Discussing patient's lifestyle choices in the consulting room: analysis of GP-patient consultations between 1975 and 2008

<p>Abstract</p> <p>Background</p> <p>The increasing prevalence of chronic diseases and the growing understanding that lifestyle behaviour plays an essential role in improving overall health suggest a need for increased attention to lifestyle choices in the consulting room.</p> <p>This study aims to examine whether or not healthy and unhealthy lifestyle choices of patients are currently being discussed more often in primary care consultations than in former decades. Furthermore, we are interested in GPs' approach to lifestyle behaviour during consultations. Lastly, we examine whether lifestyle behaviour is discussed more with certain patients during consultations, depending on gender, age and educational background.</p> <p>Method</p> <p>We analysed video-recordings of medical consultations, collected between 1975 and 2008 in Dutch GP practices. Data were analysed using logistic regression.</p> <p>Results</p> <p>This study shows that discussion of smoking behaviour and physical activity has increased somewhat over time. A change in discussion of nutrition and alcohol is, however, less clear. Overall, alcohol use is the least discussed and physical activity the most discussed during consultations. GPs mainly refer to lifestyle when it is relevant to the patient's complaints (symptom approach). GPs' approach to lifestyle behaviour did not change over time. In general, lifestyle behaviour is discussed more with older, male patients (except for nutrition). GPs talk about lifestyle behaviour with patients from different educational backgrounds equally (except for physical activity).</p> <p>Conclusion</p> <p>In recent years there is greater awareness of a healthy lifestyle, which is reflected to a limited extent in this study. Still, lifestyle behaviour is discussed in only a minority of consultations. GPs do not refer to lifestyle behaviour as a routine procedure, i.e. do not include it in primary prevention. This highlights the importance of the introduction of prevention consultations, where GPs can discuss lifestyle issues with patients who do not (yet) have risk symptoms.</p

Patient organisations and the reimbursement process for medicines: an exploratory study in eight European countries

<p>Abstract</p> <p>Background</p> <p>Little is known about the role European patient organisations play in the process of deciding on reimbursement for medicines. Therefore we <it>explore </it>the current role of patient organisations in the process of reimbursement for medicines in Western Europe. We focus in particular on collaboration between patient organisations and the pharmaceutical industry in this respect.</p> <p>Methods</p> <p>Sixty-eight patient organisations representing seven medical conditions, from ten Western European countries, were asked to participate in the study. The participating organisations reported their experiences in a web-based questionnaire.</p> <p>Results</p> <p>Twenty-one patient organisations completed the questionnaire (response rate: 31%), of which ten (47.6%) demanded reimbursement for medicines. Organisations demanding reimbursement were larger than those not demanding reimbursement. The main aim of these organisations was to create better accessibility of medicines for patients. Most organisations limited themselves to single actions. Only two engaged in multiple actions. Almost all organisations had general policies on cooperation with the pharmaceutical industry, with autonomy as the key feature. The patient organisations said they were reasonably successful and almost always satisfied with their own role in the reimbursement process.</p> <p>Conclusion</p> <p>Our study has found that the role of European patient organisations in the reimbursement process still seems limited, especially for small patient organisations.</p

Clients’ psychosocial communication and midwives’ verbal and nonverbal communication during prenatal counseling for anomaly screening

Objectives: This study focuses on facilitation of clients’ psychosocial communication during prenatal counseling for fetal anomaly screening. We assessed how psychosocial communication by clients is related to midwives’ psychosocial and affective communication, client-directed gaze and counseling duration. Methods: During 184 videotaped prenatal counseling consultations with 20 Dutch midwives, verbal psychosocial and affective behavior was measured by the Roter Interaction Analysis System (RIAS). We rated the duration of client-directed gaze. We performed multilevel analyses to assess the relation between clients’ psychosocial communication and midwives’ psychosocial and affective communication, client-directed gaze and counseling duration. Results: Clients’ psychosocial communication was higher if midwives’ asked more psychosocial questions and showed more affective behavior (b = 0.90; CI: 0.45–1.35; p < 0.00 and b = 1.32; CI: 0.18–2.47; p = 0.025, respectively). Clients “psychosocial communication was not related to midwives” clientdirected gaze. Additionally, psychosocial communication by clients was directly, positively related to the counseling duration (b = 0.59; CI: 0.20–099; p = 0.004). Conclusions: In contrast with our expectations, midwives’ client-directed gaze was not related with psychosocial communication of clients. Practice implications: In addition to asking psychosocial questions, our study shows that midwives’ affective behavior and counseling duration is likely to encourage client’s psychosocial communication, known to be especially important for facilitating decision-making

Shared Decision Making in Clinical Practice: Experiences and Needs of Patients with Limited Health Literacy

Shared Decision Making (SDM), currently considered a preferred model for making decisions in healthcare, requires that patients have the knowledge and skills to actively participate in the consultation and decision-making process. Patients with limited health literacy (LHL) often fail to do so. To gain insight into the experiences, needs and support for LHL-patients concerning SDM in clinical practice, five focus groups were held with 26 patients with LHL. A focus group discussion guide was developed based on 4-steps SDM models. Data was coded using thematic content analyses. LHL patients participating in this study had little experience with SDM in practice, but do prefer it. Important barriers for this are healthcare provider-related (involving patients too little in decision-making, using medical jargon), patient-related (feeling insecure to play a role in decision-making, inability to understand their diagnosis or information about treatment options), patient-provider interaction-related (relationship of trust) or system-related (too little consultation time). For SDM to take place more often, a shared responsibility between patients and healthcare providers is required. We recommend expanding the SDM models, by adding a step zero (patients understand their diagnosis) and a fifth step (reviewing the decision), to improve the process for LHL patients

Affective communication with patients with limited health literacy in the palliative phase of COPD or lung cancer : Analysis of video-recorded consultations in outpatient care

Objectives Affective communication in outpatient care is important, especially in the palliative phase. Appropriate responses by healthcare providers to emotional cues or concerns let patients express their feelings and enhance information recall and patient satisfaction. Patients with limited health literacy experience more barriers in health-related communication and information, which makes recognizing their cues and concerns even more relevant. This study explores emotional cues/concerns expressed by patients with limited health literacy and evaluates healthcare providers’ responses to these utterances. Methods Verona Coding Definitions of Emotional Sequences (VR-CoDES), a consensus-based system for coding patients’ expression of emotional distress in medical consultations, was used in this exploratory observational study to analyse affective communication in video-recorded outpatient consultations. Consultations of 18 (10 female, 8 male) COPD or lung cancer patients (aged 70.3±6.8) with limited health literacy were recorded and analysed. Eight healthcare providers in four hospitals participated in the study. Results 101 cues and 11 concerns were observed, making 6.2 (SD = 4.2) cues or concerns per consultation. Healthcare provider responses were explicit in 56% and left scope for further disclosures in 58% of the cases. Patients with limited health literacy seem to express more cues or concerns than other patient populations. Healthcare providers responded roughly equally often in five different ways, but they shied away from further exploring the emotion disclosed in the cue/concern. Future research should elaborate on these exploratory observations, especially regarding why HCPs often only leave limited space for further disclosure of emotions in palliative care

ListeningTime; participatory development of a web-based preparatory communication tool for elderly cancer patients and their healthcare providers

Objective: This paper outlines the participatory development process of a web-based preparatory communication tool for elderly cancer patients and their oncological healthcare providers (HCPs). This tool aims to support them to (better) prepare their encounters. An overarching aim of the project is to develop the tool in a participatory way to increase uptake and use. Methods: Scrum, a participatory framework originated from software development, was applied to develop the tool. Using constant feedback loops, elderly (former) cancer patients, oncological HCPs and their representatives were, as end-users, involved. Results: During six ‘sprints’, the communication tool ‘ListeningTime’ was developed with input from end-users. The use of scrum in developing an innovative tool was challenging in this context, because of time constraints of seriously-ill patients and busy HCPs and the co-creation involving non-profit scientific researchers and a for-profit development company. Conclusions: The collaboration with end-users facilitated the development process of ListeningTime. Early involvement of end-users and flexibility in terms of planning and setup appear to be preconditions for creating a bottom-up inspired development procedure. Several challenges emerged from using scrum as participatory framework. Nevertheless, the ‘pressure cooking situation’, using scrum, resulted in a quick development process and a product ready for implementation

The Effects of Complementary Therapies on Patient-Reported Outcomes: An Overview of Recent Systematic Reviews in Oncology

Many patients with cancer make use of complementary medicine alongside conventional medicine, but clinicians in oncology often lack the knowledge to adequately advise patients on the evidence base for complementary therapies. This study aims to provide an overview of recently published systematic reviews that assess the effects of complementary therapies on patient-reported health outcomes in patients with cancer. Systematic reviews, including a meta-analysis of at least two randomized controlled trials, were identified from the PubMed, Embase, Cochrane Library, CINAHL and PsycINFO databases. The methodological quality was assessed with AMSTAR 2. One hundred systematic reviews were included. The results suggest that several complementary therapies can improve health outcomes reported by patients with cancer, such as acupuncture to relieve pain, music interventions to reduce anxiety and yoga to improve cancer-related fatigue. The side effects related to complementary therapy use are generally mild. The results remain inconclusive for some intervention–outcome combinations. Many of the included systematic reviews insufficiently assessed the causes and impact of bias in their interpretation of the results. This overview of systematic reviews can support clinicians in counselling their patients on this topic and provide directions for future research and clinical practice guidelines in the field of complementary medicine

Hard templating synthesis of mesoporous and nanowire SnO2 lithium battery anode materials

Mesoporous and nanowire SnO2 anode materials for lithium batteries were prepared using KIT-6 and SBA-15 SiO2 templates, and their electrochemical properties were compared at different current rates. The as-prepared SnO2 nanowires had a diameter of 6 nm and a length of >3 μm and Brunauer-Emmett-Teller (BET) surface area of 80 m2 g-1 while mesoporous SnO2 showed a pore size of 3.8 nm and a BET surface area of 160 m2 g-1. The charge capacities of these two anodes were similar to each other at 800 mAh g-1, but mesoporous SnO2 showed much improved cycle life performance and rate capabilities because of its higher surface area than nanowire SnO2. Especially, the capacity retention of the mesoporous SnO2 was 98%, compared with 31% for the SnO2 nanowires at a 10 C rate (= 4000 mA g-1). The improved electrochemical performance of the mesoporous SnO2 was related to the regular porosity which permitted thorough flooding of the electrolyte between the particles, and the mesopores which acted as a buffer zone during the volume contraction and expansion of Sn.close15415

Table générale du tome XIX (1978)

Table générale du tome XIX (1978). In: Tiers-Monde, tome 19, n°76, 1978. pp. 915-919