMPLICATIONS: Providing parents with communication guidelines prior to a surgical consultation may improve physician-patient communication.
  Patient Education and Counseling 04/2013;