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Psychosocial problem assessment: to counsel or not to counsel.

A pragmatic method for assisting family practice residents in deciding whether or not to counsel patients with psychosocial problems is described. Called "the problem assessment framework," this seven-step method uses a process of sequential analysis to guide the resident through problem identification, goal setting, and determination of appropriate intervention. A checklist is employed to quickly evaluate the suitability of resident and patient for engaging in psychological counseling.

Counseling↗

[Psychotherapeutic counseling and treatment of students within the scope of a psychotherapy counseling center].

The field of psychotherapeutic counseling in germany is rather heterogeneous and scientifically scarcely investigated. As an example the author describes the organisation and methods of a psychotherapeutic counseling service for students. Statistical material of the kind of complaints and disorders is given and first results of an evaluation study are reported.

Adaptation, Psychological↗

Characteristics of inactive primary care patients: baseline data from the activity counseling trial. For the Activity Counseling Trial Research Group.

BACKGROUND: Although many primary care patients are inactive, being able to classify even small amounts and intensities of activity and factors associated with these activity levels could be helpful for physicians who are trying to motivate their patients to become more physically active. METHODS: Sociodemographics, physical activity, fitness, other cardiovascular risk factors, and psychosocial measures were measured at baseline in the 874 patients in the Activity Counseling Trial. Patients were categorized into three groups: (1) no moderate-to-vigorous physical activity (MVPA), (2) some moderate but no vigorous activity, and (3) some vigorous activity. Multiple logistic regression was used to determine factors cross-sectionally associated with activity intensity. RESULTS: One or more cardiovascular risk factors in addition to physical inactivity were present in 84% of participants. Maximal oxygen uptake averaged 25.2 ml/kg/min; 85% had poor to fair aerobic fitness. Physical activity averaged 32.7 kcal/kg/day, with 13.5 min of MVPA/day; 26% engaged in some vigorous activity, 11% engaged in no MVPA. In unadjusted analyses, gender, age, race, education, income, employment, smoking, alcohol use, and exercise self-efficacy were associated with activity intensity (P = 0.05-0.001). A greater percentage engaged in moderate than in vigorous activity in all subgroups. In multiple logistic regression analyses, odds ratios (95% confidence intervals) for engaging in vigorous activity were 0. 39 (0.28, 0.56) for women, 0.38 (0.19, 0.75) for 65+ compared with 35- to 44-year-olds, and 1.14 (1.06, 1.22) for 10-unit increases in performance self-efficacy score. CONCLUSIONS: Most primary care patients who are physically inactive have additional cardiovascular risk factors, particularly overweight and obesity. All subgroups pursue moderate-intensity activity more often than vigorous activity. Women, older persons, and those with lower exercise self-efficacy are less likely to engage in vigorous activity.

Adult↗

Assessment of the use and feasibility of video to supplement the genetic counseling process: a cancer genetic counseling perspective.

Cancer genetic counselors use a variety of teaching modalities for patient education. This survey of cancer genetic counselors assessed their use of educational videos and their recommendations for content of future videos. Thirty percent of respondents use videos for patient education. Cited benefits included reinforcement of information for clients and increased counselor efficiency. Of the 70% who do not use videos, predominant barriers included the perceived lack of an appropriate video, lack of space and/or equipment, and concern that videos are impersonal. Most respondents desired a video that is representative of the genetic counseling session, but emphasized the importance of using broad information. Content considered critical included the pros and cons of genetic testing, associated psychosocial implications, and genetic discrimination. The results of this exploratory study provide data relevant for the development of a cancer genetics video for patient education, and suggestions are made based on aspects of information processing and communication theories.

Adult↗

An academic detailing intervention to disseminate physician-delivered smoking cessation counseling: smoking cessation outcomes of the Physicians Counseling Smokers Project.

BACKGROUND: Little is known about the effectiveness of interventions to disseminate smoking cessation interventions among a population of primary care physicians. This study's objective was to determine the effect of a community-based academic detailing intervention on the quit rates of a population-based sample of smokers. METHODS: This community-based, quasi-experimental study involved representative samples of 259 primary care physicians and 4295 adult smokers. An academic detailing intervention was delivered to physicians in intervention areas over a period of 15 months. Analyses were performed on the data from the 2346 subjects who reported at least one physician visit over 24 months. Multivariate regression analyses were conducted to determine the impact of the intervention on self-reported smoking quit rates, reported by adjusted odds ratios. RESULTS: Among smokers reporting a physician visit during the study period, there was a borderline significant effect for those residing in intervention areas versus control areas (OR = 1.35; 95% CI.99-1.83; P = 0.057). Among a subgroup of 819 smokers who reported a visit with an enrolled physician, we observed a significant effect for those residing in intervention areas (OR = 1.80; 95% CI 1.16-2.75; P = 0.008). CONCLUSION: An academic detailing intervention to enhance physician delivered smoking cessation counseling is an effective strategy for disseminating smoking cessation interventions among community-based practices.

Adult↗

A randomized trial of breast cancer risk counseling: interacting effects of counseling, educational level, and coping style.

The authors evaluated the impact of individualized breast cancer risk counseling (BCRC) on breast-cancer-specific distress and general distress in 239 women with a family history of breast cancer. Following a baseline assessment of demographics, risk factors, coping styles, and distress, participants were assigned randomly to receive either BCRC or general health education (GHE; i.e., control group). After controlling for education level, women who received BCRC had significantly less breast-cancer-specific distress at 3-month follow-up compared with women who received GHE. A significant Education Level x Treatment Group interaction indicated that the psychological benefits of BCRC were greater for women with less formal education. In both the BCRC and GHE groups, participants who had monitoring coping styles exhibited increases in general distress from baseline to follow-up.

Adaptation, Psychological↗

Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial. The Voluntary HIV-1 Counseling and Testing Efficacy Study Group.

BACKGROUND: Our aim was to determine the efficacy of HIV-1 voluntary counselling and testing (VCT) in reducing unprotected intercourse among individuals and sex-partner couples in Nairobi (Kenya), Dar es Salaam (Tanzania), and Port of Spain (Trinidad). METHODS: Individual or couple participants were randomly assigned HIV-1 VCT or basic health information. At first follow-up (mean 7.3 months after baseline) health-information participants were offered VCT and all VCT participants were offered retesting. Sexually transmitted infections were diagnosed and treated at first follow-up. The second follow-up (mean 13.9 months after baseline) involved only behavioural assessment, and all participants were again offered VCT. FINDINGS: 3120 individuals and 586 couples were enrolled. The proportion of individuals reporting unprotected intercourse with non-primary partners declined significantly more for those receiving VCT than those receiving health information (men, 35% reduction with VCT vs 13% reduction with health information; women, 39% reduction with VCT vs 17% reduction with health information), and these results were maintained at the second follow-up. Individual HIV-1-infected men were more likely than uninfected men to reduce unprotected intercourse with primary and non-primary partners, whereas HIV-1-infected women were more likely than uninfected women to reduce unprotected intercourse with primary partners. Couples assigned VCT reduced unprotected intercourse with their enrolment partners significantly more than couples assigned health information, but no differences were found in unprotected intercourse with non-enrolment partners. Couples in which one or both members were diagnosed with HIV-1 were more likely to reduce unprotected intercourse with each other than couples in which both members were uninfected. These changes were replicated by those in the health-information group diagnosed with HIV-1 at first follow-up. INTERPRETATION: These data support the efficacy of HIV-1 VCT in promoting behaviour change.

AIDS Serodiagnosis↗

[When the patient asks for counselling, when the patient doesn't ask for counselling, when the patient refuses therapy].

A large debate that has brought some depths changes is in action. It is on the relationship between patients and health professionals, physicians, nurses, psychologists etc. The path went through the medical paternalism to the phase of the autonomy, thin to reach the ethics of taking care. In these years, bioethics has tried to answer to urgent questions that primarily interest the private sphere of the people. Currently, by contributions of European and American philosophies, an ethics of the responsibility is delineating This, differentiates the ethics of the rights and the rules (autonomy, self-determination). The attitude of taking care postpones to a whole intellectual, affective, moral competences, that every health professional has to possess to establish relationship with people. This allows, beyond the autonomy, a fundamental moral principle that remains, to give a positive emotional answer and support the conditions and the situation of others. In this answer, the availability to be in the identification process is affirmed to, with their problems and, the desire to do the possible to assuage their suffering. If the person is set in a large net of relationships, is able to express autonomy mediating counselling process of health professionals. The client will freely choose to assume self-care responsibilities.

Counseling↗

[Clinics for counseling on cancer genetics. Experiences with genetic studies and counseling on familial breast cancer and colorectal cancer].

Five to ten percent of cases of breast cancer and colorectal cancer are familial. These families can be divided into high-risk families and moderate-risk families. Cancer in high-risk families can often be explained by dominant inheritance of a gene causing increased susceptibility to cancer. There is a great demand for genetic counseling in these families, and the structure of and experiences from a familial cancer clinic at Odense University Hospital is described. The establishment of a familial cancer clinic involves three steps: 1) Identification of families with increased cancer susceptibility; 2) Molecular tests to identify gene carriers; 3) Clinical examinations for early detection of tumors. Achievement of these three steps requires the involvement of several medical specialties to ensure patient care. Experience with familial cancer clinics is still limited and the involvement of genetic testing and clinical examination programs at risk individuals are insufficiently examined. The rapidly improving techniques for genetic testing make it urgent that it is implemented as part of already established clinical programs.

Adult↗

An educational model for improving diet counselling in primary care A case study of the creative use of doctors' own diet, their attitudes to it and to nutritional counselling of their patients with diabetes.

Aiming to improve the quality of diet recording and instruction in primary care, we developed a simple semi-quantitative food frequency questionnaire for type 2 diabetic patients and had doctors record each other's diet habits with the same questionnaire. The analysis of the diet composition was given to the doctors who considered the educational model to be fun, instructive and thought-provoking. Doctors with a relatively unhealthy diet and a relatively high body weight tended to show dissatisfaction with their own diet, had poor self-assessed knowledge about nutrition, and even a wish to improve their own diet after having seen the result of the diet interview. The proportion of diabetic patients being treated with diet alone tended to decrease with their doctors' decreasing diet counselling skills, which indicates that doctors' attitudes may exert an effect at patient level.

Adult↗

Multicultural peer counseling: counseling the multicultural student.

This article focuses on methods of recruitment, selection, and training of multicultural peer advisors, e.g. screening, training workshops, and innovative recruitment methods are discussed. The author devotes special attention to instructional elements that are intended to provide peer advisors with those humanistic skills needed to work directly with primarily adolescent clients between the ages of 18 and 24 and to serve as a referral agent. The author believes that peer advisors can serve as an important adjunct to core services and can serve as an effective means to humanize and increase utilization of all the services available to multicultural students.

Adolescent↗