Physicians' prevention counseling behaviors: current status and future directions.
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Counseling↗
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Results for “Directive Counseling”
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Prevalence of and factors associated with hormone replacement therapy counseling: results from the 1994 National Health Interview Survey.
OBJECTIVES: This study estimated the prevalence of and the factors associated with hormone replacement therapy (HRT) counseling. METHODS: We analyzed the responses of 3170 women, aged 40 to 60 years, from the 1994 National Health Interview Survey. RESULTS: The prevalence of HRT counseling was 43.6%. Women were more likely to report having received HRT counseling if they were White, older, more educated, had had a hysterectomy, had experienced menopausal symptoms, and had a regular source of care. CONCLUSIONS: More attention should be directed at counseling non-White women and women with less formal education. Reducing the barriers to having a regular source of care appears to increase the likelihood of receiving HRT counseling.
Adult↗
Lessons from anti-thalassemia campaigns in Italy, before prenatal diagnosis.
The essay reconstructs the antithalassemia campaign carried out by means of population screening and pre-marriage counseling for about twenty years in Italy, immediately after the relationship between microcythemia and Cooley's anemia had been established, as well as its genetic bases. We examine the Italian contributions to the understanding of the genetics and of the clinical treatment of thalassemic disorders, and analyze the approaches to prevention as well as the results obtained by the first campaign against a genetic disease, conceived and largely implemented in Italy by Ezio Silvestroni and Ida Bianco. We discuss the resistances met by the antithalassemia campaign due to the cultural and organizational backwardness of the Italian medical community and of the public health system. Moreover we analyze the explanations and interpretations of the problematic results of these experiences in terms of morbidity reduction. It will be pointed out that the objective of genetic counselling practised in that context assumed the concept of disease prevention at the population level, and it was far from the idea, emerged in the 1970s, of non directive genetic counselling.
Genetic Testing↗
Direct evaluation of adolescent HIV counseling and testing services.
The incidence of HIV disease in adolescents is increasing. Studies indicate this population is not receiving adequate information or support to bring about healthy behavior choices that prevent infection, reinfection, or infection of a partner. Physicians themselves, according to a study, are providing services well below the current established guidelines. The current study provides direct evaluation of services provided to youths by adolescents trained to address critical issues using fictional (undercover) stories at actual sites advertising HIV/AIDS counseling and testing to teenagers. Thirty-three health-care sites were identified within the Washington, DC, area; eight were eliminated during the process, leaving 25 sites for appraisal. Less than 40% of the participating clinics that advertised HIV testing qualified for recommendation. In addition, many female youth evaluators reported they received unsolicited advice regarding abstinence or reduction of sexual activity; male evaluators did not report similar findings. Results of the study were translated into recommendations in the form of reports to those sites that chose to receive them. The authors recommend implementing a similar study on an annual basis of similar sites with publication of results in order to improve staff training and maintain standards that will encourage adolescent and young adult clients to be tested and follow through for test results and appropriate education and counseling.
AIDS Serodiagnosis↗
Relational ethics and genetic counseling.
Genetic counseling is viewed as a therapeutic interrelationship between genetic counselors and their clients. In a previous relational ethics research project, various themes were identified as key components of relational ethics practice grounded in everyday health situations. In this article the relational ethics approach is further explored in the context of genetic counseling to enhance our understanding of how the counselor-client relationship is contextually developed and maintained. Qualitative interviews were conducted with six adult clients undergoing genetic counseling for predictive testing. Engagement, dialogue and presence were revealed as relevant to genetic counselor-client relationships. A relational ethics approach in genetic counseling challenges the concept of nondirectiveness and may enhance the outcome of counseling for both counselor and client.
Adult↗
Cash and counseling: a promising option for consumer direction of home- and community-based services and supports.
The Cash and Counseling Demonstration began as a 3-state social experiment to test the claims of members of the disability community that, if they had more control over their services, their lives would improve and costs would be no higher. The 2004 expansion to 12 states brings us closer to the tipping point when this option will be broadly available. The original demonstration was a controlled experiment with randomized assignment, supplemented by an ethnographic study and a process evaluation. Consumers managing flexible, individualized budgets were much more satisfied, had fewer unmet needs, and had comparable health outcomes. Access to service and supports was greatly improved. Consumer direction is increasingly accepted as a desirable option in home and community services.
Aged↗
Ethics and practice: two worlds? The example of genetic counselling.
The aim of this paper is to work out the relationship between ethics and practice with reference to genetic counselling. First, the most important principles with respect to genetic counselling and to counsellor-client-interaction, are explained briefly. Then, we discuss what these principles might mean, when applied to the practice of counselling. To do so, we also look at some empirical data. Finally, we draw some conclusions.
Beneficence↗
Housing and health counseling: design and environmental results.
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Directive Counseling↗
Uptake of workplace HIV counselling and testing: a cluster-randomised trial in Zimbabwe.
BACKGROUND: HIV counselling and testing is a key component of both HIV care and HIV prevention, but uptake is currently low. We investigated the impact of rapid HIV testing at the workplace on uptake of voluntary counselling and testing (VCT). METHODS AND FINDINGS: The study was a cluster-randomised trial of two VCT strategies, with business occupational health clinics as the unit of randomisation. VCT was directly offered to all employees, followed by 2 y of open access to VCT and basic HIV care. Businesses were randomised to either on-site rapid HIV testing at their occupational clinic (11 businesses) or to vouchers for off-site VCT at a chain of free-standing centres also using rapid tests (11 businesses). Baseline anonymised HIV serology was requested from all employees. HIV prevalence was 19.8% and 18.4%, respectively, at businesses randomised to on-site and off-site VCT. In total, 1,957 of 3,950 employees at clinics randomised to on-site testing had VCT (mean uptake by site 51.1%) compared to 586 of 3,532 employees taking vouchers at clinics randomised to off-site testing (mean uptake by site 19.2%). The risk ratio for on-site VCT compared to voucher uptake was 2.8 (95% confidence interval 1.8 to 3.8) after adjustment for potential confounders. Only 125 employees (mean uptake by site 4.3%) reported using their voucher, so that the true adjusted risk ratio for on-site compared to off-site VCT may have been as high as 12.5 (95% confidence interval 8.2 to 16.8). CONCLUSIONS: High-impact VCT strategies are urgently needed to maximise HIV prevention and access to care in Africa. VCT at the workplace offers the potential for high uptake when offered on-site and linked to basic HIV care. Convenience and accessibility appear to have critical roles in the acceptability of community-based VCT.
AIDS Serodiagnosis↗
[Medical counseling to promote smoking cessation during pregnancy: clinical guide-lines for health professionals].
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Clinical Protocols↗
"Should I give you my smoking lecture now or later?" Characterizing emergency physician smoking discussions and cessation counseling.
STUDY OBJECTIVE: We determine frequency and manner in which emergency physicians address smoking with their patients. METHODS: This was a descriptive secondary analysis of 871 audiotapes of physician-patient interactions collected during a trial assessing the effect of computer-based health risk assessment on emergency physician-patient communication. Consenting nonemergency female patients, ages 18 to 65 years, were enrolled from 2 socioeconomically diverse academic emergency department (EDs) for audiotaping of the ED visit. All audio files with any mention of smoking were independently coded with an in-depth structured coding form to characterize the nature of smoking-related discussions. Logistic regression was used to determine factors associated with emergency physician screening and discussion of tobacco exposure with women patients. RESULTS: Overall, 484 of 871 (56%) participants were verbally screened for smoking, with 156 of 484 (32%) disclosing current smoking, with similar incidence at both sites. Tobacco screening was higher (odds ratio 2.2; 95% confidence interval 1.3 to 3.5), whereas rates of smoking-related discussions were lower (odds ratio 0.41; 95% confidence interval 0.17 to 0.98) at the urban site. At both sites, physicians tended to screen and discuss smoking when patients presented with a health condition that could be aggravated by smoking. Only 56% of discussions with current smokers contained advice to quit, 16% included assessment of readiness to quit, and a minority (13%) included a referral. Physician empathy/encouragement was associated with patients' detailing quit attempts. CONCLUSION: Emergency physicians were likely to gather information about smoking but not to counsel or advise patients to quit. These results raise the question of whether emergency medicine resident training should include additional emphasis on smoking cessation counseling and motivational interviewing techniques.
Academic Medical Centers↗
Genetic counseling and the disabled: feminism examines the stance of those who stand at the gate.
This essay examines the possible systematic bias against the disabled in the structure and practice of genetic counseling. Finding that the profession's "nondirective" imperative remains problematic, the authors recommend that methodology developed by feminist standpoint epistemology be used to incorporate the perspective of disabled individuals in genetic counselors' education and practice, thereby reforming society's view of the disabled and preventing possible negative effects of genetic counseling on the self-concept and material circumstance of disabled individuals.
Attitude of Health Personnel↗
Moral issues arising from genetics.
Gene therapy, pre-natal diagnosis, genetically altered bacteria, patenting new life forms: these are all outgrowths from the development of genetics. Our focus will be on the moral issues engendered by some of the genetic techniques which are now so well integrated into clinical medicine. The section on genetic counseling is meant to show the most frequent moral problems encountered as they might really occur. Genetic screening is presented as a mix of preventive medicine and aid for genetic counseling. Genetic engineering is discussed in the context of evolution and human needs and desires.
DNA, Recombinant↗
A perspective on the similarities among selected concepts of traditional scientific research and clinical counseling.
In an age of increasing reliance on scientific theory and technology, social work, as well as other behavioral science professions, has been challenged to utilize traditional scientific methodology for evaluation of counseling and direct practice services. A dilemma has arisen, however, because practitioners charge that the tools of traditional science lack conceptual relevance and practical utility within the practice setting. Analysis of selected research and counseling concepts, however, will reveal significant similarities between the two areas of practice and will demonstrate a way of teaching the integration of scientific and counseling ideas for the benefit of researchers and practitioners.
Consumer Behavior↗
Synchronizing clinician engagement and client motivation in telephone counseling.
Health care increasingly incorporates telephone counseling, but the interactions supporting its delivery are not well understood. The authors' clinical trial of a tailored, nurse-administered smoking cessation intervention for surgical patients included a telephone counseling component and provided an opportunity to describe the interaction dynamics of proactive telephone counseling over the course of 4 months. Tape-recorded telephone counseling calls for 56 consecutively enrolled individuals randomized to the intervention group resulted in a data set of 368 calls, which were transcribed and analyzed using constant comparative methods. The findings revealed varying interaction dynamics depending on the nurse's level of engagement with participants and participants' motivation to stop smoking. The authors identified four interaction dynamics: affirming/working, chasing/skirting, controlling/withdrawing, and avoiding commitment. Shifts in interaction dynamics were common and influenced the provision of support both positively and negatively. The findings challenge many assumptions underlying telephone counseling and suggest strategies to improve its delivery.
Directive Counseling↗
Pediatric obesity-related counseling in the outpatient setting.
OBJECTIVE: To determine rates of pediatric obesity-related counseling in the outpatient setting. METHODOLOGY: The 1993-2002 data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Care Survey (NHAMCS) were extracted for estimates of 1) percentage of all pediatric encounters that included obesity-related counseling and 2) percentage of all pediatric encounters that included general growth/ development counseling. Obesity-related counseling rates were compared with corresponding growth/development counseling rates and with the number of pediatric-obesity articles listed in Medline for each year. RESULTS: The rate of obesity-related counseling steadily improved and was correlated with the number of published obesity articles (Spearman's rho .721) between 1993 and 2002. In 1995, for example, 4.3% of encounters included such counseling, compared with 19.0% in 2001 and 15.4% in 2002. CONCLUSIONS: Obesity-related counseling has become an important part of ambulatory care, which suggests increasing awareness of this serious problem.
Ambulatory Care↗
Smoking-cessation services in Iowa community pharmacies.
STUDY OBJECTIVE: To examine community pharmacy practice with regard to providing smoking-cessation counseling. DESIGN: Mailed survey. SETTING: Iowa community pharmacies. PARTICIPANTS: A stratified random sample of pharmacists statewide. MEASUREMENTS AND MAIN RESULTS: Descriptive statistics were computed for all study variables. Fisher exact test or chi2 analysis was performed on selected variables to determine the relationship of each item with pharmacists routinely offering smokers suggestions for quitting. Responses from 129 (38.2%) of 338 pharmacists indicated that although most felt it is important to offer smoking-cessation counseling, about half actually offer this service. Most pharmacists indicated they are prepared to provide counseling, but fewer than 25% had received formal training or were aware of national clinical practice guidelines. Those who had received specific training (p=0.020) or recently attended an educational program (p=0.014) on smoking cessation were more likely to counsel smokers. Primary barriers to providing counseling were lack of time, inability to identify smokers, low patient demand, and lack of reimbursement. CONCLUSION: Our findings suggest that opportunities exist for improving pharmacist education and reducing practice barriers in order to bridge the gap between pharmacists' knowledge and attitudes related to smoking-cessation counseling and their provision of patient counseling in community pharmacy practice.
Community Pharmacy Services↗
Nondirectiveness and its lay interpretations: the effect of counseling style, ethnicity and culture on attitudes towards genetic counseling among Jewish and Bedouin respondents in Israel.
To evaluate the effects of ethnicity, culture, and counseling style on the interpretation of nondirectiveness in genetic counseling, a questionnaire containing premarital and prenatal case vignettes in two versions (pessimistic/optimistic) was administered to 281 Jewish and 133 Bedouin respondents. The first study population was comprised of Jewish students enrolled in a university and a community college in the Negev (southern part of Israel). The second study population was comprised of Muslim-Bedouin college students from the same area. The majority of Jewish respondents interpreted the nondirective message as intended by counselors, while the majority of Bedouin respondents did not. Counseling style was found to have a statistically significant effect on the interpretation of the general role of counseling. Gender and susceptibility were not found to have a significant effect on interpretation. Group differences are analyzed through a cultural lens in which different interpretive norms can generate expectations for either nondirectiveness or directiveness.
Arabs↗