| 1. |
- Strömberg, Anna, 1967-, et al.
(författare)
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Computer-based education for patients with chronic heart failure : A randomised, controlled, multicentre trial of the effects on knowledge, compliance and quality of life
- 2006
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Ingår i: Patient Education and Counseling. - Shannon, Ireland : Elsevier. - 0738-3991 .- 1873-5134. ; 7, s. 128-35
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the effects of a single-session, interactive computer-based educational program on knowledge, compliance and quality of life in heart failure patients with special emphasis on gender differences.METHODS: One hundred and fifty-four patients, mean age 70 years, from five heart failure clinics were randomised to either receiving only standard education (n = 72) or standard education and additional computer-based education (n = 82).RESULTS: Knowledge was increased in both groups after 1 month with a trend towards higher knowledge (P = 0.07) in the computer-based group. The increase in knowledge was significantly higher in the computer-based group after 6 months (P = 0.03). No differences were found between the groups with regard to compliance with treatment and self-care or quality of life. The women had significantly lower quality of life and did not improve after 6 months as the men did (P = 0.0001).CONCLUSION: Computer-based education gave increased knowledge about heart failure. PRACTICE IMPLICATIONS: Computers can be a useful tool in heart failure education, but to improve compliance a single-session educational intervention is not sufficient. Gender differences in learning and quality of life should be further evaluated.
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| 2. |
- Fossum, Bjöörn, et al.
(författare)
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How physicians experience patient consultations at an orthopaedic out-patient clinic : a qualitative study
- 2002
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 47:2, s. 127-35
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to describe physicians' experiences in their encounters with patients by allowing the physicians to observe and comment on their own video-recorded medical consultations. Eighteen orthopaedic surgeons took part in the study; they were informed that we were interested in studying what actually takes place during a consultation, the quality of communication between doctor and patient, and how the physicians themselves experience the consultation. Each time the physician wished to make a comment, the video film was stopped and the comments were taped on audiocassette. The results showed that when the physicians watched the video-recorded consultations they commented spontaneously on issues regarding, among others: (1) how they try to adapt their communication to the patient's situation; (2) the need to explain things to the patient; (3) perceptions of working under unfavourable conditions; (4) difficulties in helping certain patients.
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| 3. |
- Fossum, Bjöörn, et al.
(författare)
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Patient-centred communication : videotaped consultations
- 2004
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Ingår i: Patient Education and Counseling. - 0738-3991 .- 1873-5134. ; 54:2, s. 163-9
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to analyse the way in which orthopaedic physicians manage consultations, and to identify those factors associated with patient-experienced satisfaction/dissatisfaction. This was explored both using a descriptive method and by analysing comments from patients. Consultations were videotaped; 18 physicians and 18 patients participated. Approximately 1 week after the consultation, the patient was shown the video recording and asked for his/her points of view and spontaneous reactions. Each time, the patient wished to say something, the video was stopped and the comments recorded. According to the patients' comments of the videotaped consultations four consultations were mainly positive, seven negative and seven neither completely positive nor completely negative. We analysed the positive and negative consultations using the Consultation Map (CM) method. The pattern in the positive consultations shows a greater flexibility. Statements regarding initial history and aetiology often move to and fro between other items, and the consultation as a whole was often characterised by this rapid change between items. The pattern in the negative consultations seems to indicate a slower motion; with longer time spent with few items and fewer items covered. The positive consultations were characterised by a greater prevalence of the items 'Sharing Understanding' and 'Involving the Patient in Management'. On the other hand, the negative consultations were characterised by more time spent with the items 'History of problems', and 'Patient Ideas'. This might be due to the patient having tried to express him/herself in order to present his/her views but the physician not following them up. In this study, the CM has been helpful in clarifying the difference between encounters experienced as satisfactory or dissatisfactory.
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| 4. |
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| 5. |
- Hellström, Olle, 1940-, et al.
(författare)
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A phenomenological analysis of doctor-patient interaction : a case study
- 1998
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Ingår i: Patient Education and Counseling. - : Elsevier. - 0738-3991 .- 1873-5134. ; 33:1, s. 83-89
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Tidskriftsartikel (refereegranskat)abstract
- The fact that the biomedical model has been very successful in practice does not preclude that some health issues can be understood by way of other health care perspectives. Acquiring skills in meeting patients requires theories that structure other fields of knowledge than the biomedical sciences. An old man, who experiences himself as deeply misunderstood by the medical profession, is interviewed, his personal life-story is gone into and his case records and other available data are analysed. A phenomenological method is used, i.e. disciplined and rigorous reflection upon available data, remaining close to the particular pieces of the patient's narrative as they stand forth in their contextual relationships. The study shows that the doctors involved did not relate to the patient but to a biomedical image of him. His efforts to make himself understood were converted into instrumentally manageable disorders. Finally, dialogue medicine is briefly introduced as a model for counselling patients, especially when they need assistance to abandon the notion that they have been afflicted with a disease, a perception that might serve the purpose of keeping a threatening self-image out of consciousness.
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| 6. |
- Hellström, Olle, 1940-
(författare)
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Dialogue medicine : a health-liberating attitude in general practice
- 1998
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Ingår i: Patient Education and Counseling. - : Elsevier. - 0738-3991 .- 1873-5134. ; 35:3, s. 221-231
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Tidskriftsartikel (refereegranskat)abstract
- Dialogue medicine is presented as the prime means of understanding patients' illnesses. It is a practical attitude especially aimed to assist or inspire patients to consider, see and manage their illness–demanding efforts to unwittingly suppress or disguise such self-reproaching thoughts as are worse to bear than the feeling of being afflicted with a disease. Along with diagnosing patients' perceived bodily disorders, doctors can choose to see them as persons whose ailments stand for efforts to manage their existence as communicative human beings. The core of the paper is an encounter between the author and a female patient which illuminates the usefulness of genuine dialogue in medical practice. The paper illustrates how the dialogical attitude helps patients to see and manage their difficult life-situations and how the doctor can be inspired to change and develop and improve his/her skills as a dialogue partner. Doctors' dialogical attitude in the encounter encompasses for example openness, empathy, sensitivity, courage, attentiveness and responsiveness, accompanied by concern, trust, respect, affection, appreciation and hope. The philosophical and theoretical foundations of the concept of dialogue medicine are sketched out and some practically significant traits are described.
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| 7. |
- Hellström, Olle, 1940-
(författare)
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Health promotion and clinical dialogue
- 1995
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Ingår i: Patient Education and Counseling. - : Elsevier. - 0738-3991 .- 1873-5134. ; 25:3, s. 247-256
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Tidskriftsartikel (refereegranskat)abstract
- Clinical medicine would gain from a discussion of the significance of health promotion. Some central concepts are discussed: the diagnostic process; disease prevention vs. health promotion; the practical importance of the understanding of the difference between the 2 concepts health and absence-of-disease. The concept of health catches the intra-personal level, the undisrupted self, whereas absence of disease concerns the proper functioning of the organism, the human biology. By means of comparing 2 diagnoses, multiple sclerosis (MS) and fibromyagia syndrome (FS), it is argued that there are diagnoses of at least 2 distinct kinds. The diagnosis of MS is similar to a scientific discovery, whereas the diagnosis of FS is constructed more like criminal law. Consequently, diagnosis-based disease prevention and health promotion have to comply with a wide range reality. Finally, clinical dialogue is pointed out as a method that successfully combines diagnostic, preventive and promotive efforts, as well as clinical care and cure.
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| 8. |
- Holmström, Inger, et al.
(författare)
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A change of the physicians' understanding of the encounter parallels competence development
- 2001
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Ingår i: Patient Education and Counseling. - 0738-3991 .- 1873-5134. ; 42:3, s. 271-278
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Tidskriftsartikel (refereegranskat)abstract
- Patients today complain that physicians do not listen. There is a need to improve the professional competence in the patient encounter. According to theory, competence is a result of how people perceive their work. Observation and reflection can improve the competence. The aim of this study was to investigate if physicians can develop a more patient-centred consultation style by an experienced-based specialist course and how such a development is related to the physicians understanding of the task. The physicians video recorded consultations and reflected on these. The video consultations were analysed with a time study and Pendleton et al.’s consultation schedule [Pendleton D, Schoefield T, Tate P, Havelock P. The consultation: an approach to learning and teaching. Oxford: Oxford University Press, 1984.]. Before–after questions were answered. The study indicates that seven out of 10 physicians participating in the course had developed a patient-centred attitude and acted according to it. The time study gave ambiguous results. This study implicates that it is possible to initiate competence development by influencing the understanding of the encounter.
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| 9. |
- Holmström, Inger, et al.
(författare)
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Swedish health care professionals' diverse understandings of diabetes care
- 2003
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Ingår i: Patient Education and Counseling. - 0738-3991 .- 1873-5134. ; 51:1, s. 53-58
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Tidskriftsartikel (refereegranskat)abstract
- Knowledge of health care professionals’ different understandings of diabetes care is important when preparing such professionals in patient education. For patients to manage illness effectively, the actions of health care professionals are crucial. Patients’ understanding of their condition should be taken as the point of departure when creating a learning situation. The professionals’ understandings of diabetes care were mapped using a survey including 169 primary care doctors, nurses, assistant nurses and chiropodists in Stockholm, Sweden. The responses were analysed using a phenomenographic approach. Five understandings were identified: the professionals treat the patients, the professionals give information, the professionals focus relation and organisation, the professionals seek the patient’s agreement, and the professionals focus the patient’s understanding of the situation. Only 20 (12%) of the 169 professional caregivers focused the patient’s understanding. Professionals need to develop their understandings of health care and the professional–patient interaction in order to support the patients’ learning.
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| 10. |
- Kjellgren, Karin I, 1950, et al.
(författare)
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Antihypertensive treatment and patient autonomy--the follow-up appointment as a resource for care.
- 2000
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Ingår i: Patient education and counseling. - 0738-3991 .- 1873-5134. ; 40:1, s. 39-49
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Tidskriftsartikel (refereegranskat)abstract
- Since hypertension is a chronic condition which generally requires long-term commitment to pharmacological therapy as well as alterations of patient lifestyle, the patient-physician communication in the clinical setting is an important determinant of the quality of care and health outcome. The aim of the present study was to explore the structure and content of the communication between the patient and the physician, and the process of decision-making at a routine follow-up appointment for hypertension. The study was based on 51 audio-recordings of authentic consultations. Most patients had a passive role in the consultations, and initiated few topics of conversation. The few topics that the patients initiated were usually not about hypertension. Patients' questions about medication mainly referred to unwanted effects of the drugs. Little time was invested in discussing risks related to hypertension. A collaborative shared decision-making was seldom observed in the consultations.
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