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Abstract: Objective: This paper describes a translational project that explored the feasibility and effect of introducing a coordinated approach to emotional care. Methods: The project was undertaken using Action Research on one ward at St John of God Hospital Subiaco, Western Australia. A senior Registered Nurse was appointed to provide the leadership and direction to staff regarding emotional care and an education program for staff was provided. The project was evaluated using both quantitative and qualitative data. Results: Data demonstrated an increase in the patient''s evaluation of emotional care, although levels were found to fluctuate throughout the project. Factors such as the emotional distress of the staff were hypothesised as impacting on the delivery of emotional care. Conclusion: The approach used in this project was found to be a useful method of improving emotional care. However, the data collected in this study revealed the complexity of emotional care delivery and the possible impact of a number of factors within the environment. Practice implications: Emotional care delivery can be improved by using a coordinated research-based educational approach led by a clinical champion. However, the impact of other factors within the hospital environment needs to be considered and more research is required. [Copyright &y& Elsevier]

Objective: The health status and life experiences of older diabetes patients may be highly heterogeneous, thus making their perspectives particularly relevant for developing individualized self-management plans for this population. Our earlier research showed older diabetes patients' healthcare goals and self-management behaviors are frequently shaped through social comparisons with peers/family members. The present paper explores this role of social comparison in their self-management practices and develops a conceptual model depicting the process.Methods: Data were collected using open-ended, semi-structured interviews to elicit 28 older, type 2 diabetes patients' healthcare goals and self-management practices. Qualitative techniques were used to extract salient themes.Results: Social comparison plays a salient role in routinizing older patients' self-management practices. Almost all patients assess their self-management by making "downward" comparisons with individuals doing worse than them; "upward" comparisons are rarely invoked. Occasionally patients' social comparisons lead them to adopt "normalizing" behaviors resulting in deviations from medically recommended self-care.Conclusion: The findings formed the basis for developing a conceptual model delineating the role of social comparison in self-management that can be beneficial for providers in tailoring educational interventions for self-management.Practice Implications: Fostering these comparisons can help providers enhance communication on initiating and sustaining self-management practices. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The health status and life experiences of older diabetes patients may be highly heterogeneous, thus making their perspectives particularly relevant for developing individualized self-management plans for this population. Our earlier research showed older diabetes patients’ healthcare goals and self-management behaviors are frequently shaped through social comparisons with peers/family members. The present paper explores this role of social comparison in their self-management practices and develops a conceptual model depicting the process. Methods: Data were collected using open-ended, semi-structured interviews to elicit 28 older, type 2 diabetes patients’ healthcare goals and self-management practices. Qualitative techniques were used to extract salient themes. Results: Social comparison plays a salient role in routinizing older patients’ self-management practices. Almost all patients assess their self-management by making “downward” comparisons with individuals doing worse than them; “upward” comparisons are rarely invoked. Occasionally patients’ social comparisons lead them to adopt “normalizing” behaviors resulting in deviations from medically recommended self-care. Conclusion: The findings formed the basis for developing a conceptual model delineating the role of social comparison in self-management that can be beneficial for providers in tailoring educational interventions for self-management. Practice implications: Fostering these comparisons can help providers enhance communication on initiating and sustaining self-management practices. [Copyright &y& Elsevier]

Objective: Stroke survivors are at high risk of stroke recurrence yet current strategies to reduce recurrence risk are sub-optimal. The UK Medical Research Council (MRC) have proposed a framework for developing and evaluating complex interventions, such as community management of stroke secondary prevention. The Framework outlines a five-phased approach from theory through to implementation of effective interventions. This paper reports Phases I-III of the development of a novel intervention to improve risk factor management after stroke.Methods: The pre-clinical/theoretical phase entailed reviewing the literature and undertaking quantitative and qualitative studies to identify current practices and barriers to secondary prevention. In Phase I (modelling), findings were used to design an intervention with the potential to overcome barriers to effective stroke secondary prevention management. The feasibility of delivering the intervention and its acceptability were tested in the Phase II exploratory trial involving 25 stroke survivors and their general practitioners.Results: This led to the development of the definitive risk factor management intervention. This comprises multiple components and involves using an on-going population stroke register to target patients, carers and health care professionals with tailored secondary prevention advice. Clinical, socio-demographic and service use data collected by the stroke register are transformed to provide an individualised secondary prevention package for patients, carers and health care professionals at three time points: within 10 weeks, 3 and 6 months post-stroke.Conclusion: The intervention is currently being evaluated in a randomised controlled trial. Further research is needed to test generalisability to other aspects of stroke management and for other chronic diseases.Practice Implications: The MRC Framework for complex interventions provides a structured approach to guide the development of novel interventions in public health. Implications for practice in stroke secondary prevention will emerge when the results of our randomised controlled trial are published. [ABSTRACT FROM AUTHOR]

Objective: This article focuses on design, training, and delivery of motivational interview (MI) in a longitudinal randomized controlled trial intended to assess the efficacy of two separate interventions designed to increase colorectal screening when compared to a usual care, control group. One intervention was a single-session, telephone-based MI, created to increase colorectal cancer screening within primary care populations. The other was tailored health counseling. We present the rationale, design, and process discussions of the one-time motivational interviewing telephone intervention. We discuss in this paper the training and supervision of study interventionists, in order to enhance practice and research knowledge concerned with fidelity issues in motivational interview interventions.Methods: To improve motivational interviewing proficiency and effectiveness, we developed a prescribed training program adapting MI to a telephone counseling session.Results: The three interventionists trained in MI demonstrate some MI proficiency assessed by the motivational interviewing treatment integrity scale. In the post-intervention interview, 20.5% of the MI participants reported having had a CRC screening test, and another 19.75% (n=16) had scheduled a screening test. Almost half of the participants (43%) indicated that the phone conversation helped them to overcome the reasons why they had not had a screening test.Conclusions: Ongoing supervision and training (post-MI workshop) are crucial to supporting MI fidelity. The trajectory of learning MI demonstrated by the interventionists is consistent with the eight stages of learning MI. The MI road map created for the interventionists has shown to be more of a distraction than a facilitator in the delivery of the telephone intervention. MI can, however, be considered a useful tool for health education and warrants further study.Practice Implications: MI training should include consistent training and process evaluation. MI can, however, be considered a useful tool for health education and warrants further study. MI can also be adapted to diverse health promotion scenarios. [ABSTRACT FROM AUTHOR]

Objective: The paper presents the development of a coding tool for self-efficacy orientated interventions in diabetes self-management programmes (Analysis System for Self-Efficacy Training, ASSET) and explores its construct validity and clinical utility. Methods: Based on four sources of self-efficacy (i.e., mastery experience, role modelling, verbal persuasion and physiological and affective states), published self-efficacy based interventions for diabetes care were analysed in order to identify specific verbal behavioural techniques. Video-recorded facilitating behaviours were evaluated using ASSET. Results: The reliability between four coders was high (K=0.71). ASSET enabled assessment of both self-efficacy based techniques and participants' response to those techniques. Individual patterns of delivery and shifts over time across facilitators were found. In the presented intervention we observed that self-efficacy utterances were followed by longer patient verbal responses than non-self-efficacy utterances. Conclusion: These detailed analyses with ASSET provide rich data and give the researcher an insight into the underlying mechanism of the intervention process. Practice Implications: By providing a detailed description of self-efficacy strategies ASSET can be used by health care professionals to guide reflective practice and support training programmes. [ABSTRACT FROM AUTHOR]

Objective: This article focuses on design, training, and delivery of motivational interview (MI) in a longitudinal randomized controlled trial intended to assess the efficacy of two separate interventions designed to increase colorectal screening when compared to a usual care, control group. One intervention was a single-session, telephone-based MI, created to increase colorectal cancer screening within primary care populations. The other was tailored health counseling. We present the rationale, design, and process discussions of the one-time motivational interviewing telephone intervention. We discuss in this paper the training and supervision of study interventionists, in order to enhance practice and research knowledge concerned with fidelity issues in motivational interview interventions. Methods: To improve motivational interviewing proficiency and effectiveness, we developed a prescribed training program adapting MI to a telephone counseling session. Results: The three interventionists trained in MI demonstrate some MI proficiency assessed by the motivational interviewing treatment integrity scale. In the post-intervention interview, 20.5% of the MI participants reported having had a CRC screening test, and another 19.75% (n =16) had scheduled a screening test. Almost half of the participants (43%) indicated that the phone conversation helped them to overcome the reasons why they had not had a screening test. Conclusions: Ongoing supervision and training (post-MI workshop) are crucial to supporting MI fidelity. The trajectory of learning MI demonstrated by the interventionists is consistent with the eight stages of learning MI. The MI road map created for the interventionists has shown to be more of a distraction than a facilitator in the delivery of the telephone intervention. MI can, however, be considered a useful tool for health education and warrants further study. Practice implications: MI training should include consistent training and process evaluation. MI can, however, be considered a useful tool for health education and warrants further study. MI can also be adapted to diverse health promotion scenarios. [Copyright &y& Elsevier]

Objective: Stroke survivors are at high risk of stroke recurrence yet current strategies to reduce recurrence risk are sub-optimal. The UK Medical Research Council (MRC) have proposed a framework for developing and evaluating complex interventions, such as community management of stroke secondary prevention. The Framework outlines a five-phased approach from theory through to implementation of effective interventions. This paper reports Phases I–III of the development of a novel intervention to improve risk factor management after stroke. Methods: The pre-clinical/theoretical phase entailed reviewing the literature and undertaking quantitative and qualitative studies to identify current practices and barriers to secondary prevention. In Phase I (modelling), findings were used to design an intervention with the potential to overcome barriers to effective stroke secondary prevention management. The feasibility of delivering the intervention and its acceptability were tested in the Phase II exploratory trial involving 25 stroke survivors and their general practitioners. Results: This led to the development of the definitive risk factor management intervention. This comprises multiple components and involves using an on-going population stroke register to target patients, carers and health care professionals with tailored secondary prevention advice. Clinical, socio-demographic and service use data collected by the stroke register are transformed to provide an individualised secondary prevention package for patients, carers and health care professionals at three time points: within 10 weeks, 3 and 6 months post-stroke. Conclusion: The intervention is currently being evaluated in a randomised controlled trial. Further research is needed to test generalisability to other aspects of stroke management and for other chronic diseases. Practice implications: The MRC Framework for complex interventions provides a structured approach to guide the development of novel interventions in public health. Implications for practice in stroke secondary prevention will emerge when the results of our randomised controlled trial are published. [Copyright &y& Elsevier]

Objective: The paper presents the development of a coding tool for self-efficacy orientated interventions in diabetes self-management programmes (Analysis System for Self-Efficacy Training, ASSET) and explores its construct validity and clinical utility. Methods: Based on four sources of self-efficacy (i.e., mastery experience, role modelling, verbal persuasion and physiological and affective states), published self-efficacy based interventions for diabetes care were analysed in order to identify specific verbal behavioural techniques. Video-recorded facilitating behaviours were evaluated using ASSET. Results: The reliability between four coders was high (K =0.71). ASSET enabled assessment of both self-efficacy based techniques and participants’ response to those techniques. Individual patterns of delivery and shifts over time across facilitators were found. In the presented intervention we observed that self-efficacy utterances were followed by longer patient verbal responses than non-self-efficacy utterances. Conclusion: These detailed analyses with ASSET provide rich data and give the researcher an insight into the underlying mechanism of the intervention process. Practice implications: By providing a detailed description of self-efficacy strategies ASSET can be used by health care professionals to guide reflective practice and support training programmes. [Copyright &y& Elsevier]

Objective: To provide health professionals involved in cervical cancer screening with an insight into the complex issues relating to communication about screening and to provide a framework for a more effective communication strategy. Methods: This paper has been compiled by a multidisciplinary pan-European group of health professionals and cancer advocates from several European screening programmes. European surveys on screening communication, literature reviews and group discussion were used for this purpose. Results: Information on cervical screening must be accessible, relevant, comprehensible, comprehensive, client-centred, phase-specific and multilevel. An effective communication strategy should consider health professionals’ screening knowledge and their communication skills, consumers’ health literacy skills and the communication needs of specific sub-groups in the target population. Co-operation between screening professionals, advocacy groups and journalists should be promoted. Conclusion: To communicate effectively and appropriately is a complex task which can be influenced by a number of factors. Screening workers need better information themselves and must take into account the needs and characteristics of the target population. Practice implications: This document should provide a useful tool to help screening professionals in designing and developing good quality and effective communication strategies. [Copyright &y& Elsevier]

Objective: Although there is broad consensus that careful content vetting and user testing is important in the development of technology-based educational interventions, often these steps are overlooked. This paper highlights the development of a theory-guided, web-based communication aid (CONNECT), designed to facilitate treatment decision-making among patients with advanced cancer.Methods: The communication aid included an on-line survey, patient skills training module and an automated physician report. Development steps included: (1) evidence-based content development; (2) usability testing; (3) pilot testing; and (4) patient utilization and satisfaction.Results: Usability testing identified some confusing directions and navigation for the on-line survey and validated the relevance of the "patient testimonials" in the skills module. Preliminary satisfaction from the implementation of the communication aid showed that 66% found the survey length reasonable and 70% found it helpful in talking with the physician. Seventy percent reported the skills module helpful and about half found it affected the consultation.Conclusion: Designing patient education interventions for translation into practice requires the integration of health communication best practice including user feedback along the developmental process.Practice Implications: This developmental process can be translated to a broad array of community-based patient and provider educational interventions. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This paper was prepared by the National Cancer Institute of Canada (NCIC) Working Group on Translational Research and Knowledge Transfer. The goal was to nurture common ground upon which to build a platform for translating what we know about cancer into what we do in practice and policy. METHODS: Methods included expert panels, literature review, and concept mapping, to develop a framework that built on earlier cancer control conceptualizations of communications that have guided researchers and end users. RESULTS: The concept of 'knowledge integration' is used to describe the resulting refinement and the nature of evidence necessary for decision-making to at the systems level. Current evidence for knowledge integration in cancer control is presented across the levels of individual, organizational and systems level interventions and across basic, clinical and population science knowledge bases. CONCLUSION: A systems-oriented approach to integrating evidence into action assists organizations to conduct research and policy and practice. PRACTICE IMPLICATIONS: Practitioners can use this framework to understand the challenges of implementing and evaluating cancer control strategies. [ABSTRACT FROM AUTHOR]

Objective: Immigrant populations are vulnerable to serious health disparities, with many immigrants experiencing significantly worse health outcomes, such as higher rates of morbidity and mortality, than other segments of society. Immigrants disproportionately suffer from heart attacks, cancer, diabetes, strokes, HIV/AIDS, and many other serious diseases. These health risks demand effective health communication to help immigrants recognize, minimize, and respond effectively to potential health problems. Yet, while the need for effective communication about health risks is particularly acute, it is also tremendously complicated to communicate effectively with these vulnerable populations. Methods: A literature review using online databases was performed. Results: Immigrants often have significant language and health literacy difficulties, which are further exacerbated by cultural barriers and economic challenges to accessing and making sense of relevant health information. Conclusion: This paper examined the challenges to communicating relevant information about health risks to vulnerable immigrant populations and suggested specific communication strategies for effectively reaching and influencing these groups of people to reduce health disparities and promote public health. Practice Implications: Communication interventions to educate vulnerable populations need to be strategic and evidence-based. It is important for health educators to adopt culturally sensitive communication practices to reach and influence vulnerable populations. Community participative communication interventions are a valuable strategy for integrating consumers' perspectives into health education efforts and building community commitment to health communication interventions. [ABSTRACT FROM AUTHOR]

Objective: Family caregivers play a significant role in the diagnosis, treatment, and recovery of individuals with cancer. This position paper reviews and links the research on family caregiving and health information with the importance of cancer literacy. Method: Review of literature obtained through searching in Academic Search Premier, EBSCO, Communication and Mass Media Complete, PsychArticles, PsycInfo, and Health Source: Nursing/Academic Edition library databases. Results: Family members are important sources of health information, informal caregivers who learn and enact medical procedures, and influential aspects of patients’ healthcare and treatment decision-making, but are not seriously considered by healthcare practitioners or researchers in terms of assessing and improving health literacy. Further, very few studies have directly examined or acknowledged the potential importance of family caregiver health literacy. Conclusion: The extent to which family caregivers can comprehend the health information they receive along with the patient is crucial for the patient to achieve the most successful health outcome. Practice implications: To acknowledge the impact that family caregiver health literacy could have on patient health outcomes, targeted practical recommendations for understanding family caregiver health literacy in the cancer context are proposed: (1) family member health literacy should be assessed; (2) close relational partners should be trained as peer health educators; (3) written cancer information should be provided directly to family caregivers; (4) health interactions between family caregivers and patients should be improved; (5) theoretical perspectives into the understanding of family caregiver health literacy should be integrated into practice; and (6) patient and family caregiver health literacy should be improved. [Copyright &y& Elsevier]

Objective: Although there is broad consensus that careful content vetting and user testing is important in the development of technology-based educational interventions, often these steps are overlooked. This paper highlights the development of a theory-guided, web-based communication aid (CONNECT™), designed to facilitate treatment decision-making among patients with advanced cancer. Methods: The communication aid included an on-line survey, patient skills training module and an automated physician report. Development steps included: (1) evidence-based content development; (2) usability testing; (3) pilot testing; and (4) patient utilization and satisfaction. Results: Usability testing identified some confusing directions and navigation for the on-line survey and validated the relevance of the “patient testimonials” in the skills module. Preliminary satisfaction from the implementation of the communication aid showed that 66% found the survey length reasonable and 70% found it helpful in talking with the physician. Seventy percent reported the skills module helpful and about half found it affected the consultation. Conclusion: Designing patient education interventions for translation into practice requires the integration of health communication best practice including user feedback along the developmental process. Practice implications: This developmental process can be translated to a broad array of community-based patient and provider educational interventions. [Copyright &y& Elsevier]

Objective: Immigrant populations are vulnerable to serious health disparities, with many immigrants experiencing significantly worse health outcomes, such as higher rates of morbidity and mortality, than other segments of society. Immigrants disproportionately suffer from heart attacks, cancer, diabetes, strokes, HIV/AIDS, and many other serious diseases. These health risks demand effective health communication to help immigrants recognize, minimize, and respond effectively to potential health problems. Yet, while the need for effective communication about health risks is particularly acute, it is also tremendously complicated to communicate effectively with these vulnerable populations. Methods: A literature review using online databases was performed. Results: Immigrants often have significant language and health literacy difficulties, which are further exacerbated by cultural barriers and economic challenges to accessing and making sense of relevant health information. Conclusion: This paper examined the challenges to communicating relevant information about health risks to vulnerable immigrant populations and suggested specific communication strategies for effectively reaching and influencing these groups of people to reduce health disparities and promote public health. Practice implications: Communication interventions to educate vulnerable populations need to be strategic and evidence-based. It is important for health educators to adopt culturally sensitive communication practices to reach and influence vulnerable populations. Community participative communication interventions are a valuable strategy for integrating consumers’ perspectives into health education efforts and building community commitment to health communication interventions. [Copyright &y& Elsevier]

Objective: This paper was prepared by the National Cancer Institute of Canada (NCIC) Working Group on Translational Research and Knowledge Transfer. The goal was to nurture common ground upon which to build a platform for translating what we know about cancer into what we do in practice and policy. Methods: Methods included expert panels, literature review, and concept mapping, to develop a framework that built on earlier cancer control conceptualizations of communications that have guided researchers and end users. Results: The concept of ‘knowledge integration’ is used to describe the resulting refinement and the nature of evidence necessary for decision-making to at the systems level. Current evidence for knowledge integration in cancer control is presented across the levels of individual, organizational and systems level interventions and across basic, clinical and population science knowledge bases. Conclusion: A systems-oriented approach to integrating evidence into action assists organizations to conduct research and policy and practice. Practice implications: Practitioners can use this framework to understand the challenges of implementing and evaluating cancer control strategies. [Copyright &y& Elsevier]

Objective: The physiological, cognitive, language and communicative changes that take place as we enter into old age have become quite well documented within the social scientific literature. Many of these changes lead in some way to a lessening of previous interactive abilities and competencies. The new mantra for gerontologists attempting to help older adults compensate for these potential losses is to develop strategies to maintain existing abilities as long as possible. Methods: A literature review using online databases was performed. Results: Older adults who are diagnosed with cancer or help care for an individual coping with cancer must confront a health care system that demands a high level of health literacy to successfully manage the disease. Older adults may be at a distinct disadvantage in their ability to successfully cope with cancer because of age-related physiological, cognitive, psychological and communicative factors. Conclusion: This paper highlights the relevant research findings and theoretical positioning that points not only to possible pragmatic dilemmas faced by those adapting to cancer but also highlights streams of research that scholars may wish to focus upon to better understand how older adults and their formal and informal caregivers can improve their cancer health literacy. Practice implications: Providers, patients, and caregivers must all participate in creating a health care environment of shared meaning and understanding of health messages tailored to the aging patient diagnosed with cancer. Health communication scholars have various theoretical, methodological, and pragmatic communication-based approaches that provide important contributions to the complexities of caring for the aging patient. [Copyright &y& Elsevier]

OBJECTIVE: To describe the form and content of ethics policies on euthanasia in Flemish hospitals and the possible influence of religious affiliation on policy content. METHODS: Content analysis of policy documents. RESULTS: Forty-two documents were analyzed. All policies contained procedures; 57% included the position paper on which the hospital's stance on euthanasia was based. All policies described their hospital's stance on euthanasia in competent terminally ill patients (n=42); 10 and 4 policies, respectively, did not describe their stance in incompetent terminally and non-terminally ill patients. Catholic hospitals restrictively applied the euthanasia law with palliative procedures and interdisciplinary deliberations. The policies described several phases of the euthanasia care process - confrontation with euthanasia request (93%), decision-making process (95%), care process in cases of no-euthanasia decision (38%), preparation and performance of euthanasia (79%), and aftercare (81%) - as well as involvement of caregivers, patients, and relatives; ethical issues; support for caregivers; reporting; and practical examples of professional attitudes and communication skills. CONCLUSION: Euthanasia policies go beyond summarizing the euthanasia law by addressing the importance of the euthanasia care process, in which palliative care and interdisciplinary cooperation are important factors. PRACTICE IMPLICATIONS: Euthanasia policies provide tangible guidance for physicians and nurses on handling euthanasia requests. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe the form and content of ethics policies on euthanasia in Flemish hospitals and the possible influence of religious affiliation on policy content. Methods: Content analysis of policy documents. Results: Forty-two documents were analyzed. All policies contained procedures; 57% included the position paper on which the hospital''s stance on euthanasia was based. All policies described their hospital''s stance on euthanasia in competent terminally ill patients (n =42); 10 and 4 policies, respectively, did not describe their stance in incompetent terminally and non-terminally ill patients. Catholic hospitals restrictively applied the euthanasia law with palliative procedures and interdisciplinary deliberations. The policies described several phases of the euthanasia care process – confrontation with euthanasia request (93%), decision-making process (95%), care process in cases of no-euthanasia decision (38%), preparation and performance of euthanasia (79%), and aftercare (81%) – as well as involvement of caregivers, patients, and relatives; ethical issues; support for caregivers; reporting; and practical examples of professional attitudes and communication skills. Conclusion: Euthanasia policies go beyond summarizing the euthanasia law by addressing the importance of the euthanasia care process, in which palliative care and interdisciplinary cooperation are important factors. Practice implications: Euthanasia policies provide tangible guidance for physicians and nurses on handling euthanasia requests. [Copyright &y& Elsevier]

Abstract: Objective: This paper describes the development of a physical training programme for cancer patients. Four related but conceptually and empirically distinct physical problems are described: decreased aerobic capacity, decreased muscle strength, fatigue and impaired role physical functioning. The study aimed to identify the optimal content for an exercise programme that addresses these four physical problems, based on the highest level of evidence available. The study further aimed to review the evidence available on the delivery of the programmes. The final goal was to develop a programme in which content and delivery are based on the best available evidence. Methods: Literature searches (PUBMED and MEDLINE, to July 2006) on content looked for evidence about the efficacy of exercise on aerobic capacity, muscle strength, fatigue and impaired role physical functioning. Literature searches on delivery looked for self-management and/or self-efficacy enhancing techniques in relation to outcome, adherence to and/or adoption of a physically active lifestyle. Results: Evidence on the effectiveness of exercise in cancer patients varies and increases when moving from muscle strength (RCT level), fatigue and physical role functioning to aerobic capacity (all at the meta-analysis level). Effect sizes for aerobic capacity were moderate, while effect sizes for fatigue and physical role functioning were zero and/or small. Many of the studies have significant methodological shortcomings. There was some evidence (meta-analyses) that self-management programmes and self-efficacy enhancing programmes have beneficial effects on health outcomes in a variety of chronic diseases, on the quality of life in cancer patients, and on exercise adherence and later exercise behaviour. Conclusion: Limited data are available on the effectiveness of exercise for cancer patients. Although evidence supports the positive effects of exercise on exercise capacity during and after completion of cancer treatment, the effects for fatigue and role functioning are ambiguous. Evidence on the effectiveness of progressive exercise training on muscle strength is promising. In addition, some evidence supports the positive effects of self-management programmes and self-efficacy enhancing programmes on health outcomes, exercise adherence and later exercise behaviour. Practice Implications: The resulting programme was developed on the basis of the highest quality of evidence available regarding content and delivery. The content is based on information obtained from the present review, and on the recommendations of the American College of Sports Medicine. Potential advantages of the programme include: (a) tailored physical training towards focusing on the patient''s established problems and (b) delivery of the training as a self-management programme that might have beneficial effects on health outcome, exercise adherence and a long-term physically active lifestyle. [Copyright &y& Elsevier]

Abstract: Objective: The objectives of this paper were to identify specific factors associated with intact or disrupted social connectedness among Dominican women with chronic filarial lymphedema and better understand the impact of disrupted connectedness on their lives. Methods: Data were collected through 28 individual interviews and 3 focus group discussions of 28 women from filariasis-endemic areas of the Dominican Republic presenting with lymphedema of one or both legs. Results: The confluence of chronic and acute stressors with severity of lymphedema lead women to rely on others for social support. Women described complications of aging, disability, reduced social networks, and inability to adhere to cultural scripts as contributing to disrupted social connectedness. Conclusion: Social disconnectedness appears to exacerbate the negative consequences of living with lymphedema among women. Social connectedness and cultural scripts often define a social role for women that transcend physical deformity and disability, while disrupted social connectedness contributes to social isolation, depressive symptoms, and poor health outcomes. Practice implications: Further behavioral research into the contribution of intact social connectedness to resiliency and coping is warranted in order to develop effective interventions for women. Identifying women with disrupted social connectedness and engaging them in behavioral interventions to enhance natural social networks and create new or enhanced social support opportunities may mitigate the negative effects of social disconnectedness and improve quality of life. [Copyright &y& Elsevier]

OBJECTIVE: Active listening is a prerequisite for a successful healthcare encounter, bearing potential therapeutic value especially in clinical situations that require no specific medical intervention. Although generally acknowledged as such, active listening has not been studied in depth. This paper describes the development of the Active Listening Observation Scale (ALOS-global), an observation instrument measuring active listening and its validation in a sample of general practice consultations for minor ailments. METHODS: Five hundred and twenty-four videotaped general practice consultations involving minor ailments were observed with the ALOS-global. Hypotheses were tested to determine validity, incorporating patients' perception of GPs' affective performance, GPs' verbal attention, patients' self-reported anxiety level and gender differences. RESULTS: The final 7-item ALOS-global had acceptable inter- and intra-observer agreement. Factor analysis revealed one homogeneous dimension. The scalescore was positively related to verbal attention measured by RIAS, to patients' perception of GPs' performance and to their pre-visit anxiety level. Female GPs received higher active listening scores. CONCLUSION: The results of this study are promising concerning the psychometric properties of the ALOS-global. More research is needed to confirm these preliminary findings. PRACTICE IMPLICATIONS: After establishing how active listening differentiates between health professionals, the ALOS-global may become a valuable tool in feedback and training aimed at increasing listening skills. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Active listening is a prerequisite for a successful healthcare encounter, bearing potential therapeutic value especially in clinical situations that require no specific medical intervention. Although generally acknowledged as such, active listening has not been studied in depth. This paper describes the development of the Active Listening Observation Scale (ALOS-global), an observation instrument measuring active listening and its validation in a sample of general practice consultations for minor ailments. Methods: Five hundred and twenty-four videotaped general practice consultations involving minor ailments were observed with the ALOS-global. Hypotheses were tested to determine validity, incorporating patients’ perception of GPs’ affective performance, GPs’ verbal attention, patients’ self-reported anxiety level and gender differences. Results: The final 7-item ALOS-global had acceptable inter- and intra-observer agreement. Factor analysis revealed one homogeneous dimension. The scalescore was positively related to verbal attention measured by RIAS, to patients’ perception of GPs’ performance and to their pre-visit anxiety level. Female GPs received higher active listening scores. Conclusion: The results of this study are promising concerning the psychometric properties of the ALOS-global. More research is needed to confirm these preliminary findings. Practice implications: After establishing how active listening differentiates between health professionals, the ALOS-global may become a valuable tool in feedback and training aimed at increasing listening skills. [Copyright &y& Elsevier]

Objective: The objective of the present paper was to determine the association between parent-provider communication and parent ratings of satisfaction and quality of care for a group of parents of children identified with a psychosocial problem.Methods: A sample of 804 parents of children with psychosocial concerns enrolled in the Child Behavior Study (CBS) was used for the present analyses. As part of the CBS, parents of children with psychosocial problems answered questions that assessed parent-provider communication and parent ratings of satisfaction and quality of care.Results: Overall, parents reported good communication with their child's provider. Eighty-two percent of parents were very satisfied with the care received and 68% reported a very high quality of care. Parent-provider communication (e.g., collaboration and mutual understanding) was strongly related to parental reports of both satisfaction and quality of care.Conclusions: Parent-provider communication is an important correlate of parental report of satisfaction and quality of care. Involvement of parents in the treatment planning process was particularly important in determining satisfaction and quality ratings within this sample.Practice Implications: When working with families with identified psychosocial concerns, the use of collaboration and an empathic style by providers may enhance the quality of care parents report receiving from their primary care clinicians. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective of the present paper was to determine the association between parent–provider communication and parent ratings of satisfaction and quality of care for a group of parents of children identified with a psychosocial problem. Methods: A sample of 804 parents of children with psychosocial concerns enrolled in the Child Behavior Study (CBS) was used for the present analyses. As part of the CBS, parents of children with psychosocial problems answered questions that assessed parent–provider communication and parent ratings of satisfaction and quality of care. Results: Overall, parents reported good communication with their child''s provider. Eighty-two percent of parents were very satisfied with the care received and 68% reported a very high quality of care. Parent–provider communication (e.g., collaboration and mutual understanding) was strongly related to parental reports of both satisfaction and quality of care. Conclusions: Parent–provider communication is an important correlate of parental report of satisfaction and quality of care. Involvement of parents in the treatment planning process was particularly important in determining satisfaction and quality ratings within this sample. Practice implications: When working with families with identified psychosocial concerns, the use of collaboration and an empathic style by providers may enhance the quality of care parents report receiving from their primary care clinicians. [Copyright &y& Elsevier]

OBJECTIVE: Basic research and careful observation of clinical practice have yielded a vast amount of empirical data on communication in health care. This research has been guided by the assumption that good communication will be better understood and easier to teach when its single constituents are identified. This paper points to the limitation of this approach. METHODS: Based upon the terminology of phenomenological thinking grounded in neo-phenomenology (Hermann Schmitz) contradictory findings from the literature on patient-centred communication in Internal Medicine and Oncology are used as a starting point to elucidate different paradigms in conducting research in clinical communication. RESULTS: The phenomenological approach of the German philosopher Hermann Schmitz ((*)1928) is briefly presented. It is based upon experiences that 'on the average everybody can vividly access or retrieve from his memory'. Empirical research does not provide unequivocal advice how to communicate with an individual patient. Likewise, researchers note unexpected reactions from real patients-they do not behave as the expert would assume. The inclusion of the phenomenon of a certain atmosphere is proposed referring to the impression of 'something in the air' that sometimes can be identified during communication or upon entering a room. Even though it can be sensed with high evidence, it cannot be deduced from particular observations. Instead, the atmosphere is part of a situation in which meaning is dissolved in chaotic manifoldness. Sensing an atmosphere is a function of the lived body (Leib) as opposed to phenomena that are mediated by the senses. CONCLUSION: Current research and teaching models cover only part of the phenomenology of professional communication. How research and education might profit from the addition of Schmitz' philosophical approach will be outlined in this article. PRACTICE IMPLICATIONS: Including perceptions of the lived body (Leib) should improve research in clinical communication and teaching courses. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Describe the content and of mode of patient-physician-nurse interactions during ward-rounds in Internal Medicine. METHODS: In 267/448 patients, 13 nurses, and 8 physicians from two wards in General Internal Medicine 448 interactions on ward rounds were tape recorded by observers. After exclusion of interactions with more than three participants (N=150), a random sample of 90 interactions was drawn. Data were analysed with a modified RIAS version that allowed for the registration of a third contributor and for the assessment of the direction of a communicative action (e.g.: nurse-->patient, etc.). Furthermore, time spent per individual patient was registered with a stop-watch. RESULTS: A total of 12,078 utterances (144 per ward round) were recorded. Due to problems with the comprehensibility of some interactions the final data set contains 71 ward round interactions with 10,713 utterances (151 per ward round interaction). The average time allotted to an individual patient during ward-rounds was 7.5min (range: 3-16min). The exchange of medical information is the main topic in physicians (39%) and nurses (25%), second common topic in patients (28%), in whom communicative actions like agreement or checking are more common (30% patients/25% physicians/22% nurses). Physicians and patients use a substantial number of communicative actions (1397/5531 physicians; 1119/3733 patients). Patients receive about 20 bits of medical or therapeutic information per contact during ward-rounds. CONCLUSIONS: If ward rounds serve as the central marketplace of information nurses' knowledge is under-represented. Further research should try to determine whether the quality of patient care is related to a well balanced exchange of information, to which nurses, physicians, and patients contribute their specific knowledge. PRACTICE IMPLICATIONS: Given the fact that in-patients in Interna Medicine usually present complex problems, the exchange of factual information, expectations, and concepts is of paramount importance. We hope that this paper is going to direct the attention of the scientific community to the characteristics of ward-rounds because they will remain the central marketplace of communication in hospital. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This paper explores physician perceptions of the ways professional and family interpreters affect their performance of doctor-communication tasks described in the Calgary-Cambridge Framework. METHODS: Physicians' (19) encounters with patients (24) accompanied by an interpreter were videotaped. Stimulated recall was used to elicit each of the participants' perceptions of the clinical encounter. We analyzed transcriptions of the physician interviews using Atlas-ti software. RESULTS: Physicians perceived all communication tasks to be more difficult using an interpreter than when one was not needed. Physicians perceived family interpreters to be less skilled translators than professional interpreters. Physicians expected professional interpreters to serve as culture brokers at least some of the time. Although only some family interpreters were also caregivers, physicians assumed that all of them fulfilled caregiver roles. CONCLUSION: With professional interpreters, physicians follow communication rules they were taught. In contrast, physicians act as though these rules are not relevant with family interpreters who they treat as caregivers. PRACTICE IMPLICATIONS: Guidelines to working with an interpreter should include directives on working with both professional and family interpreters, describing the similarities and differences with each type, and modifying the clinical encounter process to correspond to those attributes. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Basic research and careful observation of clinical practice have yielded a vast amount of empirical data on communication in health care. This research has been guided by the assumption that good communication will be better understood and easier to teach when its single constituents are identified. This paper points to the limitation of this approach. Methods: Based upon the terminology of phenomenological thinking grounded in neo-phenomenology (Hermann Schmitz) contradictory findings from the literature on patient-centred communication in Internal Medicine and Oncology are used as a starting point to elucidate different paradigms in conducting research in clinical communication. Results: The phenomenological approach of the German philosopher Hermann Schmitz (*1928) is briefly presented. It is based upon experiences that ‘on the average everybody can vividly access or retrieve from his memory’. Empirical research does not provide unequivocal advice how to communicate with an individual patient. Likewise, researchers note unexpected reactions from real patients—they do not behave as the expert would assume. The inclusion of the phenomenon of a certain atmosphere is proposed referring to the impression of ‘something in the air’ that sometimes can be identified during communication or upon entering a room. Even though it can be sensed with high evidence, it cannot be deduced from particular observations. Instead, the atmosphere is part of a situation in which meaning is dissolved in chaotic manifoldness. Sensing an atmosphere is a function of the lived body (Leib) as opposed to phenomena that are mediated by the senses. Conclusion: Current research and teaching models cover only part of the phenomenology of professional communication. How research and education might profit from the addition of Schmitz’ philosophical approach will be outlined in this article. Practice implications: Including perceptions of the lived body (Leib) should improve research in clinical communication and teaching courses. [Copyright &y& Elsevier]

Objective: Many people are concerned about their family history of breast cancer, and are anxious about the possibility of developing breast cancer themselves. The majority of these people are likely not to be at significantly increased risk of developing inherited breast cancer. All women are at risk of developing sporadic breast cancer, and this risk increases with age. This project aims to aid people's understanding of these issues using an interactive online computer programme. Methods: The UK National Institute of Health and Clinical Excellence has published guidance for the National Health Service on the management of familial breast cancer. That guidance lays down clear criteria for categorising risk level and the appropriate management options. We have developed a user-friendly computer programme named OPERA (online patient education and risk assessment) which captures the individuality of the user's situation in a comprehensive way, and then produces personalised information packages, building on the theoretical framework of argumentation developed by Toulmin [Toulmin S. The uses of argument. Cambridge, MA: Cambridge University Press; 1958]. We will test this programme in a series of pilot studies commencing in 2007. Results: This paper describes the progress of this project to date and focuses on the design of the programme. Conclusion: It is possible to construct a user friendly programme which delivers a personalised information package to individuals who are concerned about their risk of developing breast cancer. Practice Implications: This user friendly programme needs to be tested within a series of carefully thought out pilot studies before it is ready for general release and use by the public. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Describe the content and of mode of patient–physician–nurse interactions during ward-rounds in Internal Medicine. Methods: In 267/448 patients, 13 nurses, and 8 physicians from two wards in General Internal Medicine 448 interactions on ward rounds were tape recorded by observers. After exclusion of interactions with more than three participants (N =150), a random sample of 90 interactions was drawn. Data were analysed with a modified RIAS version that allowed for the registration of a third contributor and for the assessment of the direction of a communicative action (e.g.: nurse→patient, etc.). Furthermore, time spent per individual patient was registered with a stop-watch. Results: A total of 12,078 utterances (144 per ward round) were recorded. Due to problems with the comprehensibility of some interactions the final data set contains 71 ward round interactions with 10,713 utterances (151 per ward round interaction). The average time allotted to an individual patient during ward-rounds was 7.5min (range: 3–16min). The exchange of medical information is the main topic in physicians (39%) and nurses (25%), second common topic in patients (28%), in whom communicative actions like agreement or checking are more common (30% patients/25% physicians/22% nurses). Physicians and patients use a substantial number of communicative actions (1397/5531 physicians; 1119/3733 patients). Patients receive about 20 bits of medical or therapeutic information per contact during ward-rounds. Conclusions: If ward rounds serve as the central marketplace of information nurses’ knowledge is under-represented. Further research should try to determine whether the quality of patient care is related to a well balanced exchange of information, to which nurses, physicians, and patients contribute their specific knowledge. Practice implications: Given the fact that in-patients in Interna Medicine usually present complex problems, the exchange of factual information, expectations, and concepts is of paramount importance. We hope that this paper is going to direct the attention of the scientific community to the characteristics of ward-rounds because they will remain the central marketplace of communication in hospital. [Copyright &y& Elsevier]

Abstract: Objective: The goal of this paper is to show that nonverbal aspects in the physician–patient interaction play an important role. Interpersonal judgment relies mostly on nonverbal and appearance cues of the social interaction partner. This is also true for the physician–patient interaction. Moreover, physicians and patients tend to mirror some of their nonverbal behavior and complement each other on other aspects of their nonverbal behavior. Nonverbal cues emitted by the patient can contain important information for the doctor to use for treatment and diagnosis decisions. Conclusion: The way the physician behaves nonverbally affects patient outcomes, such as, for instance, patient satisfaction. Affilliative nonverbal behavior (e.g., eye gaze and proximity) of the physician is related to higher patient satisfaction. However, how different physician nonverbal behaviors are related to patient satisfaction also depends on personal attributes of the physician such as gender, for instance. Practice implications: Physician training could profit from incorporating knowledge about physician and patient nonverbal behavior. [Copyright &y& Elsevier]

Abstract: Objective: This paper explores physician perceptions of the ways professional and family interpreters affect their performance of doctor-communication tasks described in the Calgary-Cambridge Framework. Methods: Physicians’ (19) encounters with patients (24) accompanied by an interpreter were videotaped. Stimulated recall was used to elicit each of the participants’ perceptions of the clinical encounter. We analyzed transcriptions of the physician interviews using Atlas-ti software. Results: Physicians perceived all communication tasks to be more difficult using an interpreter than when one was not needed. Physicians perceived family interpreters to be less skilled translators than professional interpreters. Physicians expected professional interpreters to serve as culture brokers at least some of the time. Although only some family interpreters were also caregivers, physicians assumed that all of them fulfilled caregiver roles. Conclusion: With professional interpreters, physicians follow communication rules they were taught. In contrast, physicians act as though these rules are not relevant with family interpreters who they treat as caregivers. Practice implications: Guidelines to working with an interpreter should include directives on working with both professional and family interpreters, describing the similarities and differences with each type, and modifying the clinical encounter process to correspond to those attributes. [Copyright &y& Elsevier]

Abstract: Objective: Many people are concerned about their family history of breast cancer, and are anxious about the possibility of developing breast cancer themselves. The majority of these people are likely not to be at significantly increased risk of developing inherited breast cancer. All women are at risk of developing sporadic breast cancer, and this risk increases with age. This project aims to aid people''s understanding of these issues using an interactive online computer programme. Methods: The UK National Institute of Health and Clinical Excellence has published guidance for the National Health Service on the management of familial breast cancer. That guidance lays down clear criteria for categorising risk level and the appropriate management options. We have developed a user-friendly computer programme named OPERA (online patient education and risk assessment) which captures the individuality of the user''s situation in a comprehensive way, and then produces personalised information packages, building on the theoretical framework of argumentation developed by Toulmin [Toulmin S. The uses of argument. Cambridge, MA: Cambridge University Press; 1958]. We will test this programme in a series of pilot studies commencing in 2007. Results: This paper describes the progress of this project to date and focuses on the design of the programme. Conclusion: It is possible to construct a user friendly programme which delivers a personalised information package to individuals who are concerned about their risk of developing breast cancer. Practice implications: This user friendly programme needs to be tested within a series of carefully thought out pilot studies before it is ready for general release and use by the public. [Copyright &y& Elsevier]

Abstract: Objective: Based on Weissman and Hackett''s comprehensive definition of denial, a semi-structured interview was developed to measure denial in cancer patients. The denial in cancer interview (DCI) covers both the patients’ recount of their illness experience and the expert''s impression of the level of denial in the patient story. This paper describes the development and first psychometric analyses of the instrument. Method: The development of the DCI was based on clinical observation, the expert opinion of eight specialised psychiatrist as well as three small pilot studies to assess feasibility. The DCI is composed of two parts: a semi-structured interview consisting of nine specific items to be answered by the patient and two items covering the interviewer''s clinical impression of the patient''s type and level of denial. Follow-up interviews were held at 8, 16 and 32 weeks after the baseline assessment (T2–4). To measure the inter-rater reliability, interviews were recorded and rated independently by one interviewer and one of the study''s co-workers. Results: One hundred and ninety-five consecutive newly diagnosed lung cancer patients were interviewed. The internal consistency of the DCI (Cronbach''s α) was 0.84 at first interview and 0.85, 0.82 and 0.83 at T2–4, respectively. The inter-rater agreement was good for the DCI overall and the patient''s assessment scale, and satisfactory for the clinical impression items. Content validity was supported by clinical observation, in depth open interviewing and expert opinion. Conclusion: The DCI proved to be a feasible and reliable instrument for measuring denial in lung cancer patients. Further testing in other oncology settings will provide insight in wider applicability. Practice implications: The DCI can be used in future studies concerning denial in cancer patients. Insight in denial and its background will help us to adequately address denial in patients and communicate with them. [Copyright &y& Elsevier]

Abstract: Objectives: Limited research exists addressing issues of website development and attitudes towards websites that promote physical activity. This paper describes the design and process evaluation of a physical activity intervention, from a randomised trial (RT) that examined the effectiveness of delivery modes (face-to-face, Internet-mediated (combined Internet and face-to-face) and Internet-only). Methods: Evaluation surveys were completed at the end of the RT intervention (n =159), and a random sample (n =23) participated in focus group discussions. Differences were assessed using ANOVA, t-tests, and qualitative analysis. Results: Face-to-face participants were more satisfied with their group allocation than the Internet groups. Internet groups reported accessing the Internet at home, and that they liked the self-paced nature of the website. Difficulties associated with time and motivation were raised by the Internet groups. No differences were found for content acceptability and credibility. Website usability scores were high for both Internet groups. Conclusion: These findings support the use of the Internet in terms of content satisfaction and usability; however, issues were raised regarding the acceptability of an Internet-based program when traditional face-to-face delivery options are available. Practice implications: Identifying avenues to support user perceptions of ‘motivation’, and mechanisms for enhancing engagement and retention, and user acceptability are required. [Copyright &y& Elsevier]

Abstract: Objective: To analyze which factors contribute to improvement in glycemic control in educational interventions in type 2 diabetes reported in randomized controlled trials (RCT) published in 2001–2005. Methods: Papers were extracted from Medline and Scopus using educational intervention and adults with type 2 diabetes as keywords. Inclusion criteria were RCT design. Data were analyzed with a data-mining program. Results: Of 464 titles extracted, 21 articles reporting 18 studies met the inclusion criteria. Data mining showed that for initial glycosylated hemoglobin (HbA1c) level ≤7.9% the diabetes education intervention achieved a small change in HbA1c level, or from +0.1 to −0.7%. For initial HbA1c ≥8.0%, a significant drop in HbA1c level of 0.8–2.5% was found. Data mining indicated that duration, educational content and intensity of education did not predict changes in HbA1c levels. Conclusion: Initial HbA1c level is the single most important factor affecting improvements in glycemic control in response to patient education. Data mining is an appropriate and sufficiently sensitive method to analyze outcomes of educational interventions. Diversity in conceptualization of interventions and diversity of instruments used for outcome measurements could have hampered actual discovery of effective educational practices. Practice implications: Participation in educational interventions generally seems to benefit people with type 2 diabetes. Use of standardized instruments is encouraged as it gives better opportunities to identify conclusive results with consequent development of clinical guidelines. [Copyright &y& Elsevier]

OBJECTIVE: There are several measurement tools to assess verbal dimensions in clinical encounters; in contrast, there is no established tool to evaluate physical nonverbal dimensions in geriatric encounters. The present paper describes the development of a tool to assess the physical context of exam rooms in doctor-older patient visits. METHOD: Salient features of the tool were derived from the medical literature and systematic observations of videotapes and refined during current research. RESULTS: The tool consists of two main dimensions of exam rooms: (1) physical dimensions comprising static and dynamic attributes that become operational through the spatial configuration and can influence the manifestation of (2) kinesic attributes. CONCLUSION: Details of the coding form and inter-rater reliability are presented. The usefulness of the tool is demonstrated through an analysis of 50 National Institute of Aging videotapes. Physicians in exam rooms with no desk in the interaction, no height difference and optimal interaction distance were observed to have greater eye contact and touch than physicians' in exam rooms with a desk, similar height difference and interaction distance. PRACTICE IMPLICATIONS: The tool can enable physicians to assess the spatial configuration of exam rooms (through Parts A and B) and thus facilitate the structuring of kinesic attributes (Part C). [ABSTRACT FROM AUTHOR]

Abstract: Objective: There are several measurement tools to assess verbal dimensions in clinical encounters; in contrast, there is no established tool to evaluate physical nonverbal dimensions in geriatric encounters. The present paper describes the development of a tool to assess the physical context of exam rooms in doctor–older patient visits. Method: Salient features of the tool were derived from the medical literature and systematic observations of videotapes and refined during current research. Results: The tool consists of two main dimensions of exam rooms: (1) physical dimensions comprising static and dynamic attributes that become operational through the spatial configuration and can influence the manifestation of (2) kinesic attributes. Conclusion: Details of the coding form and inter-rater reliability are presented. The usefulness of the tool is demonstrated through an analysis of 50 National Institute of Aging videotapes. Physicians in exam rooms with no desk in the interaction, no height difference and optimal interaction distance were observed to have greater eye contact and touch than physicians’ in exam rooms with a desk, similar height difference and interaction distance. Practice implications: The tool can enable physicians to assess the spatial configuration of exam rooms (through Parts A and B) and thus facilitate the structuring of kinesic attributes (Part C). [Copyright &y& Elsevier]

Abstract: Objective: This paper describes the development and validation of the Health Education Impact Questionnaire (heiQ). The aim was to develop a user-friendly, relevant, and psychometrically sound instrument for the comprehensive evaluation of patient education programs, which can be applied across a broad range of chronic conditions. Methods: Item development for the heiQ was guided by a Program Logic Model, Concept Mapping, interviews with stakeholders and psychometric analyses. Construction (N =591) and confirmatory (N =598) samples were drawn from consumers of patient education programs and hospital outpatients. The properties of the heiQ were investigated using item response theory and structural equation modeling. Results: Over 90 candidate items were generated, with 42 items selected for inclusion in the final scale. Eight independent dimensions were derived: Positive and Active Engagement in Life (five items, Cronbach''s alpha (α)=0.86); Health Directed Behavior (four items, α =0.80); Skill and Technique Acquisition (five items, α =0.81); Constructive Attitudes and Approaches (five items, α =0.81); Self-Monitoring and Insight (seven items, α =0.70); Health Service Navigation (five items, α =0.82); Social Integration and Support (five items, α =0.86); and Emotional Wellbeing (six items, α =0.89). Conclusion: The heiQ has high construct validity and is a reliable measure of a broad range of patient education program benefits. Practice Implications: The heiQ will provide valuable information to clinicians, researchers, policymakers and other stakeholders about the value of patient education programs in chronic disease management. [Copyright &y& Elsevier]

Abstract: Objective: This paper examines how the term “empowerment” has been used in relation to the care and education of patients with chronic conditions over the past decade. Methods: Fifty-five articles were analysed, using a qualitative method of thematic analysis. Results: Empowerment is more often defined according to some of its anticipated outcomes rather than to its very nature. However, because they do not respect the principle of self-determination, most anticipated outcomes and most evaluation criteria are not specific to empowerment. Concerning the process of empowerment, our analysis shows that (i) the educational objectives of an empowerment-based approach are not disease-specific, but concern the reinforcement or development of general psychosocial skills instead; (ii) empowering methods of education are necessarily patient-centred and based on experiential learning; and (iii) the provider–patient relationship needs to be continuous and self-involving on both sides. Conclusion: Our analysis did not allow for the unfolding of a well-articulated theory on patient empowerment but revealed a number of guiding principles and values. Practice implications: The goals and outcomes of patient empowerment should neither be predefined by the health-care professionals, nor restricted to some disease and treatment-related outcomes, but should be discussed and negotiated with every patient, according to his/her own particular situation and life priorities. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the use of computer-based softwares for educating patients with coronary heart disease. Methods: A systematic electronic search for randomised controlled trials and comparison studies published from 1999 to the end of 2005 using the MEDLINE (1999–2005), EMBASE (1999–2005) and CINAHL (1999–2005) was carried out. Articles including the reference lists in the following journals were hand-searched: Patient Education and Counselling and Patient Counselling and Health Education. Results: A total of 487 articles were identified. Based on a review of abstracts, five studies fulfilled the inclusion criteria of the review. A scoring sheet was used to assess the papers’ quality. All studies reported significantly increased knowledge in patients using the educational software when compared to standard education. The difference in knowledge between the intervention and control groups remained high even at 6 months follow up. Furthermore, patients reported high satisfaction with the educational programs. Conclusion: Despite there only being five studies that met the inclusion criteria, this review supports the successful use of computer software to increase knowledge in patients with coronary heart disease. The reviewed articles reveal that computer-based education has an important role in increasing patients’ knowledge about their condition. Practical implications: It is commonly reported that patients want more information about their illness. This study shows that computer-based education can be a useful, acceptable to patients and effective way to deliver education about coronary heart disease. [Copyright &y& Elsevier]

Abstract: Objective: This paper will report the results of a pilot test of a 6-month, 21-session intervention to increase breast cancer survivors’ physical activity by teaching them to incorporate short periods of moderate activity into their daily routines (lifestyle intervention). The effect of the intervention on physical performance, quality of life, and physical activity are reported. Methods: Sixty breast cancer survivors were randomized to either a lifestyle intervention or a standard care control group. Physical performance, quality of life (Medical outcomes study short form-36 [SF-36]), and physical activity (7-day recall and motivation readiness), were assessed at baseline and 6 months. Results: The lifestyle group had significantly better performance in the 6-min walk task than the controls (p =0.005) at 6 months. The intervention had positive effects on the bodily pain (p =0.020) and general health (p =0.006) subscales from the SF-36. The lifestyle group had a greater motivational readiness for physical activity at 6-month than standard care, but no significant differences were seen between the two in terms of number of minutes of moderate or more intense physical activity or number of days on which they did ≥30min of moderate or more intense activity. Conclusions: Despite the small sample size, the lifestyle intervention showed promise for improving physical functioning and quality of life and increasing physical activity, and should be tested in a larger randomized trial. Practice Implications: If the lifestyle approach is shown to be effective in a larger trial, it represents a highly feasible intervention that it can be delivered to cancer survivors by health care institutions or community organizations without dedicated exercise facilities and equipment. [Copyright &y& Elsevier]

Abstract: Objective: While recent studies of organ donation have recognized cultural factors, most analyses in developed countries have focused on awareness as the critical constraint. The present paper examines this assumption and assesses the number of potential organ donors as well as their knowledge and attitudes regarding organ donation. Methods: We conducted a telephone survey of 1509 adults using a stratified random sample of the main three language groups (German, French, and Italian) in Switzerland with oversampling of the Italian language group to compensate for its relatively small size. Because our analyses are performed separately on each language group, the oversampling does not distort our findings. Results: The three language groups display substantial differences with respect to patterns of knowledge, motives, and concerns underlying their willingness to donate organs—differences that persist even in the context of strong national identity, relatively homogeneous cultural background, and the public good nature of organ donation. Conclusion: The results demonstrate a need to consider and address cultural factors and barriers when designing organ donation campaigns. Practice implications: Centrally designed organ donation campaigns are not likely to be effective and efficient. Message strategies should rather be tailored to different (micro-) cultural groups. [Copyright &y& Elsevier]

Abstract: Objective: Culture and ethnicity have often been cited as barriers in establishing an effective and satisfying doctor–patient relationship. The aim of this paper is to gain more insight in intercultural medical communication difficulties by reviewing observational studies on intercultural doctor–patient communication. In addition, a research model for studying this topic in future research is proposed. Methods: A literature review using online databases (Pubmed, Psychlit) was performed. Results: Findings reveal major differences in doctor–patient communication as a consequence of patients’ ethnic backgrounds. Doctors behave less affectively when interacting with ethnic minority patients compared to White patients. Ethnic minority patients themselves are also less verbally expressive; they seem to be less assertive and affective during the medical encounter than White patients. Conclusion: Most reviewed studies did not relate communication behaviour to possible antecedent culture-related variables, nor did they assess the effect of cultural variations in doctor–patient communication on outcomes, leaving us in the dark about reasons for and consequences of differences in intercultural medical communication. Five key predictors of culture-related communication problems are identified in the literature: (1) cultural differences in explanatory models of health and illness; (2) differences in cultural values; (3) cultural differences in patients’ preferences for doctor–patient relationships; (4) racism/perceptual biases; (5) linguistic barriers. It is concluded that by incorporating these variables into a research model future research on this topic can be enhanced, both from a theoretical and a methodological perspective. Practice implications: Using a cultural sensitive approach in medical communication is recommended. [Copyright &y& Elsevier]

Abstract: Objective: To explore the application of the original Charles et al. model of shared treatment decision-making [Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med 1997;44:681–92; Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med 1999;49:651–61] in the context of general practice, and to determine whether the model needs tailoring for use in this clinical context. Methods: Conceptual paper, presenting the defining characteristics of general practice compared to the original clinical context for which the model was developed (i.e. life threatening disease with different treatment options), and exploring how the model can be tailored for use in the context of general practice. Results: We identify two areas where the original model requires tailoring: sharing the decision-making around agreeing on an agenda for each consultation; and adapting the information transfer component of the model to acknowledge that doctors may not be the only, or even the main, source of technical information for patients. Finally, we explore the importance of shared decision-making in the context of chronic disease. Conclusion: The Charles et al. model can be tailored for use in general practice. Practice implications: Tailoring the model for use in general practice has implications for research, in terms of identifying the additional physician competencies needed for implementation. Policy makers who wish to promote shared decision-making need to ensure that incentives which prioritize access and health outcomes do not militate against shared decision-making in general practice. [Copyright &y& Elsevier]

Abstract: Objective: This paper providers an overview and discussion of virtual communities in health care. Furthermore, we aim to discuss in this context ethical, legal and technical considerations and the current status of research in this domain. Methods: We searched medical and social science literature including survey studies, randomized and non-randomized controlled interventions and reviews. Results: The literature indicates that a virtual community in health care as a group of people using telecommunication with the purposes of delivering health care and education, and/or providing support, covers a wide range of clinical specialties, technologies and stakeholders. Examples include peer-to-peer networks, virtual health care delivery and research teams. Ethical challenges including the concepts of identity and deception, privacy and confidentiality and technical issues, such as sociability and usability are discussed. Conclusion: Virtual communities may empower patients and enhance coordination of care services; however, there is not sufficient systematic evidence of the effectiveness of virtual communities on clinical outcomes or patient empowerment. Researchers need to address issues, such as sample sizes and experimental design to further the research field in this domain. Practice implications: When practitioners utilize virtual community tools to communicate with patients or colleagues they have to maximize sociability and usability of this mode of communication, while addressing concerns for privacy and the fear of de-humanizing practice, and the lack of clarity or relevance of current legislative frameworks. [Copyright &y& Elsevier]

Abstract: Objective: Easier access and increased awareness results in more referral for genetic testing for hereditary breast cancer in healthy at-risk women and breast cancer patients. To investigate the psychological impact of genetic testing on breast cancer patients, literature pertaining to this group was reviewed. Method: Medline and PsychInfo databases were searched over the period 1995–2004 for studies aimed at breast cancer patients referred for genetic testing. Qualitative and quantitative psychological outcome measures were identified. Results: Eight papers were identified focusing on women affected by breast cancer and undergoing genetic counseling and DNA testing. Conclusion: Genetic testing does not lead to an increase in psychological distress in breast cancer patients. However, a recent breast cancer diagnosis adds to general and cancer-specific distress prior to genetic counseling and after DNA test disclosure. Practice implications: Clinicians need to be aware of possible high psychological distress and additional counseling needs of recently diagnosed breast cancer patients taking part in genetic testing. Further research should focus on patients who decline genetic counseling or receive an inconclusive test result, including age upon and time since diagnosis. [Copyright &y& Elsevier]

Abstract: Objective: : Computer-assisted telephone interviewing (CATI) systems used by telephone counselors (TCs) may be efficient mechanisms to counsel patients on cancer and recommended preventive screening tests in order to extend a primary care provider''s reach to his/her patients. The implementation process of such a system for promoting colorectal (CRC) cancer screening using a computer-assisted telephone interview (CATI) system is reported in this paper. Methods: : The process evaluation assessed three components of the intervention: message production, program implementation and audience reception. Results: Of 1181 potentially eligible patients, 1025 (87%) patients were reached by the TCs and 725 of those patients (71%) were eligible to receive counseling. Five hundred eighty-two (80%) patients agreed to counseling. Conclusions: : It is feasible to design and use CATI systems for prevention counseling of patients in primary care practices. Practice Implications: : CATI systems have the potential of being used as a referral service by primary care providers and health care organizations for patient education. [Copyright &y& Elsevier]