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Gu X, Zhu P, Zhang H, Wang W, Ding Y, Qian M, Shi G, Zhang Q, Hegarty J. A Qualitative Thematic Analysis Exploring Chinese Young Adults' Experiences in Decision Making on the Management of Low-Risk Papillary Thyroid Cancer. Thyroid 2024. [PMID: 39417219 DOI: 10.1089/thy.2024.0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2024]
Abstract
Background: Thyroid cancer is the most common endocrine neoplasm in China. Questions regarding the extent of patient involvement in shared decision-making (SDM) processes persist; this is particularly pertinent to patients considering treatment options for low-risk papillary thyroid cancer (PTC). In this study, we aimed to explore Chinese young adults' experiences of SDM relating to the choice of treatment for low-risk PTC. Methods: The study used a qualitative descriptive design and semistructured interviews. Interviews were conducted with 24 patients (ages ranging from 18 to 38 years; 4 men and 20 women) diagnosed with low-risk (PTC) between March 2023 and May 2024. Twenty-two of 24 patients' tumor size measured 1 cm or smaller; the largest tumor size measured 1.47 cm. Reflexive thematic analysis was used to identify key themes from the transcribed interviews. Results: The analysis revealed that the SDM experiences of young patients with low-risk PTC involve four themes: challenges in information sharing; reasons for information seeking; factors influencing decision making; and self-positioning in treatment decision making. Three self-positions relating to treatment decision making were identified. These included dependent positioning, which reflects a "paternalistic" decision-making pattern; collaborative positioning, reflecting a "sharing" of decision making; and autonomous positioning, reflecting an increased sense of personal responsibility for both managing their health and engagement in decision making. Limited treatment options being offered, overuse of medical terminology, and communication gaps between clinicians and patients were the main challenges described during the information-sharing process. Information that needs persisting after physician-patient consultations resulted in active information-seeking behavior. The key variables identified in this study that potentially affected the decision-making process were future personal considerations, language used to discuss cancer, and negative emotions. Conclusions: These results highlight the necessity of adopting flexible strategies when supporting collaborative treatment decision making in the context of the doctor-patient interaction for low-risk PTC. Based on these findings, clinicians can take measures to enhance the quality of SDM by inquiring about patients' role preferences, providing details of the full range of treatment options, and encouraging patients to share their preferences and concerns relating to possible treatment options.
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Affiliation(s)
- Xinyue Gu
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu, P. R. China
| | - Pingting Zhu
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu, P. R. China
- Jiangsu Key Laboratory of Zoonosis, Yangzhou, Jiangsu, P. R. China
| | - Hui Zhang
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu, P. R. China
| | - Wen Wang
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu, P. R. China
| | - Yinwen Ding
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu, P. R. China
| | - Meiyan Qian
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu, P. R. China
| | - Guanghui Shi
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu, P. R. China
| | - Qianqian Zhang
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu, P. R. China
- Department of Anesthesia and Perioperative Medicine, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Josephine Hegarty
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
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Li M, An X, Wang Q, Ma J, Wang Y, Ma J. Effect of Hope Theory combined with active cycle of breathing techniques on pulmonary rehabilitation among COPD patients: A quasi-experiment study. Appl Nurs Res 2024; 79:151842. [PMID: 39256012 DOI: 10.1016/j.apnr.2024.151842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/28/2023] [Accepted: 08/18/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND Pulmonary rehabilitation plays a positive role in improving exercise tolerance and reducing readmission rates in patients with chronic obstructive pulmonary disease (COPD), while the adherence of pulmonary rehabilitation in COPD patients is still poor. The active cycle of breathing techniques based on the Hope Theory is a method to enhance patients' confidence in overcoming the disease and improve the intrinsic motivation of exercise through symptom improvement such as cough and sputum evacuation ability. OBJECTIVES To investigate the effect of Hope Theory education combined with the active cycle of breathing techniques on pulmonary rehabilitation of COPD patients, including exercise adherence, cough and sputum evacuation ability, hope index and exercise self-efficacy. METHODS The study assigned 70 COPD patients hospitalized into intervention and control groups to receive the active cycle of breathing techniques based on Hope Theory or routine treatment in order of admission. Data for cough and sputum evacuation ability, hope, exercise confidence were collected at baseline and after the program. Exercise adherence was assessed at the end of 1, 4 and 8 week following discharge. RESULTS The actual number of sample consisted of 65 patients divided into intervention (n = 33) and control (n = 32) groups due to severe complications, explicit refusal, disinterest and loss to follow-up. After two weeks of intervention, exercise adherence of the intervention group were better than those of the control group at the end of 4 and 8 week of discharge (P < 0.05). And there was an improvement in cough and sputum evacuation ability, hope and exercise self-efficacy outcomes in the intervention group, with a statistically significant difference between the two groups (P < 0.05). CONCLUSION The active cycle of breathing techniques based on Hope Theory education can improve cough and sputum evacuation ability, hope index, exercise self-efficacy, and exercise adherence of COPD patients.
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Affiliation(s)
- Meng Li
- College of Nursing, Hebei University of Chinese Medicine, No. 3 Xingyuan Road, Shijiazhuang, China
| | - Xin An
- College of Nursing, Hebei University of Chinese Medicine, No. 3 Xingyuan Road, Shijiazhuang, China
| | - Qiushuang Wang
- College of Nursing, Hebei University of Chinese Medicine, No. 3 Xingyuan Road, Shijiazhuang, China
| | - Jiangtao Ma
- College of Nursing, Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, China
| | - Yanli Wang
- Department of Respiratory, Hebei Provincial Hospital of Traditional Chinese Medicine, No. 389 Zhongshan East Road, Shijiazhuang, China
| | - Jinghua Ma
- College of Nursing, Hebei University of Chinese Medicine, No. 3 Xingyuan Road, Shijiazhuang, China.
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Cartwright C, Greenhill B, Griffiths AW, Harrison J. A meta-ethnography of shared decision-making in mental health care from the perspective of staff and service users. BMC Health Serv Res 2024; 24:1142. [PMID: 39334231 PMCID: PMC11437683 DOI: 10.1186/s12913-024-11540-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Human rights, recovery, and value-based approaches are integral to strategic changes and development in mental health care. Successfully integrating such person-centred values in mental health services requires a paradigm shift from traditional biomedical models of care to a more human rights-based approach. An important aspect of this is shared decision making (SDM) between mental health staff and service users. Whilst it is widely acknowledged SDM leads to improved outcomes, there are barriers and challenges to implementing this approach effectively in clinical practice. OBJECTIVES This systematic review aimed to assess existing empirical research exploring mental health service users and/or staff's attitudes towards and experiences of SDM in adult mental health care settings. METHODS The review and protocol were registered on PROSPERO (CRD42023369472). Systematic searches were run on four databases. Search terms pertained to studies reporting on mental health staff or service users' experiences of SDM in adult mental health care. Initial searches yielded 721 results. Included studies were analysed using a meta-ethnographic approach. RESULTS Thirteen articles were included. Data were synthesised using meta ethnographic synthesis, which produced four higher order themes with related subthemes; the role of service user ownership, the influence of fluctuating capacity, the importance of therapeutic alliance and changing clinicians' behaviours and attitudes. IMPLICATIONS Both staff and service users found SDM to be an important factor in delivering high quality, effective mental health care. Despite this, participants had very little experience of implementing SDM in practice due to several personal, professional, and organisational challenges. This suggests that differences exist between what services strive towards achieving, and the experience of those implementing this in practice. These findings suggest that further research needs to be conducted to fully understand the barriers of implementing SDM in mental health services with training delivered to staff and service users about SDM.
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Affiliation(s)
- Claire Cartwright
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Beth Greenhill
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK.
- Eleanor Rathbone Building, The University of Liverpool, Bedford Street South, Liverpool, L69 7ZA, UK.
| | | | - John Harrison
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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An X, Zhang D, Wang Q, Shi X, Wang M, Wang Y, Ma J. The role of evidence-based practice and empathy in shared decision-making attitudes among newly graduated nurses: A cross-sectional study. J Adv Nurs 2024. [PMID: 38736281 DOI: 10.1111/jan.16236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 04/05/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
AIM Examine the levels of variables and explore drivers associated with shared decision-making attitudes among newly graduated nurses. DESIGN This was a descriptive and cross-sectional study. METHODS From August 2022 to October 2022, a cross-section of 216 newly graduated nurses from four comprehensive A-level hospitals in northern China was recruited using convenience sampling. Newly graduated nurses are generally defined as nurses with a service period of six months to one year. Data were collected using an online questionnaire support platform, including the Nursing Shared Decision-Making Attitude scale, Jefferson scale of Empathy-Health profession students and the Health Sciences Evidence-Based Practice questionnaire. All data were analysed descriptively, and correlational analysis and hierarchical regression were used to make identical connections between variables. RESULTS Newly graduated nurses supported shared decision-making. Perceptions of shared decision-making were correlated with the experiences of empathy and evidence-based practice. Additionally, perspective-taking of empathy and beliefs, and the ability to search for and apply existing scientific findings of evidence-based practice had a significant impact on more positive attitudes. CONCLUSION The survey showed that acceptance of shared decision-making was positive among newly graduated nurses. Clinical nursing managers and teachers should pay attention to cultivating the evidence-based practice and empathy of newly graduated nurses to adopt an optimistic attitude towards shared decision-making in the long term. IMPACT The survey addresses attitudes of shared decision-making among newly graduated nurses and determines whether empathy and evidence-based practice has an impact on it. The main finding is that newly graduated nurses have an optimistic outlook on the implementation of shared decision-making. This survey showed that empathy and evidence-based practice competencies are associated with shared decision-making attitudes among newly graduated nurses. The results of this survey have an impact on educational institutions and hospitals in the form of recommendations. Several training programmes on empathy and evidence-based practice can help adopt the shared decision-making attitudes of newly graduated nurses. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Xin An
- Department of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Dan Zhang
- Department of Geriatric Gastroenterology, Hebei General Hospital, Shijiazhuang, China
| | - Qiushuang Wang
- Department of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Xinhui Shi
- Department of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Mengdi Wang
- Department of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Yingzhe Wang
- Department of Respiratory, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Jinghua Ma
- Department of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
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He Y, Tan X, Wang J, Wiley J, Huang Y, Ding H, Wang Q, Huang T, Sun M. Trust, discrimination and preference for shared decision-making in adolescents diagnosed with depression: Implications from Chinese mental health professionals. PATIENT EDUCATION AND COUNSELING 2024; 122:108137. [PMID: 38232674 DOI: 10.1016/j.pec.2024.108137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/02/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND While evidence suggests that the attitudes of healthcare providers toward medical decision-making in adolescents diagnosed with depression merit exploration, research on their preferences for Shared Decision-Making (SDM) and the factors affecting these preferences remains limited. OBJECTIVE To investigate Chinese mental health professionals' (MHPs) preferences for SDM in adolescents with depression and identify the relationships between their preference for SDM and trust and discrimination. METHODS A cross-sectional design was used in this study. Clinical Decision-making Style-Staff (CDMS-S) was applied to evaluate their preferences for SDM. Physician Trust in the Patient Scale (PTPS) was utilised to assess their trust in consumers. Social Distance Scale to Mental Illness (SDSMI) was utilised to measure their discrimination against people with mental illness. RESULTS A total of 581 MHPs were identified in China. MHPs rated their preference for participation in decision making (PD) as shared (1.89 ± 0.472), information (IN) as moderate (2.62 ± 0.682), and family involvement (FI) as high (3.13 ± 0.840). The preferences for three decision topics ranked from the highest to the lowest score were working-related decision (2.35 ± 0.681), general preferences in decision (1.82 ± 0.581) and medication-related decision (1.74 ± 0.826). The mean score of PTPS and SDSMI were 34.71 (SD=9.709) and 15.17 (SD=4.299), respectively. Logistic regression indicated that the preference for PD was associated with discrimination; the preference for IN was associated with trust, discrimination and SDM-related training experience; and the preference for FI was associated with both trust and discrimination. CONCLUSIONS While MHPs generally exhibit a favourable attitude toward SDM, this positivity is not universally observed across all contexts. There remains room for improvement in the willingness to co-develop medication regimens and share health information. Rational recognition of depression, and building trusting and friendly therapeutic relationships are key to promoting MHPs' preferences for SDM. PRACTICAL VALUE MHPs' preferences for SDM have a significant impact on SDM implementation, which will be promoted by implementing SDM-related training.
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Affiliation(s)
- Yuqing He
- Xiangya School of Nursing, Central South University, Changsha, China.
| | - Xiangmin Tan
- Xiangya School of Nursing, Central South University, Changsha, China.
| | - Jianjian Wang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - James Wiley
- School of Nursing, University of California, San Francisco.
| | - Yuxin Huang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Hui Ding
- The second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Qian Wang
- The second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Tianhui Huang
- Lanzhou University Second Hospital, Lanzhou, Gansu, China.
| | - Mei Sun
- Xiangya School of Nursing, Central South University, Changsha, China; School of Nursing, Changsha Medical University, 1501 Leifeng Avenue, Wangcheng district, Changsha, Hunan 410219, China.
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El-Abidi K, Moreno-Poyato AR, Cañabate-Ros M, Garcia-Sanchez JA, Lluch-Canut MT, Muñoz-Ruoco E, Pérez-Moreno JJ, Pita-De-La-Vega J, Puig-Llobet M, Rubia-Ruiz G, Santos-Pariente C, López AMR, Golmar LJ, López CE, Roldán-Merino JF. The therapeutic relationship from the perspective of patients and nurses in the first days of admission: A cross-sectional study in acute mental health units. Int J Ment Health Nurs 2024; 33:134-142. [PMID: 37743558 DOI: 10.1111/inm.13227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
The therapeutic relationship (TR) is essential in mental health nursing care and plays a fundamental role in the understanding and treatment of the patient's health status. Despite being a bidirectional construct, limited evidence is available to shed light on this issue in mental health units and even less so in the first days of admission. This study aimed to examine the association and differences between nurses' and patients' perspectives on the establishment of the therapeutic relationship in acute mental health units during the first days of hospitalization. A cross-sectional study was carried out in 12 Spanish mental health units. Data were collected from patients and nurses using the Working Alliance Inventory-Short (WAI-S) questionnaire. A total of 234 cases were analysed, including 234 patients and 58 nurses. The results showed a positive association between nurses' and patients' perspectives on the therapeutic relationship, but also revealed significant differences on each WAI-S dimension. Nurses assigned higher scores compared to patients on the perception of the quality of the therapeutic relationship. The dimensions with the greatest weight from the patients' perspective regarding the quality of the therapeutic relationship were the perception of greater agreement on goals and tasks among nurses. This study demonstrates the importance of establishing shared goals and tasks with nurses from the first days of hospitalization to improve the quality of the therapeutic relationship as perceived by patients. These findings underline the need to consider the different perspectives of both parties to promote a high-quality therapeutic relationship.
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Affiliation(s)
- Khadija El-Abidi
- Institut de Neuropisquiatria i Addiccions, Centre Fòrum, Hospital del Mar, Barcelona, Spain
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
- Grup de Recerca en Cures Infermeres de Salut Mental, Psicocials i de Complexitat, NURSEARCH - 2021 SGR 1083, Barcelona, Spain
| | - Montserrat Cañabate-Ros
- Universidad Católica de Valencia, San Vicente Mártir, Grupo de investigación MHG, Valencia, Spain
- Hospital Clínico Universitario de Valencia, Unidad de hospitalización de psiquiatría y toxicomanía, Valencia, Spain
| | - Juan A Garcia-Sanchez
- Department of Mental Health, Biomedical Research Institute of Malaga (IBIMA), University General Hospital of Málaga, Málaga, Spain
| | - M Teresa Lluch-Canut
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
- Grup de Recerca en Cures Infermeres de Salut Mental, Psicocials i de Complexitat, NURSEARCH - 2021 SGR 1083, Barcelona, Spain
| | - Estibaliz Muñoz-Ruoco
- Psychiatry Service, Galdakao-Usansolo Hospital, Osakidetza-Basque Health Service, Galdakao-Usansolo, Spain
| | - Juan J Pérez-Moreno
- Psychiatry Service, Galdakao-Usansolo Hospital, Osakidetza-Basque Health Service, Galdakao-Usansolo, Spain
| | - Javier Pita-De-La-Vega
- Children's Mental Health Centre, Department of Mental Health, Consorci Sanitari del Maresme, Mataró, Spain
| | - Montserrat Puig-Llobet
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
- Grup de Recerca en Cures Infermeres de Salut Mental, Psicocials i de Complexitat, NURSEARCH - 2021 SGR 1083, Barcelona, Spain
| | | | | | | | | | - Cristina Esquinas López
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Juan F Roldán-Merino
- Campus Docent Sant Joan de Déu Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
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Verwijmeren D, Grootens KP. Shifting Perspectives on the Challenges of Shared Decision Making in Mental Health Care. Community Ment Health J 2024; 60:292-307. [PMID: 37550559 PMCID: PMC10821819 DOI: 10.1007/s10597-023-01170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/08/2023] [Indexed: 08/09/2023]
Abstract
Although shared decision making (SDM) has become the most preferable way in doctor-patient communication, it is not fully implemented in mental health care likely due to the complex nature of psychiatric syndromes and treatments. In this review we provide a systematic overview of all perceived and reported barriers to SDM in the literature, acknowledging field-specific challenges, and offering perspectives to promote its wider use. We conducted a systematic search of the wider literature in different databases and included all publications mentioning specified barriers to SDM in psychiatric care. Relevant data and opinions were categorised into micro-, meso- and macro-level themes and put into clinical perspective. We derived 20 barriers to SDM from 100 studies and reports. Eight were on micro-level care delivery, seven involved meso-level issues, five concerned macro-level themes. The multitude of perceived and actual barriers to SDM underline the challenges its implementation poses in mental health care, some of which can be resolved while others are inherent to the nature of the care, with its long-term relationships, complex dynamics, and social consequences, all requiring a flexible approach. We present four perspectives to help change views on the potential of SDM in mental health care.
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Affiliation(s)
- Doris Verwijmeren
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, The Netherlands.
- Reinier van Arkel Mental Health Institute, 's-Hertogenbosch, The Netherlands.
| | - Koen P Grootens
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, The Netherlands
- Reinier van Arkel Mental Health Institute, 's-Hertogenbosch, The Netherlands
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Geng L, Shi Z, Chai XY, Nie HW, Cong HB, Li SP. Patient and clinician perspectives on shared decision-making in infertility treatment: A qualitative study. PATIENT EDUCATION AND COUNSELING 2023; 116:107948. [PMID: 37672920 DOI: 10.1016/j.pec.2023.107948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES To explore the considerations and barriers to implementing shared decision-making (SDM) in infertility treatment among female infertility patients, their male spouses, and fertility clinicians. METHODS Participants were recruited from a reproductive medicine hospital in China's Shandong Province using purposive sampling. One-on-one interviews were held with female infertility patients and their spouses. In addition, a focus group discussion was conducted with fertility clinicians. Data analysis was subjected to open, axial, and selective coding. RESULTS Nineteen female infertility patients and 10 male spouses were interviewed one-on-one. Five clinicians participated in the focus group discussion. Most female patients wanted to participate in the decision-making process, and that spouses and fertility clinicians supported SDM. Furthermore, key barriers were identified from the perspectives of multiple stakeholders, including communication difficulties, psychological pressure on female patients, patient preferences, multiple treatment stages, male spousal participation, clinician-patient trust, and subjective patient factors. CONCLUSIONS/PRACTICE IMPLICATIONS This study explored the considerations of and barriers to implementing SDM in infertility treatment. Key barriers were identified from the perspectives of multiple stakeholders. Based on the findings, clinicians should encourage patients and their spouses to actively participate in decision-making, and provide objective and realistic guidance.
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Affiliation(s)
- Ling Geng
- Center for Reproductive Medicine, Shandong University, Jinan, China; Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhao Shi
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China; Center for Health Preference Research, Shandong University, Jinan, China
| | - Xiao-Yun Chai
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China; Center for Health Preference Research, Shandong University, Jinan, China
| | - Hong-Wei Nie
- Center for Reproductive Medicine, Shandong University, Jinan, China
| | - Hong-Bin Cong
- Center for Reproductive Medicine, Shandong University, Jinan, China
| | - Shun-Ping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China; Center for Health Preference Research, Shandong University, Jinan, China.
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9
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Tan X, He Y, Ning N, Peng J, Wiley J, Fan F, Wang J, Sun M. Shared decision-making in the treatment of adolescents diagnosed with depression: A cross-sectional survey of mental health professionals in China. J Psychiatr Ment Health Nurs 2023. [PMID: 37882490 DOI: 10.1111/jpm.12990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
WHAT IS ALREADY KNOWN?: SDM improves clinical outcomes by increasing attendance and treatment adherence in adolescents diagnosed with depression. SDM could reduce treatment disagreements and enhance consumers' and their families' satisfaction with mental healthcare services. Healthcare professionals are a critical part of SDM. However, MHPs' practices of SDM in the daily management of adolescents diagnosed with depression need to be clarified. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: From the viewpoints of MHPs, SDM was not extensively applied in the daily management of adolescents diagnosed with depression. MHPs who trust their consumers and have received training related to SDM are more likely to practice SDM in the daily management of adolescents diagnosed with depression. The positive preferences for providing information and family involvement in treatment decision-making are facilitators; working in closed inpatient mental health wards and open inpatient mental health wards are hindering factors for MHPs' practices of SDM. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: MHPs should encourage information sharing with consumers and their family members to help them participate in treatment decision-making actively. A trusting and friendly therapeutic relationship with consumers should be maintained in the daily management of adolescents diagnosed with depression. SDM-related training should be encouraged for MHPs to promote widespread SDM. ABSTRACT INTRODUCTION: Shared decision-making (SDM) is an ideal model for a therapeutic relationship that can improve health outcomes. Healthcare professionals are a critical part of SDM, and they play an important role in the practices of SDM in the clinical setting. Evidence suggests that adolescents diagnosed with depression can benefit substantially from SDM. However, mental health professionals' (MHPs) practices of SDM for adolescents diagnosed with depression in China are not well-documented. AIM This study aimed to investigate the practices of SDM for adolescents diagnosed with depression from the viewpoints of MHPs in China. METHOD In this cross-sectional study, we recruited a total of 581 MHPs by convenience sampling. The Shared Decision-Making Questionnaire-Physician Version (SDM-Q-Doc) was used to evaluate the MHPs' practices of SDM for adolescents diagnosed with depression. RESULTS The mean SDM-Q-Doc was 80.47 (±16.31). Within the six specific decision-making situations, most MHPs selected non-SDM (52.7%-71.6%). Substantial numbers of respondents believed that MHPs made the final decision, especially with regard to the development (37%) and adjustment of medication regimens (42%). The practice of SDM was predicted by MHPs' preference for providing information, their trust in consumers, preference for family involvement in treatment decision-making, working in an outpatient clinic and receiving SDM training (F = 23.582; p = .000; R2 = .198; adjusted R2 = .189). DISCUSSION Although the MHPs' self-rated score of SDM-Q-Doc was high, SDM was not extensively applied in the daily management of adolescents diagnosed with depression. Thus, SDM needs to be further promoted by enhancing SDM-related training for MHPs, thereby actively promoting the involvement of families, facilitating the information sharing for consumers and families, and building an active, trusting consumer-practitioner relationship. IMPLICATIONS FOR PRACTICE MHPs should prioritise information sharing with consumers and families, as well as build trusting and friendly therapeutic relationships. Family involvement in treatment decisions should be encouraged when adolescents diagnosed with depression are in need. Actively participating in training related to SDM is also important. Future high-quality evidence is still needed to explore the facilitators and barriers to SDM practices from a tripartite perspective of MHPs, adolescents diagnosed with depression and their families.
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Affiliation(s)
- Xiangmin Tan
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yuqing He
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Ni Ning
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jiayuan Peng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - James Wiley
- School of Nursing, University of California, San Francisco, California, USA
| | - Fangxiu Fan
- Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, Hunan, China
| | - Jianjian Wang
- Clinical Nursing Teaching and Research Section, The second Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Mei Sun
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- School of Nursing, Changsha Medical University, Changsha, Hunan, China
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10
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Keij SM, Lie HC, Laidsaar-Powell R, Kunneman M, de Boer JE, Moaddine S, Stiggelbout AM, Pieterse AH. Patient-related characteristics considered to affect patient involvement in shared decision making about treatment: A scoping review of the qualitative literature. PATIENT EDUCATION AND COUNSELING 2023; 111:107677. [PMID: 36857803 DOI: 10.1016/j.pec.2023.107677] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To identify patient-related characteristics considered to affect patient involvement in shared decision making (SDM) about treatment. METHODS We conducted a scoping review of qualitative studies. We searched for literature across seven databases until March 2022, and included qualitative studies that focused on associations between patient-related characteristics and SDM about treatment in adults. We analyzed studies using an inductive thematic approach. RESULTS The search yielded 5948 articles, of which 70 were included. We identified many different patient-related characteristics, which we grouped into four categories related to: (1) the individual who is facing the decision, (2) the decision, (3) the relationship between the patient and the clinician and others involved in the decision, and (4) the healthcare context. CONCLUSIONS Studies report a variety of patient-related characteristics that may affect patient involvement in SDM. Amongst others, patients may need to feel informed, to understand their role in SDM, and be able to communicate. Involvement may be challenging with characteristics such as perceived time pressure, poor patient-clinician relationships, emotional distress, and severe illness. PRACTICE IMPLICATIONS In order to truly involve patients in SDM, we might need to focus on characteristics such as patient emotions and relationship building, besides information provision and values clarification.
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Affiliation(s)
- Sascha M Keij
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands.
| | - Hanne C Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Joyce E de Boer
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Saïda Moaddine
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
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11
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Hua N, Tan X, He Y, Sun M, Wang X. Medical decision-making for adolescents with depression: A bibliometric study and visualization analysis via CiteSpace. Int J Ment Health Nurs 2023; 32:365-377. [PMID: 36317375 DOI: 10.1111/inm.13085] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
This study focussed on evaluating the status of recent research on medical decision-making for adolescents with depression and identifying research hotspots and frontiers via CiteSpace. We extracted studies that were concerned with medical decision-making for adolescents with depression from the Web of Science Core Collection (WoSCC), covering the period from 1 January 1999 to 20 September 2022. We used CiteSpace to generate online maps of worldwide cooperation among countries, institutions, and authors. Hotspots and frontiers were systematically summarized. A total of 368 papers related to medical decision-making for adolescents with depression were obtained from WoSCC. The most prolific author was Nick Midgley (seven papers). The United States and University College London were the leading country and institution in this research area, with 177 and 17 papers, respectively. Countries, institutions, and authors all actively collaborated. Main recent research trends include the preference or attitude towards medical treatment in adolescents with depression; approaches for adolescents with depression to seeking medical help; and the key role of parent, family, and primary care in medical decision-making for adolescents. Thus, further attention should be paid to determining how to promote the role of parents, families, and primary care in the decision-making process and create appropriate online help-seeking tools and decision aids to facilitate shared decision-making in the future.
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Affiliation(s)
- Nan Hua
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiangmin Tan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yuqing He
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Mei Sun
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiuhua Wang
- Xiangya School of Nursing, Central South University, Changsha, China
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12
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Liu YQ, Guo YL, Xu J, Geng WJ, Li ZZ, Jia M, Liu YD, Zhao H. Shared Decision-Making in Hemophilic Arthropathy Rehabilitation: A Qualitative Study. Patient Prefer Adherence 2023; 17:249-257. [PMID: 36721389 PMCID: PMC9884430 DOI: 10.2147/ppa.s394095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023] Open
Abstract
Purpose To probe into the needs and barriers underlying patients' participation in shared decision-making related to rehabilitation nursing for hemophilic arthropathy. Patients and Methods The phenomenological research approach was adopted to conduct a series of semi-structured, in-depth interviews with 15 patients with hemophilic arthropathy undergoing rehabilitative treatments, 10 caregivers, and 7 healthcare providers from a hemophilia treatment center in Shanxi province, China. Colaizzi's seven-step method of data analysis was applied to organize, analyze, and extract the themes from the interview materials. Results Three main themes emerged from the analysis: the status quo of the healthcare system (insufficient decision support systems and mismatch between healthcare providers' and patients' resources), circumstances of provider-patient interactions (lack of information exchange and unbalanced power structure between healthcare providers and patients), and patient-related factors influencing participation in decision-making (lack of self-efficacy, personal characteristics, family and social decision support, and attitude toward participation in decision-making). Conclusion Participation in rehabilitation decision-making among patients with hemophilic arthropathy is affected by multiple barriers. Healthcare professionals should improve their understanding of shared decision-making, offer patients active guidance on participating in the decision-making process, prioritize their affective needs, and formulate professional and effective solutions to support shared decision-making as early as possible.
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Affiliation(s)
- Yan-Qiu Liu
- College of Nursing, Shanxi University of Chinese Medicine, Jinzhong, Shanxi, People’s Republic of China
| | - Yu-Lin Guo
- Department of Rehabilitation, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Jia Xu
- Department of Nephrology, Shanxi Bethune Hospital, Taiyuan, Shanxi, People’s Republic of China
| | - Wen-Jing Geng
- College of Nursing, Shanxi University of Chinese Medicine, Jinzhong, Shanxi, People’s Republic of China
| | - Zhen-Zhen Li
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Ming Jia
- College of Nursing, Shanxi University of Chinese Medicine, Jinzhong, Shanxi, People’s Republic of China
| | - Yu-Dan Liu
- College of Nursing, Shanxi University of Chinese Medicine, Jinzhong, Shanxi, People’s Republic of China
| | - Hua Zhao
- College of Nursing, Shanxi University of Chinese Medicine, Jinzhong, Shanxi, People’s Republic of China
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13
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Zhou W, Xiao S, Xie G, Ouyang F, Luo B. A comparison of patient-reported quality between inpatient services for mental and physical health: A tertiary-hospital-based survey in China. Front Psychiatry 2023; 14:1090892. [PMID: 36846224 PMCID: PMC9949676 DOI: 10.3389/fpsyt.2023.1090892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/11/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND It is widely acknowledged that quality of mental health services is routinely worse than physical health services across countries. However, studies separately investigating mental health services often report high-level satisfaction, even comparing with physical health services. Therefore, this study aimed to compare patient-reported quality between inpatient services for mental and physical health in China. METHODS An inpatient survey was conducted among service users of mental and physical health services. Patient-reported quality was measured by the responsiveness performance questionnaire after patient discharge and based on patients' multiple experiences of hospitalization in the past 3 years. Chi-square tests were performed to compare the two patient groups' ratings on inpatient services for mental and physical health, and multivariate logistic regression was performed to adjust covariates in the group comparison. RESULTS Inpatient services for mental health were rated better than those for physical health on "treating with respect" (AOR = 3.083, 95% CI = 1.102-8.629) and "choosing a healthcare provider" (AOR = 2.441, 95% CI = 1.263-4.717). However, mental health services had poorer ratings on "asking patient's opinions" (AOR = 0.485, 95% CI = 0.259-0.910). For other responsiveness items, no significant difference was detected between the two types of inpatient services. CONCLUSION Mental health inpatient services provided by China's tertiary hospitals could perform as well as physical health inpatient services in most aspects and even better perform regarding dignity and choice of healthcare providers. However, neglecting patients' voices is more severe in inpatient services for mental health.
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Affiliation(s)
- Wei Zhou
- Research Center for Public Health and Social Security, School of Public Administration, Hunan University, Changsha, Hunan, China
| | - Shuiyuan Xiao
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Guanqing Xie
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Feiyun Ouyang
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Bihua Luo
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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14
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Tang C, Wang A, Yan J. Exploring motivations and resistances for implementing shared decision-making in clinical practice: A systematic review based on a structure-process-outcome model. Health Expect 2022; 25:1254-1268. [PMID: 35662361 PMCID: PMC9327808 DOI: 10.1111/hex.13541] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/22/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Shared decision-making (SDM) as a multicollaborative approach is vital for facilitating patient-centred care. Considering the limited clinical practice, we attempted to synthesize the motivations and resistances, and investigate their mutual relationships for advancing the implementation of SDM. METHODS A comprehensive systematic review using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines was performed. 'Shared decision making' was searched as the mesh term through PubMed, Web of Science and EBSCO from 2000 to 2021, and the quality of literature was appraised using the QualSyst Tool. Motivations and resistances were categorized based on content analysis and the 'structure-process-outcome' model. RESULTS From 8319 potential citations, 105 were included, comprising 53 qualitative studies (the average quality score is 0.92) and 52 quantitative studies (the average quality score is 0.95). A total of 42 categories of factors were identified into 11 themes and further grouped into three dimensions: structure, process and outcome. The structure dimension comprised six themes (71.43%), the process dimension contained four themes (11.01%) and the outcome dimension covered only one theme. Across all categories, decision-making time and patients' decision preparedness in the process dimension were the most reported, followed by physicians' communication skills and health care environment in the structure dimension. Analysis of implementation of SDM among various types of diseases showed that more influencing factors were extracted from chronic diseases and unspecified disease decisions. CONCLUSIONS The major determinants for the implementation of SDM are focused on the structural dimension, which challenges the health systems of both developed and low- and middle-income countries. Furthermore, we consider it important to understand more about the interactions among the factors to take integrated measures to address the problems and to ensure the effectiveness of implementing SDM. PATIENT OR PUBLIC CONTRIBUTION Patients, healthcare professionals and other stakeholders articulated their perspectives on the implementation of SDM actively, and these were adopted and analysed in this study. However, the above-mentioned individuals were not directly involved in the process of this study. Protocol was registered on PROSPERO (CRD42021259309).
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Affiliation(s)
- Changhai Tang
- School of Public Health, Weifang Medical University, Weifang, Shandong, China
| | - Anqi Wang
- School of Public Health, Weifang Medical University, Weifang, Shandong, China
| | - Jingjing Yan
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
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15
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Liang L, Zheng Y, Ge Q, Zhang F. Exploration and Strategy Analysis of Mental Health Education for Students in Sports Majors in the Era of Artificial Intelligence. Front Psychol 2022; 12:762725. [PMID: 35308079 PMCID: PMC8928123 DOI: 10.3389/fpsyg.2021.762725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/28/2021] [Indexed: 01/10/2023] Open
Abstract
This study aims to explore new educational strategies suitable for the mental health education of college students. Big data and artificial intelligence (AI) are combined to evaluate the mental health education of college students in sports majors. First, the research status on the mental health education of college students is introduced. The internet of things (IoT) on mental health education, a structure based on big data and convolutional neural network (CNN), is constructed. Next, the survey design and questionnaire survey are carried out. Finally, the questionnaire data are analyzed and compared with the mental health status under traditional education. The results show that the CNN model has good accuracy and ability to distinguish symptoms, so it can be applied to the existing psychological work in colleges. In the symptom comparison survey, under the traditional education and big data network, the number of college students with mild mental health problems is found to be 158 (84.9%) and 170 (91.4%), respectively. It indicates that the number of college students with moderate mental health problems decreases significantly. In the comparative investigation of the severity of mental problems, the number of students with normal mental health, subhealth, and serious mental health problems under the background of traditional mental health education is 125 (67.2%), 56 (30.1%), and 5 (2.7%), respectively. The mental health status of college students under the influence of big data networks on mental health education is better than that of traditional mental health education. There are 140 students with normal mental health, a year-on-year increase of 16.7%. In the comparative survey of specific mental disorders, students with obsessive-compulsive symptoms under traditional mental health education account for 22.0% of the total sample, having the largest proportion. In the subhealth psychological group under the big data network on mental health education, the number of hostile students decreases by 7, which is the psychological factor with the most obvious improvement. Hence, the proposed path of mental health education is feasible.
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Affiliation(s)
- Liang Liang
- College of Sports Science, Changsha Normal University, Changsha, China
| | - Yong Zheng
- Physical Education Institute, China West Normal University, Nanchong, China
| | - Qiluo Ge
- Department of Literature and Law, Nanchang Jiaotong Institute, Nanchang, China
| | - Fengrui Zhang
- College of Life Science, Sichuan Agricultural University, Yaan, China
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16
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Giordano GM, Brando F, Pezzella P, De Angelis M, Mucci A, Galderisi S. Factors influencing the outcome of integrated therapy approach in schizophrenia: A narrative review of the literature. Front Psychiatry 2022; 13:970210. [PMID: 36117655 PMCID: PMC9476599 DOI: 10.3389/fpsyt.2022.970210] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022] Open
Abstract
The integration of pharmacotherapy with psychosocial interventions has an important role to play in the improvement of functional outcome of subjects with schizophrenia (SCZ), in all stages of the disorder. It is essential for the adequate management of unmet therapeutic needs, such as negative symptoms and cognitive dysfunctions which account for most of the functional impairment of subjects with SCZ and do not respond to available antipsychotics. Enhancing the knowledge on factors involved in the effectiveness of integrated treatment plans is an important step forward for SCZ care. This review aims to identify factors that might influence the impact of integrated treatments on functional outcome. Most studies on the impact of psychosocial treatments on functional outcome of subjects with SCZ did not control for the effect of prescribed antipsychotics or concomitant medications. However, several factors relevant to ongoing pharmacological treatment might influence the outcome of integrated therapy, with an impact on the adherence to treatment (e.g., therapeutic alliance and polypharmacotherapy) or on illness-related factors addressed by the psychosocial interventions (e.g., cognitive dysfunctions or motivational deficits). Indirect evidence suggests that treatment integration should consider the possible detrimental effects of different antipsychotics or concomitant medications on cognitive functions, as well as on secondary negative symptoms. Cognitive dysfunctions can interfere with participation to an integrated treatment plan and can be worsened by extrapyramidal or metabolic side effects of antipsychotics, or concomitant treatment with anticholinergics or benzodiazepines. Secondary negative symptoms, due to positive symptoms, sedation, extrapyramidal side effects or untreated depression, might cause early drop-out and poor adherence to treatment. Researchers and clinicians should examine all the above-mentioned factors and implement appropriate and personalized integrated treatments to improve the outcome of SCZ.
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Affiliation(s)
| | | | | | | | - Armida Mucci
- University of Campania Luigi Vanvitelli, Naples, Italy
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