Patient Adherence With Medical Treatment Regimens: An Interactive Approach

Inadequate patient adherence to treatment regimens is a ubiquitous problem in health care and carries a profound personal, societal, and economic cost. This article illustrates a general theoretical framework we believe to be useful for the interpretation, conception, and design of adherence research. The core tenet of this framework is that factors that influence adherence can be better understood by considering the interactive effects of patients' characteristics, type of adherence intervention, and characteristics of the illness and medical treatment context. This framework represents an extension and application of previous theory and research from personality, social, and clinical psychology concerning the value of an interactionalist perspective. We illustrate the framework using some of our past work involving treatment adherence among patients with chronic renal failure.     

Guidelines for Writing Letters to Patients

Patient letters provide a permanent record of the genetic counseling that was provided and are unique in medical care; rarely do other health care providers send summaries written specifically to their patients and families. We surveyed genetic counseling training program directors and found that while the acquisition of patient letter-writing skills was considered important, there were no specific guidelines made available to students. To develop letter-writing guidelines, we evaluated patient letters, reviewed references on professional correspondence, surveyed the medical literature, and worked with a writing consultant. The guidelines we subsequently developed and present here include a format for writing patient letters, suggestions on presenting medical information in understandable terms, and wording considerations. These patient letter-writing guidelines are intended to serve as a guide for teaching students this important skill and as a resource for practicing health care professionals.     

Prospective and retrospective evaluations of experiences: how you evaluate an experience depends on when you evaluate it

Prior research (cf. Soman & Shi, 2001 ) has shown that obstacles and periods of low progress in an experience reduce the evaluation of that experience. In this research, we propose that the temporal distance between the obstacle and the time of making the evaluation moderates the effect of the obstacle. Consequently, an early (late) obstacle reduces prospective (retrospective) evaluation more significantly than a late (early) obstacle. In two experiments, we find support for this temporal proximity hypothesis. Further, differences between prospective and retrospective evaluations disappeared when the data were analyzed in terms of temporal distance, suggesting that the judgment policies underlying prospective and retrospective evaluations were the same. We also show that it is possible to create pairs of paths such that one of the two paths would be preferred when viewed in prospect, but the other path might be preferred in retrospect. Copyright © 2002 John Wiley & Sons, Ltd.     

Genetic Counselors' Judgments of Patient Concerns: Concordance and Consequences

The aims of this prospective study were to determine (a) the concordance between patient concerns and genetic counselors' judgments of these concerns, (b) the predictors of patient and counselor judgments, and (c) the relationship between concordance and patient outcomes. Patients' and counselors' views were sought before and after 131 routine genetic consultations. Before consultations, there was concordance about level of patient concern to within one point in 63% (82/131) of consultations and about type of patient concern in 60–84% of consultations. Lack of concordance in judging level and type of concern was associated with lower satisfaction with information and higher anxiety after the consultation. The biggest predictor of counselor judgment of concern was professional background: doctors judged patients to be more concerned than did nurses. Concordance of concern was predicted by counselors' experience in genetics: less experienced counselors overestimated patient concern. Future research needs to determine whether improving judgment of concern improves patient outcome.     

Synchronistic mind‐matter correlations in therapeutic practice: a commentary on Connolly (2015)

This commentary adds some ideas and refinements to the inspiring discussion in a recent paper by Connolly ( 2015 ) that makes use of a dual‐aspect framework developed by us earlier. One key point is that exceptional experiences (of which synchronicities are a special case) cannot in general be identified with experiences of non‐categorial or acategorial mental states. In fact, most exceptional experiences reported in the literature are experiences of categorial states. Conversely, there are non‐categorial and acategorial states whose experience is not exceptional. Moreover, the psychodynamics of a synchronistic experience contain a subtle mesh of interacting processes pertaining to categorial, non‐categorial and acategorial domains. We outline how this mesh may be addressed in particular cases of synchronicity described by Connolly.     

Therapist experiences of equine-assisted psychotherapy in South Africa: A qualitative study

This study examined therapists’ perceptions and experiences of equine-assisted psychotherapy (EAP). Participants were 14 practising EAP therapists (females = 86%; male = 14%; age range 20 to 69 years) from across South Africa. They were interviewed utilising electronic interview media. Thematic analysis revealed therapists perceived effectiveness of EAP in providing emotional and interpersonal growth for clients. They also identified training, safety and ethical concerns with this therapeutic modality. Therapists’ experiences with EAP were influenced by their prior interaction with horses as horse owners or horse riders.     

Depth of Field: Using photographs and narratives to explore and reflect on ageing

The learning landscape of the higher education environment is changing, with an increased focus over the past decade on how educators might begin to cultivate reflective skills in health professions students. In addition, changing professional requirements demand that health professionals are adequately prepared to practise in today’s complex healthcare systems, including responding to changing demographics of population ageing. In this educational case study, we will share how we (a group of education, medical and nursing academics) developed ‘Depth of Field: Exploring Ageing’ a digital, consumer-driven, interprofessional reflective learning resource that uses photographs, narrative and small-group work to strengthen reflective capacity in current and/or future health professionals.     

Clients’ experiences of dynamic interpersonal therapy (DIT): opportunities and challenges for brief,manualised psychodynamic therapy in the NHS

Dynamic interpersonal therapy (DIT) is a brief manualised psychodynamic intervention for depression. This is a first study exploring clients’ experiences of DIT specifically and brief, manualised psychodynamic psychotherapy (PP) in general. Interpretative phenomenological analysis was the methodology employed. Five participants completed a semi-structured interview, three weeks to ten months after completing DIT. The scores of pre- and post-therapy outcome measures of depression and anxiety were also available. Two emerging superordinate themes are presented here: (1) ‘The Distinct Features of DIT’, referring to how its therapeutic style and time limitations were experienced and (2) the ‘Impact of Therapy’, referring to perceived outcomes. While previous findings showed that therapist’s perceived limited activity in long-term PP was experienced as hindering/unhelpful, the perceived sense of direction in DIT appeared adequate to most participants. Secondly, the time limitations provoked complex responses. Reactions to the distinct elements of DIT are to be treated both as therapeutic opportunities and as challenges. Further, in line with psychoanalytic theory, most participants described relational changes that went beyond symptom relief and remained in progress after therapy ended. Intriguingly, there was no consistency between participants’ qualitative accounts of change and the scores of the outcome measures.