Office Counseling Research Articles

Improving delivery of smoking cessation assistance for patients with cancer: Results of the Beyond ASK quality improvement.

11011 Background: Smoking by cancer patients and survivors causes adverse health outcomes, and quitting smoking after a cancer diagnosis can improve survival. However, assistance with smoking cessation is not regularly provided to cancer patients. Reported are results of the national 2023 Beyond ASK quality improvement initiative to increase and sustain delivery of smoking cessation assistance across participating sites. Methods: In 2023, American College of Surgeons Commission on Cancer (CoC) accredited sites were invited to participate in the Beyond ASK quality improvement initiative to increase evidence-based smoking cessation assistance delivery to cancer patients who report current smoking. Participating sites were required to monitor and periodically report on provider performance (e.g., assist rate = number of patients assisted with smoking cessation / number of patients who smoke), resource utilization, barriers, and facilitators. Educational resources, webinars, toolkits, and online data collection were facilitated by CoC. Results: Among 306 participating programs who completed the Beyond ASK initiative (94% of baseline programs), high rates of asking patients about and documenting smoking status were maintained at 88-92% from the baseline to final survey. During the 12-month project period, overall rates of assisting with smoking cessation increased from 53% to 67%. Referral to state quitlines increased from 31% to 49%, and referral to ‘in house’ smoking cessation programs increased from 15% to 28%. Rates of providing brief in office counseling more than tripled from 20% at baseline to 66% at final. The most frequently reported components that contributed to programs’ success were educational webinars (30.6%), structured data collection (28.2%), and smoking cessation toolkit (21.2%). The leading logistical barriers were extracting clinical data from the EHR and making changes to the clinical workflow, reported by 36.5% and 28.2% of respondents, respectively. Overall, 95.3% of respondents “agreed” or “strongly agreed” that identifying patients who smoke and assisting patients with cessation was sustainable. Conclusions: Increasing smoking cessation assistance through a national accreditation organization is feasible with substantial improvements in assisting patients. Results support delivery of smoking cessation as an achievable national quality component of cancer care.

Acceptance of Psycho-Oncological Counseling Formats in a Cancer Counseling Center during the COVID-19 Pandemic: An Exploratory Care Study.

Background: The COVID-19 pandemic made it necessary to change established structures of medical counseling services and quickly establish digital counseling formats to ensure continuity of care. In this context, we offered telephone and video-telephonic counseling in addition to traditional face-to-face counseling in the office. Methods: Patients (n = 100) of the Cancer Counseling Center, Tübingen, were asked to complete a questionnaire to assess the acceptance of the counseling format following each counseling session (office, telephone, and video) in the period between July 2020 and February 2021. The questionnaire included the subject areas of patient characterization, assessment of therapeutic contact, therapeutic relationship, and hurdles and was used in this exploratory care study. Results: The satisfaction and acceptance of the three counseling formats (office, telephone, and video) were rated as “good” to “very good” in the three subgroups (range 1–6, office M = 1.2, telephone M = 1.3, video M = 1.4). Likewise, the “therapeutic relationship” achieved high ratings in terms of establishment of a therapeutic relationship in all three subgroups (office M = 5.7, telephone M = 5.0, video M = 5.0). The type of contact (office and video counseling) achieved a significant main effect on the therapeutic relationship for items such as “I believe that counseling is helping me” (F(2,97) = 4.80, p = 0.01) and “I feel that I can rely on the counselor/therapist” (F(2,97) = 3.29, p = 0.04). The “hurdles” were rated as minor and tolerable (office M = 1.3, telephone M = 1.3, video M = 1.4). Predictor analyses showed that there was no effect of age and gender on the acceptance of digital counseling formats in the present sample. Discussion and Conclusion: On the basis of this survey, it can be concluded that digital counseling formats were perceived by patients as a promising addition to the classic face-to-face setting. In addition, it can be stated that the digital formats (telephone and video) were not generally preferred to face-to-face counseling, but that the innovative telecounseling was accepted and perceived with great satisfaction and acceptance. Accordingly, the additional use of digital counseling formats could be an opportunity to enrich and expand the existing presence structures also after the COVID-19 pandemic.

Preoperative Counseling Method and Postoperative Opioid Usage: A Secondary Analysis of the PREOP Study.

The purpose of this analysis is to determine if postoperative opioid usage differs among women randomized to office or phone preoperative counseling for pelvic organ prolapse surgery. This was a planned exploratory analysis of the Patient Preparedness for Pelvic Organ Prolapse Surgery study, which randomized women to standardized preoperative counseling by office visit or phone call before prolapse surgery. Inclusion criteria were the completion of the assigned counseling intervention and submission of a 7-day postoperative pain and medication diary. Multivariable logistic regression was done to assess the association between counseling method and total opioid use while controlling for variables significant on univariate analysis (surgery type and county of residence). There were 84 participants with postoperative data (41 office, 43 phone). Median total number of 5-mg oxycodone tablets used was higher for the office group (5 [interquartile range, 0-10]) than the phone group (0 [interquartile range, 0-2], P = 0.002). On multivariable logistic regression, women who underwent phone counseling were less likely to be in the highest third of opioid use when controlling for surgery type and county of residence (odds ratio, 0.23; P = 0.012; 95% confidence interval, 0.07-0.72). Daily pain scores and nonopioid medication use (nonsteroidal anti-inflammatory medications and acetaminophen) were similar between groups (P > 0.05). Despite similar pain scores, women who received preoperative phone counseling before pelvic organ prolapse surgery had lower opioid utilization than those with office counseling. Further research is needed to determine the optimal method of preoperative counseling and its role in postoperative pain management.

Student Satisfaction After Attending Individual Counseling Services in terms of Gender and Counselor's Working Period

This research was motivated by the existence of several students who had problems and attended individual counseling services and then did not come back for further counseling. This can be seen because students feel less satisfied after getting individual counseling services because students do not get new knowledge, do not get new solutions and students feel that the counseling teacher does not understand student expectations. The purpose of this study was to describe student satisfaction after participating in individual counseling services in terms of gender and work tenure of the counseling counselor / counselor. This study used a comparative descriptive approach with a 2x2x2 factorial model. This research was conducted on class XI and XII students of SMA N 8 and SMA N 13 Padang in the 2020/2021 school year. The sample size is 90 students with purposive sampling technique. The research instrument was a student satisfaction questionnaire after participating in an office counseling service using the Guttman scale mosel. Data were analyzed using analysis of variance techniques (ANOVA). There is no interaction of student satisfaction after participating in individual counseling services seen from the gender of the student, the gender of the counselor and the working period of the counselor / counselor simultaneously.

How Well Do Patients Clearly Understand Invasive Prenatal Genetic Diagnostic Testing? [38L

INTRODUCTION: To determine patient clarity of the perceived benefits/drawbacks about invasive prenatal genetic diagnostic testing (PGDT). METHODS: Cross-sectional design. Voluntary, anonymous questionnaire (Q) assessing patient's decision making process in regards to invasive (CVS and/or amniocentesis) PGDT. Qs (paper and online options) were distributed between 2017 and 2018 to those recommended for PGDT in a university academic practice. Questions (5 items on clarity, 5-point Likert scale) were structured to evaluate patient decisional clarity, and were partly adapted from published validated Q's. Exclusion criteria: English or Spanish illiterate. Means, variances (SD), and ranges were tabulated. RESULTS: 50 female patients returned the study; 38 (76%) completed it in entirety. 75% had equal PGDT decision making with their partner. Most were referred due to a positive carrier screen followed by positive cell free DNA result. Participants expressed high clarity of understanding advantages and disadvantages of PGDT (mean 3.28 on a 1=no clarity to 5=high clarity scale, SD 0.94). CONCLUSION: Patients have a clear understanding of PGDT; this may be attributable to in office counseling (MD and/or genetic counselors) done prior to decision making.

What are the risks and benefits of intrauterine device (IUD) insertion on the same day as office counseling?

EVIDENCE-BASED ANSWER Risk of pelvic inflammatory disease (PID) does not differ between same-day or delayed insertion for women without overt cervicitis (SOR: A, meta-analysis of RCTs and prospective cohort). Same-day insertion increases probability of continued IUD use compared with delayed insertion. However, women with same-day insertion after an induced or spontaneous abortion are more than twice as likely to have IUD expulsion than women with delayed insertion (SOR: A, meta-analysis of RCTs). Return rates for a subsequent appointment for IUD insertion are as low as 54% (SOR: B, cross-sectional study). Delaying IUD placement for sexually transmitted disease testing is discouraged in asymptomatic patients (SOR: C, consensus opinion).

가정폭력에 대한 이해와 치유를 위한 집단상담에 관한 소고: 보호관찰소 상담을 중심으로

가정폭력에 대한 이해와 치유를 위한 집단상담에 관한 소고: 보호관찰소 상담을 중심으로

Weight loss in preparation for robotic-assisted surgery in the management of low-grade stage I uterine carcinoma: Clinical outcomes

Objectives: To evaluate the feasibility of weight loss through office counseling regarding diet and exercise and megestrol acetate for control of endometrial cancer (EC) before definitive hysterectomy.

Smoking status in patients with a new cancer diagnosis and effectiveness of smoking cessation efforts.

e17699 Background: Smoking is associated with increased incidence of morbidity and mortality, but its effects after a diagnosis of cancer are less well studied. We hypothesized that patients who presented with a new cancer diagnosis who were active smokers would be less likely to undergo chemotherapy, have higher mortality and be only modestly successful at smoking cessation efforts. Methods: The database at our community cancer center was queried to look at rates of smoking, smoking cessation, chemotherapy treatments and mortality. Results: Between November 1, 2012 and January 31, 2014, 2448 patients with an oncology diagnosis were assessed for smoking status. Of those, 412 (16.8%) were current smokers. Current smokers were offered smoking cessation tools including in office counseling and enrollment into a focused smoking cessation program called Quitworks. Subsequently, 30 (7.3%) patients quit smoking. Of the 412 current smokers, 159 (38.6%) patients were given literature on smoking cessation. Of those given literature on smoking cessation, 7 actually quit (4.4%), while of the patients not given smoking cessation literature, 23 (9.0%) quit. Patients who were current smokers were more likely to receive chemotherapy as part of their treatment course (50.2 vs. 36.5%), but more likely to die during the time period (12.4% of patients vs. 7.4%). Conclusions: Patients who smoke at the time of their cancer diagnosis are more likely than non-or former smokers to undergo chemotherapy and suffer earlier mortality than non-or former smokers. This is likely a reflection of both comorbid conditions and presenting with more advanced cancer. Despite its importance, smoking cessation efforts in this population were offered only to a minority of patients and were ineffective, as nearly twice as many patients in the group not offered smoking cessation tools quit. These results emphasize the importance of smoking cessation and development of effective programs for smoking cessation efforts. 412 Active Smokers 159 (38.6%) given smoking cessation literature 253 (61.4%) NOT given smoking cessation literature 7 Quit (4.4%) 23 Quit (9.1%)

Knowledge of Psychotropics and Prescribing Preferences of Family Physicians: A Preliminary Study

Family doctors often provide care for their patients' mental health needs. This study was designed to survey their opinions and actual practice of providing mental health care, specifically, prescribing psychotropic medication to outpatients with mild/moderate mental health disorders. A group of 241 family medicine faculty and residents completed a self-administered survey designed to evaluate their comfort level with providing brief office counseling and psychotropic medication to their patients with mental health disorders. The majority of the sample reported that they prescribe psychotropic medication to their patients, despite often assessing their knowledge of psychotropics as absent or marginal. Most of the sample expressed strong interest in learning more about prescribing psychiatric medications. Results of the study suggest the need for improved training of family physicians who often prescribe psychiatric medications for outpatients with mental health disorders.

Increasing Patient Preparedness for Sacral Neuromodulation Improves Patient Reported Outcomes Despite Leaving Objective Measures of Success Unchanged

We assessed how a group shared appointment influenced patient preparedness for sacral nerve stimulation for refractory overactive bladder and/or urge urinary incontinence. We also evaluated subjective and objective outcomes. Patients considering sacral nerve stimulation were prospectively enrolled and invited to attend a group shared appointment. This 75-minute presentation included a question and answer period with an implanting surgeon and an implanted patient. Control patients received standard office counseling. A patient preparedness questionnaire was completed after the group shared appointment or office counseling. Response to treatment was determined using the postoperative satisfaction questionnaire, Patient Global Impression of Improvement (PGI-I) and voiding diaries. In our study 36 women with a mean ± SD age of 61 ± 15 years underwent sacral nerve stimulation. There was no significant difference in patient demographics between the 19 women who attended the group shared appointment and the 17 controls. Overall preparedness was greater in the shared appointment group (p = 0.043) with better understanding of the purpose of (p = 0.003) and alternatives to (p = 0.043) sacral nerve stimulation. Significantly more women in the shared appointment group than controls felt completely prepared (78.9% vs 29.4%, p = 0.003) and completely satisfied (78.9% vs 35.3%, p = 0.003) with sacral nerve stimulation as well as very much better (68.4% vs 17.6%, p = 0.002) according to the PGI-I. There was no difference between the groups in the number of women with a 50% or greater symptom reduction on voiding diary. Participating in a group shared appointment before sacral nerve stimulation improved patient preparedness and perceived outcomes of treatment, although there was no difference in objective outcomes based on voiding diary.

Action-oriented obesity counseling attains weight stabilization and improves liver enzymes among overweight and obese children and adolescents

Introduction: Pediatricians are encouraged to promote behavior modification to reduce childhood obesity and its co-morbidities, yet the effectiveness of office counseling is unclear. We aimed to evaluate if a low-intensity intervention (action-oriented counseling) in a clinic setting results in weight stabilization, and if the effect is modified by a diagnosis of non-alcoholic fatty liver disease (NAFLD). We hypothesized that patients with NAFLD would be more motivated to adhere to the lifestyle goals set in clinic, due to the diagnosis of an obesity-related condition; and, would therefore achieve greater weight reduction compared to similarly overweight and obese patients without a diagnosis of NAFLD. Methods: A retrospective chart review was conducted on 73 (35 male, 38 female) overweight and obese patients (BMI ≥ 85th percentile) attending a pediatric GI clinic between January 2006 and October 2011. Analysis was conducted to determine if lifestyle goals discussed with the patient at each clinic visit were associated with improved BMI, BMI z-score, and liver enzymes. Treatment outcomes among NAFLD patients and similarly obese patients without NAFLD were compared using t-tests and chi-square tests. Results: Of the children evaluated, 74.0% achieved a reduction or stabilization in BMI z-score after 3 months of follow-up. Among NAFLD patients, liver enzymes improved in 72% of those who were able to stabilize or reduce their BMI and among 43% of those who gained weight. Treatment outcome did not significantly differ based on having a diagnosis of NAFLD, although there was a trend towards greater improvements. Conclusion: Our study suggests that action oriented counseling including goal-setting in a low intensity, clinic based approach is effective in improving patient BMI, in the presence or absence of an obesity-related co-morbidity, such as NAFLD. Further, we demonstrated that lifestyle modification led to improvement of liver enzymes in NAFLD patients and may result in other clinically relevant improvements. Longer studies will be needed to determine if the improvements are sustained.

Partnering With Mutual Aid Associations to Provide Home Injury Prevention

Injury is the leading cause of death and a leading cause of morbidity among children in the US. Poor, minority children, especially those with language and cultural differences, are disproportionately affected. The traditional childhood injury prevention approaches (eg, physician office counseling, public service announcements) may not be effective when significant language and cultural differences exist between provider and client. Partnering with mutual aid associations to create low literacy education tools for their home visitors to use to teach immigrant families about home safety may be one method to provide injury prevention information.

Improving firearm storage habits: impact of brief office counseling by family physicians.

Firearm injury is the leading cause of injury-related death among youth and second leading cause of injury-related death overall in the United States. Our objective is to determine the impact of brief office counseling by family physicians on patients' firearm storage habits. Of the 1,233 patients who completed the enrollment questionnaire, 156 (13%) reported they had guns in their household and agreed to participate in the study. Postintervention survey instruments were completed by 127 (81%) of participants. Participants received either no counseling, verbal counseling alone, or counseling and a gun safety brochure from their physician. Firearm storage habits were measured at baseline and 60 to 90 days after intervention. At the postintervention interview, 64% of the group receiving verbal counseling and 58% of the group receiving verbal counseling plus written information made a safe change in gun storage compared with 33% of participants in the no-intervention group (P =. 02). A logistic regression model controlling for demographics and gun ownership showed that compared with the no-intervention group, intervention participants were three times more likely to make safe changes. Family physicians' brief counseling efforts made a significant positive impact in the firearm storage habits of their patients. With a verbal or written recommendation, a significant improvement was observed in firearm storage.

Children, adolescents, and the media: issues and solutions.

I believe television is going to be the test of the modern world, and that in this new opportunity to see beyond the range of our vision we shall discover either a new and unbearable disturbance of the general peace or a saving radiance in the sky. We shall stand or fall by television. —Author E. B. White1 Television and other media represent one of the most important and underrecognized influences on children and adolescents' health and behavior in the 1990s. Their impact should be eliciting serious concern, not just from parents and educators but from physicians, public health advocates, and politicians as well (Fig 1). Although objections to various programming and advertising practices can exist on common sense, philosophical, aesthetic, humanistic, or public health grounds without strict scientific data,2 increasing numbers of studies document that a serious problem exists. Fig. 1. One political cartoonist's view of children's television. (Reprinted with permission from the San Antonio Express News .) By time criteria alone, television represents the predominant medium. Young people average 16 to 17 hours of viewing weekly, beginning as early as age 2.3 When video game and videocassette usage are added, some teenagers may spend as many as 35 to 55 hours in front of the television set.4 More families own a television set than a telephone.5 However, other media are important as well. Adolescents can spend nearly equal amounts of time listening to the radio, although music is used frequently as an accompaniment to other activities.4 ,6 More than half of all 15- to 16-year-olds had seen the majority of the most popular, recent R-rated movies in one study.7 In a separate study, 92% of males and 84% of females had seen or read Playboy or Playgirl by age 15.8Finally, playing …

VIOLENCE ANTICIPATORY GUIDANCE

A series of brief office counseling interventions for the prevention and treatment of violence is reviewed in this article. Primary prevention strategies throughout the pediatric age span cover topics from gun storage to nonviolent handling of a potential street fight. Secondary prevention strategies deal with patients who have been injured by violence or patients who engage in street violence, weapon carrying, or dating violence.

Office counseling: When, why, what, and how

Counseling patients is an important component of primary care. There is no standard definition of “counseling,” however. The term “counseling” can be used for activities ranging from simple explanations of a medical condition to long-term psychological treatment of individual or family problems. All primary practitioners do the former, but the extent of their counseling beyond that level varies widely. Many factors contribute to the variation: time, training, level of comfort, relationships with particular patients and families, experience with particular disease entities and patient populations, and the availability of qualified mental health professionals to advise the primary care provider and/or accept referrals of patients. This article will help the obstetrician/gynecologist decide when a patient's distress is likely to resolve on its own, when she needs counseling, what kind and how much, and when she should be referred to a mental health specialist. The article will also provide suggestions for the performance of office counseling.

Depression. Management tips for the primary care physician.

Treatment of major depression can in most cases be handled by the primary care physician who is willing and able to take the time. The minority of patients who pose particular problems in diagnosis or treatment should be referred to a psychiatrist. Primary care physicians are encouraged to regard major depression as being as much within their scope as other common disorders. After pharmacotherapy and office counseling, some patients may need psychotherapy to help them alter patterns of thinking and interaction that contribute to depression.

Psychotherapy by Family Physicians

Practical, brief, specific techniques that primary care physicians can use in office counseling are reviewed. Useful applications of supportive therapy, cognitive therapy, and interpersonal therapy are described. Family therapy is introduced as a means of approaching problems originating in the social context.

Sexuality During the Menopause

Although the evidence is not conclusive, overall many sexual changes seem to occur in the climacteric years. It would be easy to propagate and perpetuate longstanding beliefs and myths that would do a great disservice to all of the women to whom our care is dedicated. In the coming years it is hoped that we shall learn more about how to understand these changes. In recent years the International Menopause Society has actively encouraged work in this area. An entire issue of its journal Maturitas is devoted to a series of scientific papers on sexuality in the climacteric years. For those who desire further reading that issue is strongly recommended. All medical professionals who come into contact with women during the climacteric years should be prepared to ask about sexuality and to deal with any concerns that arise. Taking a good sexual history along with a good general medical history and full social background is the best starting point for coping with these concerns. How to take a comprehensive sexual history is well described by Munjack and Oziel. Of course, it is not usual to take this full history on every woman with menopause symptoms. A few key questions should identify the woman who has sexual problems and facilitate selection of appropriate questioning for each patient (Table 2). Often, taking such a history allows the physician to identify a problem area that may be helped by medication or, more often, by education and simple office counseling. When it is clear that these simple approaches will not be adequate, the physician should have good resources for referral to the appropriate specialist, whether it be gynecologist, menopause center, psychologist, family therapist, or sex therapist.