Search

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time., (© American Society of Health-System Pharmacists 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objectives: In palliative care, validated tools for professionals that facilitate day-to-day spiritual conversations with patients and loved ones are scarce. The objective of this study was to validate the Diamond spiritual conversation model across different palliative care settings as well as professional and educational levels., Methods: An online survey was filled in by 387 professionals providing palliative care for patients in hospice, home care, hospital and nursing home settings. The five polarities of the Diamond model: holding on-letting go, doing-undergoing, remembering-forgetting, me-the other and believing-knowing were operationalised and evaluated on reported occurrence., Results: In conversations with patients, palliative care professionals reported letting go of loved ones (81.8%) , dealing with pain and suffering (88.1%) , dealing with issues from the past (67.2%) , dealing with own versus loved one's wishes (69.4%) and giving meaning to death (66.7%) as themes occurring regularly to very often. In conversations with loved ones, this was 70.8%, 78.5%, 55.4%, 68,8% and 62%, respectively. Respondents working in hospices reported these themes significantly more than those working in home care settings, nursing homes or hospitals. Nurse assistant respondents reported the themes significantly less than nurses or chaplains., Conclusion: From the perspective of professionals providing palliative care in different palliative care settings, the Diamond model offers a validated framework for addressing relevant spiritual themes for patients and loved ones., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Home-based palliative care is a growing trend, necessitating a deeper understanding of the unique challenges faced by professional staff members in this setting. The shift to home-based care has been driven by advances in technology, changing demographics, and a move toward more patient-centered approaches. As a care setting, the home environment offers distinct characteristics, presenting both advantages and drawbacks for patients and healthcare providers., Objectives: This study aims to explore the experiences and perceptions of professional staff members providing palliative care in patients' homes., Design: A qualitative descriptive study., Methods: Qualitative study with 36 home-based hospice professionals using questionnaires and interviews. Thematic analysis identified key themes in staff experiences and challenges., Results: The central theme of "The Professional Guest" highlights the hybrid identity and boundary role professional staff members must navigate, being both medical professionals and guests in the patient's domain. Four sub-themes emerged: (1) Observing and Applying, emphasizing the conscious scanning of the home environment to build trust and tailor care plans; (2) Asking for Permission, respecting the patient's territory and adapting to their norms; (3) Expecting the Unexpected, maintaining flexibility and improvising in unfamiliar situations; and (4) Preparing the Ground for Your Absence, equipping patients and families with comprehensive self-care guidance during professional staff members' absences., Conclusion: The "Professional Guest" phenomenon captures the complexities of providing care in patient's homes, necessitating a delicate balance between professionalism and personal vulnerability. Specialized training programs and policies should be developed to support professional staff members in navigating this hybrid identity and effectively negotiating the boundaries between professional and personal spheres., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2024.)

Background: Empathizing with patients is an essential component of effective clinical care. Yet, a debate persists regarding how healthcare professionals' emotions and performance are impacted when they engage in empathetic behaviors and attempt to discern patients' mental states during clinical interactions. To approach this issue, this study explores the psychometric properties of the Mental State Inferences in Healthcare Professionals Scale (MSIHPS), a novel eight-item scale to evaluate healthcare professionals' perceptions of their own disposition to infer patients' mental states during clinical interactions., Method: The study was conducted across various units within a regional hospital and primary care units affiliated with the Canarian Public Health Service in Spain. Data collection took place over the course of 2022, spanning from February to November. The psychometric properties of the scale were analyzed, including an exploratory and a confirmatory factor analysis, to test reliability and validity. Additionally, an item response model was run to test potentially biased items. The study collected data from a sample of 585 healthcare professionals., Results: Overall, the results indicate that the psychometric properties of the tool are adequate. Furthermore, the unidimensionality of the scale was confirmed using the item response model, wherein the eight-items significantly contribute to predicting the latent construct., Conclusion: The MSIHPS offers the opportunity to explore the role of mentalizing in a diversity of healthcare settings. This measure can be useful to explore the relationship between healthcare professionals' disposition to infer patients' mental states and other relevant variables in clinical interactions, such as empathy and clinical performance., (© 2024. The Author(s).)

Background: The abandonment of psychotherapeutic treatments is influenced by various factors, including patient characteristics, therapist traits, and the therapeutic relationship. Despite the well-documented importance of these factors, limited empirical research has focused on the role of the therapeutic relationship and the characteristics of therapist-patient dyads in predicting treatment dropout. This study protocol outlines a longitudinal research project aimed at predicting dropout and non-response in psychotherapy for individuals with personality disorders. The research seeks to identify predictive factors related to psychotherapy outcomes, focusing on patient, therapist, and dyadic elements. Specifically, the study will examine the influence of therapist characteristics (e.g., personality traits, countertransference, responsiveness) on treatment outcomes, explore the impact of relational factors (e.g., treatment expectations, epistemic trust, therapeutic alliance) on therapy effectiveness, and assess how the therapeutic alliance within therapist-patient dyads affects the likelihood of dropout and non-response., Methods: The longitudinal study will include 100 therapist-patient dyads (200 participants) recruited from various Mental Health Services in Milan, Italy. Validated instruments will be administered to both patients and therapists at four-time points: T0 (baseline), T1 (3 months), T2 (6 months), and T3 (1 year). Data will be collected at baseline and at the one-year mark to evaluate the relationships between therapist, patient, and dyadic factors and treatment outcomes., Discussion: Identifying predictive variables associated with high dropout rates can help preempt treatment discontinuation, reducing the financial and operational burdens on mental health services. Understanding these factors will enable the development of targeted interventions to improve treatment engagement and reduce attrition. This approach could enhance outcomes for individuals with personality disorders and lead to more efficient resource allocation and sustainable delivery of mental health care., (© 2024. The Author(s).)

Objective: The objective of this study was to explore patients' learning and support needs within contemporary diabetes care to help them deal with daily life challenges., Design: A qualitative descriptive design was used following the Consolidated Criteria for Reporting Qualitative Studies. The 15 individual face-to-face interviews were analysed using qualitative content analysis., Setting: Participants were drawn from three healthcare centres in rural and urban regions of West Sweden., Participants: The study involved 15 patients (8 men, 7 women) with T2DM who experienced contemporary diabetes care., Results: Patients expressed a strong desire for access to person-centred, multidimensional learning, with a focus on genuine partnership, tailored education, and emotional engagement. Digital tools were seen as valuable aids in their self-care efforts. Sub-themes were ' Desiring genuine partnership and tailored patient education ' and ' Needing support related to altered perspectives on life and awareness of care standards but with finite care resources '., Conclusion: The findings suggest that integrating person-centred, multidimensional learning strategies into diabetes care could be beneficial, particularly when addressing both practical and emotional needs. Encouraging active patient engagement through flexible digital solutions and providing support for emotional well-being may improve the overall patient experience. However, further research and practical application are needed to fully understand how these strategies could be effectively implemented to support patients with T2DM in managing their daily health challenges.

In routine outcome monitoring, psychotherapists receive feedback from their clients about their self-reported progress during therapy. This practice is based on research indicating that therapists overestimate their effectiveness and cannot detect and predict negative client change. However, this assumption is based on only a few studies. This study aimed to investigate whether trainee therapists could estimate client deterioration after each session and after therapy and whether they, from session to session, could predict client post-therapy outcomes. Fifty-three postgraduate trainee therapists at a university clinic treated 105 clients, with an average of 13.1 sessions. A questionnaire was developed to measure the therapists' estimation of client change at each session and their session-by-session prediction of client post-therapy outcomes. The 10-item version of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) was used to measure clients' self-reported change at each session. The data included 96 (91.5%) therapist estimations of client post-therapy outcomes, 1015 (87.8%) estimations of client change from the second to the penultimate session, and 1140 predictions of post-therapy outcomes. The study found that at post-therapy, the therapists were only able to identify one out of eight clients who showed deterioration on the CORE-10. Additionally, during therapy, they could accurately estimate only six out of 83 sessions in which clients had experienced deterioration on the CORE-10, and they failed to predict any of the eight clients who ended therapy with deterioration. In conclusion, therapists cannot rely on their clinical judgement alone to assess client progress and outcomes and will depend on routine outcome monitoring to detect client deterioration., (© 2024 The Author(s). Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.)

Objective: Network models hold much promise for use in the form of personalized feedback, which the TheraNet Project aims to investigate. In the present study, we share therapists' first reactions to patient network models based on ecological momentary assessment (EMA) data., Method: Therapists (N = 24) were taught to interpret the network models based on their patient's data. They were provided with concrete use suggestions at the end of the workshop. The workshops were analysed using descriptive qualitative content analysis. The resulting codes were then grouped thematically., Results: Therapists spoke about using the networks for "case conceptualization", "therapy planning", and "psychoeducation", but also commented on the "study design". Before the concrete suggestions, therapists most frequently voiced thoughts on its uses for "case conceptualization". After the suggestions, "psychoeducation" was mentioned most frequently., Conclusions: Therapists intuitively connected network models to case conceptualizations. Once concrete suggestions were provided, therapists more frequently discussed networks as psychoeducative tools., (© 2024 The Author(s). Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.)

Introduction: Relationships are the core of Indigenous Peoples' spiritual and cultural identities, and therapeutic relationships are an integral part of the physical rehabilitation process, directly influencing health outcomes. However, participating in therapeutic relationships can be difficult for First Nations Peoples, particularly in the virtual landscape. There is limited understanding of First Nations Peoples' perspectives on this issue, and this understanding is crucial to developing culturally safe and effective telehealth physiotherapy programs. Therefore, the purpose of this study is to explore the perspectives of First Nations Peoples from British Columbia, Canada, on telehealth physiotherapy, with an emphasis on the virtual therapeutic relationship., Methods: A narrative qualitative study that utilized one-on-one, semistructured interviews was conducted with 19 First Nations adults from remote and rural First Nations communities in north-central British Columbia, Canada. Interviews were recorded, transcribed verbatim, and analyzed using an inductive approach to reflexive thematic analysis., Results: Three themes emerged from data analysis. 'Therapist's attitude and rapport' captures participants' perceptions of what matters the most in how physiotherapists relate to First Nations Peoples and carry out their work. 'Remote nature of virtual care' encompasses the main challenges of virtual care visits, particularly how these were perceived to impact establishing and maintaining solid therapeutic relationships. 'Fostering culturally appropriate and safe telehealth physiotherapy' focuses on what is needed to advance telehealth physiotherapy in a manner that respects and reflects First Nations cultures, equipping all involved parties to provide comprehensive and sensitive services. Our findings advocate a hybrid model that combines in-person and telehealth visits to address communication barriers and the absence of physical interaction. Bridging the digital health literacy gap through training and collaboration with local support staff is crucial (as it is to bridge the possible cultural literary gap of therapists), and the incorporation of cultural elements holds promise for enhancing the engagement and effectiveness of telehealth services in these communities., Conclusion: The pursuit of equitable health care for First Nations communities demands not only increased access but also a thoughtful, culturally safe, trauma-informed, and holistic approach. This approach must be tailored to the unique needs of First Nations Peoples, emphasizing the integration of cultural elements and community support. A hybrid model combining in-person and telehealth visits is recommended to address logistical challenges and enhance the therapeutic relationship, ensuring that care is both effective and respectful of cultural values and practices.

Aim: To investigate the influence of contextual framing on physio- and occupational therapists' clinical reasoning in sensory rooms for patients admitted to psychiatric units., Material and Method: Physiotherapists and occupational therapists from acute and intensive care units with sensory rooms were invited to participate in the study. The therapists were interviewed following sessions with patients in sensory rooms, using a semi-structured interview guide. These therapists also participated in a focus group interview. All interviews were transcribed and analysed based on the thematic analysis by Braun and Clarke., Results: Twenty individual interviews and one focus group interview were conducted with seven physio- and occupational therapists. Three themes with accompanying subthemes emerged: (i) The contextual influence: Therapists' perceptions of the use of sensory rooms, The dominance of the medical paradigm). (ii) The therapeutic alliance: The therapists' relational skills, The importance of a good therapeutic patient relation, and Physio- and occupational therapy in a psychiatric setting.: (iii) The therapeutic diagnosis, Therapeutic sensory room interventions, and Holistic approach in a limited timeframe ., Conclusion: The clinical reasoning of physio- and occupational therapists in sensory-modulating sessions for patients admitted to psychiatric units is influenced by a primarily medically dominated paradigm; legally, economically, and politically. Occupational therapists mainly focus on everyday skills and being in the present, whereas physiotherapists focused on activities with bodily anchoring and awareness.

In this lecture, I wish to speak about the faithless analyst. This is an analyst without fixed religious notions, without specific preferences with regard to religious faith and practice, without religious commitments or attachments of the kind that would influence the course of the analysis. Is this possible? Analysts like everyone else grow up in specific cultures that are deeply entangled with religious traditions. Can analysts shed this formation when they enter the consulting room? Should they? Values come with religious faith and practice. Should the analyst shed such religiously based values for the sake of absolute neutrality? I want to think about such faithlessness as an impossible ideal for analytical practice and how to work with failures to remain faithless in the presence of different faiths or the absence of faith among patients., (© 2024 The Society of Analytical Psychology.)

Purpose: Hearing trouble (HT) impairs communication with health care providers (HCPs) and may lead to negative care experiences that impact health outcomes. The current study aimed to examine how HT influences patient perceptions of provider interactions and whether having an accompanying companion during health care visits modifies perceptions of provider interactions., Method: This cross-sectional study analyzed 9,104 responses from the 2016 Medicare Current Beneficiary Survey., Results: Compared to beneficiaries without HT, those with HT had greater odds of negative perceptions of HCP interactions. Beneficiaries with HT had greater odds of disagreeing with positive statements about care, including provider competence, provider cares to check everything, provider response, and provider rarely in a hurry. Having an accompanying companion during health care visits was not found to significantly modify perceptions of interactions., Conclusion: Findings suggest HT is a modifiable factor impacting health care communication. Implementing simple accommodation strategies in clinical practice can improve nursing care for older adults with HT. [ Journal of Gerontological Nursing, 50 (11), 29-35.].

Despite the common assumption that increased therapist experience correlates with improved client outcomes, studies reveal inconsistent relationships between therapist experience and therapy effectiveness. Some studies have demonstrated a slight worsening of client outcomes as therapists gain more experience. Yet, there are few studies that have examined how therapists change in their client outcomes over time, especially across different outcomes (e.g., depression, life functioning, anxiety). The present study used the Behavioral Health Measure-17 to investigate therapist effectiveness over time on multiple treatment outcomes (e.g., general distress, life functioning, anxiety, alcohol/drug use) using a large naturalistic sample of 613 professional therapists and 42,690 clients over approximately 12 years of psychotherapy data. Our results show a significant decrease in client outcomes over time in three domains: general distress, life functioning, and anxiety, albeit small-sized effects. Our findings also indicate that therapist caseload and baseline severity were not associated with predicting client outcomes and that, unexpectedly, the severity of therapist caseloads decreased over time. These findings underscore the importance of a nuanced understanding of therapist effectiveness, challenging the assumption of universal improvement with experience. Furthermore, we believe that these findings may offer preliminary support for matching therapists with clients based on domain-specific strengths. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The therapeutic alliance is a principal element that allows the dynamics and effects of psychotherapy to be analyzed. In the past half-century, many studies have explored various psychotherapeutic approaches, including psychoanalytic, cognitive-behavioral and systemic psychotherapy, but hypnotherapy has not been addressed. This article presents the first analysis using current methods of verifying and understanding the dynamics of change in hypnotherapy, regarding to the therapeutic alliance. Luborsky et al.'s (1996) revised Helping Alliance Questionnaire (HAq-II) was administered to 59 patients in treatment with psychologists and psychiatrists using Ericksonian hypnosis. Our results suggest that the dynamics of the alliance in the first sessions of hypnotherapy involve factors related more to the therapist's adjustment to the patient than to the progress the patient makes in these initial sessions., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: Patients' interactions with health care providers influence back pain-related outcomes. The Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) is an instrument that assesses providers' attitudes and beliefs about patients with persistent back pain, with lower scores implying that persistent pain does not indicate disability or limitation of activities. This scoping review aims to explore the extent of research involving the HC-PAIRS., Literature Survey: PubMed, Embase, and PEDro databases were searched from inception to April 2022., Methods: Extracted HC-PAIRS scores were standardized to 15-item scores and categorized by profession, student or professional status, and pre/post-educational intervention to evaluate scores. Psychometric properties and educational interventions of the HC-PAIRS were described., Results: After screening, 51 studies representing 10,416 participants were included. Student and professional scores were investigated in 24 and 29 studies, respectively. Twenty-one studies included educational interventions, with heterogenous follow-up. Psychometric properties of the HC-PAIRS were assessed in 10 studies and demonstrated acceptable reliability and validity. The overall baseline mean score among all participants was 55.34 (95% CI: 53.54-57.14) (students: 56.54 [56.54-60.87]; professionals: 51.67 [49.08-54.27]). Nurses (61.99 [55.66-68.31]) and non-health care professionals (65.30 [57.33-73.28]) had the highest overall baseline mean scores, whereas chiropractors (51.69 [33.73-69.66]), MDs/PAs (52.64 [47.27-58.00]), physical therapists (53.42 [50.67-56.17]), and exercise professionals (57.36 [49.39-65.33]) had lower scores., Conclusions: The HC-PAIRS has been used across many disciplines in both students and professionals and demonstrated acceptable reliability and validity. Professionals commonly treating back pain had lower HC-PAIRS scores. Future research could benefit from standardization of interventions and timing of follow-up assessments., (© 2024 The Authors. PM&R published by Wiley Periodicals LLC on behalf of American Academy of Physical Medicine and Rehabilitation.)

Communication is an integral component in palliative care. A number of studies have used conversation analysis (CA) to examine communication between healthcare professionals (HCPs) and patients/companions in palliative care. To the best of our knowledge, however, no work has been done to synthesize these studies. Thus, the review aimed to synthesize these conversation analytic studies in the setting of palliative care. The review included peer-reviewed studies that focused on communication between HCPs and patients/companions and that were published in English before September 10 2022. The database and manual search produced 16 eligible studies. The thematic analysis generated five themes: (1) promoting patient agency and autonomy; (2) practices for gathering pain-related information and navigating pain concerns (practices for gathering pain-related information and practices for navigating patients' pain concerns); (3) initiating and managing end-of-life discussions; (4) facilitating shared decision making in palliative care; and (5) navigating sensitive topics and uncertainty in prognostic talk. The review highlighted the potential of CA for research in palliative care and had implications for communication practice.

Therapists' outcome expectations influence the psychotherapy process and outcomes, but little is known about the factors influencing their development. This study explored therapists' experiences with establishing outcome expectations for their patients. The participants were 35 therapists from a public mental health setting, who were interviewed in five different focus groups. Interviews were transcribed and analyzed using thematic analysis. Three themes and 10 subthemes were identified. In Theme 1 (understanding the problem), participants' expectations were influenced by (a) their patients' diagnoses and the diagnostic process, (b) their perceptions of the complexity of the presenting problem, (c) how stable the patients' symptoms and situations were, and (d) whether they experienced familiarity with the patient or the patients' situation. In Theme 2 (the patient's openness to change), participants' expectations were influenced by (a) the patient's stated reason for seeking treatment, (b) the patient's conceptualization of their problem/situation, and (c) their perception of the patient's willingness to invest in the treatment. In Theme 3 (the fit between the therapist and patient), the participants discussed the factors that influenced whether they felt they were a good fit for working with an individual patient and how this perception of personal and professional fit influenced their expectations. We identify several ways that therapists' situational factors and their recognition of the patient through their own past experiences can influence their expectations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

This review aimed to develop a conceptual model of the therapeutic alliance in the context of psychotherapy and suicidal experiences from therapist and client perspectives. The protocol was pre-registered on PROSPERO (CRD42021268273). MEDLINE, PsycINFO, Web of Science, Embase and CINAHL were systematically searched from database inception to April 2024. Eligible studies were peer-reviewed, qualitative, and included client and/or therapist's perspectives of the therapeutic alliance in the context of psychotherapy and suicidal experiences. Studies were critically appraised and analysed using a meta-ethnography approach involving a reciprocal translation of studies and line of argument synthesis. Thirty-seven papers were included, generating two overarching themes; 'Working on the edge' and 'Being ready, willing, and able to build an alliance in the context of suicidal experiences'. Therapeutic alliance in the context of suicidal experiences is unique, fluid, potentially lifesaving, and influenced by multiple inter-connected internal and external processes and systems. Clinical implications emphasise the need to improve training, supervision, and support for therapists to equip them with the additional skills required in navigating the intricacies of the therapeutic alliance with clients who have suicidal experiences. Flexibly interweaving risk assessment into therapeutic conversation was beneficial to the alliance with suicidal clients and enhanced their safety., Competing Interests: Declaration of competing interest PG and DP are among other co-authors of a suicide-focussed CBT treatment manual for people with psychosis (Tarrier et al., 2013), which is published under copyright as a book. Cognitive Behavioural Suicide Prevention Therapy has been applied, adapted, and assessed in pilot and phase 2 trials for several high-risk populations. The authors of the review have been and/or are currently funded to work on these trials and have published work arising from these trials., (Copyright © 2024. Published by Elsevier Ltd.)

In this study we introduce an innovative mathematical and statistical framework for the analysis of motion energy dynamics in psychotherapy sessions. Our method combines motion energy dynamics with coupled linear ordinary differential equations and a measurement error model, contributing new clinical parameters to enhance psychotherapy research. Our approach transforms raw motion energy data into an interpretable account of therapist-patient interactions, providing novel insights into the dynamics of these interactions. A key aspect of our framework is the development of a new measure of synchrony between the motion energies of therapists and patients, which holds significant clinical and theoretical value in psychotherapy. The practical applicability and effectiveness of our modelling and estimation framework are demonstrated through the analysis of real session data. This work advances the quantitative analysis of motion dynamics in psychotherapy, offering important implications for future research and therapeutic practice., (© 2024 The Authors. British Journal of Mathematical and Statistical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Objective This study aimed to explore whether behavioral synchrony (BS) and inter-brain synchrony (IBS) could serve as potential biomarkers for alliance quality or outcomes among clients with different adult attachment styles. Method: We assessed the clients' self-report working alliance and clinical outcomes as well as simultaneously measured BS using motion energy analysis (MEA) and IBS with functional near-infrared spectroscopy (fNIRS) among 37 secure ( N  = 21) or dismissing ( N  = 16) clients with their counselors during the first psychological counseling meeting. Results: Dismissing dyads manifested significantly higher late-stage counselor-led and client-led IBS ( p  = .018) than secure dyads. Adult attachment style served as the moderators in the correlation of both whole-stage client-led BS with bond dimension of alliance ( p  = .015) as well as in the correlation of both whole-stage no-lag IBS with CORE-10 score changes ( p  = .022). Moreover, increases in the whole-stage client-led BS were significantly associated with decreases in early-stage, late-stage and whole-stage no-lag IBS (all p s ≤ 0.01). Conclusion: These findings revealed the potentially impeding role of interpersonal synchrony in alliance quality for dismissing clients, at least during the first psychological counseling meetings. They also might partially validate the relationship between different modalities of interpersonal synchrony.

Objective: This scoping review aimed to identify and map how asynchronous digital two-way communication is used between patients and healthcare professionals after hospital discharge, as well as identify facilitators and barriers to implementation., Methods: Following the JBI guidance for scoping reviews, we searched seven databases on August 29, 2022. Rayyan was employed for screening the articles, and data were extracted using a predefined and iteratively modified data extraction tool. Facilitators and barriers were systematically categorized according to the domains and constructs of the Consolidated Framework for Implementation Research (CFIR)., Results: Forty articles were included, primarily published between 2012 and 2022 and from the USA. In the majority of articles (77.5 %), asynchronous digital two-way communication was a part of a larger eHealth intervention. Nurses were the healthcare professionals most frequently mentioned as answering patients' messages (35 %) with response times sparsely described, and varying between four hours and three days. Efforts done to implement asynchronous digital two-way communication were only mentioned in 37.5 % of the articles. Facilitators included easy access, convenience, less disturbance, shared expectations for use and communication with professionals familiar to the patient. Barriers involved fear of overlooking health issues, risk of answers being delayed, technical issues and unclear response times., Conclusion: There is a gap in the literature between studies that describe the use of asynchronous digital two-way communication after hospital discharge exhaustively and reports on facilitators and barriers to implementation., Practice Implications: This scoping review serves as an overview of the current use of asynchronous digital two-way communication after hospital discharge and sheds light on facilitators and barriers to implementation pertinent to this specific period., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

In health sciences, including physical therapy, communication techniques are a critical part of the success in the therapeutic process. Managing the patient's beliefs, perceptions, and the narrative of their problems, becomes an essential part of the therapeutic process. This is the key to achieving real changes regarding how the patient copes with pain, illness, dysfunction, as well as the ability to develop adequate resources for facing them. We call this "Therapeutic expectancy" a new concept that originates from the well-known Therapeutic alliance and incorporates practices from the field of Motivational interviewing and Strategic dialogue. The Therapeutic expectancy starts from the first interaction with the patient and continues throughout the different stages of the therapeutic process. This article describes the structure of the relationship with the patient and some verbal communication techniques to generate an effective physical therapist-patient interaction, building Therapeutic expectancy, through a "centered on the patient's narrative" strategy. Expectancy constitutes a desirable goal in any patient and in any pathological condition as it pursues a change in an individual's perception of their state of health, thereby enhancing the desire for healing and empowerment.

Objective: This study examines how therapist emotional response/countertransference (CT) develops during treatment for patients with personality disorders (PDs) and how pre-treatment patient factors (severity of personality pathology, PD category, level of symptom distress) predict CT responses. Secondly, we explored associations between patient clinical outcome and CT., Method: A longitudinal, observational study including 1956 patients with personality pathology treated at psychotherapy units within specialist mental health services. Therapists' emotional response was repeatedly assessed by the Feeling Word Checklist-Brief Version (FWC-BV) with three subscales- Inadequate , Confident, and Idealized ., Results: Levels of Inadequate CT were lowest and stable over time while Confident and Idealized increased over time. Greater severity of personality pathology and borderline PD predicted higher initial Inadequate , lower initial Confident and decreasing Inadequate over time. Antisocial PD predicted decreasing Confident . Number of PD criteria had higher impact on therapist CT than level of symptom distress. Clinical improvement was associated with decreasing Inadequate ., Conclusion: Therapists reported predominantly Confident CT when working with PD patients. More severe personality pathology, and borderline PD, specifically, predicted more negative CT initially, but the negative CT decreased over time. Patients who did not improve were associated with increasing Inadequate .

Abstract Responsiveness is currently a hot topic in the psychotherapy literature with a large variation in what the term means to colleagues of various orientations. This adds to its popularity but limits the scope of whatever is written or said about responsiveness. The fact that the meaning of responsiveness has developed over time within the approaches adds also to the variation, while an understanding of development has the potential of deepening the understanding of each approach. As a fair description and comparison of even just the most important approaches is by far out of reach for a page-limited article, the development of one approach, which may be termed the "Bernese" approach is described here, along with lessons learnt and general comments. The approach includes Plan Analysis case formulations, the concept of complementary or Motive-Oriented Relationship, a description of a combined qualitative and quantitative assessment, and many methodological and conceptual considerations. Personal development is woven in. Overall, it seems fair to say that this approach, at its core developed long before responsiveness became popular, has turned out to still be useful, with a gain in depth as far as concepts and assessment are concerned.

In this professional theoretical article, the authors argue that patient care should be centered on connection and that authentically turning toward suffering necessitates an approach to care that transcends medicine's traditional focus on cure and physical restoration and differentiates between pathology and disability. The meaning of illness and suffering for those who have experienced life-changing injuries or illness is explored. Strategies for approaching the lifeworld of these individuals are discussed using the concepts of phenomenology and embodiment, rooted in the work of philosophers from the phenomenological tradition. The authors also propose an approach to patient care offering a case-based example based on postmodernist concepts that elevate connection, relationship, and interdependency above the traditional focus of restoring normality and physical independence for individuals with disabilities. Traditional assumptions about quality of life, illness, and disability are called into question by focusing on the fluidity of being and disability identity, which serves to destabilize static, binary conceptions of individuals as either healthy or ill, disabled, or able-bodied. A postmodern lens invites healthcare practitioners to envision themselves as part of an assemblage that may promote a more expansive view of the relationship between patient and healthcare practitioner.

Objective: Dietitians have a central role in eating disorder (ED) treatment, however few studies exist investigating therapeutic aspects of dietetic care and factors influencing the dietitian-patient relationship. To address the gap, this study aimed to use a qualitative description approach to explore the experiences of delivering and receiving dietetic care in ED treatment in the UK., Method: Semi-structured interviews were conducted with 6 specialist ED dietitians and focus groups with 11 recovered ED patients. Interviews were transcribed and inductive thematic analysis was performed to identify key themes describing the data., Results: Six key themes were generated: (1) Building trust, (2) Appropriate timing, (3) Adapting, (4) Dietitians as experts, (5) Boundaries, and (6) Difficult relationships. Participants highlighted the importance of building trust and considering nutritional risk and readiness in treatment approach. Patients expressed a desire for dietitians to have experience in EDs, facilitating understanding of their illness. However, dietitians identified the nature of EDs making their role challenging at times., Discussion: This study described various factors affecting dietetic care in EDs and provided a valuable insight into patients' perceptions of treatment. The findings support advancements in ED dietitians' knowledge and understanding, helping to enhance quality of care., (© 2024 The Author(s). European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)

Background: Previous research among diverse patient populations suggests that healthcare staff routinely do not talk about sexuality with their patients even when such talks are highly indicated and relevant., Aim: In this study we sought to investigate how patients at outpatient anxiety clinics in Denmark experience sexual communication with healthcare staff and what barriers they encounter in this connection., Methods: We employed a survey design from January 1, 2018, to June 30, 2019. In collaboration with 11 outpatient anxiety clinics in Denmark, patients with a primary diagnosis of panic disorder, social phobia, generalized anxiety, or obsessive-compulsive disorder were invited to participate in the study. The final sample included 272 patients. Survey questions were related to sociodemographic characteristics, sexual activity and dysfunctions, pharmacological treatment adherence, anxiety and depression symptoms, and experience with and barriers to sexual communication. For each participant, clinicians at the clinics provided the International Classification of Diseases, 10th revision, diagnostic codes, medications, and dosage. Study inclusion criteria were not having an organic disorder that may cause anxiety, not having a previous diagnosis of bipolar affective disorder or schizophrenia, and the ability to speak and read Danish., Outcomes: Outcomes included patients' experiences with and barriers to sexual communication with healthcare staff., Results: In total, 61% of the patients in this sample group found it relevant to talk to healthcare staff about sexuality but only 28% of the study patients had done so, of whom 83% reported this communication to be a positive experience. The most frequently reported patient barriers to communication with healthcare professionals regarding sexual concerns were a belief that if sexual matters were relevant, the healthcare staff would bring it up (94%), fear of transgressing their own boundaries (94%), embarrassment (92%), and lack of knowledge as to how to start a conversation about sex (91%)., Clinical Implications: The study results indicated a need for healthcare staff to routinely map out and address sexual matters in their clinical work with anxiety patients while bearing in mind the common patient barriers for this topic., Strengths and Limitations: This study included a large clinical outpatient sample of anxiety patients and an extensive survey. However, the results may not be generalizable across all anxiety patients or patients in general., Conclusion: The results of this study strongly indicate that a majority of anxiety patients find it both relevant and beneficial to discuss sexual matters with healthcare staff in connection with their anxiety treatment, and therefore healthcare staff should be educated and equipped to routinely address these matters while bearing in mind the most common patient barriers for conversations about sexuality., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society for Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: In the UK, inpatient psychiatric rehabilitation services for complex psychosis aim to provide recovery-orientated treatment to patients, with the goal of supporting sustained stepdown into community living. The extent to which rehabilitation services uphold this recovery orientation is associated with better outcomes. However, few studies have been able to ascertain what promotes or prevents recovery orientation in inpatient settings., Methods: We conducted an ethnographic study of treatment on a National Health Service (NHS) psychiatric rehabilitation ward in London over six months during August 2022-February 2023. Data were collected through participant observation and semi-structured interviews with 9 patients and 14 staff members. Fieldnotes and interview transcripts were analysed using situational analysis., Results: Our analysis highlights the importance of what we term 'relational engagement' between staff and patients to nurture and sustain recovery-orientated treatment. This relational engagement was embodied through small acts of genuine human connection grounded in mutual acceptance and affective bonding; close attention to detail that communicated curiosity and respect; and recognition, appreciation, and encouragement of the slow and gradual progress that characterises recovery in complex psychosis. Yet, this relational engagement was often limited or foreclosed by the social environment of the ward and the wider institutional context. Limiting elements included the dominance of hospital logics geared towards high-throughput acute treatment and risk management; the presence of audit culture that led to a level of standardisation curtailing more genuine human connection; and staff demoralisation driven by events on and off the ward, including system-wide crises and more localised conflicts and disturbances. Some of these conflicts involved discrimination, most prominently anti-Black racism and homophobia, reflecting wider structural inequalities that characterise inpatient psychiatric populations and the healthcare workforce., Conclusion: Relationships, often under-prioritised in mental health services, were a key cornerstone of recovery-orientated treatment on a psychiatric rehabilitation ward. The shaping of therapeutic relationships amounted to an active process of relational engagement, which may be afforded or constrained by complex social elements requiring careful consideration in inpatient psychiatry. These social elements go beyond more surface-level factors such as staff training, knowledge, or attitudes and may require structural and system-level interventions., (© 2024. The Author(s).)

Introduction: In the United States, maternal mortality is high and patterned by race and socioeconomic status (SES). Patient-provider relationships and societal discrimination have been separately associated with poor maternal outcomes, but it is not clear how such mechanisms may be interrelated. Thus, the present study investigates how societal experiences of discrimination are associated with and manifest in patient-provider relationship quality among perinatal women., Methods: The study uses a mixed methods design with an explanatory-sequential approach. First, a path analysis using structural equation modeling of a cross-sectional representative survey of 244 perinatal women in Kalamazoo County, Michigan, was conducted. Second, a thematic qualitative analysis was conducted of focus groups composed of survey participants (n = 34)., Results: In the quantitative analyses, race and SES were associated with experiences of societal discrimination in the expected directions (race: b, 1.87; SE, 0.58; P = .001; SES: b, 2.18; SE, 0.60; P < .001), discrimination positively predicted vigilant behaviors (b, 0.81; SE, 0.15; P < .001), and more vigilant behaviors predicted worse patient-provider relationship quality (b, 0.18; SE, 0.07; P < .001). In the qualitative findings, we found detailed accounts linking provider discrimination, vigilance, and patient-provider relationships among focus groups composed of only women of color (n = 9)., Discussion: Overall, the quantitative analyses find support for the conceptual model showing race and SES are associated with societal discrimination, which is associated with vigilant behaviors and, in turn, quality of patient-provider relationships. The qualitative analyses provide preliminary evidence for how these pathways manifest in care settings and demonstrate the importance of establishing trust in patient-provider relationships, especially among women of color., (© 2024 by the American College of Nurse‐Midwives.)

Aim: Interactions between patients and healthcare professionals (HCP) during hospital admissions are complex and difficult to interrogate using traditional analysis of electronic patient record (EPR) data. The objective of this study was to determine the feasibility of applying temporal network analytics to EPR data, focusing on HCP-patient interactions over time., Method: Network (graph) analysis was applied to routinely collected structured data from an EPR for HCP interactions with individual patients during admissions for patients undergoing renal transplantation between May 2019 and June 2023. Networks were constructed per day of admission within a session, defined by whether the patient was in the intensive care unit (ICU) or standard hospital ward. Connections between HCP were defined using a 60 min period. Reports were generated visualising daily interaction network structures, across individual admissions., Results: 2300 individual networks were constructed from 127 hospital admissions for renal transplantation. The number of nodes or HCP per network varied from 2 to 45, and network metrics provided detail regarding variation in the density and transitivity, changes in structure with different diameters and radii, and variations in centralisation. Each network analysis metric has a contribution to play in describing the dynamics of a daily HCP network and the composite findings provide insights that cannot be determined with standard approaches., Conclusions: Network analysis provides a novel approach to investigate and visualise patterns of HCP-patient interactions which allow for a deeper understanding of the complex nature of hospital patient care and could have numerous practical operational applications., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Satisfaction with birth and healthcare provider experiences have long-term effects for maternal health. Research has shown that mothers who report more trust, respect, and self-efficacy in their relationship with their healthcare providers are more likely to report positive birthing experiences. Further, individuals with obesity, including pregnant mothers, are more likely to experience weight-related stigma from healthcare providers which may negatively impact satisfaction with this relationship. Thus, the current study examines maternal pre-pregnancy body mass index (BMI) as a moderator between birth and provider satisfaction., Methods: A sample of 94 women (ages 16-38) were recruited during pregnancy. Participants completed surveys about their satisfaction with their birth experience, provider satisfaction, height, weight, and demographics including age and education. A moderation analysis was used to examine pre-pregnancy BMI as a moderator between birth and provider satisfaction., Results: Results show that provider satisfaction is positively associated with birth satisfaction among mothers with moderate (overweight) to high (obese) pre-pregnancy BMI scores in our sample., Conclusions: Findings suggest that strengthening the patient-provider relationship may promote satisfaction with birth experiences., (© 2024. The Author(s).)

Background: The hospital discharge process poses significant safety risks for older patients due to complexities in communication and coordination among stakeholders, leading to potential drug-related problems post-discharge. Adopting a person-centred care (PCC) approach in medication communication by healthcare professionals (HCPs) is crucial to ensure positive health outcomes. This study aimed to explore the practice of PCC in medication communication between older patients and HCPs during the hospital discharge process., Methods: We conducted a qualitative study using non-participatory direct observations of patient-HCP consultations during hospital discharge, followed by semi-structured interviews with observed patients and, when applicable, their informal caregivers. Data collection occurred from October 2020 to May 2021 at two Swedish hospitals. We gathered data using an observational form and audio-recorded all consultations and interviews. The data were analysed thematically using the systematic text condensation method., Results: Twenty patients were included (median age: 81 years [range: 65-94]; 9 female) in observations and 13 of them participated in interviews. Two patients were accompanied by an informal caregiver during the interviews. Three main themes were identified: (1) The impact of traditional authoritarian structures, depicts power dynamics between patients and their HCPs, showing how traditional structures influence the practice of PCC in medication communication during hospital discharge; (2) Consultation timing and mode not on patients' terms, describes suboptimal times and settings for consultations, along with the use of complex language that hinders effective communication; and (3) Discrepancy in expectations of self-care ability, illustrates a mismatch between the self-care guidance provided by HCPs during hospital discharge and the actual needs and preferences of patients and informal caregivers., Conclusion: Medication communication between older patients and HCPs during hospital discharge is frequently inconsistent with the practice of PCC. Not only must HCPs improve their communication strategies, but patients and their informal caregivers should also be better prepared for discharge communication and encouraged to participate in their care. This involvement would give them relevant knowledge and tailor communication to their individual needs, preventing problems in managing their medications after discharge., Patient or Public Contribution: An advisory group of six patients and/or informal caregiver contributors provided input on the study design, edited the consent forms, and helped develop the interview guide., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Introduction: The Chronic Care Model (CCM), the Expanded Chronic Care Model (ECCM) and the eHealth Enhanced Chronic Care Model (eCCM) focus on how healthcare teams and eHealth support can offer effective care and relevant solutions for patients facing chronic care conditions. However, they do not consider how patients can help these teams in their work, nor do they promote ways in which patients can help themselves. However, in the last decade, three different models have emerged that can complete our capacity to design and deliver integrated care for people with chronic diseases. In this article, we propose a revised version of the model that integrates the patient perspective and patients' experience-based knowledge. It integrates three different ways of engaging patients that complement the other patient engagement point of view: the experience of care and mediation in healthcare, therapeutic patient education and patient learning pathways, as well as patient-professional partnership., Methodology: For each of the three models, we conducted a review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct and government reports on patient engagement and partnership with their healthcare providers, to integrate the different components of these models into the ECCM and eCCM. The goal is to create a model that better takes into account the experiential knowledge of patients and citizens throughout its different dimensions., Results: We identified 129 papers based on their framework, design, sample, measures and fit with patient engagement and chronic illness and added our own research when relevant. Integrating the three models provides an opportunity to amplify the role played by the patient perspective in the management of chronic disease. The Expanded Chronic Care Patient-Professional Partnership Model (E2C3PM) is intended to rebalance power relations between healthcare professionals and patients (and their caregivers). This new model is based on recognizing patients' experiential knowledge and their roles as caregivers and as full members of the care team. Integrating patient empowerment into the E2C3PM underscores the importance of coproduction care with patients at the clinical, organizational and system levels within a supportive environment., Conclusion: Applying this new model should make it possible to better take into account the complexity of chronic diseases, improving the integration not only of care, services and eHealth support but also the various determinants of health and reaching a mutually beneficial settlement among all actors involved., Patient or Public Contribution: A patient-researcher contributed to the development of the protocol, the data collection and the preparation and writing of this manuscript., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Background: The path of a complaint and patient satisfaction with complaint resolution is often dependent on the responses of healthcare professionals (HCPs). It is therefore important to understand the influences shaping HCP behaviour. This systematic review aimed to (1) identify the key actors, behaviours and factors influencing HCPs' responses to complaints, and (2) apply behavioural science frameworks to classify these influences and provide recommendations for more effective complaints handling behaviours., Methods: A systematic literature review of UK published and unpublished (so-called grey literature) studies was conducted (PROSPERO registration: CRD42022301980). Five electronic databases [Scopus, MEDLINE/Ovid, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Health Management Information Consortium (HMIC)] were searched up to September 2021. Eligibility criteria included studies reporting primary data, conducted in secondary and tertiary care, written in English and published between 2001 and 2021 (studies from primary care, mental health, forensic, paediatric or dental care services were excluded). Extracted data included study characteristics, participant quotations from qualitative studies, results from questionnaire and survey studies, case studies reported in commentaries and descriptions, and summaries of results from reports. Data were synthesized narratively using inductive thematic analysis, followed by deductive mapping to the Theoretical Domains Framework (TDF)., Results: In all, 22 articles and three reports met the inclusion criteria. A total of 8 actors, 22 behaviours and 24 influences on behaviour were found. Key factors influencing effective handling of complaints included HCPs' knowledge of procedures, communication skills and training, available time and resources, inherent contradictions within the role, role authority, HCPs' beliefs about their ability to handle complaints, beliefs about the value of complaints, managerial and peer support and organizational culture and emotions. Themes mapped onto nine TDF domains: knowledge, skills, environmental context and resources, social/professional role and identity, social influences, beliefs about capability, intentions and beliefs about consequences and emotions. Recommendations were generated using the Behaviour Change Wheel approach., Conclusions: Through the application of behavioural science, we identified a wide range of individual, social/organizational and environmental influences on complaints handling. Our behavioural analysis informed recommendations for future intervention strategies, with particular emphasis on reframing and building on the positive aspects of complaints as an underutilized source of feedback at an individual and organizational level., (© 2024. The Author(s).)

SYNOPSIS: This Viewpoint provides practical guidance for early-career musculoskeletal clinicians who are navigating the complexities of clinical practice. Key themes are embracing uncertainty, seeing and treating the whole person, avoiding judgemental mindsets, embracing shared decision-making, focusing on building strong therapeutic relationships and finding a work-related niche that resonates with one's own passions and strengths. We encourage clinicians to consume information carefully in an era of social media health influencers, and suggest ways of accurately identifying reliable sources of information. We do not presume to inoculate against all challenges that clinicians will encounter. Instead, we strive to help early-career clinicians navigate potential friction points in clinic and research based on our collective experience. J Orthop Sports Phys Ther 2024;54(10):621-624. Epub 17 September 2024. doi:10.2519/jospt.2024.12676 .

For people with severe or profound intellectual disability (ID), support staff are important interaction partners. The quality of their interactions, a multidimensional construct, is well documented, but the staff perspective remains underexposed. This study aims to capture the behaviors, thoughts, and emotions of staff when interacting with their clients, and their views on what constitutes quality. Thirty-four support staff completed a 5-day diary about a daily interaction with a specific client. A thematic analysis was carried out. The diary entries depicted behaviors and thoughts with different foci, and emotions with positive and negative valences. The pursuit of Harmonization and the experience of Return emerged as overarching dimensions central to staff's views on quality interaction. Limitations and directions for future research are discussed., (©AAIDD.)

This study sought to understand the network of meanings mutually experienced among women who survived maternal near miss due to lapses in care during pregnancy, labor and birth, based on Habermas' theory of communication. A qualitative methodology was selected, with the participation of 14 women who survived maternal near miss by means of the autobiographical narrative interview proposed by Schutze, based on the Communicative Action theory of Jurgen Habermas. From the analysis, two categories emerged: "Selective listening, clashes and negligence" and "Blaming the Patient and Violent Communication." The narratives reveal that the interpersonal relationship was not based on dialogue, but on superior knowledge as opposed to acknowledging the other, reflecting an authoritarian, non-reflexive posture of the professionals, without self-criticism or genuine critical freedom, with important repercussions on user care. The primacy of strategic rationality and the defense of verticalized technical success contributed to important communication lapses in the care of women who progressed to maternal near miss.

We study the process of value co-creation in physiotherapist-patient relationships and the underlying mechanisms of this process. We present the Googling Effect Model outlining the relationship between patients' pre-encounter online information search and their commitment to compliance in physiotherapy service exchange. We tested the model on a sample of physiotherapy service patients (n = 446) in the United States. We analyzed the collected responses using the partial least squares method, using SmartPLS 4.0. Our study contributes to the existing body of knowledge in several ways. We developed and tested the Googling Effect Model. Doing so adds to the healthcare literature on value co-creation in physiotherapy. The Googling Effect Model increases the predictive value of the Service-Dominant Logic as it outlines the mechanism underlying value co-creation in healthcare, including the role and importance of pre-encounter online information search in collaborative healthcare. Moreover, the findings illustrate how the underlying mechanism through which pre-encounter online information search affects commitment to compliance differs between men and women and different ethnic groups. These findings can be used to create an environment that increases service engagement and commitment to compliance by accounting for patients' gender and ethnicity., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This paper explores transformative strategies in hand therapy aimed at improving the patient experience - a critical factor linked to improved clinical outcomes and increased satisfaction for patients and therapists. The focus is on three key areas: personalized interactions, empathic communication, and sensory engagement. Personalized interactions ensure therapy is uniquely tailored to each patient' needs, fostering a sense of individual attention and care. Empathic communication involves understanding and responding effectively to patients' verbal and nonverbal cues, creating a supportive environment where patients feel genuinely heard. Sensory engagement utilizes the therapeutic environment's visual, olfactory, and auditory elements to create a calming, welcoming space conducive to healing and relaxation. Integrating these strategies aims to increase treatment effectiveness and improve therapist well-being by promoting a fulfilling and less stressful work environment. Through a comprehensive review of existing evidence, current practices and innovative approaches, this paper advocates for a holistic, patient-centered model of hand therapy that significantly improves treatment outcomes and enhances the overall therapeutic experience, ensuring it is both practical and compassionate., (Copyright © 2024 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: The complex logics of healthcare systems inherit paradoxes that can lead to interpersonal conflicts impacting both patients and professionals. In this study, we aimed to identify and explore tensions and conflicts arising from paradoxes within hospital haemodialysis., Methods: We conducted a secondary supplementary analysis to previously collected qualitative data, including individual interviews with 11 patients and 10 nephrologists and focus groups involving a total of 13 haemodialysis nurses. Data were collected in Norway through three primary studies focused on exploring experiences of patient participation. For the current study, we employed thematic analysis., Results: Patient-professional conflicts emerged in three fundamental areas: (1) the hospital haemodialysis treatment, in which patients' views of treatment diverged from those of professionals, (2) patient-professional responsibility that became a negotiation point, with differing views on responsibilities, and (3) time, in which professional time took precedence over patients' time, indirectly impacting patients due to resource allocation. These conflicts stemmed from paradoxes driven by unevenly validated principles, conflict of interest, and conceptual ambiguity., Conclusion: Altering healthcare logics by bringing in new perspectives or clarifying conceptual ambiguity could mitigate patient-professional conflicts. However, changing existing healthcare logics may give rise to new paradoxes and conflicts, which health services at various levels must address., Patient or Public Contribution: This secondary analysis utilized previously collected data from a project that did not involve patient or public contribution., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Aim: To design and validate a tool to assess a woman's perception of whether she has experienced a situation of abuse or disrespect during childbirth attendance: "Childbirth Abuse and Respect Evaluation-Maternal Questionnaire" (CARE-MQ)., Methods: Multidisciplinary panel of experts (gynecologists, midwives, mothers) participated in creating CARE-MQ. A cross-sectional study was carried out on 901 Spanish women who had given birth between 1 and 3 months before to determine psychometric characteristics. Finally, an exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and a convergent validity study were carried out with the Quality Questionnaire from the Patient's Perspective-Intrapartum (QPP-I), and a reliability study using internal consistency (Cronbach's α) and coefficient of intraclass correlation (CCI)., Findings: The KMO test gave a value of 0.935, and Bartlett's sphericity test was <0.001. The EFA identified four components ("Emotional Abuse", "Inadequate Professionalism", "Physical Abuse" y "Lost contact") that explained 55.16 % of variance. In the CFA, a good fit was observed for most of the evaluated indicators. CARE-MQ correlated negatively with QPP-I (Spearman's rho = -0.641, 95 % CI: -0.679, -0.600; p < 0.001) and was statistically associated with variables related to childbirth experience (p < 0.005) such as the use of a birth plan, use of regional analgesia, type of birth, episiotomy, presence of severe tears, skin-to-skin contact, length of hospital stay and postpartum surgical intervention. Cronbach's α value was 0.903. The ICC of absolute agreement after administering the questionnaire one week after was 0.927 (95 % CI: 0.85-0.97)., Conclusions: CARE-MQ is a valid and reliable instrument to evaluate the perception of a woman regarding the situation of abuse and/or disrespect that she may have experienced during birth in a population of Spanish postpartum women., Competing Interests: Declaration of competing interest No conflict of interest has been declared by the author(s)., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Study Aims: Despite being mentioned in well-known models of psychotherapeutic change, the concept of extra-therapeutic factors seems to have left the scene across time, eaten away by the progressive refinement of the construct of common factors. Aim of the present study is to better understanding the historical evolution of the concept of extra-therapeutic factors and its importance for psychotherapy today., Methods: This is a position paper based on a literature review on extra-therapeutic factors and psychotherapy outcome and process., Discussion: There is growing evidence of the decisive role of clients' and therapists' characteristics, as well as of the importance of therapeutic alliances and relationships in promoting change. Within this context, the concept of extra-therapeutic factors still deserves proper attention, rather than being relegated to a residual and vanishing category., Conclusion: A renewed interest on extra-therapeutic factors could reinvigorate the debate over the relationship between psychotherapy and life contexts and conditions. In terms of complexity and systems thinking nothing, a priori, really falls outside the realm of psychotherapy and, in turn, psychotherapy is not a practice that could be abstracted from the context in which it is practiced or from clients' and therapists' lives., (© 2024 John Wiley & Sons Ltd.)

Foster youth reportedly have a significant need for mental health services and the quality of the therapeutic relationship can influence service engagement. We employed grounded theory methods to conduct interviews and focus groups with 48 key stakeholders in child welfare to deepen our theoretical understanding of therapeutic relationships with foster youth. The central theory that emerged was that a successful therapeutic relationship is an essential ingredient of the healing process for current and former foster youth. Participants identified hindrances to a successful therapeutic relationship, such as when therapist mishandles countertransference or inappropriately uses self-disclosure, as well as what therapists can do to build a successful therapeutic relationship, such as when a therapist fosters a secure attachment and promotes client agency. The findings offer insight into some of the important facets of building and maintaining a trusting and successful therapeutic relationship with current and former foster youth., (© 2024 American Association for Marriage and Family Therapy.)

Background and Goal: Marginalized patients often feel unwelcome in healthcare. The concept of culturally safe healthcare (CSH) represents an important paradigm shift from provider control to patients who feel safe voicing health concerns and believe that they are heard by providers. This study has five goals: review works describing CSH, identify CSH themes, describe provider behaviors associated with CSH, describe interventions, and discuss how health communication can advance CSH., Methods: A scoping review was conducted for articles published between 2019 and 2023 following modified PRISMA guidelines. Online databases included Pubmed (Medline), CINAHL, Web of Science, Google Scholar, and Redalyc. Thematic analysis was also conducted., Results: Twenty-one articles meeting inclusion criteria were identified and analyzed. Of these, five explained features of CSH, four were empirical studies, seven were content analyses, and five were interventions. Five themes were identified including (1) how patients perceive CSH, (2) sociocultural determinants of health inequity, (3) mistrust of care providers, (4) issues with the biomedical model of healthcare, and (5) the importance of provider-patient allyship. Care provider communication behaviors fostering CSH were discussed. Three CSH interventions were highlighted. Finally, there was a discussion for how health communication scholars can contribute to CSH., Conclusions: CSH offers a paradigm shift from provider control to marginalized patients' experience of patient-provider communication. Recommendations for how health communication scholars can contribute to the implementation of CSH included developing guiding theories and measurement, evaluation of CSH outcomes, and conducting focus groups with patients to assess the meaning of cultural safety.

Background: Person-centred care underscores the therapeutic alliance (TA) as fundamental, fostering positive treatment outcomes through collaborative patient-clinician interactions. Biobehavioural synchrony within the TA, essential for effective care, reflects an adaptive process where organisms align responses during interactions. Enactivism and active inference provide profound insights into human perception, reshaping musculoskeletal care understanding. Touch and verbal communication, integral to the TA, foster synchrony and alignment of personal beliefs., Aim: This study aimed to identify the tools used by manual therapists in musculoskeletal care to establish a TA with patients. Furthermore, it endeavours to evaluate the alignment of these strategies with current literature and their correlation with biobehavioural synchrony, enactivism, and the role of touch in active inference., Methods: The methodology followed rigorous qualitative research principles, particularly Grounded Theory and interpretative-constructivist principles, conducting eleven semi-structured interviews with open-ended questions., Results: The core category identified in the study is elucidated as follows: "Interwoven Connection: The Fabric of Therapeutic Synchrony." The interviews unveiled three main categories, each comprising sub-categories: (1) Creating a meaningful dialogue; (2) Promoting active patient participation; (3) Synchronisation., Conclusion: Fostering meaningful dialogue, patient involvement, and therapeutic synchrony is crucial for a robust therapeutic alliance in musculoskeletal care. This underscores the importance of establishing a deep connection between clinicians and patients, central to effective person-centred care. Clinicians must prioritise two-way communication, empathy, and patient collaboration in defining personalised goals. Emphasizing touch and seeking patient feedback are also pivotal. Further research is needed to explore these elements and their impact., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Consumer experience is a key driver of successful health and education outcomes. Yet, the key factors influencing consumer experiences with care are not fully understood. The aim of this study was to understand, from the perspective of people receiving health care or education services, factors that determine positive and negative experiences with care. We interviewed people who received services, including occupational therapists, and analyzed recordings of the interviews using content analysis. Themes emerged from positive experiences with care on a continuum from "Acknowledges Me" to "Shares Problem Solving." Themes from negative experiences were also on a continuum from "Lacks Curiosity" to "Disregards." A fifth theme emerged from occupational therapists, describing "transformational insights" regarding how their personal experiences receiving care affected their practice. The findings from this study align with core OT constructs and advances understanding of authentic partnerships with people receiving professional services., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

In obstetric clinics in Berlin, Germany, more than half of the women are immigrants. The main objective of the qualitative study was to explore the staff's experiences with obstetric care for immigrants and juxtapose it with the immigrants' comments on their birth experiences. We analyze potential differences along the framework of a cultural health capital (CHC). Between May and August 2017, semi-structured interviews were carried out with 17 obstetricians and 17 midwives at four obstetric clinics in Berlin. The verbally transcribed interview material was subjected to a qualitative content analysis according to Mayring. Furthermore, a secondary data from an interview study was analyzed in the purpose of providing some insight into the practitioner study participant perspective. Between January and May 2017, in the postpartum ward at the Berlin Charité Campus Virchow Clinic, an interview study guided by the migrant-friendly maternity care questionnaire was conducted among 410 migrant and non-migrant women. For this study, the free-text comments on the pregnancy care were analyzed. The staff interviewees identified language barrier and legal status as risk factors for the late onset of obstetric care. CHC functioning potentially as alternatives to the established health care structures were voiced. Strong family ties among immigrant families bear a high potential for support. Gratefulness was voiced by the staff and immigrant patients as a source of satisfaction with care. Our study shows that obstetric care for immigrant women remains a challenge. CHC of immigrant women might partially compensate for exclusion., (© 2023. The Author(s).)

The American Psychological Association task force on empirically supported therapy relationships defined countertransference (CT) management (i.e., awareness of CT) as a "promising" element in psychotherapy research. The present study aimed to examine how changes in therapist CT and awareness of CT relate to therapy process and outcome. The data analysis was based on 41 treatments and used the core conflictual relationship theme to measure CT. We found that changes in therapists' Wishes from the relationship with the patient at the beginning of therapy were related to patients' working alliance and symptom changes at the end of treatment. Changes in therapist awareness of CT moderated the relationship between therapists' wishes from the therapy and patients' symptom changes during therapy. Last, we present a case study and discuss how awareness of CT can help the therapist handle the challenges that arise from it. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pairing is a commonly recommended practice used to build rapport and create positive therapeutic environments. However, there are limited evaluations of training procedures to teach pairing skills to direct-care staff. The purpose of the present study was to formalize and improve the efficiency of the training process for the initial stages of pairing using video modeling with embedded voice-over instructions plus performance feedback. Participants included three dyads of behavior technicians and children with autism. The results indicated that the training package increased the consistency of pairing implementation. These outcomes were maintained in a novel setting and for up to 4 weeks following training. We also measured relevant child behaviors such as joint attention, engagement, indices of happiness, and calm. Specific areas for future research are described., (© 2024 The Author(s). Journal of Applied Behavior Analysis published by Wiley Periodicals LLC on behalf of Society for the Experimental Analysis of Behavior (SEAB).)

Introduction: Individuals identifying as lesbian, gay, bisexual, transgender, queer, intersex, asexual and other related identities (LGBTQIA+) experience challenges with healthcare, including physiotherapy. To understand potential contributions to poor experiences, this study explored physiotherapists' experiences and perspectives about working with members of LGBTQIA+ communities., Methods: This study employed a qualitative research design, suitable for exploring the experiences and perspectives of individuals within the physiotherapy context. The sample consisted of physiotherapists working in Australia who participated in a larger survey study. Data were collected via semi-structured interviews which were audio-recorded and transcribed verbatim. Data analysis was conducted using a relativistic and queer theoretical framework with a reflexive thematic approach., Results: Eighteen physiotherapists with diverse sexual orientations participated in the interviews. While all participants identified as women or men, not all used binary gender pronouns. Five key themes were developed: 1) "anti-discrimination" regarding choice of language and providing safe environments; 2) "current and historical discrimination" against LGBTQIA+ individuals; 3) "taking an equality approach" when working with LGBTQIA+ patients; 4) "knowledge of LGBTQIA+ health" in a broad sense and specifically with transgender and gender-diverse people; and 5) "managing own reactions" with respect to individual biases and discomfort., Conclusion: Underpinning all themes was the overarching concept of cis/hetero/endonormativity. Assuming normativity when working with LGBTQIA+ patients, is likely to have negative effects on patients' mental health, the therapeutic relationship and quality of care. In order to improve diversity, safety, inclusion and equity of care for LGBTQIA+ individuals, it is vital that normativity within physiotherapy is challenged.