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PubMed2000

The effect of advance care planning on completion of advance directives and patient satisfaction in people with HIV/AIDS.

The effects of advance care planning are poorly understood. The purpose of this study was to evaluate the effect of an advance care planning intervention on the completion of advance directives (ADs) and patient satisfaction. A volunteer sample of persons with HIV/AIDS received advance directive documents, watched an educational video and received individual counselling on completing an advance directive during three face-to-face interviews over approximately six months. The advance care planning intervention was associated with an increase in advance directive completion rates from 16.4% to 40.7% (p = 0.001), but 23.1% of advance directives reported as completed were legally invalid. There was a trend towards decreased overall patient satisfaction with health care (p = 0.07). Advance are planning increases the rate of AD completion but many 'completed' advance directives are legally invalid. Advance care planning did not improve patient satisfaction with health care.

Adult↗
PubMed2003

Genetic counselling for cancer and risk perception.

The main aim was to investigate risk perception and psychological distress in individuals attending genetic counselling. A consecutive series of 86 individuals with a diagnosis and/or family history of breast, ovarian or colorectal cancer was included. Risk assessments were performed before and immediately after genetic counselling and at a one-year follow-up. Psychological distress was assessed 1 week before, and 6 weeks, 6 months and 1 year after genetic counselling. The number of individuals who correctly-estimated the general risk in the population increased significantly from 35%, before to 82% after counselling (p < 0.001). One year later, data on general risk estimates showed a significant reduction of the number of correct estimations to 51%, compared with directly after the counselling (p < 0.005). In total, 54% estimated their own lifetime risk correctly after the counselling, compared with 17% before (p < 0.001) (those with a cancer diagnosis estimated the risk of their children developing cancer). One year later, the number of correct estimations had dropped to 28%. Before the counselling, the majority of the participants overestimated both the general risk and their own/children's risk. The participants experienced moderate levels of psychological distress before the counselling and a decrease of anxiety afterwards (p < 0.02). However, half of the participants reported moderate or high distress. There were no differences in psychological distress between those who estimated their risk/ children's risk as low, moderate or high or between those who over-, under- or correctly estimated their own/children's risk. Further investigations are needed to develop and adjust the risk information provided to the individual in order to avoid misunderstanding, especially as this information is going to be revealed to family members Counselling support should be offered to those individuals who experience psychological distress.

Anxiety↗
PubMed1984

Genetic counselling: its need in psychiatry and the directions it gives for future research.

The methods for investigating the extent to which genetic factors can influence vulnerability to psychiatric illness are, in increasing order of precision: family, twin, and adoption studies. The evidence from these studies is in support of a gene-environment interaction for schizophrenia and the affective disorders. While the family study method cannot supply precise etiological data, the empirically derived information can be used by the genetic counsellor to provide empirical risk estimates to the counsellee. The psychiatrist, geneticist, and social worker make an appropriate team for reliable genetic counselling. The clinician must determine the precise psychiatric diagnoses in family members which the geneticist may use to estimate risk. The social worker can follow-up the counselling session or sessions to assess the counsellees' understanding of what has been told to them. It is stressed that while genetic counselling should be available, clinical judgement should be exercised to ensure its appropriate use.

Genetic Counseling↗
PubMed1997

Predictors of quality of life after hospital admission for heart attack or angina.

This study tests the hypothesis that it is possible to predict people who will have a low quality of life (QOL) 6 months after hospital admission for acute myocardial infarction (AMI) or angina. Among 424 patients discharged from hospital in the Hunter Region of New South Wales with a diagnosis of AMI or angina, follow-up questionnaires were received from 303 at 6 months. Baseline data collected during hospitalisation included demographic variables and the 'emotional' factor of a disease-specific QOL measure using a modified and validated self-administered questionnaire. The full QOL measure comprises 'emotional', 'physical' and 'social' factors, each factor being assessed at the 6-month follow-up. Only baseline 'emotional' QOL score and sex predicted 6-month QOL scores in patients with AMI. Scores were consistently lower in patients with angina, in whom marital and employment status, having had a previous AMI, current cigarette smoking, the presence of cardiac failure and baseline emotional QOL were all significantly associated with the 6-month QOL scores. The assessment of simple measures during hospitalisation for angina can be helpful in predicting those who will have a low QOL 6 months later. They may represent a high-risk group at whom counselling could be directed.

Aged↗
PubMed2004

Time expenditure in patient-related care provided by specialist palliative care nurses in a community hospice service.

Although the importance of specialist palliative care in home care programmes for terminally ill patients is well known, German community hospice services did not begin to employ nurses who had specialized in palliative care until the early 1990s. The general tasks of these nurses are sufficiently well defined, but no comprehensive data of their daily workload are available in Germany to date. The present article examines time expenditure in direct patient-related care at the community-based hospice service in Mainz, Germany, by analysing time registration sheets concerning 351 patients who received care from January 2000 until December 2002. Fifty-five per cent of care time spent on each individual patient was in direct contact with that patient and/or his or her relatives, 20% of the time was spent on networking and other related tasks, 17% on travelling and 8% on bereavement counselling. Activities in direct patient contact were allotted to pain and symptom control (36.4%) and psychosocial support of the patient (32.4%) or his or her relatives (27.1%), whereas nursing issues played a minor role (4%).

Adolescent↗
PubMed2000

The development and initial validation of the Multicultural Environmental Inventory: a preliminary investigation.

This article describes the development and initial validation of the Multicultural Environmental Inventory (MEI). The MEI is an instrument designed to measure an individual's perceptions about the degree to which graduate counseling programs address multicultural issues within curriculum, supervision, climate, and research. This investigation was conducted using the data from 208 students and faculty from counseling psychology graduate programs across the United States approved by the American Psychological Association. By using techniques of exploratory factor analysis, a 4-factor solution was determined to account for the relationships among the items on the MEI. The instrument was modified from 53 to 27 items on the basis of the items' effectiveness in measuring the underlying constructs of interest, and internal consistency information is provided on the final revised instrument (MEI-R). The factors underlying the MEI-R are discussed within the context of a multicultural environment in graduate counseling programs, and directions for future research are considered.

Adult↗
PubMed1998

[Smoking and diabetes. An intervention protocol].

Tobacco smoking habit has been considered like an important cause of diabetes mellitus complications. Health education efficiency has been supported by many experiences in order to promote tobacco withdrawal by personal counselling with a direct nurse role at primary health care level. This study was carried out by all this information with tre straight goal of describing changes in the diabetic tobacco behaviour after a stepped counselling and a primary care nurse following. Description details are given of the smoking diabetic population counselled and listed at the same time in a nurse control clinic over a 18 months period. A Smokers Helping Scheme (SHS) was used. SHS understood that tobacco withdrawal is behavioural changing process with a few steps. Smokers were given with special written material for thes purpose. Results data were caught by the researchers from the chronical patient's census and from the tobacco program control sheets. Tobacco withdrawal was verified by espirated air CO determination (Smokorlizar system) and has been maintained by the 25% of managed diabetic people in this investigation. We strongly believe that nursing diabetic tobacco counselling by SHS acts like a behavioural modificator as results are showing. Health state improvement and a better life quality have been got on the diabetic people that has been managed.

Counseling↗
PubMed2001

Consumer and surrogate preferences for a cash option versus traditional services: Florida adults with developmental disabilities.

As long-term service expenditures have risen, policymakers have sought ways to control costs while maintaining consumer satisfaction. Concurrently, there is increasing interest in the disability community in consumer direction. The Cash and Counseling Demonstration and Evaluation (CCDE) seeks to increase consumer direction and control costs by offering a cash allowance and information services to persons with disabilities, enabling them to purchase needed assistance. Because the disability community is composed of diverse subgroups, needs of these consumer communities must be assessed individually. Results from a telephone survey conducted to assess the interest in a cash option for Florida adults with developmental disabilities is presented, the three-state CCDE described, how survey findings can inform consumer information efforts discussed, and policy issues highlighted.

Adult↗
PubMed2005

Accuracy of MSI testing in predicting germline mutations of MSH2 and MLH1: a case study in Bayesian meta-analysis of diagnostic tests without a gold standard.

Microsatellite instability (MSI) testing is a common screening procedure used to identify families that may harbor mutations of a mismatch repair (MMR) gene and therefore may be at high risk for hereditary colorectal cancer. A reliable estimate of sensitivity and specificity of MSI for detecting germline mutations of MMR genes is critical in genetic counseling and colorectal cancer prevention. Several studies published results of both MSI and mutation analysis on the same subjects. In this article we perform a meta-analysis of these studies and obtain estimates that can be directly used in counseling and screening. In particular, we estimate the sensitivity of MSI for detecting mutations of MSH2 and MLH1 to be 0.81 (0.73-0.89). Statistically, challenges arise from the following: (a) traditional mutation analysis methods used in these studies cannot be considered a gold standard for the identification of mutations; (b) studies are heterogeneous in both the design and the populations considered; and (c) studies may include different patterns of missing data resulting from partial testing of the populations sampled. We address these challenges in the context of a Bayesian meta-analytic implementation of the Hui-Walter design, tailored to account for various forms of incomplete data. Posterior inference is handled via a Gibbs sampler.

Adaptor Proteins, Signal Transducing↗
PubMed1997

Is there a "women's ethic" in genetics: a 37-nation survey of providers.

The ethical views of 2,903 geneticists in 37 nations were surveyed and compared by gender. Women made up about half the physicians and PhDs and the great majority of genetic counselors. US women physicians differed from men physicians on 13% of 491 ethical questions; genetic counselors differed from all MDs on 60% and from women MDs on 46%. Women physicians were similar to men in directiveness and most counseling after prenatal diagnosis. More women would refer for sex selection, more would warn a patient's relatives of genetic risks against the patient's wishes, and fewer would test children for genes for adult-onset disorders. Genetic counselors were less directive than physicians, more likely to preserve confidentiality, and less willing themselves to abort. Outside the United States, women physicians differed from men 43% of the time; they were more directive than men, more pessimistic about disabilities, more willing to abort fetuses with genetic disorders, and more likely to place the health of potential children or the welfare of family above parental autonomy. No universal "women's ethic" emerged from the study; culture and professional locus affected views more than gender.

Adult↗
PubMed2006

Genetic disorders among Palestinian Arabs. 4: Genetic clinics in the community.

Genetic disorders are frequent in the Arab population of Israel, mainly because of the preference for consanguineous marriages. Many of the inherited diseases are present with a high frequency only in a limited region or a single village. It is therefore not surprising that, in each of the villages, a different distribution of genetic diseases is found; thus, a detailed knowledge of the genetic disorders present in each village is of utmost importance for genetic counseling. As a direct consequence of these observations two community genetics clinics were opened as a pilot project to study their impact on the population to be served. The use of a computer database allowed for easier and more accurate genetic counseling. There were almost 1,500 visits in the 4-year period since the introduction of the services. During the years an increase in the mean number of consultations per clinic as well as a change in the type of referrals was observed. There was an increasing proportion of clinics that were made at a time in which genetic counseling allow for primary prevention. The presence of a genetic counselor in the village clinic allows for better and closer contacts with the family physician.

Arabs↗
PubMed1998

The impact of counselling on HIV-infected women in Zimbabwe.

The objective of this study was to examine the impact of counselling provided for HIV-infected women in Zimbabwe. Qualitative research was used for data collection. In total, 44 women were heard; most were members of an HIV support group. Doctors and nurses play an important role in the first counselling session, because tests to diagnose HIV-infection are done in the hospital. Interviewed women mention slow disclosure of status as the most comforting way to hear the news. The HIV-infected women experience strong emotions directly after diagnosis. Counselling at this moment is of major importance to reduce fear and can prevent suicide. Women should be prevented from discovering their status on their own. Counselling given once is found not to be effective. First, if only one counselling session is given, the women may not hear or remember all that is said. Second, in case of depression, access to counselling is important and it appears that periods of depression return frequently. Support groups play an important role in providing this continuous counselling. Another advantage of the counselling provided by HIV-positive women of a support group is that the counsellors function as examples.

Adult↗
PubMed1998

Genetic counseling: clinical and ethical challenges.

After explaining the origin, nature, and goals of genetic counseling, we consider the impact of the Human Genome Project on its practice. In light of the availability of presymptomatic tests for late-onset disorders and the possibility of preventive behavior or treatment, we examine the apparent conflict between nondirectiveness and directiveness in genetic counseling. We discuss views of genetic counselors, medical geneticists, and counselees on specific issues, and document gender differences in attitudes toward genetic ties to offspring. Because genetic discrimination and unequal access to genetic services are likely to increase with advances in genetics, we conclude that efforts of genetic counselors to adhere to the principle of justice or equity in their practice cannot be successful without governmental and public support, as well as support from researchers and colleagues in health care.

Ethics, Medical↗
PubMed2004

[The roles and functions of volunteer counselors to the elderly].

In Taiwan's current counseling centers for the elderly, large numbers of volunteers are supervised by only a few social workers or nurses, so the roles and functions of these volunteers are very important. A neat summary of the services provided by the volunteers would include: (1) Direct services: telephone counseling, telephone interviewing, case handling, mail counseling, resource provision. (2) Indirect services: fundraising, supervision. (3) Administration: administrative assistance, management of institutional web sites. (4) Strategic consultancy: consultancy, provision of expertise. (5) Advocacy: service as educators and spokespersons; public relations and marketing. (6) MANAGEMENT: team leadership, plan implementation. To sum up, their functions are, by means of telephone and face-to-face contact, to provide information to the elderly about finances, medical services, housing, citizenship, the dignity of life and death, and related issues, as well as to serve as advocates for the provision of resources--such as educational courses--and to facilitate such provision. Indeed, the roles and functions of volunteer counselors become more diverse and more comprehensive by the day.

Aged↗
PubMed1989

Antilibidinal drugs and mental retardation: a review.

A minority of people with mental retardation have sexual behaviour which is socially unacceptable or which brings them into conflict with the law. Such behaviour may be the result of ignorance about sexual matters, often best managed by counselling or by a behavioural approach. There are a small number of men with mental retardation and aberrant sexual behaviour who benefit from the prescription of an antilibidinal drug. Treatment with an antilibidinal drug alone reduces the intensity of sexual drive but does not alter its direction; concurrent sexual counselling or psychotherapy is often indicated. The various antilibidinal medications available are reviewed, with particular attention to reports which have described the treatment of people with mental retardation. Of the antilibidinals currently used, medroxyprogesterone acetate and cyproterone acetate are those for which there is most evidence of efficacy. Cyproterone acetate is preferable because it has a specific antiandrogenic action and fewer adverse effects. There is a need for controlled studies of antilibidinal drugs, with clearly defined inclusion criteria and adequate measures of both behavioural and attitudinal change.

Benperidol↗
PubMed1991

Sexual counselling in the neuroscience setting: theory and practical tips for nurses.

Human sexuality and sexual function may be profoundly affected by a number of neurologic illnesses and injuries. While nurses have historically supported the value of the holistic approach to patient care, sexuality (as a routine component of the recovery process) has frequently been neglected. Nurses' discomfort with this topic must be addressed in order to maximize patients' adjustment to any sexual changes. The purpose of this presentation is to reduce some of the anxiety surrounding the topic of sexuality, by suggesting strategies which nurses may find useful in approaching the subject and approaches to initiating the discussion outlined. Finally, a theoretical framework for promoting sexual health will be presented and its congruence with popular nursing models briefly examined. "Sexual counselling should be directed as to supporting a client's ability to make choices in every aspect of his life, including use of sexual experience." Comarr & Vigue.

Humans↗
PubMed1997

[The importance of counseling in the context of prenatal diagnosis].

Counseling plays a central role of the utmost importance in the doctor-patient/client relationship in medical genetics. Historically, its development may be described as a paradigm shift from eugenics via preventive medicine to a more psychosocial understanding as a communication process, which aims at individually bearable, autonomous decisions. The widely accepted conception of non-directiveness in genetic counseling has implications for the rights of patients and clients as well as for the duties of those offering and performing genetic diagnosis and counseling. In the context of prenatal diagnosis, genetic counseling has its special role as a framework to prevent ethically unacceptable automatism and to safeguard the interests of the individual patient/client. In view of the marked lack of adequate counseling capacities, increasing the potential of prenatal genetic diagnosis requires the development of different, possibly new concepts for counseling in this area.

Abortion, Induced↗
PubMed2001

Does health habit counseling affect patient satisfaction?

BACKGROUND: Health behavior advice can potentially prevent a large burden of illness, but the acceptability of this advice to patients is not well understood. This study assessed whether physician discussion of behavioral risk factors decreases patient satisfaction with the outpatient visit. METHODS: In a cross-sectional study of 2,459 consecutive adult outpatient visits to 138 community family physicians in Northeast Ohio, the association of health habit counseling, measured by direct observation, with patient satisfaction, assessed by a modified subscale of the MOS 9-item visit rating scale, was calculated by logistic regression. RESULTS: In analyses controlling for patient mix, discussion of diet, exercise, alcohol and other substance use, sexually transmitted disease, and HIV prevention was not associated with patient satisfaction. Patients who were asked about their tobacco use or counseled about quitting were more likely to be very satisfied with the physician. CONCLUSIONS: Discussion of health behavior change, as practiced by community family physicians, is not associated with diminished patient satisfaction. In fact, tobacco use assessment and cessation counseling are associated with greater satisfaction.

Counseling↗