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Pichonnaz C, Ancey C, Mbarga J, Foley RA. Patients' expectations of physiotherapists before and after an intensive chronic low back pain rehabilitation programme: a qualitative study based on semi-structured interviews and observations. Disabil Rehabil 2024; 46:1776-1786. [PMID: 37128151 DOI: 10.1080/09638288.2023.2205171] [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: 08/24/2022] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE To investigate the expectations regarding physiotherapists of patients attending an interdisciplinary CLBP rehabilitation programme and the response to these expectations. MATERIALS AND METHODS A thematic analysis was conducted, based on interviews of working-age patients with CLBP and without significant comorbidities. RESULTS Twenty patients participated (9 male, 11 female, aged 21-58 years; symptoms duration 4.3 ± 3.0 years; pain VAS 53 ± 21 mm). Patients expected to learn pain and activity management. Expected outcomes were a reduction of pain, increased well-being and a return to normality. A collaborative approach involving therapeutic and relational adaptation was expected. Despite divergences concerning emotional aspects, patients expected a large range of applied psychosocial skills.The programme met the expectations of most patients, especially when its goals matched those reported by the individuals. For most participants, the pain relief was below expectations. Active therapies were valued. After the programme, patients felt more ready to take responsibility for their back. CONCLUSION The expectation of developing self-management skills was prevalent. Expected treatments were mostly compatible with recommendations. Expectations to resume activities and decrease pain were in line with the rehabilitation goals, although the expected reduction in pain was overestimated. Relational expectations converged towards patient-centred care.
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Affiliation(s)
- Claude Pichonnaz
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Department of Musculoskeletal Medicine, University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Céline Ancey
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Josiane Mbarga
- Department of research and development, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Rose-Anna Foley
- Department of research and development, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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Chun J, Curtiss SL, Richard C, Zhou K, Rios YC, Park S, Kim J, Koc M. Where Does Hope Lie? The Dialectical Tensions Between Hopes and Expectations of Vocational Transition Planning from the Perspectives of Autistic Young Adults, Parents, and Practitioners. J Autism Dev Disord 2024:10.1007/s10803-024-06348-9. [PMID: 38635131 DOI: 10.1007/s10803-024-06348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 04/19/2024]
Abstract
The post-secondary transition for autistic youth is a complex process, with hopes and expectations serving as malleable mediators often overlooked in research and practice. Career awareness, exploration, and counseling services play a critical role in facilitating vocational transition, but the vocational hopes and expectations of autistic youth and their parents are often disregarded. This study aims to explore these aspirations and their impact on the vocational transition process, seeking to harmonize elements to better align with the needs of autistic youth and their families. This study used a focus group design involving group interviews with three participant groups: autistic transition-aged youth, parents, and practitioners. The findings reveal five key themes: 1) Accepting Disability or Constrained by Ableism: Resisting Marginalization, 2) Finding the Sweet Spot: Are Parents and Youth's Expectations Too High or Too Low, 3) Market Forces at Work-Finding a Meaningful Vocational Path in a Capitalist Society, 4) Despite Meticulous Planning, there is a Disconnect Between Needs and Resources, and 5) The Hills and Valleys of Finding Resilience. Navigating the multifaceted landscape of vocational transition planning for autistic youth necessitates a collaborative and flexible approach. Identified tensions serve as opportunities for growth and transformation. Recognizing and addressing system shortcomings is crucial for informed decision-making. Challenges extend beyond individual circumstances, reflecting broader systemic issues, and identifying these gaps allows for a comprehensive understanding of available resources, cultivating a basis of hope as uncertainties are addressed.
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Affiliation(s)
- Jina Chun
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, 1000 Bascom Mall, Room 415, Madison, WI, 53706, U.S.A..
| | - Sarah L Curtiss
- College of Education and Human Development, University of Delaware, Newark, DE, U.S.A
| | - Constance Richard
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, 1000 Bascom Mall, Room 415, Madison, WI, 53706, U.S.A
| | - Kaiqi Zhou
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, U.S.A
| | - Yazmin Castruita Rios
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, East Lansing, MI, U.S.A
| | - Sara Park
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, 1000 Bascom Mall, Room 415, Madison, WI, 53706, U.S.A
| | - Jaeyong Kim
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, East Lansing, MI, U.S.A
| | - Muharrem Koc
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, 1000 Bascom Mall, Room 415, Madison, WI, 53706, U.S.A
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Mann S, Paarup HM, Søgaard K. The user experience of violinists playing with a novel ergonomic chinrest: An evaluation on motivation, usage behaviour, usability and acceptance. Work 2024; 78:817-828. [PMID: 38277333 DOI: 10.3233/wor-230389] [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] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND This study focuses on the user experience of a novel developed ergonomic chinrest (EC), customised to accommodate the individual violinist's anthropometry and playing style. The EC was recently tested for biomechanical effect, but the violin player's motivation, usage behaviour, usability and acceptability may be equally important. OBJECTIVE To explore the user experience of violinists who used the novel EC with a low shoulder rest for two weeks. Through that experience, we wanted to learn about the potential user barriers and facilitators related to their motivation, usage behaviour, usability, and acceptability, when trying a new product. METHODS Thirty-eight professional violinists participated and evaluated motivation, user behaviour, usability and acceptance using a 5-point Likert scale and open-ended questions. RESULTS Participants showed high motivation hoping to improve posture, reduce muscle tension and enhance performance. Usage behaviour was also high, while product appearance, adjustment time, and sound impact were negatively evaluated. However, 37% planned to continue to use EC after the study. CONCLUSION Participants showed high motivation and usage behaviour but faced challenges with product appearance, adjustment time, and sound impact compared to their usual chinrest. Incorporating user feedback and addressing design and usability challenges can enhance the user experience.
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Affiliation(s)
- Stephanie Mann
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Helene M Paarup
- Department of Clinical Research, Research Unit of Occupational and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Research Unit of Occupational and Environmental Medicine, University of Southern Denmark, Odense, Denmark
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Kirchner L, Kloft M, Arias Martín B, Berg M, Anjedanimoghadamaraghi P, Schäfer L, Rief W. Measuring dysfunctional interpersonal beliefs: validation of the Interpersonal Cognitive Distortions Scale among a heterogeneous German-speaking sample. BMC Psychiatry 2023; 23:702. [PMID: 37759204 PMCID: PMC10523705 DOI: 10.1186/s12888-023-05155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
BACKROUND Dysfunctional interpersonal beliefs (DIBs) are a key symptom domain in numerous mental disorders. Because DIBs exert a strong influence on social experience and behavior, they play an important role in a mental disorder's development and progression. To date, only the Interpersonal Cognitive Distortions Scale (ICDS) captures DIBs independently of specific disorders, populations, or contexts. The present study's aim was to psychometrically evaluate and validate a German translation of the ICDS. METHODS The ICDS was administered along with indicators of convergent (rejection sensitivity, depressive expectations, interpersonal trust, interpersonal problems, perceived social support), discriminant (self-efficacy, perseverative negative thinking, optimism), and clinical validity (psychopathology, perceived stress, well-being) to a pooled sample incorporating non-clinical (N = 114) and clinical (N = 94) participants. RESULTS An exploratory factor analysis (EFA) suggested a five-factor solution (factor loadings: .44 to .85). Correlational analyses demonstrated acceptable convergent (ρ = -.29 to -.35, ρ = .27 to .59), suboptimal discriminant (ρ = -.27 to -.38, ρ = .52), and acceptable clinical validity (ρ = -.21, ρ = .36 to .44) at the total-scale level. However, results at the subscale level were mixed and required nuanced interpretation. Likewise, internal consistency was acceptable at the total-scale level (α = .76), but ranged from good to poor at the subscale level (α = .61 to .80). DIBs mediated the negative relationship between mental disorder onset and psychopathology levels. DISCUSSION Our results imply DIBs' relevance to mental health and related outcomes. When working with the ICDS's German version, we recommend employing only the "insecurity" subscale, as this was the only scale revealing acceptable psychometric properties. Future studies should improve the construct validity of the ICDS (and its subscales), e.g., by adding more items to the respective subscales and further classes of DIBs.
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Affiliation(s)
- Lukas Kirchner
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35037, Marburg, Germany.
| | - Matthias Kloft
- Department of Psychology, Psychological Methods, Philipps-University of Marburg, Marburg, Germany
| | - Beatriz Arias Martín
- Department of Psychology, Psychological Diagnostics, Philipps-University of Marburg, Marburg, Germany
| | - Max Berg
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35037, Marburg, Germany
| | - Paria Anjedanimoghadamaraghi
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35037, Marburg, Germany
| | - Leonora Schäfer
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35037, Marburg, Germany
| | - Winfried Rief
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35037, Marburg, Germany
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Scharnetzki E, Waterston L, Scherer AM, Thorpe A, Fagerlin A, Han PKJ. Effects of Prosocial and Hope-Promoting Communication Strategies on COVID-19 Worry and Intentions for Risk-Reducing Behaviors and Vaccination: Experimental Study. JMIR Form Res 2023; 7:e41959. [PMID: 37379364 PMCID: PMC10411423 DOI: 10.2196/41959] [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: 08/16/2022] [Revised: 04/11/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has engendered widespread fear and skepticism about recommended risk-reducing behaviors including vaccination. Health agencies are faced with the need to communicate to the public in ways that both provide reassurance and promote risk-reducing behaviors. Communication strategies that promote prosocial (PS) values and hope are being widely used; however, the existing research on the persuasiveness of these strategies has offered mixed evidence. There is also very little research examining the comparative effectiveness of PS and hope-promoting (HP) strategies. OBJECTIVE The aim of this study is to evaluate the comparative effectiveness of PS and HP messages in reassuring the public and motivating COVID-19 risk-reducing behaviors. METHODS A web-based factorial experiment was conducted in which a diverse sample of the US public was randomized to read messages which adapted existing COVID-19 information from a public website produced by a state government public health department to include alternative framing language: PS, HP, or no additional framing (control). Participants then completed surveys measuring COVID-19 worry and intentions for COVID-19 risk-reducing behaviors and vaccination. RESULTS COVID-19 worry was unexpectedly higher in the HP than in the control and PS conditions. Intentions for COVID-19 risk-reducing behaviors did not differ between groups; however, intentions for COVID-19 vaccination were higher in the HP than in the control condition, and this effect was mediated by COVID-19 worry. CONCLUSIONS It appears that HP communication strategies may be more effective than PS strategies in motivating risk-reducing behaviors in some contexts but with the paradoxical cost of promoting worry.
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Affiliation(s)
- Elizabeth Scharnetzki
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, United States
| | - Leo Waterston
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, United States
| | - Aaron M Scherer
- Department of Internal Medicine, University of Iowa, Iowa City, IA, United States
| | - Alistair Thorpe
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, United States
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences Center for Innovation, University of Utah School of Medicine, Salk Lake City, UT, United States
| | - Paul K J Han
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, United States
- Tufts University School of Medicine, Boston, MA, United States
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States
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Neale J, Parkin S, Strang J. Patients' goals when initiating long-acting injectable buprenorphine treatment for opioid use disorder: findings from a longitudinal qualitative study. Subst Abuse Treat Prev Policy 2023; 18:37. [PMID: 37349776 PMCID: PMC10288705 DOI: 10.1186/s13011-023-00551-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/16/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Long-acting injectable buprenorphine (LAIB) is a new treatment for opioid use disorder that has been introduced against an international policy backdrop of recovery and person-centred care. This paper explores the goals that people want to achieve from LAIB to identify potential implications for policy and practice. METHODS Data derive from longitudinal qualitative interviews conducted with 26 people (18 male; 8 female) initiating LAIB in England and Wales, UK (June 2021-March 2022). Participants were interviewed up to five times by telephone over six months (107 interviews in total). Transcribed interview data relating to each participant's treatment goals were coded, summarised in Excel, and then analysed via a process of Iterative Categorization. RESULTS Participants often articulated a desire to be abstinent without defining exactly what they meant by this. Most intended to reduce their dosage of LAIB but did not want to rush. Although participants seldom used the term 'recovery', almost all identified objectives consistent with current definitions of this concept. Participants articulated broadly consistent goals over time, although some extended the timeframes for achieving treatment-related goals at later interviews. At their last interview, most participants remained on LAIB, and there were reports that the medication was enabling positive outcomes. Despite this, participants were aware of the complex personal, service-level, and situational factors that hindered their treatment progress, understood the additional support they needed to achieve their goals, and voiced frustrations when services failed them. CONCLUSIONS There is a need for wider debate regarding the goals people initiating LAIB are seeking and the diverse range of positive treatment outcomes LAIB could potentially generate. Those providing LAIB should offer regular on-going contact and other forms of non-medical support so that patients have the best opportunity to succeed. Policies relating to recovery and person-centred care have previously been criticised for responsibilising patients and service users to take better care of themselves and to change their own lives. In contrast, our findings suggest that these policies may, in fact, be empowering people to expect a greater range of support as part of the package of care they receive from service providers.
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Affiliation(s)
- Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8BB UK
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052 Australia
| | - Stephen Parkin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8BB UK
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8BB UK
- South London & Maudsley (SLaM) NHS Foundation Trust, London, SE5 8AZ UK
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7
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Boretto JG. CORR Insights®: Treatment Invasiveness and Illness Perceptions Are Strongly Associated With Outcome Expectations in Patients Treated for Hand or Wrist Conditions: A Cross-sectional Study. Clin Orthop Relat Res 2023; 481:1006-1007. [PMID: 36790436 PMCID: PMC10097536 DOI: 10.1097/corr.0000000000002590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Jorge G Boretto
- Head of the Hand and Upper Extremity Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Shedden-Mora MC, Alberts J, Petrie KJ, Laferton JAC, von Blanckenburg P, Kohlmann S, Nestoriuc Y, Löwe B. The Treatment Expectation Questionnaire (TEX-Q): Validation of a generic multidimensional scale measuring patients' treatment expectations. PLoS One 2023; 18:e0280472. [PMID: 36689398 PMCID: PMC9870103 DOI: 10.1371/journal.pone.0280472] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/31/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Patients' expectations, as a central mechanism behind placebo and nocebo effects, are an important predictor of health outcomes. Yet, theoretically based generic assessment tools allowing for an integrated understanding of expectations across conditions and treatments are lacking. Based on the preliminary 35-item version, this study reports the development and validation of the Treatment Expectation Questionnaire (TEX-Q), a generic, multidimensional self-report scale measuring patients' expectations of medical and psychological treatments. METHODS The TEX-Q was developed in a validation sample of n = 251 patients undergoing different treatments using exploratory factor analyses and item analyses, as well as analysis of convergent and divergent validity. Confirmatory factor analysis was conducted in an independent sample of n = 303 patients undergoing cancer treatment. Two-weeks test-retest reliability was assessed in n = 28 psychosomatic outpatients. RESULTS Factor analyses revealed six theoretically founded stable subscales. The TEX-Q assesses expectations of treatment benefit, positive impact, adverse events, negative impact, process and behavioural control with a total of 15 items. Results for the subscales and the sum score indicated good internal consistency (α = .71-.92), moderate to high test-retest reliability (r = .39-.76) as well as good convergent validity with regard to other expectation measures (r = .42-.58) and divergent validity with regard to measures of generalized expectations (r < .32) and psychopathology (r < .28). CONCLUSIONS While further validation is needed, the results suggest that the TEX-Q is a valid and reliable scale for the generic, multidimensional assessment of patients' treatment expectations. The TEX-Q overcomes constraints of ad-hoc and disease-specific scales, while allowing to compare the impact of different expectation constructs across conditions and treatments.
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Affiliation(s)
- Meike C. Shedden-Mora
- Department of Psychology, Medical School Hamburg, Hamburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jannis Alberts
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Keith J. Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | | | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Sebastian Kohlmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yvonne Nestoriuc
- Department of Clinical Psychology, Helmut-Schmidt-University /University of the federal armed forces Hamburg, Hamburg, Germany
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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"Let's see what happens:"-Women's experiences of open-label placebo treatment for menopausal hot flushes in a randomized controlled trial. PLoS One 2022; 17:e0276499. [PMID: 36331921 PMCID: PMC9635716 DOI: 10.1371/journal.pone.0276499] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
Abstract
Open-label (honestly prescribed) placebos are an ethical way to evoke placebo effects in patients. As part of a mixed-methods study, we conducted in-depth interviews with eight menopausal women who underwent and benefitted from open-label placebo treatment in a randomized-controlled trial of hot flushes. Data were analyzed using Interpretative Phenomenological Analysis. We found that the women had low expectations about the placebo treatment yet endorsed what they referred to as “hope” and openness to “see what happens”. Recording hot flushes via the symptom diary was viewed as a valuable opportunity for self-examination and appraising outcomes. Receiving relief from the placebo treatment empowered women and enhanced their sense of control and agency. In summary, participants’ initial openness towards placebos, their hopes to get better, monitoring symptoms closely, and taking the initiative to address symptoms were components of a positive open-label placebo experience.
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Nelson S, Smith AM, Jervis K, Silvia MN, Randall E. Will This Treatment Help My Child?: How Parent/Caregiver Treatment Expectations Relate to Intensive Pain Rehabilitation Outcomes for Youth With Chronic Pain. Clin J Pain 2022; 38:651-658. [PMID: 36075895 PMCID: PMC9720665 DOI: 10.1097/ajp.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE An extensive body of research has highlighted the impact that parent/caregiver factors have on functioning and treatment outcomes among youth with chronic pain. However, parent/caregiver expectations in pain treatment have been largely understudied, despite strong evidence that treatment expectations are associated with treatment engagement and overall outcomes in nonpain populations. Accordingly, the primary aim of this investigation was to preliminarily examine the manifestation and measurement of parent/caregiver treatment expectations in an intensive interdisciplinary pediatric pain treatment (IIPT) setting. METHODS Participants in this study (N=328) included children and adolescents who attended an IIPT program for chronic pain between August 2013 and March 2020 and their parent/caregiver(s). Outcomes examined include parent/caregiver self-report of treatment expectations for their child upon admission to the IIPT in addition to pain-related and psychosocial factors at admission and discharge. RESULTS Findings revealed a high level of expectations (ie, belief that the treatment will be helpful) on average, with higher parent/caregiver expectations associated with poorer functioning at admission to and discharge from the IIPT program. CONCLUSION Extremely high treatment expectations among parents of more disabled youth may be indicative of unrealistic hopes or the "need" for IIPT to help their child; tempering parental expectations with psychoeducation about IIPT goals and realistic outcomes may indirectly improve treatment outcomes for their children. Future research should examine the potentially unique and important role that treatment expectations, of both parent/caregivers and their children, may have in overall IIPT outcomes.
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Affiliation(s)
- Sarah Nelson
- Division of Pain Medicine, Department of Anesthesiology, Pain, and Perioperative Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Allison M. Smith
- Division of Pain Medicine, Department of Anesthesiology, Pain, and Perioperative Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kelsey Jervis
- Division of Pain Medicine, Department of Anesthesiology, Pain, and Perioperative Medicine, Boston Children’s Hospital, Boston, MA, USA
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children’s Hospital, Waltham, MA
| | - Megan N. Silvia
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA
| | - Edin Randall
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children’s Hospital, Waltham, MA
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11
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Escritt K, Mann M, Nelson A, Harrop E. Hope and meaning-making in phase 1 oncology trials: a systematic review and thematic synthesis of qualitative evidence on patient-participant experiences. Trials 2022; 23:409. [PMID: 35578308 PMCID: PMC9112562 DOI: 10.1186/s13063-022-06306-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background Phase 1 drug trials are popular treatment options for patients with advanced disease, despite the greater levels of uncertainty associated with them. However, their meaning and consequences for patient-participants remains under-explored. This review synthesises the qualitative evidence of patients’ experiences of participating in phase 1 oncology trials, exploring their decisions to take part and the impacts of these trials on patient wellbeing. Methods A comprehensive literature search involving medical subject headings (MeSH) and keywords was undertaken in the following databases: MEDLINE, EMBASE, PsycINFO, Scopus, CINAHL, and Cochrane CENTRAL, with supplementary searches also conducted. Studies were independently screened for inclusion by two researchers. Included studies were critically appraised and data extracted using standardised forms. Qualitative results were analysed using thematic synthesis. Results Three main themes were identified across 13 studies: decision-making and joining the trial; experiences of taking part in the trial and hope and coping. Patients primarily joined trials hoping for therapeutic benefits, sentiments which prevailed and shaped their experiences across their trial journey. Rather than indicate therapeutic misconception based on poor understanding, patient perspectives more commonly pointed to differences between hope and expectation and cultural narratives of staying positive, trying everything and trusting in experts. Conclusions These findings challenge information-based models of consent, favouring coping frameworks which account for the role of hope and meaning-making during serious illness. Personalised consideration of existential and quality-of-life matters before and during trials is recommended, including palliative and supportive care alternatives to active treatment. Review Registration The review was registered with PROSPERO international prospective register of systematic reviews (CRD 42020163250). Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06306-9.
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Han PKJ, Scharnetzki E, Anderson E, DiPalazzo J, Strout TD, Gutheil C, Lucas FL, Edelman E, Rueter J. Epistemic Beliefs: Relationship to Future Expectancies and Quality of Life in Cancer Patients. J Pain Symptom Manage 2022; 63:512-521. [PMID: 34952170 PMCID: PMC8930513 DOI: 10.1016/j.jpainsymman.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 11/28/2022]
Abstract
CONTEXT Expectations about the future (future expectancies) are important determinants of psychological well-being among cancer patients, but the strategies patients use to maintain positive and cope with negative expectancies are incompletely understood. OBJECTIVES To obtain preliminary evidence on the potential role of one strategy for managing future expectancies: the adoption of "epistemic beliefs" in fundamental limits to medical knowledge. METHODS A sample of 1307 primarily advanced-stage cancer patients participating in a genomic tumor testing study in community oncology practices completed measures of epistemic beliefs, positive future expectancies, and mental and physical health-related quality of life (HRQOL). Descriptive and linear regression analyses were conducted to assess the relationships between these factors and test two hypotheses: 1) epistemic beliefs affirming fundamental limits to medical knowledge ("fallibilistic epistemic beliefs") are associated with positive future expectancies and mental HRQOL, and 2) positive future expectancies mediate this association. RESULTS Participants reported relatively high beliefs in limits to medical knowledge (M = 2.94, s.d.=.67) and positive future expectancies (M = 3.01, s.d.=.62) (range 0-4), and relatively low mental and physical HRQOL. Consistent with hypotheses, fallibilistic epistemic beliefs were associated with positive future expectancies (b = 0.11, SE=.03, P< 0.001) and greater mental HRQOL (b = 0.99, SE=.34, P = 0.004); positive expectancies also mediated the association between epistemic beliefs and mental HRQOL (Sobel Z=4.27, P<0.001). CONCLUSIONS Epistemic beliefs in limits to medical knowledge are associated with positive future expectancies and greater mental HRQOL; positive expectancies mediate the association between epistemic beliefs and HRQOL. More research is needed to confirm these relationships and elucidate their causal mechanisms.
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Affiliation(s)
- Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine; Tufts University School of Medicine (P.K.J.H., E.A., T.D.S., F.L.L.), Boston, Massachusetts.
| | - Elizabeth Scharnetzki
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine
| | - Eric Anderson
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine; Tufts University School of Medicine (P.K.J.H., E.A., T.D.S., F.L.L.), Boston, Massachusetts
| | - John DiPalazzo
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine
| | - Tania D Strout
- Tufts University School of Medicine (P.K.J.H., E.A., T.D.S., F.L.L.), Boston, Massachusetts; Department of Emergency Medicine, Maine Medical Center (T.D.S.), Portland, Maine
| | - Caitlin Gutheil
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine
| | - F Lee Lucas
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine; Tufts University School of Medicine (P.K.J.H., E.A., T.D.S., F.L.L.), Boston, Massachusetts
| | - Emily Edelman
- The Jackson Laboratory (E.E., J.R.), Bar Harbor, Maine
| | - Jens Rueter
- The Jackson Laboratory (E.E., J.R.), Bar Harbor, Maine
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Radomska M, Flores Alves Dos Santos J, Weber K, Baertschi M, Burkhard PR, Herrmann F, Belayachi S, Favez N, Canuto A. Assessing preoperative hope and expectations related to functional neurosurgery: a new questionnaire. BMC Psychol 2022; 10:53. [PMID: 35246249 PMCID: PMC8897841 DOI: 10.1186/s40359-022-00766-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite successful functional neurosurgery, patients suffering from epilepsy or Parkinson's disease may experience postoperative psychological distress and social maladjustments. Difficulties in coping with postoperative changes, even positive ones, have shown to be related to patients' presurgery cognitive representations (i.e., expectations, hope). The aim of this study was to develop an instrument assessing various key features of surgery outcomes' representations, namely the Preoperative Hope and Expectations Questionnaire (PHEQ). METHODS Participants were patients (n = 50) diagnosed with Parkinson's disease (n = 25) or epilepsy (n = 25), candidates for functional neurosurgery (i.e., Deep brain stimulation, anterior temporal lobectomy). Two to three weeks before the planned surgery, they were administrated items assessing their actual state, preoperative expectations, and hope regarding surgery outcomes. They also completed measures assessing optimism, quality of life and mood. RESULTS Exploratory analysis resulted in a 14-item version of the PHEQ composed of two factors (abstract representations, including psychological well-being and concrete representations, such as direct surgery outcomes). The PHEQ demonstrated high internal consistency and good convergent validity. Patients were more prone to express postoperative improvements in terms of hope rather than expectations. They generally focused on concrete rather than abstract features, although patients with Parkinson's disease had higher abstract future-oriented representations. CONCLUSIONS The PHEQ presents satisfactory psychometric properties and may be considered as a reliable instrument for research and clinical practice.
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El-Haddad C, Hegazi I, Hu W. A patient expectations questionnaire for determining criteria for entrustment decisions. MEDICAL TEACHER 2021; 43:1031-1038. [PMID: 33840349 DOI: 10.1080/0142159x.2021.1907324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION To train health professionals for patient-centered care, patient engagement in medical curriculum development and assessment is widely recommended. But there are few published methods on how to consult with patients effectively, particularly when creating entrustable professional activities (EPAs). In this mixed-method study, we developed a questionnaire for facilitating patient input when developing EPA assessment criteria. METHODS We developed a questionnaire for documenting patient expectations of their doctors which included: patient interviews to identify questionnaire items, expert validation, cognitive interviews with respondents, and finally, pilot testing. For the pilot testing, 87 participants with a variety of health problems from medical/surgical wards and outpatient clinics at a tertiary hospital were recruited. The final questionnaire included open-ended and ranking-style questions. RESULTS Using the questionnaire, patients could identify their key expectations of their doctors when managing their current medical problem. Most patients wrote clear, brief free-text responses directly applicable to EPA descriptors that were time-efficient to analyze. CONCLUSIONS The questionnaire is a feasible method of recording patient expectations, enabling educators to consult with and include patient perspectives when developing criteria for entrustment decisions in a diverse range of clinical contexts.
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Affiliation(s)
- Carlos El-Haddad
- Department of Rheumatology, Liverpool Hospital, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Iman Hegazi
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Wendy Hu
- School of Medicine, Western Sydney University, Sydney, Australia
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15
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Cheng BBY, Ryan B, Copland DA, Wallace SJ. Prognostication in post-stroke aphasia: speech pathologists' clinical insights on formulating and delivering information about recovery. Disabil Rehabil 2021; 44:5046-5059. [PMID: 33969776 DOI: 10.1080/09638288.2021.1922514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE For people with post-stroke aphasia, "Will I get better?" is a question often asked, but one that is intellectually and emotionally demanding for speech pathologists to answer. Speech pathologists' formulation and delivery of aphasia prognoses is varied and there is limited evidence for optimising practice. We aimed to understand speech pathologists' clinical experiences, reasoning, and support needs in aphasia prognostication. MATERIALS AND METHODS Twenty-five Australian speech pathologists working with people with aphasia participated in individual, semi-structured interviews. Their age, level of experience, work setting, and location were maximally varied. Interview responses were analysed qualitatively using thematic analysis. RESULTS Five themes were drawn from the interviews: (1) prognostic challenges are shared but not voiced; (2) truth is there's no quick fix; (3) recovery is more than words; (4) the power of words; and, (5) prognostic competence is implicit. CONCLUSIONS Speech pathologists use implicit competencies to formulate and deliver aphasia prognoses. A patient-centred, holistic contextualisation of aphasia recovery may enable realistic, optimistic, and constructive conversations about prognosis. These conversations may have therapeutic potential if prognostic uncertainty, emotional adjustment, and conditional outcomes are carefully addressed. Future research should seek to understand the perceptions and preferences of people with aphasia and their significant others.Implications for RehabilitationAphasia prognostication in clinical practice is complex and nuanced, thus increased clinical and research focus is warranted to ensure key stakeholder needs are met.Conversations about prognosis may be more meaningful to people with aphasia if recovery is conceptualised as encompassing impairment, activity, and participation outcomes.Given the implicit competencies required for prognostication, a structured approach to reflective practice and experience-based training may be beneficial.Conversations about prognosis may have therapeutic value, but further research is needed to explore this potential.
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Affiliation(s)
- Bonnie B Y Cheng
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
| | - Brooke Ryan
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia.,Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia.,University of Queensland Centre for Clinical Research, Herston, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
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16
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Rosenfield MN, Bernstein MH. The Importance of Patient Expectations: A Mixed-Methods Study of U.S. Psychiatrists. Front Psychiatry 2021; 12:781494. [PMID: 34925105 PMCID: PMC8678457 DOI: 10.3389/fpsyt.2021.781494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/03/2021] [Indexed: 11/20/2022] Open
Abstract
Objective: To examine how psychiatrists think about and modulate non-specific factors (e.g., hope, expectations) in clinical practice. Methods: U.S. psychiatrists were recruited for two studies assessing attitudes and behaviors related to non-specific factors. Study 1 entailed remote qualitative focus groups (k = 7) with n = 26 participants (36.0% female). Study 2 was a quantitative survey with n = 346 respondents (34.0% female) designed to assess the generalizability of focus group findings. Results: Four themes were identified in Study 1 that were used to inform the survey (Study 2): (1) Expectations (2) Hope, (3) Placebo Effect, and (4) Aesthetic Features. Nearly all surveyed psychiatrists (92.2%) considered patient expectations at least "most of the time" when interacting with a patient. Focus groups revealed that psychiatrists often attempt to balance optimism and realism to improve outcomes. A majority of survey respondents believed office design and physician attire could at least somewhat influence expectations (72.5 and 77.3%, respectively) and even outcomes (51.5 and 58.7%, respectively). Focus group psychiatrists described how physical features may be used as therapeutic tools. Conclusions: Psychiatrists are highly mindful of patient expectations. Although there is variability in the perceived importance of expectations, hope, the placebo effect, and aesthetic features, many utilize these factors in clinical practice.
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Affiliation(s)
- Maayan N Rosenfield
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, United States
| | - Michael H Bernstein
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, United States
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Laferton JAC, Oeltjen L, Neubauer K, Ebert DD, Munder T. The effects of patients' expectations on surgery outcome in total hip and knee arthroplasty: a prognostic factor meta-analysis. Health Psychol Rev 2020; 16:50-66. [PMID: 33228474 DOI: 10.1080/17437199.2020.1854051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patients' expectations are among the most frequently studied psychological prognostic factors in total knee and hip arthroplasty (TKA/THA). So far, however, evidence on the effect of patients' preoperative expectations on surgery outcome is inconclusive. Heterogeneity of expectation constructs and the use of psychometrically not evaluated measurement instruments have constituted major obstacles for the integration of the current literature. Using a theory-based model of expectation constructs , this meta-analysis set out to disentangle the conflicting results in the current literature. Systematic literature searches yielded k = 46 studies (N = 10,465) that reported associations of preoperative expectations with postoperative pain, functioning and disability, and satisfaction. Random effects meta-analysis revealed a robust small association (r = .16; 95% CI .13, .19) between patients' positive preoperative expectations and better postoperative outcomes. This effect did not differ between THA and TKA, different outcome categories and different follow-up periods. Studies using psychometrically evaluated expectation measures reported significantly higher effects (r = .19; 95% CI .16, .22). Whether this effect varies among different expectation constructs remains unclear. High-quality studies using validated, multidimensional expectation measures are needed to further understand the role of different expectation constructs in THA and TKA surgery.
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Affiliation(s)
- Johannes A C Laferton
- Division of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany.,Division of Clinical Psychology and Psychotherapy, Department of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Division of Psychological Medicine, Department of Medicine, Health and Medical University Potsdam, Potsdam, Germany
| | - Lara Oeltjen
- Department of Psychological Methods, Institute of Psychology, Friedrich-Schiller-Universität Jena, Jena, Germany
| | | | - David D Ebert
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Thomas Munder
- Department of Psychology, University of Zurich, Zurich, Switzerland
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Facing life-prolonging treatment: The perspectives of men with advanced metastatic prostate cancer - An interview study. Eur J Oncol Nurs 2020; 49:101859. [PMID: 33126157 DOI: 10.1016/j.ejon.2020.101859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 09/07/2020] [Accepted: 10/16/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE Several life-prolonging treatment options have recently become available for metastatic castration-resistant prostate cancer. However, research regarding patient experiences while undergoing these treatments is scarce. The aim was to explore the perspectives of men when facing life-prolonging treatment of metastatic castration-resistant prostate cancer. METHOD Qualitative interviews were conducted with 16 men as they were starting, undergoing or had completed their first life-prolonging treatment. Interpretive description was used for analysis. RESULTS The results illuminate the complexity of facing life-prolonging treatment, with interlaced dimensions beyond just the outcome, and where the men described other dimensions of their lives in relation to the treatment. The results are presented as 4 themes; Considering treatment when the remainder of life is at stake, Preparing for the life-prolonging treatment after deciding to go through with it, Considering the prospect of the life-prolonging treatment not being successful and Reflecting on death and dying in the light of a life-limiting illness. CONCLUSIONS The quality and content of the remainder of life are central for men when facing life-prolonging treatment of metastatic castration-resistant prostate cancer. This is important when weighing desired treatment outcomes against side effects, and when reflecting upon whether going through with treatment would be worth it or not. The results illuminate the importance of encouraging men at this stage to express expectations, hopes and fears regarding the treatment and the future when considering life-prolonging treatments. Nurses working with these patients are important in the decision-making process and in evaluating treatments, to detect needs for interventions.
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El-Haddad C, Hegazi I, Hu W. Understanding Patient Expectations of Health Care: A Qualitative Study. J Patient Exp 2020; 7:1724-1731. [PMID: 33457636 PMCID: PMC7786689 DOI: 10.1177/2374373520921692] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Understanding and measuring patient expectations of health care is central to improving patient satisfaction and delivering patient-centered care. However, most empiric research in this field has focused on measuring patient expectations for specific diseases only. Patient expectations common to a variety of settings and clinical contexts need to be better understood to design measures with wider utility. We aimed to understand how patients express and conceptualize their expectations of health care across a range of clinical contexts and conditions. Semi-structured interviews were conducted with patients presenting to a major metropolitan hospital, informed by interpretive phenomenological analysis. Sampling continued until thematic saturation. Interview topics explored the illness experience, interactions with clinicians, how patients communicated and conceptualized their expectations of health care, and the nature of these expectations. The 26 participants conceptualized and described their expectations in 3 distinct domains: (1) health outcomes, (2) individual clinicians, and (3) the health-care system. Importantly, these domains were consistent across a variety of clinical contexts, participant demographics, and medical conditions. Despite variation in expectations due to individual patient circumstances, we identified 3 conceptual domains within which expectations consistently lie. When designing measurement tools for patient expectations, we suggest incorporating questions specifically addressing the 3 domains we have identified. With such measures, clinicians and health-care providers can be empowered to provide and monitor patient-centered care with outcomes tailored to what patients desire.
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Affiliation(s)
- Carlos El-Haddad
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Iman Hegazi
- Medical Education & Academic Program, School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Wendy Hu
- Medical Education, School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
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Drummond N, McCleary L, Freiheit E, Molnar F, Dalziel W, Cohen C, Turner D, Miyagishima R, Silvius J. Antidepressant and antipsychotic prescribing in primary care for people with dementia. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:e488-e497. [PMID: 30429194 PMCID: PMC6234938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To use data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) to evaluate the prevalence of antidepressant and antipsychotic prescriptions among patients with no previous depression or psychosis diagnoses, and to identify the factors associated with the use of these drugs in this population. DESIGN Retrospective cohort study using data derived from CPCSSN. SETTING Primary care practices associated with CPCSSN. PARTICIPANTS Patients who were born before 1949; who were associated with a CPCSSN primary care practitioner between October 1, 2007, and September 30, 2013; and whose electronic medical records contained data from at least 6 months before and 12 months after the date of dementia diagnosis. MAIN OUTCOME MEASURES Prescription for an antidepressant or antipsychotic medication in the absence of a depression or psychosis diagnosis. Multivariable models were fitted to determine estimated odds ratios (ORs) and were adjusted for age and sex. RESULTS Of the 3252 patients without a depression diagnosis, 8.5% received a new prescription for an antidepressant in the 12 months following their diagnosis of dementia. Prescribing was reduced in association with older age (OR of 0.86 per 5-year age increase, P=.001) and male sex (OR=0.77, P=.056), and prescribing increased in association with prescription of cholinesterase inhibitor medications (OR=1.57, P=.003). Of the 4262 patients without a diagnosis of psychosis, 6.1% received a new prescription for an antipsychotic in the 12 months following their diagnosis of dementia. Higher rates of antipsychotic prescriptions were reported in men (OR=1.31, P=.046), those receiving a prescription for steroids (OR=1.90, P=.037), and those diagnosed with Parkinson disease (OR 1.58, P=.051). CONCLUSION A substantial number of patients with dementia are being prescribed antidepressant or antipsychotic medications by their primary care practitioners without evidence of depression or psychosis in their electronic medical records.
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Affiliation(s)
- Neil Drummond
- Professor and holds the Alberta Health Services Chair in Primary Care Research in the Department of Family Medicine at the University of Alberta in Calgary.
| | - Lynn McCleary
- Associate Professor in the Department of Nursing at Brock University in St Catharines, Ont
| | - Elizabeth Freiheit
- Managing Director in the Statistical Analysis of Biomedical and Educational Research unit in the Department of Biostatistics at the University of Michigan School of Public Health in Ann Arbor
| | - Frank Molnar
- Specialist in geriatric medicine practising in Ottawa, Ont
| | - William Dalziel
- Professor of Geriatric Medicine in the Department of Medicine at the University of Ottawa
| | - Carole Cohen
- Clinical Director of the Psychiatric Services for the Elderly at Sunnybrook Health Sciences Centre in Toronto, Ont
| | - Diana Turner
- Medical Director of Carewest of Alberta Health Services
| | - Rebecca Miyagishima
- Research Coordinator in the Department of Family Medicine at the University of Alberta in Edmonton
| | - James Silvius
- Clinical Associatie Professor in the Cumming School of Medicine at the University of Calgary
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22
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Nierop-van Baalen C, Grypdonck M, van Hecke A, Verhaeghe S. Health professionals’ dealing with hope in palliative patients with cancer, an explorative qualitative research. Eur J Cancer Care (Engl) 2018; 28:e12889. [DOI: 10.1111/ecc.12889] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 04/12/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Corine Nierop-van Baalen
- Haaglanden Medical Centre; The Hague The Netherlands
- Department of Public Health; University Hospital; Ghent University; Ghent Belgium
| | - Mieke Grypdonck
- Department of Public Health; University Hospital; Ghent University; Ghent Belgium
| | - Ann van Hecke
- Department of Public Health; University Hospital; Ghent University; Ghent Belgium
| | - Sofie Verhaeghe
- Department of Public Health; University Hospital; Ghent University; Ghent Belgium
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Alnasser A, Kyle J, Alkhalifah A, Marais D. Relationship Between Evidence Requirements, User Expectations, and Actual Experiences: Usability Evaluation of the Twazon Arabic Weight Loss App. JMIR Hum Factors 2018; 5:e16. [PMID: 29666042 PMCID: PMC5930174 DOI: 10.2196/humanfactors.9765] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/03/2018] [Accepted: 03/19/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Saudi Arabia has faced a steady growth in the prevalence of obesity. The concurrent and ubiquitous use of mobile technology, such as smartphones and apps, provides an opportunity for the implementation of mHealth technology, a method for delivering behavioral interventions. Despite their effectiveness in promoting lifestyle and diet modification, culturally adapted weight loss apps and related interventions are lacking in Gulf Cooperation Council countries. OBJECTIVE The objective of our study was to identify the relationship between adherence to evidence-informed practices, potential user expectations, and actual user experiences in order to enhance the understanding of the overall usability of the Twazon Arabic weight loss app. METHODS In 2 previous studies, 39 Saudi women were recruited for focus group discussions and 240 Saudi women were recruited for an app-based weight loss intervention. Usability of the Twazon Arabic weight loss app was evaluated by analyzing the opinions and experiences of 26 participants who engaged with the Twazon app for 4 months; the System Usability Scale (SUS) and word clouds were used. The results were triangulated with potential user expectations obtained in the focus group discussion and with the findings from an Arabic app screening for evidence-informed practices. RESULTS The average reported SUS score was 69.3. The most favored features were the calorie counter, step counter, and physical activity calorie counter. The features in need of improvement were the social network, notifications, and the Twazon Saudi Food Database. Twazon users preferred and found useful 7 of the 13 evidence-informed weight loss practices that were integrated into the features of the app. CONCLUSIONS Triangulation identified the most notable relationship to be the disparity between user experience and 2 of the evidence-informed practices, namely a minimum weight loss goal of 0.5 to 1 kg/week and social support; no relationship was found between user expectations and evidence-informed weight loss practices. The overall usability of the Twazon Arabic weight loss app ranged between high marginal and acceptable, indicating that some improvements to the app should be considered for implementation in future app-based weight loss interventions of this kind.
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Affiliation(s)
- Aroub Alnasser
- Food Science and Nutrition Department, College of Food and Agriculture Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Janet Kyle
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Abdulrahman Alkhalifah
- Food Science and Nutrition Department, College of Food and Agriculture Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Debbi Marais
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Monnery D, Webb E, Richardson L, Isaac J, Chapman L. Targeted palliative care day therapy interventions using modified MYMOP2 tool can improve outcomes for patients with non-malignant diseases. Int J Palliat Nurs 2018; 24:92-95. [DOI: 10.12968/ijpn.2018.24.2.92] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel Monnery
- Registrar in Palliative Medicine, Clatterbridge Cancer Centre, Wirral, UK
| | - Esther Webb
- Healthcare Assistant, Marie Curie Hospice, Liverpool, UK
| | | | - Jane Isaac
- Occupational Therapist, St Rocco's Hospice, Warrington, UK
| | - Laura Chapman
- Medical Director, Marie Curie Hospice, Liverpool, UK
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Laferton JAC, Kube T, Salzmann S, Auer CJ, Shedden-Mora MC. Patients' Expectations Regarding Medical Treatment: A Critical Review of Concepts and Their Assessment. Front Psychol 2017; 8:233. [PMID: 28270786 PMCID: PMC5318458 DOI: 10.3389/fpsyg.2017.00233] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/06/2017] [Indexed: 01/29/2023] Open
Abstract
Patients’ expectations in the context of medical treatment represent a growing area of research, with accumulating evidence suggesting their influence on health outcomes across a variety of medical conditions. However, the aggregation of evidence is complicated due to an inconsistent and disintegrated application of expectation constructs and the heterogeneity of assessment strategies. Therefore, based on current expectation concepts, this critical review provides an integrated model of patients’ expectations in medical treatment. Moreover, we review existing assessment tools in the context of the integrative model of expectations and provide recommendations for improving future assessment. The integrative model includes expectations regarding treatment and patients’ treatment-related behavior. Treatment and behavior outcome expectations can relate to aspects regarding benefits and side effects and can refer to internal (e.g., symptoms) and external outcomes (e.g., reactions of others). Furthermore, timeline, structural and process expectations are important aspects with respect to medical treatment. Additionally, generalized expectations such as generalized self-efficacy or optimism have to be considered. Several instruments assessing different aspects of expectations in medical treatment can be found in the literature. However, many were developed without conceptual standardization and psychometric evaluation. Moreover, they merely assess single aspects of expectations, thus impeding the integration of evidence regarding the differential aspects of expectations. As many instruments assess treatment-specific expectations, they are not comparable between different conditions. To generate a more comprehensive understanding of expectation effects in medical treatments, we recommend that future research should apply standardized, psychometrically evaluated measures, assessing multidimensional aspects of patients’ expectations that are applicable across various medical treatments. In the future, more research is needed on the interrelation of different expectation concepts as well as on factors influencing patients’ expectations of illness and treatment. Considering the importance of patients’ expectations for health outcomes across many medical conditions, an integrated understanding and assessment of such expectations might facilitate interventions aiming to optimize patients’ expectations in order to improve health outcomes.
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Affiliation(s)
- Johannes A C Laferton
- Department of Psychology, Clinical Psychology and Psychotherapy, Psychologische Hochschule BerlinBerlin, Germany; Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of MarburgMarburg, Germany
| | - Tobias Kube
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg Marburg, Germany
| | - Stefan Salzmann
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg Marburg, Germany
| | - Charlotte J Auer
- Division of Psychotherapy and Psychiatry, University Hospital Lübeck Lübeck, Germany
| | - Meike C Shedden-Mora
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf Hamburg, Germany
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Zeppieri G, George SZ. Patient-defined desired outcome, success criteria, and expectation in outpatient physical therapy: a longitudinal assessment. Health Qual Life Outcomes 2017; 15:29. [PMID: 28143546 PMCID: PMC5282693 DOI: 10.1186/s12955-017-0604-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-centered approaches offer an alternative method in evaluating treatment outcomes. This study investigated; 1) if patient's criteria for success (satisfaction of clinical outcomes) changes from pre to post treatment, 2) whether patients who met their success criteria also meet minimal clinical important difference scores (MCIDs), and 3) if patient's success criteria differed from their expected (what the patient believes will occur) and desired (what the patient wants to occur) outcomes following intervention. METHODS A consecutive sample of 225 subjects with complaints of musculoskeletal pain was referred to an outpatient, sports medicine physical therapy clinic. Participants completed the Patient Centered Outcome Questionnaire (PCOQ) prior to their initial evaluation session and a follow-up PCOQ at discharge. The PCOQ asks subjects to rate their pain, fatigue, emotional distress, and interference with daily activities for usual, desired, successful, and expected levels, and how important improvement is for each domain on a 101-point numerical rating scale. Paired-sample T-test were used to determine patient's pre and post success criterion and whether success criteria differed from desired and expected outcomes following intervention. Chi-squared were used to determine if individuals desired, expected, and success criteria for treatment outcome differed from established MCIDs. RESULTS The results revealed no change in success criteria pre to post treatment for all domains. Chi-square test revealed patients desired, expected, and success criteria were independent of established MCIDs (P > .01). There were no differences between patients expected outcomes and success criteria. However, there were differences between patient's desired outcomes and expected and success outcomes, with patients reporting lower desired levels of pain, emotional distress, fatigue, and interference with daily activities following physical therapy intervention (P < .01). CONCLUSION Patients in this setting do not appear to modify their success criteria throughout the course of outpatient physical therapy. Additionally, individually defined success criterion differs from established clinically important changes. Clinicians interested in a broader assessment of outcome need to consider patient determined criterion in addition MCIDs. Furthermore, desired outcomes are lower than both expectation and success criteria. In this setting, outcomes following physical therapy episodes were likely to meet patient's expectations and success criteria but not desired criterion.
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Affiliation(s)
- Giorgio Zeppieri
- UF Health at the Orthopedic and Sports Medicine Institute, 3450 Hull Road, Gainesville, Fl, 32607, USA.
| | - Steven Z George
- Department of Orthopeadic Surgery and Duke Clinical Research Institute, Duke University, PO Box 17969, 2400 Pratt Street, Room 0311 Terrace Level, Durham, North Carolina, USA
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Letter to the Editor on "What Do Scottish Patients Expect of Their Total Knee Arthroplasty?". J Arthroplasty 2016; 31:2374. [PMID: 27378641 DOI: 10.1016/j.arth.2016.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 05/10/2016] [Indexed: 02/01/2023] Open
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Sarungi M, Deakin AH. Response to Letter to the Editor on "What Do Scottish Patients Expect of Their Total Knee Arthroplasty?". J Arthroplasty 2016; 31:2374-5. [PMID: 27394073 DOI: 10.1016/j.arth.2016.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/10/2016] [Indexed: 02/01/2023] Open
Affiliation(s)
- Martin Sarungi
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, Scotland, UK
| | - Angela H Deakin
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, Scotland, UK
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Abstract
In this paper, we explore hope in the context of living with chronic pain. Individuals with chronic pain from temporomandibular disorder(s) were interviewed four to five times over the course of their 18-month participation in a clinical trial investigating the effectiveness of Traditional Chinese Medicine. We sought to understand shifts in participants' descriptions of expectations and hopefulness, particularly with regard to the work involved in counterbalancing positive thinking with buffers against disappointment. We found hope to be a dynamic and multifaceted mindset as distinct from being a single entity to be measured. Drawing upon Polanyi's concept of tacit knowing, we explore how different ways of hoping emerge and index one another in participant narratives. We offer a working typology of hope and raise as an issue the manner in which the paradox of hope--hoping enough to carry on while keeping hopes in check to avoid the ever-present possibility of despair--complicates simplistic notions of the relationship between positive thinking and the placebo response.
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Exploring hope and expectations in the youth mental health online counselling environment. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2015.08.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sesen H, Demirkale I, Karaduman M, Vural CA, Okkaoglu MC, Altay M. Why two-thirds of patients accepted the second session in staged bilateral total knee arthroplasty: a prospective analysis of 111 patients. Knee Surg Sports Traumatol Arthrosc 2015; 23:3585-90. [PMID: 25169111 DOI: 10.1007/s00167-014-3251-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE In staged bilateral total knee arthroplasty (TKA), regaining functional recovery and a painless joint with fulfilment of patients' expectations at the first stage is an integral part for a patient to progress to the second stage. As patient expectations drive postoperative satisfaction, the challenge is to match patient and surgeon expectations before surgery. Therefore, this study aimed to evaluate the postoperative patient expectations and clinical outcomes and to evaluate the rate of second stage in bilateral staged TKA. METHODS The study included 111 patients; 81 females and 30 males with a median age at surgery of 68 years (range 59-85 years) and 46 were older than 70 years. Postoperative functional data included Knee Society Scores (KSS). Expectation data were collected according to the post-visit 'Questionnaire of Patient Expectations of Healthcare'. RESULTS The overall refusal rate for the second stage was 36.9 % (n = 41). The patients older than 70 years had a higher refusal rate compared to relatively younger patients (< 70 years old) (p = 0.038). Younger age, postoperatively improved KSS, fulfilment of patient expectations of the healthcare process, treatment outcomes and whole expectations were the main determinants for patients accepting the second stage. The most important determinative factors for attendance were 'Process of Healthcare' and subsequently 'Treatment Outcomes' and total questionnaire scores (p < 0.001). CONCLUSION The postoperative perception of healthcare and the treating surgeon's knowledge and responsivity are the major concerns for patients considering second stage TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hakan Sesen
- Department of Orthopaedics and Traumatology, Kecioren Education and Research Hospital, Ardahan S no 25 Kecioren, 06380, Ankara, Turkey.
| | - Ismail Demirkale
- Department of Orthopaedics and Traumatology, Kecioren Education and Research Hospital, Ardahan S no 25 Kecioren, 06380, Ankara, Turkey.
| | - Mert Karaduman
- Department of Orthopaedics and Traumatology, Kecioren Education and Research Hospital, Ardahan S no 25 Kecioren, 06380, Ankara, Turkey.
| | - Celal Alp Vural
- Department of Orthopaedics and Traumatology, Kecioren Education and Research Hospital, Ardahan S no 25 Kecioren, 06380, Ankara, Turkey.
| | - Mustafa Caner Okkaoglu
- Department of Orthopaedics and Traumatology, Kecioren Education and Research Hospital, Ardahan S no 25 Kecioren, 06380, Ankara, Turkey.
| | - Murat Altay
- Department of Orthopaedics and Traumatology, Kecioren Education and Research Hospital, Ardahan S no 25 Kecioren, 06380, Ankara, Turkey.
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Dowling M, Rickwood D. A naturalistic study of the effects of synchronous online chat counselling on young people's psychological distress, life satisfaction and hope. COUNSELLING & PSYCHOTHERAPY RESEARCH 2015. [DOI: 10.1002/capr.12037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Debra Rickwood
- Applied Psychology; University of Canberra; Canberra Australia
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Khan CM, Rini C, Bernhardt BA, Roberts JS, Christensen KD, Evans JP, Brothers KB, Roche MI, Berg JS, Henderson GE. How can psychological science inform research about genetic counseling for clinical genomic sequencing? J Genet Couns 2015; 24:193-204. [PMID: 25488723 PMCID: PMC4777349 DOI: 10.1007/s10897-014-9804-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/25/2014] [Indexed: 01/02/2023]
Abstract
Next generation genomic sequencing technologies (including whole genome or whole exome sequencing) are being increasingly applied to clinical care. Yet, the breadth and complexity of sequencing information raise questions about how best to communicate and return sequencing information to patients and families in ways that facilitate comprehension and optimal health decisions. Obtaining answers to such questions will require multidisciplinary research. In this paper, we focus on how psychological science research can address questions related to clinical genomic sequencing by explaining emotional, cognitive, and behavioral processes in response to different types of genomic sequencing information (e.g., diagnostic results and incidental findings). We highlight examples of psychological science that can be applied to genetic counseling research to inform the following questions: (1) What factors influence patients' and providers' informational needs for developing an accurate understanding of what genomic sequencing results do and do not mean?; (2) How and by whom should genomic sequencing results be communicated to patients and their family members?; and (3) How do patients and their families respond to uncertainties related to genomic information?
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Affiliation(s)
- Cynthia M Khan
- Department of Health Behavior, University of North Carolina-Chapel Hill, 312 Rosenau Hall, CB#7440, Chapel Hill, NC, 27599-7440, USA,
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Bright F, Kayes N, McCann C, McPherson K. Understanding Hope After Stroke: A Systematic Review of the Literature Using Concept Analysis. Top Stroke Rehabil 2015; 18:490-508. [DOI: 10.1310/tsr1805-490] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Peay HL, Henderson GE. What motivates participation in HIV cure trials? A call for real-time assessment to improve informed consent. J Virus Erad 2015; 1:51-53. [PMID: 25866844 PMCID: PMC4392850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
HIV cure research, a diverse set of studies aimed at eradicating or greatly reducing HIV in latent reservoirs, has become a strategic priority for global AIDS research. However, in early-phase HIV cure research there are ethical challenges related to the uncertainty around potential risks and the risk-benefit balance. Similar to clinical trials in other disease areas, these concerns may impact clinical trial participants' comprehension and decision making. Here we suggest attention to the terminology used to describe HIV cure research that may promote therapeutic misconception, and exploration of the decision-making influences and processes of those who accept and decline participation in HIV cure trials. These data will facilitate efforts to improve protocols and informed consent based on an understanding of participant preferences and needs.
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Affiliation(s)
- Holly L Peay
- Department of Clinical Genetics,
Leiden University Medical Centre,
Leiden,
the Netherlands
| | - Gail E Henderson
- Department of Social Medicine,
University of North Carolina School of Medicine,
Chapel Hill,
NC,
USA,Corresponding author: Gail E Henderson,
Department of Social Medicine,
University of North Carolona School of Medicine,
333 South Columbia St, 347 MacNider,
Chapel Hill,
NC27599-7240,
USA.
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Peay HL, Henderson GE. What motivates participation in HIV cure trials? A call for real-time assessment to improve informed consent. J Virus Erad 2015. [DOI: 10.1016/s2055-6640(20)31143-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Adopting a Sustainable Community of Practice Model when Developing a Service to Support Patients with Epidermolysis Bullosa (EB): A Stakeholder-Centered Approach. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 8:51-63. [DOI: 10.1007/s40271-014-0097-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Boa S, Duncan EAS, Haraldsdottir E, Wyke S. Goal setting in palliative care: A structured review. PROGRESS IN PALLIATIVE CARE 2014. [DOI: 10.1179/1743291x14y.0000000097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Snyder J, Adams K, Crooks VA, Whitehurst D, Vallee J. "I knew what was going to happen if I did nothing and so I was going to do something": faith, hope, and trust in the decisions of Canadians with multiple sclerosis to seek unproven interventions abroad. BMC Health Serv Res 2014; 14:445. [PMID: 25265935 PMCID: PMC4263058 DOI: 10.1186/1472-6963-14-445] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 09/23/2014] [Indexed: 11/23/2022] Open
Abstract
Background Chronic cerebrospinal venous insufficiency (CCSVI) treatment is an unproven intervention aimed at relieving some of the symptoms of multiple sclerosis (MS). Despite limited evidence of the efficacy and safety of this intervention, Canadians diagnosed with MS have been traveling abroad to access this procedure as it is not available domestically outside of limited clinical trials. This paper discusses the experiences of Canadians with MS seeking CCSVI treatment abroad. Methods This paper presents a secondary analysis of 15 interviews with participants who had gone abroad for CCSVI treatment. Interviews were conducted over the phone between October 2012 and December 2012. All interviews were digitally recorded and transcribed verbatim. Transcripts were hand coded for: 1) why CCSVI treatment was sought and where it was obtained; 2) the role of having hope for a cure in seeking CCSVI; 3) the impact of MS on everyday life; and 4) the role other people played in the decision to go abroad. Results The authors identified loss of faith, hope, and trust as themes emerging from the transcripts. The participants experienced a loss of faith with the Canadian health system and especially the neurologists who were responsible for their care and the classification of MS as a neurological disease. Access to CCSVI treatment abroad generated hope in these participants, but they were cautious in their expectations, focusing on symptom management rather than a cure. Trust in their caregivers abroad was generated through the recommendations of other MS sufferers and the credentials of their caregivers abroad. Conclusions By deciding to seek an unproven intervention abroad, these individuals took on responsibility for their care from the Canadian health system. While evidence of the efficacy of CCSVI treatment is limited, the participants felt that they were making a rational care decision, focusing on the empowerment and renewed hope generated by seeking this intervention. Health professionals and policy makers globally should consider the causes of loss of faith in their domestic care systems and balance the benefits of empowerment and renewed hope against concerns that unproven interventions may create new health risks.
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Affiliation(s)
- Jeremy Snyder
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC, Canada.
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Eaves ER, Ritenbaugh C, Nichter M, Hopkins AL, Sherman KJ. Modes of hoping: understanding hope and expectation in the context of a clinical trial of complementary and alternative medicine for chronic pain. Explore (NY) 2014; 10:225-32. [PMID: 25037665 DOI: 10.1016/j.explore.2014.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Indexed: 11/29/2022]
Abstract
This article explores the role of hope in participants' assessments of their expectations, experiences and treatment outcomes. Data analysis focused on semi-structured, open-ended interviews with 44 participants, interviewed 3-5 times each over the course of a study evaluating Traditional Chinese Medicine (TCM) for temporomandibular disorders (TMD), a form of chronic orofacial pain. Transcripts were coded and analyzed using qualitative and ethnographic methods. A "Modes of Hoping" (Webb, 2007)(1) framework informed our analysis. Five modes of hoping emerged from participant narratives: Realistic Hope, Wishful Hope, Utopian Hope, Technoscience Hope, and Transcendent Hope. Using this framework, hope is demonstrated as exerting a profound influence over how participants assess and report their expectations. This suggests that researchers interested in measuring expectations and understanding their role in treatment outcomes should consider hope as exercising a multi-faceted and dynamic influence on participants' reporting of expectations and their experience and evaluation of treatment.
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Affiliation(s)
- Emery R Eaves
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ; School of Anthropology, University of Arizona, Tucson, AZ.
| | - Cheryl Ritenbaugh
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ; School of Anthropology, University of Arizona, Tucson, AZ
| | - Mark Nichter
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ; School of Anthropology, University of Arizona, Tucson, AZ; College of Public Health, University of Arizona, Tucson, AZ
| | - Allison L Hopkins
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ
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Lally JE, Thomson RG, MacPhail S, Exley C. Pain relief in labour: a qualitative study to determine how to support women to make decisions about pain relief in labour. BMC Pregnancy Childbirth 2014; 14:6. [PMID: 24397421 PMCID: PMC3893516 DOI: 10.1186/1471-2393-14-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 12/16/2013] [Indexed: 11/18/2022] Open
Abstract
Background Engagement in decision making is a key priority of modern healthcare. Women are encouraged to make decisions about pain relief in labour in the ante-natal period based upon their expectations of what labour pain will be like. Many women find this planning difficult. The aim of this qualitative study was to explore how women can be better supported in preparing for, and making, decisions during pregnancy and labour regarding pain management. Methods Semi-structured interviews were conducted with 13 primiparous and 10 multiparous women at 36 weeks of pregnancy and again within six weeks postnatally. Data collection and analysis occurred concurrently to identify key themes. Results Three main themes emerged from the data. Firstly, during pregnancy women expressed a degree of uncertainty about the level of pain they would experience in labour and the effect of different methods of pain relief. Secondly, women reflected on how decisions had been made regarding pain management in labour and the degree to which they had felt comfortable making these decisions. Finally, women discussed their perceived levels of control, both desired and experienced, over both their bodies and the decisions they were making. Conclusion This study suggests that the current approach of antenatal preparation in the NHS, of asking women to make decisions antenatally for pain relief in labour, needs reviewing. It would be more beneficial to concentrate efforts on better informing women and on engaging them in discussions around their values, expectations and preferences and how these affect each specific choice rather than expecting them to make to make firm decisions in advance of such an unpredictable event as labour.
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Affiliation(s)
- Joanne E Lally
- Institute of Health and Society, Baddiley Clark Building, Newcastle University, Baddiley-Clark Building Richardson Road, Newcastle upon Tyne NE2 4AX, United Kingdom.
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Development and psychometric evaluation of the knowledge scale for adults with congenitally malformed hearts. J Cardiovasc Nurs 2013; 28:228-37. [PMID: 22495799 DOI: 10.1097/jcn.0b013e3182498785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND RESEARCH OBJECTIVE Adults with congenitally malformed hearts have knowledge gaps regarding their heart condition, and their level of knowledge is not routinely assessed during follow-up. One reason for this is that there are few validated, user-friendly questionnaires to assess knowledge about congenital heart disease and its effects on daily life. Failure to identify low levels of knowledge could lead to less motivated and insecure individuals not actively involved in treatment and care of their heart condition. Therefore, the objective of this study was to develop and test a knowledge scale for adults with congenitally malformed hearts. PARTICIPANTS AND METHODS The development and psychometric evaluation of the Knowledge Scale for Adults With Congenitally Malformed Hearts (KnoCoMH) followed 2 phases: (1) development and evaluation of the initial version, with face validity and content validity assessed by experts and adults with congenitally malformed hearts, and (2) evaluation and refinement of the KnoCoMH in adults with congenitally malformed hearts, including item difficulty level, internal consistency, and test-retest reliability. RESULTS The development and evaluation of a knowledge scale for adults with congenitally malformed hearts resulted in the KnoCoMH including 46 items in 4 domains: General Knowledge, with a Kuder-Richardson formula 20 (KR-20) value of 0.68; Medical Treatment, with a KR-20 value of 0.74; Endocarditis Prophylaxis, with a KR-20 value of 0.90; and Contraceptives and Pregnancy, with a KR-20 value of 0.65. Test-retest evaluation showed significant correlations between 0.50 and 0.67 (P < .01) in all 4 domains. There was good variation in item difficulty, with a mean value of 0.56 in General Knowledge, 0.62 in Medical Treatment, 0.33 in Endocarditis Prophylaxis, and 0.48 in Contraceptives and Pregnancy. CONCLUSIONS The KnoCoMH has acceptable psychometric properties for most of the knowledge domains included. It can be used for evaluating knowledge among adults with congenitally malformed hearts and its associations with other outcomes. However, further studies are advisable to test construct validity, predictive validity, and responsiveness.
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Patton DJ, Busch RM, Yee KM, Kubu CS, Gonzalez-Martinez J, Ford PJ. Hope language in patients undergoing epilepsy surgery. Epilepsy Behav 2013; 29:90-5. [PMID: 23941902 DOI: 10.1016/j.yebeh.2013.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/07/2013] [Accepted: 07/04/2013] [Indexed: 11/19/2022]
Abstract
Candidates for epilepsy surgery often use the word "hope" to express their attitudes and beliefs about surgery. However, studies suggest that hope has a multiplicity of meanings that are not well understood. The goal of this analysis was to evaluate whether Candidates for epilepsy surgery use hope language to express a traditional, expected optimism during presurgery interviews. We examined patients' uses of the word "hope" and its derivatives (hoping, hopeful, hopefully) through a secondary analysis of 37 interviews of adult patients prior to epilepsy surgery. Approximately 1/3 of all hope statements were coded as expressions of optimism, while 1/3 were not optimistic, and 1/3 had unclear meanings. In addition to traditionally optimistic uses of the term, other themes surrounding use of this word included ideas of dread, worry, uncertainty, and temporizing language. This information may help clinicians communicate more effectively with patients, enhancing the informed consent process for epilepsy surgery.
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Affiliation(s)
- D J Patton
- Cleveland Clinic's NeuroEthics Program, Cleveland, OH, USA
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Georgy EE, Carr ECJ, Breen AC. Met or matched expectations: what accounts for a successful back pain consultation in primary care? Health Expect 2013; 16:143-54. [PMID: 21679288 PMCID: PMC5060651 DOI: 10.1111/j.1369-7625.2011.00706.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients' as well as doctors' expectations might be key elements for improving the quality of health care; however, previous conceptual and theoretical frameworks related to expectations often overlook such complex and complementary relationship between patients' and doctors' expectations. The concept of 'matched patient-doctor expectations' is not properly investigated, and there is lack of literature exploring such aspect of the consultation. AIM The paper presents a preliminary conceptual model for the relationship between patients' and doctors' expectations with specific reference to back pain management in primary care. METHODS The methods employed in this study are integrative literature review, examination of previous theoretical frameworks, identification of conceptual issues in existing literature, and synthesis and development of a preliminary pragmatic conceptual framework. OUTCOME A simple preliminary model explaining the formation of expectations in relation to specific antecedents and consequences was developed; the model incorporates several stages and filters (influencing factors, underlying reactions, judgement, formed reactions, outcome and significance) to explain the development and anticipated influence of expectations on the consultation outcome. CONCLUSION The newly developed model takes into account several important dynamics that might be key elements for more successful back pain consultation in primary care, mainly the importance of matching patients' and doctors' expectations as well as the importance of addressing unmet expectations.
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Affiliation(s)
- Ehab E Georgy
- School of Health and Social Care, Bournemouth University, Dorset, UK.
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Haanstra TM, Hanson L, Evans R, van Nes FA, De Vet HCW, Cuijpers P, Ostelo RWJG. How do low back pain patients conceptualize their expectations regarding treatment? Content analysis of interviews. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1986-95. [PMID: 23661035 DOI: 10.1007/s00586-013-2803-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 03/18/2013] [Accepted: 04/25/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to gain insight into how low back pain (LBP) patients conceptualize the construct of expectations regarding treatment. METHODS This study was nested within a mixed-method randomized clinical trial comparing three primary care interventions for LBP. A total of 77 participants with LBP lasting longer than 6 weeks were included; semi-structured interviews were conducted querying patients about their expectations for treatment. Also factors influencing their expectations were explored. Interviews were administered following enrollment into the study, but prior to study treatment. Two researchers independently conducted a content analysis using NVIVO 9 software. RESULTS LBP patients' expectations could be categorized in two main domains: outcome and process expectations, each with subdomains. Patients expressed expectations in all subdomains both as values (what they hoped) and probabilities (what they thought was likely). In multiple subdomains, there were differences in the nature (positive vs. negative) and frequency of value and probability expectations. Participants reported that multiple factors influenced their expectations of which past experience with treatment appeared to be of major influence on probability expectations. CONCLUSION AND RECOMMENDATIONS This study showed that LBP patients' expectations for treatment are multifaceted. Current measurement instruments do not cover all domains and subdomains of expectations. Therefore, we recommend the development of new or improved measures that make a distinction between value and probability expectations and assess process and/or outcome expectations covering multiple subdomains. Some of the influencing factors found in this study may be useful targets for altering patients' treatment expectations and improving health outcomes.
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Affiliation(s)
- T M Haanstra
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Van den Boechorststraat 7, Room A-505, 1081 BT, Amsterdam, The Netherlands,
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Crooks VA, Williams A, Stajduhar KI, Cohen SR, Allan D, Brazil K. Family caregivers' ideal expectations of Canada's Compassionate Care Benefit. HEALTH & SOCIAL CARE IN THE COMMUNITY 2012; 20:172-180. [PMID: 21919990 DOI: 10.1111/j.1365-2524.2011.01028.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present the findings of 57 interviews conducted in 2007-2008 with Canadians who have cared for a dying family member to examine their ideal expectations of the Compassionate Care Benefit (CCB) - a social programme providing job security and income support for workers caring for a dying person. Our aims are to (1) appreciate how intended users and other family caregivers view the programme's very nature; (2) identify programme challenges and improvements that emerge from considering family caregivers' ideal expectations; and (3) contribute to a larger evaluative study designed to make policy-relevant recommendations for CCB improvement. Review of transcripts across three respondent groups reveals four categories of ideal expectations: (1) eligibility, (2) informational, (3) timing and (4) financial. Ideal expectations were typically derived from respondents' experiences of care-giving, their knowledge of the programme and, for some, of applying for and/or receiving the CCB. Findings reveal that there are gaps between respondents' ideal expectations and their experienced realities. Such gaps may lead to disappointment being experienced by those who believe they should be eligible for the programme but are not, or should be entitled to receive some form of support that is not presently available. This analysis plays an important role in identifying potential changes for the CCB that may better support family caregivers, in that the ideal expectations serve as a starting point for articulating desirable programme amendments. This analysis also has wider relevance. For jurisdictions looking to create new social programmes to support caregivers based upon labour policy strategies and legislation, this analysis identifies considerations that should be made at the outset of development. For jurisdictions that already have employment-based caregiver support programmes, this analysis demonstrates that programme challenges may not always be met through legislative changes alone but also through measures such as increasing awareness.
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Affiliation(s)
- Valorie A Crooks
- Department of Geography, Simon Fraser University, Burnaby, BC, Canada.
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Salmon P, Hill J, Ward J, Gravenhorst K, Eden T, Young B. Faith and protection: the construction of hope by parents of children with leukemia and their oncologists. Oncologist 2012; 17:398-404. [PMID: 22371382 DOI: 10.1634/theoncologist.2011-0308] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Oncologists are criticized for fostering unrealistic hope in patients and families, but criticisms reflect a perspective that is oversimplified and "expert" guidance that is ambiguous or impractical. Our aim was to understand how pediatric oncologists manage parents' hope in practice and to evaluate how they address parents' needs. METHODS Participants were 53 parents and 12 oncologists whom they consulted across six U.K. centers. We audio recorded consultations approximately 1-2, 6, and 12 months after diagnosis. Parents were interviewed after each consultation to elicit their perspectives on the consultation and clinical relationship. Transcripts of consultations and interviews were analyzed qualitatively. RESULTS Parents needed hope in order to function effectively in the face of despair, and all wanted the oncologists to help them be hopeful. Most parents focused hope on the short term. They therefore needed oncologists to be authoritative in taking responsibility for the child's long-term survival while cushioning parents from information about longer-term uncertainties and being positive in providing information about short-term progress. A few parents who could not fully trust their oncologist were unable to hope. CONCLUSION Oncologists' pivotal role in sustaining hope was one that parents gave them. Most parents' "faith" in the oncologist allowed them to set aside, rather than deny, their fears about survival while investing their hopes in short-term milestones. Oncologists' behavior generally matched parents' needs, contradicting common criticisms of oncologists. Nevertheless, oncologists need to identify and address the difficulty that some parents have in fully trusting the oncologist and, consequently, being hopeful.
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Affiliation(s)
- Peter Salmon
- Division of Clinical Psychology, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK.
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Schrank B, Woppmann A, Sibitz I, Lauber C. Development and validation of an integrative scale to assess hope. Health Expect 2010; 14:417-28. [PMID: 21122040 DOI: 10.1111/j.1369-7625.2010.00645.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hope includes the dimensions of time, goals, control, relations and personal characteristics. Existing tools that measure it vary in length and psychometric properties and cover different parts of its overall concept. OBJECTIVES This study aimed to develop an instrument that integrates all relevant aspects of hope is concise, easy to use and shows good psychometric properties. DESIGN Three pre-existing instruments (Miller Hope Scale, Herth Hope Index, Snyder Hope Scale) covering complementary and overlapping aspects of hope were administered cross-sectionally to a general population sample (n = 489). Factor analysis was used for item reduction. Reliability and validity were tested using factor analysis and item correlations between the new scale and quality of life and depression scales. SETTING AND PARTICIPANTS The study was set in Austria. Participants were sampled from the general population using a quota sampling strategy. RESULTS The initial 60 items were reduced to a 23-item scale with four dimensions: 'trust and confidence', 'positive future orientation', 'social relations and personal value' and 'lack of perspective'. The new scale's factor structure was highly stable and its internal consistency high (alpha = 0.92 for the overall scale, 0.80-0.85 for its subscales). Hope scores were negatively correlated with depression (r = -0.68) and positively with quality of life (r = 0.57), with the factor analysis and item discriminant validity supporting the new scale's construct validity. CONCLUSIONS The new scale comprehensively covers the concept of hope is significantly shorter than previous scales and shows satisfactory reliability and validity.
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Affiliation(s)
- Beate Schrank
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Waehringerguertel, UK.
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Entwistle VA. Brief reflections - from Vikki. Health Expect 2010. [DOI: 10.1111/j.1369-7625.2010.00642_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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