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PubMed1995

HIV test counselling at a tertiary hospital.

A questionnaire was distributed to 64 of the 78 interns working at a teaching hospital in Cape Town in August 1992 to examine their attitudes and practice in respect of HIV test counselling. The questionnaire was completed by 61 interns. Thirteen per cent of those who responded counselled all patients, 49% counselled some patients and 38% counselled no patients. Thirty-four per cent stated that they felt that pre-test counselling was always necessary and 57% that post-test counselling was always necessary. The most frequently stated reasons for not counselling patients were language barriers, time constraints, feelings of incompetence on the part of the intern and the fact that the patient was too ill. It is recommended that standard counselling procedures be established in each ward and formal under- and postgraduate counselling training for medical students and interns be instituted.

Adult↗
PubMed1995

Physician counseling for smoking cessation: is the glass half empty?

BACKGROUND: Professional groups urge physicians to aggressively counsel their patients who smoke, but research evaluating the effectiveness of physician counseling has produced mixed results. METHODS: Four hundred ten smokers identified in a previous study were contacted 1 year later to determine whether they had quit smoking. In both studies, smokers were asked whether their physicians had counseled them in any of six specific ways (eg, advising the patient of personal health risks and the need to stop smoking, or discussing cessation methods). RESULTS: Seventy-nine percent of patients reported that their physician counseled them either at the initial visit or at some time during the following year; 42% reported having tried to quit at least once during the year, but only 5.9% were nonsmokers at 1-year follow-up. Physician counseling had no effect on the rate of successful attempts to quit. Patients with serious health problems were more likely to be counseled and to attempt to quit (P < .02). Non-Hispanic white patients were more likely to be counseled but less likely to attempt to quit (P < .01). CONCLUSIONS: Counseling by physicians appears to motivate some patients to attempt to quit, but this study did not show significant improvement in actual quit rates in patients who were counseled by a physician.

Adolescent↗
PubMed1993

Pregnancy planning and pre-conception counseling. The PRAMS Working Group.

OBJECTIVE: To estimate the percentage of women with one or more of four potentially modifiable risks who could have availed themselves of pre-conception counseling. METHODS: We defined pre-conception counseling to be consultation that occurs shortly before a couple attempts conception. Thus, we assumed that to obtain pre-conception counseling, a woman must plan her pregnancy. We used data from a population-based survey of 12,452 new mothers in four states who delivered babies during 1988-1990. Mothers were contacted 3-6 months after delivery and asked about pre-conception behaviors and the planning status of their pregnancies. We estimated the percentage of women who planned their pregnancies and had an indication for pre-conception counseling related to smoking, drinking, being underweight, or delaying initiation of prenatal care. RESULTS: State-specific response rates ranged from 68-84%. Sixty percent of mothers reported that their pregnancies were planned. In general, mothers with unintended pregnancies were more likely to have an indication for pre-conception counseling than mothers with planned pregnancies. Thirty-eight percent of all mothers planned their pregnancies and had one or more indications for pre-conception counseling. An additional 30% had one or more indications for counseling but did not have a planned pregnancy. CONCLUSIONS: Despite the limited range of indications for counseling that we considered, a substantial percentage of women potentially could have used counseling. A similar percentage of women could have benefited from family planning services.

Adult↗
PubMedDate not supplied

Counseling and testing for HIV prevention: costs, effects, and cost-effectiveness of more rapid screening tests.

New rapid human immunodeficiency virus (HIV) antibody tests permit many individuals to receive test results and appropriate counseling at one clinic visit. Because currently used tests require significant time for processing, all individuals must return for a second visit for test results and counseling. Since return rates for the second visit are low, the more rapid tests present an opportunity to improve the efficiency of HIV counseling and testing. The authors compared the costs and effectiveness of the currently used counseling and testing procedure and a streamlined procedure made possible by the new, more rapid screening tests. When test-positive clients are given preliminary screening test results, the rapid procedure is more cost-effective than the current procedure. Since over 90% of the clients in most clinics will test negative, the rapid counseling and testing procedure allows the vast majority of clients to be counseled and tested and to receive their results and posttest counseling in one visit. However, in the case where the goal of HIV counseling and testing is to focus only on infected individuals, if information regarding a positive result from the rapid screening test is not given to clients at the initial visit before a confirmatory test is performed, then the rapid counseling and testing procedure is not more cost-effective than the current procedure.

AIDS Serodiagnosis↗
PubMed1997

Counselling following diagnosis of a fetal abnormality: comparison of different clinical specialists in Mexico.

Most geneticists agree that counselling should be nondirective, and studies report that genetic counselling by geneticists is performed largely in a neutral style. However, couples at risk of having a child with a genetic condition may seek the advice of other physicians. The purpose of the present study was to describe the answers of four groups of specialists from Mexico City (internists, pediatricians, obstetricians, and neurologists) regarding how they would counsel a couple when prenatal diagnosis has shown that a fetus is affected by one of 17 different genetic disorders and to analyze the role of several variables in the development of their opinion. Our results show that physicians in these specialties are more likely to counsel directively than neutrally. Other variables did not influence the directiveness. With respect to direction of influence, internists, pediatricians, and neurologists are more likely to counsel terminating affected pregnancies than are obstetricians (P = 0.0002). Similarly, clinicians older than 37 years of age and those reporting that religion is not important to them counsel terminating affected pregnancies (P = 0.005 and P = 0.003, respectively). Physicians' gender and clinical experience with genetic diseases did not show statistically significant differences. Strong consensus among specialists was reached only on terminating pregnancies in anencephaly. A lowered and moderate consensus (51-75% agreement) was reached on continuing pregnancies with cleft lip and plate. A moderate measure of consensus for nondirective counselling was found among obstetricians regarding 14 of the 17 diseases in the study, whereas neurologists expressed a moderate measure of consensus on counselling the termination of pregnancies when the fetus was affected by neurological disorders. Hence, the approach to counselling was related in part to the fetal condition and in part to the clinician's specialty and age and the self-reported importance of religion. The data presented herein may not be representative of all Mexican physicians within the selected specialties; however, it is important to gather their opinions because they are involved in the care and treatment of genetic diseases and may have an important influence on the demand and availability of prenatal diagnosis and abortion.

Abortion, Induced↗
PubMed1998

Do pediatricians counsel families about sun protection?: a Massachusetts survey.

BACKGROUND: Pediatric visits during summer months may be especially opportune times for sun protection counseling for children and their parents. Few data exist on the extent of such counseling. OBJECTIVE: To begin to assess this, we surveyed practicing Massachusetts pediatricians to examine current attitudes and practices of sun protection counseling. DESIGN AND SETTING: Surveys mailed to Massachusetts pediatricians. RESULTS: We received surveys from 756 (60%) of 1263 eligible Massachusetts pediatricians. Almost 70% indicated that they recommended safe sun practices to more than 50% of their patients and their parents during the summer months. Counseling regarding seat belt use, bicycle helmet use, and smoking prevention were ranked higher in priority than sun protection counseling by pediatricians; nutritional guidelines were noted by pediatricians to be a parent's most frequent concern. Four variables were independently associated with a practitioner's providing safe sun recommendations to more than 50% of parents and children: (1) private setting and health maintenance organization practitioners as opposed to academic physicians, (2) high ranking of patients' safe sun knowledge, (3) high priorities of both parents and physicians for sun protection counseling and parental knowledge of safe sun practices relative to other recommendations, and (4) pediatrician interest in receiving instructional materials. CONCLUSIONS: For the most part, summer sun protection counseling among Massachusetts pediatricians seems well integrated into standard practice. Most pediatricians rated their confidence level as high for discussing sun protection and only a few cited inadequate training or poor reimbursement as barriers toward improved counseling. Small steps, such as providing more instructional materials to patients and using office-based reminder systems, may improve the quality of sun protection counseling practices. Incorporating sunburn prevention into the list of routinely recommended injury prevention guidelines for pediatricians should be considered.

Adolescent↗
PubMed2006

Factors associated with the pharmacist counselling without dispensing.

PURPOSE: To describe the pharmacist counselling without dispensing and to analysed the characteristics of pharmacies and pharmacists that provide this type of counselling, and the characteristics of customers that receive it to a greater extent. METHODS: We carried out a cohort study on a sample of 166 pharmacists in North West Spain. Different characteristics of pharmacists and clients and other variables related to counselling were measured (who initiates the consultation; type of consultation; whether or not the patient consulted with a doctor previously and who is the receptor of the counselling) were included in the models as independent variables. Pharmacist Counselling without dispensing (PhCwD) were included as dependent variable. We constructed logistic regression models. RESULTS: The response rate to the first questionnaire was 98.8% and the participation rate in the follow-up was 60%. Out of 7010 registered pharmacist counselling, 6034 were included in the final analysis (86.1%). The proportion of PhCwD is 26.3% (95%IC: 25.2-27.4). CONCLUSIONS: Our results show the number of working hours of the pharmacist and the amount of customers are associated with PhCwD. So working hours and amount customers should be reduced. Other factor that should be taken into account is the fact that pharmacists with less experience should give less counsels. Thus during the university period pharmacist counselling should be studied. Finally, our results show that an important proportion of counselling is given regardless the dispensation process, and this should be taken into account when defining the pharmacists remuneration system.

Adult↗
PubMed1995

Strengths and weaknesses in health counseling in Finnish primary health care.

Representative samples of Finnish health centres and of their physicians, nurses and physiotherapists were selected for a comprehensive survey on the professionals' work characteristics, health education attitudes and counseling practices. The main objectives of the study were to study the degree of implementation of patient counseling, with special reference to the national goals in health policy and to analyze the determinants of counseling practices in terms of predisposing, enabling and reinforcing factors. Broadly defined patient counseling was frequent in the contacts with all 3 professional groups and no differences in counseling frequency were found between different sizes of health centres. However, the objective of implementing counseling in every patient contact, with the incorporation of guidance regarding healthy living habits in it, recommended in the national health policy goals, was only partially realized. There were distinct differences between the 3 professional groups in counseling attitudes, topics, methods and purposes. These differences reflect, to a great extent, the differences in the professional tasks and the basic training between the 3 groups and also differences in the characteristics of patient contacts. These findings indicate a need for further in-service training in the methods of patients counseling, as well as restructuring the health care delivery system to allow more time for counseling, better continuity between contacts and more co-work between the members of primary care teams.

Finland↗
PubMed1997

Training in firearm safety counseling in family practice residency programs.

The purpose of this study was to establish a national baseline regarding the prevalence of training of family practice residents regarding firearm safety counseling. A national survey of the residency directors at the 420 accredited family practice residency programs in the coterminous United States was used to assess the prevalence of training in firearm safety counseling, perceived effectiveness of such training, and perceived barriers to such counseling in residency programs. Program directors were sent a two-page questionnaire on firearm safety counseling activity in their programs and 71% responded. Few residencies (16%) had formal training in firearm safety counseling. The most common perceived barriers were no trained personnel (31%), too many other important issues (31%), not enough time (30%), and lack of educational resources (28%). Patient education materials (57%), video training programs (49%), and a curriculum guide (46%) were identified as resources that would be most helpful in implementing a firearm safety counseling program. The results showed that formal training in firearm safety counseling is virtually absent from family practice residency training programs. This finding is not surprising given that less than 14% of the directors perceived firearm safety counseling would be effective in reducing firearm-related injuries or deaths and that research on effectiveness of such counseling is very limited.

Analysis of Variance↗
PubMed2000

The impact of antenatal diagnosis on the effectiveness and timing of counselling for cleft lip and palate.

Birth of a cleft child is emotionally distressing to the parents. The opportunity for forewarning the parents is now possible with antenatal ultrasound diagnosis of the cleft. This has opened up a new chapter of antenatal counselling. We present a retrospective postal study of 124 primary cleft lip and/or palate repairs operated over the last 5 years. In our study, 30% were diagnosed antenatally and received antenatal counselling. The rest received postnatal counselling. Of those who had an antenatal diagnosis 85% felt that the diagnosis prepared them psychologically for the birth of the cleft child. A total of 92% (n = 23) of parents who had antenatal as well as postnatal counselling, as compared with 71% (n = 46) of those counselled only postnatally, said the information given to them by the counselling cleft team was detailed and satisfactory. The majority of those who felt counselling was confusing had only postnatal counselling. Of those who had antenatal diagnosis 92% said that they had never contemplated termination of pregnancy. Only one parent had actually terminated her pregnancy due solely to the antenatal diagnosis of a bilateral cleft lip and palate. Our study has highlighted the importance of antenatal diagnosis of cleft and the importance of antenatal counselling for the delivery of a cleft child to be a positive experience.

Cleft Lip↗
PubMed1997

Patient counseling--a focus on maintenance therapy.

Pharmacist counseling of patients receiving long-term medications for chronic diseases is discussed. Patient counseling should be viewed as one component of the overall drug-use process. Pharmacists counseling patients prescribed long-term medications need to understand the lifestyle effects of chronic illness, particularly the different types of "work" the chronically ill patient must undertake. Pharmacists need to go beyond traditional sender-message-receiver communication models in counseling patients and to adopt a problem-solving approach through which each patient's needs and level of understanding are taken into account. Patients should be actively involved in their therapy decisions. Patients will be at varying stages in terms of making any behavioral changes needed to maximize therapeutic outcomes, and counseling must be adapted to fit the stage of change. The Indian Health Service (IHS) model of counseling uses open-ended questions to determine patients' knowledge of their disease and medications; this enables the pharmacist to fill in any gaps and review specific points. The health communication model provides strategies for enhancing patient compliance and recall and complements the IHS model. In practice, the techniques used will depend on whether the patient is a new-prescription patient or an established patient. The models can be adapted to counseling care-givers and can be complemented by compliance aids. The demand for pharmacist counseling of patients with chronic illnesses is likely to increase, and, to effectively counsel patients about long-term medication use, pharmacists need to appreciate the personal impact of chronic illness beyond the direct effects of the biomedical disease itself, and must understand modern communication models.

Chronic Disease↗
PubMedDate not supplied

Medication counseling center in a teaching hospital.

Patient compliance is often not achieved during drug therapy. Many reasons including lack of patients' understanding regarding medication and disease, poor socioeconomic pattern, unavailability of drugs are attributed to this situation. Providing counseling to patients can improve their understanding regarding medication, disease and life style modifications which in turn improves compliance. Medication counseling centers are one of the means to counsel the patients. The study was conducted to analyze the performance of such a center at Manipal Teaching Hospital, a teaching hospital in Western Nepal. Patients were counseled as per the Omnibus Budget Reconciliation Act-1990 guidelines and data were collected from the documentation form of the center and analyzed. Results indicated that 84.5% of the patients were directed to the medication counseling center by the pharmacists. Nearly one quarter of the population was either asthmatic or chronic obstructive pulmonary disease patients. Bronchodilators were found to be the major therapeutic category of drugs and were found in 26.7% of the patients. Among the various counseling aids, placebo inhalers were used in 45.1% of the patients. The counseling pharmacists dedicated an average time period of 6-10 minutes in about 42.1% of the patients. Language was found to be the major barrier while counseling 16.5% of the patients. The study concluded that the medication counseling center can play a definite role in enhancing patients' understanding about medications and disease pattern, which in turn may improve patient compliance.

Adolescent↗
PubMed1995

Impact of pharmacist counseling on medication knowledge and compliance.

The impact of discharge counseling was measured in a veteran patient population in a large tertiary-care government medical center. Upon discharge, seventy patients were randomly assigned to one of two groups: one group received verbal medication counseling from a pharmacist, the other group did not. Medication knowledge and compliance were assessed by interviewing each patient approximately 6 weeks after discharge. Sixty patients (31 counseled, 29 uncounseled) completed the study. Forty-five patients were from our rehabilitation division (housing psychiatric, intermediate, and long-term care patients), and 15 patients were from our acute-care division. Overall, counseled patients were no more knowledgeable or compliant than uncounseled patients. However, among those patients discharged from our acute-care division, counseled patients were more knowledgeable and compliant than uncounseled patients. In all patients, medication knowledge and compliance decreased as their number of medications increased. Our discharge counseling program had little impact when examining all study patients. But in acute-care patients, discharge counseling did increase both medication knowledge and compliance. Our study also showed that, in both counseled and uncounseled patients, medication knowledge and compliance decreased as the number of discharge medications increased, and additional pharmacist counseling would likely prove beneficial to those patients discharged on multiple medications.

Adult↗
PubMed1980

The determinants of mothers' knowledge of the Down syndrome before genetic counseling: part II.

Mothers coming for genetic counseling because they have an infant with the Down syndrome (DS) vary in their amount of knowledge about the cause, recurrence risk, and options for dealing with the recurrence risk. The purpose of this work has been to determine some predictors of the variability in mothers' knowledge of the DS before coming to genetic counseling. Data were collected before counseling through a detailed interview concerning mothers' knowledge of the DS, their demographic background, fertility plan, and attitude toward family planing. These data were "reduced" by multiple-regression analysis, to 7 variables used in a prediction equation for mothers' level of pre-knowledge attainment. These variables were then used to construct a model which was tested by path analysis. Results of analyses showed that about 2/3 of the variance in mothers' pre-knowledge of the DS could be accounted for by 5 independent variables: 1) time from diagnosis to counseling session, 2) date of counseling session, 3) nonreporting of emotional upset, 4) education-occupational status (EOS), and 5) utilization of birth control methods. These findings led to the conclusion that what occurs before counseling is of importance for the outcome of genetic counseling, as measured by the genetic information acquired by the counselees. Some precounseling precedures are suggested on how genetic counselors might be able to gain more control over the important factors that occur before actual counseling.

Down Syndrome↗
PubMed1980

Analysis of a follow-up study of genetic counseling.

A follow-up study of 212 families for whom genetic counseling had been provided was performed to assess the effectiveness of the non-directive genetic counseling service at the Mount Sinai Medical Center in New York City. The preliminary result have been reported previously (Godmilow & Hirschhorn 1977). Of those families surveyed, 72% responded. Adequate recall of the genetic information was demonstrated by 74% of those responding, and 80% described their counseling experience as favorable. A direct relationship was noted between the degree of satisfaction and whether or not the counselees received the mode of counseling they preferred, i.e., individual versus team. Sixty-two percent of those counselees reaching a procreative decision indicated that genetic counseling had influenced their decision making. A significant correlation was noted between the magnitude of the occurrence or recurrence risk and the procreative decisions reached. However, some decisions were modified by the counselees' subjective interpretation of the burden associated with the disorder in question. It is concluded that follow-up of genetic counseling by questionnaire, together with statistical analysis of the data received, can provide the genetic center with valuable information regarding strengths and weaknesses of the counseling program and can suggest ways to improve the counseling process and thereby enhance its effectiveness.

Congenital Abnormalities↗
PubMed2000

Genetic counseling for women with an intermediate family history of breast cancer.

Women with a family history of breast cancer often over-estimate their personal risk for cancer and may view themselves as candidates for genetic testing even when the likelihood of an informative test result is low. We report here on genetic counseling of women with an intermediate family history of breast cancer, defined as women who have one or more biological relatives with breast cancer but whose pedigree suggests a low likelihood of autosomal dominant transmission. A genetic counseling protocol based on traditional genetic counseling strategies was developed with additional components added to address the needs of women with moderately increased breast cancer risk. These additional components included information about non-genetic risk factors, comparisons of high and moderate risk pedigrees, and evaluation of personal risk based on both genetic and nongenetic risk factors. Most participants liked the genetic counseling and found it useful. At baseline, participants over-estimated both their personal risk of breast cancer and that of the average woman. After counseling, estimates of personal and average risk of breast cancer were lower, although both remained higher than actual risk. Most participants reported that they felt less worried about breast cancer after receiving their personal-risk estimate. At baseline, most women judged themselves to be candidates for genetic testing and expressed interest in testing. The number who considered themselves candidates for testing was reduced after counseling (60% versus 82%) but still constituted a majority. Similarly, interest in testing was partially reduced by counseling (60% versus 91%). We conclude that genetic counseling can help women with an intermediate family history of breast cancer to develop more accurate views of their risk, reduce their breast cancer worry, and aid some of them in developing a more realistic view of genetic testing.

Adolescent↗
PubMed2006

Telephone counselling for smoking cessation.

BACKGROUND: Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES: To evaluate the effect of proactive and reactive telephone support to help smokers quit. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register for studies using free text term 'telephone*' or the keywords 'telephone counselling' or 'Hotlines' or 'Telephone' . Date of the most recent search: January 2006. SELECTION CRITERIA: Randomized or quasi-randomized controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters. DATA COLLECTION AND ANALYSIS: Trials were identified and data extracted by one person (LS) and checked by a second (TL). The main outcome measure was the odds ratio for abstinence from smoking after at least six months follow up. We selected the strictest measure of abstinence, using biochemically validated rates where available. We considered participants lost to follow-up to be continuing smokers. Where trials had more than one arm with a less intensive intervention we used only the most similar intervention without the telephone component as the control group in the primary analysis. We assessed statistical heterogeneity amongst sub groups of clinically comparable studies using the I(2) statistic. Where appropriate, we pooled studies using a fixed-effect model. A meta-regression was used to investigate the effect of differences in planned number of calls. MAIN RESULTS: Forty-eight trials met the inclusion criteria. Among smokers who contacted helplines, quit rates were higher for groups randomised to receive multiple sessions of call-back counselling (eight studies, >18,000 participants, odds ratio (OR) for long term cessation 1.41, 95% confidence interval (CI) 1.27 to 1.57). Two of these studies showed a significant benefit of more intensive compared to less intensive intervention. Telephone counselling not initiated by calls to helplines also increased quitting (29 studies, >17,000 participants, OR 1.33, 95% CI 1.21 to 1.47). A meta-regression detected a significant association between the maximum number of planned calls and the effect size. There was clearer evidence of benefit in the subgroup of trials recruiting smokers motivated to quit. Of two studies that provided access to a hotline one showed a significant benefit and one did not. Two studies comparing different counselling approaches during a single session did not detect significant differences. A further seven studies were too diverse to contribute to meta-analyses and are discussed separately. AUTHORS' CONCLUSIONS: Proactive telephone counselling helps smokers interested in quitting. There is evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit. Three or more calls increases the odds of quitting compared to a minimal intervention such as providing standard self-help materials, brief advice, or compared to pharmacotherapy alone. Telephone quitlines provide an important route of access to support for smokers, and call-back counselling enhances their usefulness.

Counseling↗
PubMed2002

Genetic counseling in hereditary breast/ovarian cancer in Israel: psychosocial impact and retention of genetic information.

Genetic counseling for individuals at high risk for developing breast and ovarian cancer (oncogenetic counseling) involves evaluation of cancer risk, psychological assessment, and genetic testing for germline mutations in BRCA1/BRCA2 genes. The long-term psychosocial impact of oncogenetic counseling on consultees and the retention of oncogenetic information are uncertain. We retrospectively interviewed 155 women who underwent oncogenetic counseling in a single medical center in Israel in 1996 (N = 50) and 1998 (N = 105). There were 29 (18.7%) BRCA1/BRCA2 mutation carriers and 126 non-carriers; 58 (37.4%) had a past or present history of cancer, and 97 (62.6%) were first-degree relatives within breast/ovarian cancer families. A questionnaire evaluating self-reported distress and anxiety symptoms before and after counseling, as well as the retention of relevant information (e.g., individual and offspring cancer risk, early detection schemes), one and three years after the initial consultation was administered. Overall, oncogenetic counseling had a minimal effect on anxiety-related symptoms. Mutation carriers reported anxiety-associated symptoms, such as sleeplessness and "bad mood", more frequently than non-carriers following oncogenetic counseling. As expected, 61.8% of carriers and only 30% of non-carriers accurately remembered the personal and offspring cancer risk and preventive and early detection schemes. We conclude that although there seemed to be slight worsening of anxiety-related symptoms following oncogenetic counseling in BRCA1/BRCA2 mutation carriers, these symptoms were minimal and did not affect everyday life activities. In addition, there is an ongoing need to emphasize oncogenetic information to high-risk individuals.

Adult↗