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PubMed1995

Smoking cessation counseling by emergency physicians: opinions, knowledge, and training needs.

OBJECTIVES: To determine: 1) the extent of emergency physicians' (EPs') training in smoking cessation counseling; 2) their understanding of counseling and pharmacologic treatment techniques; 3) their current practices in screening, counseling, and referring patients who smoke; and 4) perceived barriers to routine smoking cessation counseling in emergency medical practice. METHODS: A 26-item questionnaire addressing the above issues was mailed to all 256 members of the Colorado Chapter of the American College of Emergency Physicians. RESULTS: Completed questionnaires were returned by 196 physicians (77% response rate). The majority of respondents were men (80%), practiced in urban settings (87%), and were board-certified in emergency medicine (82%). Most EPs lacked formal smoking cessation training (55%) and felt poorly prepared to counsel patients about smoking cessation (65%). A minority (27%) of the physicians reported routinely asking patients to quit smoking. The physicians with formal smoking cessation training were more likely to counsel and refer patients routinely (34% vs 20%, p = 0.03). The physicians cited the following barriers to routine smoking cessation counseling: a lack of time; a perception that patients are not interested; a belief that the ED setting is inappropriate for counseling; and a sense that counseling is ineffective. Lack of reimbursement was cited by only 13% of the respondents. The physicians who had formal smoking cessation training perceived fewer barriers to ED-based counseling. CONCLUSIONS: Emergency physicians have received little training in smoking cessation and perceive many barriers to ED-based smoking cessation interventions. Not surprisingly, they infrequently take action to encourage or assist their patients to quit smoking.

Adult↗
PubMed2005

Substance abuse counseling services in secondary schools: a national study of schools and students, 1999-2003.

This study focuses on (a) American 8th-, 10th-, and 12th-grade students' access to, and use of, substance abuse counseling services via schools and (b) associations between such access and student substance use prevalence. From 1999 through 2003, student data were obtained from the Monitoring the Future study; and school data were obtained through the Youth, Education, and Society study, resulting in nationally representative data from 113,008 students in 855 public and private schools. Results indicate that in contrast to relatively stable student heavy-drug use prevalence rates, internal counseling availability and participation decreased significantly over time, as did reported student referral to external counseling. Availability of internal counseling, as well as student participation in both internal and external referrals, differed significantly by school characteristics--school level, grade size, sector, population density, school socioeconomic status, majority student body race/ethnicity, and geographical region. Student use of counseling services did not show any relationships with school-level heavy drinking rates; however, student participation in external counseling referrals was positively associated with school-level prevalence rates for the use of illicit drugs other than marijuana and showed indications of a similar relationship with marijuana prevalence rates. The decreasing access to, and use of, counseling, the lower probability of counseling availability in middle schools, and the lack of association between heavy-alcohol use rates and counseling services, all suggest missed opportunities and a greater need for counseling services to reduce high-risk drug use.

Adolescent↗
PubMed1997

Women's need for information before attending genetic counselling for familial breast or ovarian cancer: a questionnaire, interview, and observational study.

OBJECTIVES: To describe women's information needs prior to genetic counselling for familial breast or ovarian cancer. DESIGN: Prospective study including semistructured telephone interviews before genetic counselling, observations of consultations, completion of postal questionnaires, and face-to face interviews within two months of counselling. SUBJECTS: 46 women attending genetic counselling for familial breast or ovarian cancer. MAIN OUTCOME MEASURES: Subjects' understanding of process and content of genetic counselling before attending and attitudes about their preparation for the counselling session. RESULTS: Although all women interviewed before the clinic expected to discuss their risk of developing cancer and risk management options, there was evidence of a lack of knowledge about the process and content of genetic counselling, 17 (37%) women said they did not know what else would happen. Most women interviewed after counselling viewed it positively, but 26 (65%) felt they had been inadequately prepared and 11 (28%) felt that their lack of preparation meant that they could not be given an accurate estimation of their risk of cancer. CONCLUSIONS: Some women felt that they did not obtain optimum benefit from genetic counselling because they were inadequately prepared for it. We suggest that cancer family history clinics should provide women with written information about the process and content of genetic counselling before their clinic attendance.

Adult↗
PubMed2000

Patient recall versus physician documentation in report of smoking cessation counselling performed in the inpatient setting.

OBJECTIVES: To determine rates of patient reported and physician documented counselling; to identify predictors of each report; and to identify the impact of each report on smoking cessation attempts after discharge from the hospital. DESIGN: Stickers on subjects' charts prompted physicians to give brief smoking cessation counselling to patients in the hospital. Patients reported counselling received and quit attempts in a phone interview conducted 7-18 days after discharge. Rates of counselling and correlations were calculated, and multivariate analysis identified predictors of patient report, physician documentation, and quit attempts. SETTING: Four hospitals in the Minneapolis/St Paul metropolitan area. SUBJECTS: 682 hospital patients who had smoked more than 100 cigarettes in their lifetime and had smoked in the last three months. RESULTS: 71.0% of patients reported counselling, and physicians documented counselling in the charts of 46.2% of patients (correlation = 0.15, kappa = 0.13). Patient report was predicted by specific hospital, belief that their hospitalisation was smoking related, diagnosis of a smoking related disease, and physician documentation of counselling. Physician documentation was predicted by female patient, specific hospital, longer hospital stay, and marginally predicted by smoking related disease. Quit attempts were predicted by patient report of counselling, but not physician documentation. CONCLUSIONS: Physicians document counselling in the hospital at a lower rate than patients report it, and the correlation between reports is very low, making an accurate assessment of true rates of counselling difficult. While it is important to increase physician documentation, it is even more important to increase patient recall, as this is the only report that predicts a quit attempt.

Adolescent↗
PubMed2006

Adaptation and implementation of an evidence-based prevention counseling intervention in Texas.

HIV prevention counseling linked with testing has been shown to reduce high-risk behaviors and new sexually transmitted diseases in public clinic settings. However, few studies have been conducted evaluating the implementation of such models outside a research setting. This study sought to determine the extent to which the introduction of a standard protocol based on Project RESPECT improves the achievement of HIV prevention counseling goals of existing counseling and testing programs. Four prevention counseling programs contracting with the Texas Department of State Health Services completed a standardized 5-day training and implemented the protocols, counseling tools, and quality assurance (QA) procedures developed for the project. Introduction of the protocol was accomplished with existing program resources and significantly improved prevention counseling. Direct observation of counseling sessions demonstrated a significant improvement in attainment for eight of the nine counseling goals of initial sessions and for all counseling goals of follow-up sessions after the protocol was introduced. Client exit questionnaires reinforced this finding. Significant improvement was also found in use of counseling skills, with improvements in 6 of 10 skills observed in initial sessions and 4 of 10 skills in follow-up sessions. Challenges identified through semistructured interviews with counselors and supervisors included serving non-English-speaking and low-risk clients, mastery of the protocol, the amount of time required for QA, and implementation in settings with severe time constraints.

Counseling↗
PubMed2004

Pediatrician self-efficacy for counseling parents of asthmatic children to quit smoking.

BACKGROUND: Although environmental tobacco smoke is a common trigger for asthma exacerbations in children, pediatricians infrequently counsel parents who smoke to quit. High physician self-efficacy, or self-confidence, in the ability to counsel parents about smoking cessation is associated with increased physician screening and counseling on this topic. However, it is not clear which factors are associated with high physician self-efficacy for counseling, such as previous training in smoking-cessation counseling or number of years in pediatric practice. OBJECTIVE: To identify factors associated with high levels of physician self-efficacy for 4 skills associated with smoking-cessation counseling. DESIGN: Cross-sectional survey. PARTICIPANTS: A national random sample of 829 primary care pediatricians. RESULTS: The response rate was 55% (457 of 829). The percentage of physicians with high levels of self-efficacy for screening parents and screening patients to identify smokers was 87% and 84%, respectively. The percentage of physicians with high levels of self-efficacy for counseling parents and patients was 59% for both groups. The presence of previous training in smoking-cessation counseling was associated with high levels of self-efficacy for all 4 skills including inquiring about an asthma patient's smoking status (odds ratio [OR]: 3.91; 95% confidence interval [CI]: 1.63, 9.37); inquiring about a parent's smoking status (OR: 2.51; 95% CI: 1.09, 5.75); counseling a patient to quit smoking (OR: 5.30; 95% CI: 3.02, 9.31); and counseling a parent to quit (OR: 4.96; 95% CI: 2.85, 8.61). Years since completion of residency were not associated with high self-efficacy. CONCLUSIONS: These findings suggest that formal training in smoking cessation has a significant impact on physician self-efficacy related to smoking cessation throughout a physician's career.

Asthma↗
PubMed2004

Unmet need for counseling services by children in New York City after the September 11th attacks on the World Trade Center: implications for pediatricians.

OBJECTIVE: The objectives of this study were to describe the prevalence of counseling services, contrasted with the need after the terrorist attacks of September 11, 2001, the types of counseling received, and the predictors of receipt of counseling services. METHODS: A cross-sectional, random-digit-dial survey was conducted in New York City (NYC) of parents (N = 434) of children who were 4 to 17 years of age 4 months after the September 11th terrorist attacks on the World Trade Center. RESULTS: Overall, 10% of NYC children received some type of counseling after the September 11th attacks, according to parental report. Among these, 44% received counseling in schools, 36% received counseling from medical or professional providers, and 20% received counseling from other sources. However, only 27% of the children who had severe/very severe posttraumatic stress reactions (PTSR) after the attacks received counseling services. In a multivariate model, receipt of counseling before the September 11th attacks (odds ratio: 4.44) and having severe/very severe PTSR (odds ratio: 3.59) were the most important predictors of use of counseling services after the September 11th attacks. Minority status and having a parent who experienced the loss of a friend or a relative were also associated with receipt of services. CONCLUSIONS: There was substantial disparity between apparent need (as indicated by severe/very severe PTSR) for and receipt of mental health services for children after the September 11th attacks. There is need for intensified efforts to identify, refer, and treat children in need, especially for children who are not already in a therapeutic relationship. An enhanced role for pediatricians is indicated.

Adolescent↗
PubMed2004

Counseling parents and children on sun protection: a national survey of pediatricians.

OBJECTIVE: To describe pediatricians' attitudes toward skin cancer (SC), sun protection (SP) counseling, and the quantity and content of such counseling and to identify barriers to counseling. METHODS: An American Academy of Pediatrics Periodic Survey was mailed to 1616 randomly selected US members between October 2001 and February 2002. The response rate was 54.6%. RESULTS: More than 90% of pediatricians agreed that SC is a significant public health problem and that preventing episodic high exposures to the sun during childhood will reduce the risk of adult melanoma. However, only 22.3% of respondents reported counseling most patients in all age groups. Female pediatricians were more likely to counsel most patients; pediatricians located in the South and West and those who practice in hospital/clinic settings were least likely to counsel compared with those in other regions. Approximately half (53%) of pediatricians reported selectively counseling on the basis of patient characteristics The most important SP recommendation named was using a sunscreen with a sun protection factor > or =15. Only 38% of pediatricians rated SP as very important to their patients' health compared with other topics such as use of car seats (86%), nutrition (79%), immunization issues (76%), and smoking/avoidance of environmental tobacco smoke (74%). The most frequently named barrier to SP counseling was lack of time (58% reporting). CONCLUSIONS: Although the majority of pediatricians believe that SC prevention is a worthy issue, only a minority reported providing routine SP counseling to most patients in every age group, and most ranked SP lower in importance than other issues. Interventions might include programs and materials to educate patients and pediatricians alike. To have an effect on increasing rates of SC and SC mortality, a broader public health approach is needed as a complement to pediatricians' counseling efforts.

Adult↗
PubMed2006

Medical staff guidelines for periviability pregnancy counseling and medical treatment of extremely premature infants.

OBJECTIVES: The goal of this report is to describe the collaborative formation of rational, practical, medical staff guidelines for the counseling and subsequent care of extremely early-gestation pregnancies and premature infants between 22 and 26 weeks. The purposes of the guidelines were to improve knowledge regarding neonatal outcomes, to provide consistency in periviability counseling, and to promote informed, supportive, responsible choices. METHODS: To formulate the guidelines, a 5-step process was conducted; it began with a series of multidisciplinary meetings among maternal-fetal medicine specialists (MFMs), obstetricians, neonatologists, neonatal nurse practitioners, and nurses from both the labor and delivery unit and the NICU at Providence St Vincent Medical Center (Portland, OR). First, our discussions reviewed mortality rates, morbidity rates, and long-term neurodevelopmental outcomes for extremely premature infants. Second, we explored the variations in counseling that pregnant women received, based on providers' individual beliefs and disparate knowledge of neonatal outcomes. Third, we asked participants to complete a survey that focused on the theoretical impending delivery of a premature infant, presenting at each week between 22 and 26 weeks of gestation. Participants indicated their recommendations for NICU care at each gestational age by using a numeric scale. Fourth, the survey results were tabulated and used as a basis for the formation of guidelines related to the recommended obstetric and neonatal care at each week of gestation. MFMs and neonatologists were urged to use these specific guidelines as a framework for counseling pregnant women between 22 and 26 weeks of gestation. Fifth, we surveyed women approximately 3 days after they were counseled by their MFM and neonatologist, to assess comprehension, utility, consistency, and comfort with the periviability counseling. RESULTS: Twenty pregnant women with the possibility of delivery between 22 and 26 weeks of gestation (mean: 24 weeks) received periviability counseling with our consensus medical staff guidelines. The respondents rated the counseling process as highly understandable (80%), useful (95%), consistent (89%), and performed in a comfortable manner (100%). All (100%) of the pregnant women thought they were given enough information to make critical decisions related to the potential level of care of their infant. CONCLUSIONS: Informative, supportive, clear, medical staff guidelines developed to assist in the counseling of women delivering extremely premature infants have been designed and implemented successfully at our hospital. These guidelines form the basis of periviability counseling, which is appreciated by our at-risk pregnant patients. We recommend that all hospitals that provide high-risk obstetric and neonatal intensive care develop similar consensus guidelines based on published outcomes and local provider experience.

Adult↗
PubMed1993

Changes in sexually transmitted disease rates after HIV testing and posttest counseling, Miami, 1988 to 1989.

OBJECTIVES: The effects of posttest counseling on acquisition of sexually transmitted diseases in patients at a large urban sexually transmitted disease clinic were studied. METHODS: Comparisons were made of the percentage of patients who had a positive gonorrhea culture (or any sexually transmitted disease) in the 6 months before and after human immunodeficiency virus (HIV) counseling and testing. RESULTS: For 331 patients counseled about a positive HIV test, the percentage with gonorrhea was 6.3 before and 4.5 after posttest counseling (29% decrease). For 666 patients counseled about a negative test, the percentage with gonorrhea was 2.4 before and 5.0 after posttest counseling (106% increase). With any sexually transmitted disease as the outcome, patients who tested positive for HIV had a 12% decrease and patients who tested negative had a 103% increase after counseling. CONCLUSIONS: HIV counseling and testing was associated with a moderate decrease in sexually transmitted diseases among patients who tested positive for the virus, but risk increased for patients who tested negative. This suggests a need to improve posttest counseling in this clinic and to assess the effects of counseling and testing in other clinics.

AIDS Serodiagnosis↗
PubMedDate not supplied

[Utilization and effectiveness of short-term counseling in child guidance].

UNLABELLED: This study investigates the utilization and effectiveness of short-term counseling in child guidance. For this purpose a comparison was made between short-term and long-term counseling (each N = 89) and a catamnestic telephone interview of the parents who had had short-term counseling was conducted (N = 70). RESULTS: 1. The rate of short-term counseling amounts to 39%. 2. The individuals seeking short-term counseling are significantly less burdened with problems. 3. In stating the reason for a short-term counseling, 58% of the individuals concerned claim that the number of counseling sessions held had been sufficient, that there had been an improvement with regard to the problems, or that according to the counselor there had been no need for further activity; 24% were dissatisfied with the counseling and for this reason broke it off; 10% were directed to other institutions. 4. On the whole the persons seeking advice evaluated the short-term counseling mainly positively. The evaluation of satisfaction and success corresponds with the evaluation commonly gained in educational guidance: 70% of the individuals seeking counseling were satisfied with the results, 44% reported positive changes due to the advice they received, and 66% seem to have gained a better understanding for their children. 5. The good relationship between the counselor and the person seeking advice appeared to be particularly important.

Adolescent↗
PubMed1998

Evaluation of a primary care counselling service in Dorset.

BACKGROUND: Research into the effectiveness of counselling in primary care is rare. This study attempts to provide a thorough evaluation of the effects of a new counselling service introduced throughout Dorset. AIM: To evaluate the impact of counselling on client symptomatology, self-esteem, and quality of life. The effect of counselling on drug prescribing, referrals to other mental health professionals, and client and general practitioner (GP) satisfaction were also assessed. METHOD: All new clients referred for counselling were asked to complete and return questionnaires before and after counselling. A total of 385 clients took part in the study. The first and second assessments were compared statistically. Clients were ascribed a psychiatric diagnosis using a simplified version of DSM-IIIR (Diagnostic and Statistical Manual of the American Psychiatric Association). GPs' views of the service were determined using a specially designed questionnaire. Drug data were obtained from the Prescription Pricing Authority and referral statistics from Dorset HealthCare National Health Service (NHS) Trust. RESULTS: The number of psychiatric symptoms and their severity were significantly reduced by counselling. There were no significant differences in the prescription of anxiolytic/hypnotic and anti-depressant medication between matched practices with and without counsellors. The presence of a counsellor did not affect the rate of referral to other mental health professionals. Clients and GPs valued the service highly. CONCLUSIONS: The Psychology Managed Counselling Service is an effective method of running a counselling service and is well received by both clients and GPs. Counselled clients improved significantly on several measures.

Counseling↗
PubMed1997

Sun protection counseling by pediatricians.

OBJECTIVE: To establish a national baseline regarding pediatricians' sun protection counseling perceptions and behaviors. INTERVENTIONS: A survey was mailed to a random sample of 600 pediatricians selected from the 1996 American Academy of Pediatrics Directory using a 3-wave mailing technique to maximize the response rate. The 3-wave mailing resulted in 414 returned surveys of 583 surveys (17 surveys were nondeliverable) (a 71% response rate). RESULTS: Most (60%) of the pediatricians lacked formal training on how to counsel parents and children about sun protection. Approximately 3 (78%) of 4 indicated that not enough time was spent in their residency program on how to educate parents and children about sun protection. Greater than half (60%) of the respondents indicated that they usually (47%) or always (13%) counseled about sun protection. Seventy-seven percent of the respondents indicated that pediatricians have a professional responsibility to counsel parents and children about sun protection. CONCLUSIONS: The results of this investigation suggest that most pediatricians surveyed believed that they had a professional responsibility to counsel about sun protection and that such counseling would be effective in decreasing skin cancer and the number of sunburns. Although most had not had training on sun protection counseling in their residency program, 6 of 10 indicated that they usually or always counseled about sun protection. Sun protection counseling training in residency programs can potentially extend pediatricians' knowledge of skin cancer and the importance of a broad spectrum of preventive measures, as well as increase their ability to counsel about such measures.

Adult↗
PubMed1995

Reduction of urinary stone recurrence by dietary counseling after SWL.

To reduce the recurrence rate of or urolithiasis, dietary counseling was conducted for calcium-stone patients. Sixty-six patients received dietary counseling and were in principle instructed to use the Recommended Dietary Allowance for Japanese as their goal. Seventy-three patients did not undergo the counseling. Comparison of the dietary intake of the patients with the dietary requirements for Japanese revealed that protein intake, especially animal protein intake, was higher and calcium intake lower in the patients. As a result of the counseling, intakes of total protein, animal protein, fat, and carbohydrates were all reduced. Patients in the stone recurrence-free group excreted less oxalate than those in the recurrent one. The excretion of oxalate was then reduced and urine volume increased owing to the diet counseling program. The stone recurrence rate of the group participating in the diet counseling was lower than that of the group not taking part. The recurrence rate of the hyperoxaluric group was higher, with statistical significance, than that of the normooxaluric group among those not receiving the dietary counseling. With dietary counseling, the recurrence rate significantly decreased in the hyperoxaluric patients. Thus, the reduction in the rate of stone recurrence resulting from participation in the diet counseling program seemed to be attributable to the decrease in urinary oxalate excretion. Dietary counseling seems to be a useful measure to prevent urinary stone recurrence.

Adolescent↗
PubMed2004

Influence of time stress and other variables on counseling by pharmacists about antiretroviral medications.

PURPOSE: The medication counseling practices of pharmacists caring for patients with HIV infection and the factors influencing their counseling behaviors regarding antiretroviral medications were examined. METHODS: A questionnaire was mailed in February 2000 to pharmacist-managers of 573 ambulatory care pharmacies providing medications to beneficiaries of the North Carolina AIDS Drug Assistance Program. The frequency of and attitudes about adherence counseling for patients with HIV infection; the time allocated, spent, and needed to provide high-quality care to these patients; and pharmacists' time pressure and time stress were measured. RESULTS: Of the 573 questionnaires mailed, 440 (77%) were usable. Fifty-nine percent of pharmacists reported that they did not have enough time to provide adherence counseling to patients receiving antiretroviral medications, and 45% reported that most of their patients did not receive such counseling. Time-stressed pharmacists were significantly less likely to perform 12 of 22 counseling behaviors, including discussing adverse effects (13% versus 24%, p < 0.0089), drug interactions (13% versus 31%, p < 0.0001), and what to do if a dose is missed (8% versus 23%, p < 0.0001). Multivariate analysis revealed that time stress, perceived skill and interest in adherence counseling, and job satisfaction were significantly associated with the counseling index. CONCLUSION: Time pressure and other barriers appeared to limit the care that some pharmacists offered to patients with HIV infection. Pharmacist age, job satisfaction, and perceived skill and interest in adherence counseling influenced the comprehensiveness of the counseling pharmacists provided for patients receiving antiretroviral medications.

Adult↗
PubMed1999

Direct observation of health-habit counseling of adolescents.

OBJECTIVES: To determine the rate of health-habit counseling of adolescents seeing community family physicians and to identify the factors associated with the delivery of recommended preventive counseling services. DESIGN: Cross-sectional multimethod study emphasizing direct observation of patient visits. SETTING: Community family practices in northeast Ohio. PATIENTS OR OTHER PARTICIPANTS: Adolescents (n = 445) aged 11 to 21 years who were being seen for outpatient visits to community family physicians (n = 119) during 2 days of observation by trained research nurses. MAIN OUTCOME MEASURE: Direct observation of the delivery of clinical preventive counseling services recommended by the Guidelines for Adolescent Preventive Services. RESULTS: During the 445 visits made by adolescents, the most frequently delivered counseling service was exercise advice (13%). At least 1 health-habit counseling service was delivered during 38% of visits. In multivariable analyses, older patient age was strongly associated with increased service delivery. Visits for well care, longer visits, and new patient visits were also associated with the provision of counseling. Visits including preventive counseling services were on average 2.5 minutes longer than visits without preventive counseling. CONCLUSIONS: The rates of delivery of preventive counseling services in clinical practice were low, raising concern about the feasibility of current recommendations. The practical implementation of prevention guidelines may require a greater use of well-care visits and longer patient visits than are currently used in community family practice.

Adolescent↗
PubMed1989

Psychological aspects of genetic counseling: VI. A critical review of the literature dealing with education and reproduction.

The post-1979 literature dealing with the educational and reproductive outcome and process of genetic counseling is reviewed. Despite methodological difficulties, recent publications strongly suggest that genetic counseling is successful in educating counselees about diagnostic and risk information. In general, investigators suggest that there is room for improvement and the factors leading to imperfect recall of information need to be elucidated. Process studies suggest that the educational priorities of counselors and counselees may not always be consistent. The contribution of these inconsistencies to outcome measures needs further study. Also, it appears that differing counseling approaches may be equally effective in achieving educational goals. Studies on the reproductive outcome of genetic counseling show no strong impact of counseling; there appears to be a net increase of desire for more children following counseling. Precounseling reproductive intentions, rather than counseling, were found to be a major factor in determining postcounseling outcome. Process studies suggest that although many counselees say that they were influenced by genetic counseling, it is uncertain what they mean, since for many counselees, reproductive decisions seem to have been made prior to counseling.

Attitude to Health↗
PubMedDate not supplied

'Dividing the desolation': clients views on the benefits of a cancer counselling service.

This paper describes clients' accounts of the benefits they derived from a short course of cancer counselling provided within a humanist framework. Three hundred and two clients who had attended at least one session of a short course of cancer counselling received an evaluation form, which incorporated both fixed-choice and open-ended questions. One hundred and forty two (47%) clients returned evaluation forms; those who had attended more sessions were significantly more likely to do so. Quantitative data were analysed using SPSS (Statistical Package for the Social Sciences) for Windows and qualitative data using a thematic approach. Almost all clients indicated that they felt they had benefited from counselling. Analysis of the open-ended questions identified nine main benefits of counselling and four key avenues or processes through which clients derived these benefits. Overall, counselling was seen as helping them to work through powerful thoughts and feelings and so to come to terms with cancer and to regain a sense of control in their lives. The benefits of a short course of counselling which clients identified reflect the aims of humanistic counselling which are not well captured by psychiatric assessments or most standard research instruments. In evaluating cancer counselling services, assessments which include these client-defined outcomes may provide a more sensitive way of gauging the value of counselling to a non-clinic population.

Adult↗