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Results for “Directive Counseling”

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PubMed1999

Direct observation of exercise counseling in community family practice.

BACKGROUND: Although physical activity is important for the prevention and management of a variety of common chronic diseases, the prevalence and patient and visit characteristics associated with provision of physical activity advice by community family physicians is not well understood. METHODS: In a cross-sectional multi-method study of 138 family physicians in northeast Ohio, exercise advice was measured by direct observation and patient report of consecutive patient visits to 138 practicing family physicians. The association of exercise advice with patient and visit characteristics, assessed by direct observation, medical record review, patient exit questionnaire, and billing data, was determined by logistic regression analysis. RESULTS: In 4,215 visits by patients older than 2 years of age, exercise counseling was observed during 927 visits (22.3%), but reported by only 13% of patients returning questionnaires. The mean time spent counseling about exercise was 0.78 minutes, with a range of 0.33 to 6.00 minutes (SD = 0.67). Exercise advice was more common during longer visits, visits for well care, and visits by patients who were older, male, and had chronic illnesses for which lack of physical activity is a risk factor. CONCLUSIONS: Exercise counseling is relatively common during outpatient visits to family physicians, and is more commonly given to patients with risk factors. Multiple patient visits over time present opportunities to integrate exercise counseling among the competing demands of primary care practice.

Adult↗
PubMed2002

The genomic revolution and the obstetrician/gynaecologist: from societal trends to patient sessions.

A major aspect of reaping the benefits of the genome revolution in women's health relates to questions of how we are going to handle this scientific manna of information and potential treatment options while minimizing social exclusion along the lines of race, class and gender. Four society-level scenarios or patterns of diffusion of genomic access are discussed, each with its own set of assumptions and outcomes in terms of equity. Like it or not, the front-line obstetrician/gynaecologist will play a critical role in whether such new information helps either to reduce or to exacerbate discrepancies in health-care status along the lines of race and socio-economic status. Patients must not be denied access to knowledge and information within the genetic counselling session, or to the opportunity to make an informed autonomous decision because of the use of unfamiliar language and conventions of conversation that support power differentials and discourage rapport and empathy. Aspects of communication that are critical to the outcome of the genetic counselling session, such as the level of directness of counselling, physician interruptions of the patient and the power implications of the rhetorical question, are explored. In addition, the special challenges to counsellor neutrality and patient autonomy offered by the longitudinal primary obstetrician/gynaecologist relationship are discussed. Strategies encouraging more effective collaboration and communication between generalist and patient in the counselling session are offered.

Communication↗
PubMed1993

Incorporation of genetics in primary care practice. Will physicians do the counseling and will they be directive?

OBJECTIVE: To determine, by response to a scenario, how willing primary care physicians would be to counsel a couple about prenatal diagnosis of cystic fibrosis and how directive they would be about whether the couple should undergo prenatal diagnosis and whether the couple should terminate the pregnancy if the fetus is affected. DESIGN: Survey of a random sample of primary care physicians, psychiatrists, and genetics professionals in 10 geographically representative states. RESPONDENTS: Sixty-five percent (N = 1140) of 1759 obstetricians, pediatricians, internists, family practitioners, and psychiatrists, and 79% (N = 280) of medical geneticists and genetic counselors. OUTCOMES AND RESULTS: Respondents were evenly divided on whether they would counsel about prenatal diagnosis or refer to a genetic counselor (49.4% and 50.6%, respectively). Those who indicated that they would counsel were likely to have greater knowledge about genetics, greater confidence in communicating about genetics, and higher tolerance for ambiguity and were more likely to have completed their medical training since 1971 and to practice in a rural area. Forty-four percent of physicians would give an opinion about prenatal diagnosis. Men would be more likely to give an opinion than women (P < .005). Only 9.6% of respondents would give an opinion regarding abortion. These respondents were more likely to come from specialties with less exposure to genetics and to value attendance at religious services. Primary care physicians were more likely to give their opinions about prenatal diagnosis and abortion than genetics professionals. CONCLUSIONS: To the extent that attitudes are reflected in practice, genetic counseling may be more directive when provided by primary care physicians than by genetics professionals, unless primary care physicians' growing involvement in genetics changes their attitudes.

Abortion, Eugenic↗
PubMed1989

Genetic counseling in families with inherited balanced translocations: experience with 36 families.

We report on genetic counseling and investigations in 36 families with inherited balanced translocations ascertained in different ways, with special regard to the completeness and reasons for incompleteness of family investigation. Quantitative evaluation of the results of cytogenetic investigations shows that non-directive genetic counseling was very effective in many families. Yet, in most of the families (34) genetic counseling and investigation remained incomplete in the sense that not all living potential translocation carriers could be counseled or investigated or that the origin of a fresh mutation could not be established by a normal karyotype in the parents of a carrier. Only in seven families could nearly all living potential carriers be counseled and investigated. The most frequent reason for incompleteness was the impossibility of transmitting or refusal to transmit information about the genetic risks to relatives (21 families), whereas direct rejection of investigation by a counseled individual was a rather rare event (18 adults). Families ascertained because of an unbalanced child seem to be more willing to transmit genetic information to relatives than families ascertained in other ways. Non-directive genetic counseling gave us an insight into the emotional problems arising during counseling of translocation families.

Female↗
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↗
PubMed2005

[Management of the patient with Meniere's disease. Clear diagnosis but vertigo-provoking perspective].

Meniere's disease is characterised by recurrent attacks of vertigo, sensory hearing loss and tinnitus. Meniere's attacks can lead to additional bouts of dizziness. While diagnosis in recurrent spells is easily secured, managing the patients is as difficult as the often unclear development of this -- mostly -- progressive disease. The underlying principle for therapy of this frequently changing disease is a reliable patient-physician relation, which should be based on extensive knowledge of the disease and not only include ENT findings but also broad medical counselling.

Directive Counseling↗
PubMed1994

[Contraception and sexuality].

Contraception implies the responsible confrontation with fertility and sexuality. Contraceptive counselling deals directly or indirectly with sexuality and comprises therefore frequently sexual counselling. 25% of women consulting our Family Planning Clinic complain spontaneously about sexual difficulties. Out of these women one fifth suffer from sexual dysfunction related to the contraceptive method used. Hormonal contraception seems to include most frequently sexual dysfunction. The symptom most frequently complained about is lack of libido. There are typical patterns of correlation between sexual dysfunction, contraceptive compliance and side-effects of contraception which are of great important for contraceptive counselling.

Adolescent↗
PubMed2004

[Prognosis for the fetus with congenital heart defects in the era of modern diagnostics and therapeutics].

BACKGROUND: Prenatal detection of structural heart diseases and rhythm disturbance has become possible using echocardiography. Authors have already documented the high diagnostic accuracy of intrauterin diagnosis of heart diseases in our country as well. AIM OF THIS STUDY: To examine the prognosis of fetal cardiac diseases diagnosed by echocardiography in the institute between 1985-2001. METHODS: The prognosis of 223 (6.3%) cardiac anomalies found in 3468 fetal echocardiograms was assessed by postnatal echo/surgery/or autopsy. RESULTS: The authors detected cardiac anomalies in 153, rhythm disturbance in 70 fetuses. They could follow (mean 4.2 yrs) the 83% of patients by postnatal echo/surgery or autopsy. They lost 46 pts (36%) by elective termination, intrauterine death, or during the postnatal period. 83% of these pts had hypoplastic left heart syndrome, fibroeleastosis, or aortic stenosis. Right heart anomalies (tetralogy of Fallot, critical pulmonary stenosis etc.) showed good prognosis with early surgical or catheter intervention. Isolated fetal supraventricular tachycardias can be successfully treated prenatally, and fetal complete heart block by emergency postnatal permanent pacemaker implantation. CONCLUSIONS: Fetal echocardiography must be considered in our country also such a method which can influence the natural history of fetal heart diseases. The result of infant cardiac surgery also dramatically improved, so we think this knowledge is very important during the counselling.

Algorithms↗
PubMed1993

Enhancing motivation for change in problem drinking: a controlled comparison of two therapist styles.

To investigate the impact of counselor style, a 2-session motivational checkup was offered to 42 problem drinkers (18 women and 24 men) who were randomly assigned to 3 groups: (a) immediate checkup with directive-confrontational counseling, (b) immediate checkup with client-centered counseling, or (c) delayed checkup (waiting-list control). Overall, the intervention resulted in a 57% reduction in drinking within 6 weeks, which was maintained at 1 year. Clients receiving immediate checkup showed significant reduction in drinking relative to controls. The 2 counseling styles were discriminable on therapist behaviors coded from audiotapes. The directive-confrontational style yielded significantly more resistance from clients, which in turn predicted poorer outcomes at 1 year. Therapist styles did not differ in overall impact on drinking, but a single therapist behavior was predictive (r = .65) of 1-year outcome such that the more the therapist confronted, the more the client drank.

Adult↗