Self-management Program For Patients Research Articles

Effectiveness of a physiotherapy self-management programme for adult patients with chronic non-specific low back pain in low- and middle-income countries: protocol for a systematic review and meta-analysis

IntroductionChronic non-specific low back pain (CNLBP) is among the most common musculoskeletal system conditions reported worldwide; however, few studies are available from low- and middle-income countries (LMICs). Self-management is a...

Effectiveness of self-management program for gastric cancer patients: A randomized controlled trial comparing gain vs. loss message framing

ObjectiveThis study aims to evaluate the effectiveness of a self-management program using gain/loss-framed messages in patients with gastric cancer. MethodsIn this randomized controlled trial, 69 patients with gastric cancer who underwent gastrectomy at a university hospital were assigned to the gain- or loss-framed message group. The self-management program consisted of: 1) face-to-face education, 2) gain/loss-framed text messages, and 3) self-monitoring of health behaviors. Health outcomes (i.e., nutritional status, physical activity, exercise intensity, and distress), and health behaviors (i.e., dietary habits, physical activity performance, and distress management) were measured, and a generalized estimating equation was used for the analysis. ResultsNutritional status and dietary habits in the loss framed message group were statistically higher after the intervention compared to the counterpart (β=-1.72, p=.049; β=0.36, p=.033, respectively). There was no time-group interaction effect on physical activity, exercise intensity, physical activity performance, distress or distress management. ConclusionsA self-management program employing loss-framed messages was effective in promoting nutrition-related self-management among patients with gastric cancer. Practice implicationsMessage-framing is an effective communication technique that can be easily used in clinical settings, and a loss-message-framing strategy may enhance nutrition-related self-management in patients with gastric cancer.

Spousal Involvement in Collaborative Management and Glycemic Behavior Change among Patients with Diabetes Mellitus: A Systematic Review.

The marked increase in the number of individuals with diabetes mellitus (DM) worldwide each year has resulted in the importance of the spouse's contribution to the promotion and support of patient self-management programs. This study aimed to systematically explore the role or involvement of spouses in collaborative management and glycemic behavior change in DM. Five databases including Scopus, PubMed, Cumulative Index of Nursing and Allied Health Literature, SAGE, and Web of Science were reviewed for relevant articles retrieved from 2017 to 2022. Literature search used keywords, including "Spouse," "Support," "Self-management," "Glycemic Control," and "Diabetes mellitus." The Joanna Briggs Institute guidelines were used for appraisal review of journals. The component of partner support in the self-management of patients with DM is associated with an increase in the patient's glycemic level. Twenty-five studies were identified that describe the different spousal roles and strategies in the promotion and support of DM management. Overall, spouses' involvement positively impacted healthy diets, higher self-efficacy, improved quality of psychological well-being, increased perceived support, and changes in glycemic-influenced behavior. Adaptation in the spouse patient relationship including maintaining cohesiveness can result in positive coping is essential in normalizing and contextualizing the chronic condition of DM. Partner-based collaboration is important for diabetes management, overcoming management barriers, and generating communal coping. This systematic review observed that the involvement of a spouse is important in improving collaborative management and results in better glycemic behavior in patients with DM. A better understanding of the relationship between spousal involvement, coping strategies, and adherence in daily management and the subsequent use of this information are highly useful for creating targeted and effective interventions.

Lipid parameters, adipose tissue distribution and prognosis prediction in chronic kidney Disease patients

BackgroundLipid management in clinic is critical to the prevention and treatment of Chronic kidney disease (CKD), while the manifestations of lipid indicators vary in types and have flexible association with CKD prognosis.PurposeExplore the associations between the widely used indicators of lipid metabolism and their distribution in clinic and CKD prognosis; provide a reference for lipid management and inform treatment decisions for patients with non-dialysis CKD stage 3–5.MethodsThis is a retrospective cohort study utilizing the Self-Management Program for Patients with Chronic Kidney Disease Cohort (SMP-CKD) database of 794 individuals with CKD stages 3–5. It covers demographic data, clinical diagnosis and medical history collection, laboratory results, circulating lipid profiles and lipid distribution assessments. Primary endpoint was defined as a composite outcome(the initiation of chronic dialysis or renal transplantation, sustained decline of 40% or more in estimated glomerular filtration rate (eGFR), doubled of serum creatinine (SCr) from the baseline, eGFR less than 5 mL/min/1.73m2, or all-cause mortality). Exposure variables were circulating lipid profiles and lipid distribution measurements. Association were assessed using Relative risks (RRs) (95% confidence intervals (CIs)) computed by multivariate Poisson models combined with least absolute shrinkage and selection operator (LASSO) regression according to categories of lipid manifestations. The best model was selected via akaike information criterion (AIC), area under curve (AUC), receiver operating characteristic curve (ROC) and net reclassification index (NRI). Subgroup analysis and sensitivity analysis were performed to assess the interaction effects and robustness..Results255 individuals reached the composite outcome. Median follow-up duration was 2.03 [1.06, 3.19] years. Median age was 58.8 [48.7, 67.2] years with a median eGFR of 33.7 [17.6, 47.8] ml/min/1.73 m2. Five dataset were built after multiple imputation and five category-based Possion models were constructed for each dataset. Model 5 across five datasets had the best fitness with smallest AIC and largest AUC. The pooled results of Model 5 showed that total cholesterol (TC) (RR (95%CI) (per mmol/L) :1.143[1.023,1.278], P = 0.018) and percentage of body fat (PBF) (RR (95%CI) (per percentage):0.976[0.961,0.992], P = 0.003) were significant factors of composite outcome. The results indicated that comprehensive consideration of lipid metabolism and fat distribution is more critical in the prediction of CKD prognosis..ConclusionComprehensive consideration of lipid manifestations is optimal in predicting the prognosis of individuals with non-dialysis CKD stages 3–5.

Feasibility of a mobile health app-based self-management program for Chinese patients with breast cancer receiving chemotherapy: A randomized controlled pilot study.

There are currently an increasing number of mobile health (mHealth) programs offered to patients with breast cancer undergoing chemotherapy, but their rate of adherence to app usage has remained low. This study aimed to examine the feasibility of an mHealth app-based program such as the adherence rate of app usage and determine the preliminary effects on self-efficacy, quality of life, symptom burden and healthcare utilization in these patients. We conducted a randomized controlled pilot trial. Ninety-six participants were randomly allocated into either an intervention group or a control group (routine care plus a placebo app). The intervention group engaged in a 6-week self-regulation activity and received nurse-led social support via the app. The intention-to-treat principle was adopted. The generalized estimating equation was utilized to analyze the between-group, within-group and interaction effectiveness of this program. Totally 96 participants were enrolled from 16 May to 23 August 2022. The average rate of adherence to app usage increased from 4.8% at week 3 to 51.2% at week 6. There was a statistically significant reduction in the physiological efficacy scores of the intervention (p < .001) and control groups (p < .001) at week 6, compared with the baseline. At week 6, the intervention group reported a significantly lower symptom burden (p = .042) and significantly better physical well-being than the control group (p = .024). It is feasible to perform an mHealth app-based self-management program for patients with breast cancer receiving chemotherapy. Nurses can utilize this program to facilitate patient self-management of symptoms during chemotherapy. Clinicaltrials.gov, https://clinicaltrials.gov, (NCT05192525).

Summary of best evidence for self-management in postoperative osteoporotic fracture patients

Osteoporotic fracture as a serious complication of osteoporosis which is usually treated surgically, and its recovery is closely related to one's own behavior and lifestyle, and is a long-term, complex management process that often requires the individual to self-manage many health-related factors. ObjectiveTo gather and synthesize the most robust evidence regarding self-management in patients with postoperative osteoporotic fractures, in order to provide scientific, evidence-based guidance for clinical healthcare professionals to assist postoperative patients in self-management efforts, and to assist patients in optimizing their self-management practices and behavioral norms. MethodsBased on the “6 S” pyramid model of evidence resources (System, Summaries, Synopses of synthesis, Syntheses, Synopses of studies, Studies), we searched the Up To Date, BMJ Best Practice, The Cochrane Library, Australian Joanna Briggs Institute JBI Evidence-Based Medicine Center Healthcare Database, National Institute for Health and Clinical Excellence (NICE), Guidelines International Network (GIN), National Guideline Clearinghouse (NGC) and Scottish Intercollegiate Guide lines Network (SIGN), MedPulse, Embase, PubMed, CINAHL, Web of Science, SinoMed, Chinese Medical Journal Full Text Database, CNKI, Wanfang Data Knowledge Service Platform, and VIP database, etc, The search period for clinical decision-making, systematic evaluation, clinical guidelines, evidence summaries and expert consensus on self-management of postoperative osteoporotic fracture patients, and it was from the establishment of the database to 18 February 2023. To ensure the quality of the literature, three researchers strictly screened the literature according to the literature inclusion and exclusion criteria, and two or more researchers independently evaluated the quality of the included literature, and extracted and integrated the relevant evidence. ResultsThirteen documents were finally included, including 4 clinical practice guidelines, 5 expert consensus, 2 recommended practices, 1 systematic evaluation, and 1 clinical decision report. The research team summarized the evidence in 6 dimensions: multidisciplinary teamwork, management of daily living, management of treatment adherence, management of exercise, management of fall prevention and subsequent fracture, and management of emotions, and 33 pieces of evidence were extracted. ConclusionThe study summarized 33 best evidence of self-management in postoperative osteoporotic fracture patients, which provides a scientific and reasonable self-management program for postoperative patients, and also provides important reference and information for clinical healthcare professionals to provide more comprehensive and scientific self-management health education to patients.

Implementation and evaluation of a warfarin patient self-management (PSM) program among experienced patients in a U.S. academic health system.

Warfarin patient self-management (PSM) is when a patient independently manages their warfarin therapy using a decision-support tool provided by their anticoagulation provider. Clinical trials of PSM, conducted predominantly in Europe, have consistently demonstrated superior efficacy without compromising safety. However, the evidence-based practice of PSM is rarely utilized in the United States (U.S.). We describe initiatives completed to implement a successful PSM program among experienced warfarin-taking patients in a U.S. academic health system by overcoming perceived barriers. The results showed PSM resulted in similar or improved INR control, and an estimated 68% reduction in pharmacist workload.

Abstract P3118: Gender Differences In The Efficacy Of A Mobile-based Self-management Program For Patients With Heart Failure

Background: This study was to develop a mobile application (App) program, presenting educational materials and giving interactive feed-backs on self-management for heart failure patients and to evaluate the gender differences in the efficacy of the program. Methods: We developed a mobile App program for heart failure patients’ self-management, which included comprehensive educational materials and daily record logs for the patients. Also, it took into account the mobile use characteristics and convenience of aged heart failure patients, as well as active and instant interactions and feedback via group chat among the patients and healthcare providers. Regarding the experimental study, we employed a randomized controlled trial to evaluate the effects of the program in 66 heart failure patients. The intervention group was guided to use the mobile App program in their daily life at home for 3 months. Results: Male patients in the experimental group exhibited significantly decreased waist circumference and improved NYHA functional class than the control group after 3 months. As for female patients in the experimental group, they showed significantly improved NYHA functional class, depressive symptoms, and quality of life than the control group after 3 months. Conclusion: This mobile App program showed effective improvements in heart failure patients' symptom classes for both men and women. Also, it showed that women had overall higher positive outcomes in psychosocial aspects, such as depressive symptoms and quality of life than men. Future study is needed to develop self-management programs considering gender differences and also to understand their effectiveness according to gender.

P006 A national patient-reported experience survey (PREM) of advanced nurse practitioners in rheumatology, Ireland

Abstract Background/Aims Data collection to assess the impact of rheumatology advanced nurse practitioners (RANPs) on service quality tends to prioritise the quantitative impact on waiting lists and hospital admissions. However, patients’ views on the quality of service experienced is fundamental and essential to achieve high quality of care. Recording patients experience of care has the potential to improve quality of care. The Irish Rheumatology Nursing Forum (IRNF) wanted to measure patients' experience of care by an RANP and highlight triggers for change to enhance the quality of care delivery nationally. Methods The IRNF conducted a service evaluation postal survey using patient reported experience measure (RA PREM), previously designed, and validated for use with rheumatology patients. This tool examines eight domains of care specific to patients with inflammatory arthritis (need and preferences; care coordination; information about care; daily living; emotional support; family and friends; access to care) and is proven to be effective in measuring and monitoring patient experience. Minor adjustments were made to the questionnaire specific to the role of the advanced nurse practitioner. Patients seen by an advanced nurse practitioner within the previous 12-months were supplied with a questionnaire and a stamped address envelope during a 6-week period, in early 2022. Patient participation was voluntary, postal return of a complete survey implied consent. Results Eleven eligible rheumatology centres with twenty advanced nurse practitioners participated nationally. A total 350 questionnaires were disseminated, 188 completed questionnaires were returned, (54% response rate). In the previous 12-month period 38% of respondents had at least 2 appointments. Appointments with the advance nurse practitioner were predominantly face-to-face (73%), and a further 26% were telephone consultations. Most patients reported involvement in their care decisions, being emotionally supported, and that communication and service access were timely. Patients endorsed a good experience of care for their inflammatory arthritis (67% strongly agreed, 25% agreed). Most patients (71%) reported good control of their arthritis which allowed them to get on with usually daily life activities. Results from the self-care domain demonstrated low levels of knowledge about patient organisations and self-management programmes. Conclusion Optimising the quality of care delivered by advance nurse practitioners is contingent on measuring patient experience. The self-management organisations/programme knowledge deficit among patients will be addressed by the IRNF in partnership with the patient organisation Arthritis Ireland. It is incumbent on advanced practice nurses to undertake service evaluations for quality improvement and further service development. Periodic use of PREMS is a feasible way to inform service evaluation for quality improvement. Disclosure U.E. Martin: None.

Self-management in Asthma Patients: A Systematic Review

Self-management is very important in treating asthma patients. Various selfmanagement support interventions have been developed to facilitate adequate self-management of asthma. This review aims to identify, describe and assess the evidence regarding self-management intervention programs and their effects on self-management outcomes among asthmatic patients. Four databases, Google Scholar, Europe PMC, Science Direct, and PubMed, were searched using a systematic strategy using keywords: Asthma, Chronic disease, eHealth, smartphone, self-management, educational programs, and quality of life. The study eligibility criteria was a Randomized Control Trial study, published between 2016 and 2021, with language restrictions published in English only. The JBI ( Joanna Brings Institute) tool was used to evaluate study quality. 422 studies were screened, and 11 studies that met the criteria were extracted. The review identified two intervention group methods to improve self-management among asthma patients, including digital-based self-management and non-digital-based self-management. Most research shows that self-management programs improve and maintain quality of life so that people with asthma can live normal lives without obstacles in carrying out daily activities. The self-management program for asthma patients provides the ability to manage the disease so that it can improve the quality of life.&#x0D; Keywords: asthma, self-management program, quality of life, mHealth

Using an electronic medical record patient portal for warfarin self-management: Empowering children and parents

BackgroundMany children taking warfarin perform their international normalized ratio (INR) at home, with results phoned to a clinician who instructs warfarin dosing. Data suggest that parents can be supported to make warfarin dosing decisions themselves, a process known as patient self-management (PSM). ObjectivesThis study aimed to determine the suitability and acceptability of warfarin PSM in children using the Epic Patient Portal. MethodsChildren currently performing INR patient self-testing were eligible. Participation involved an individualized education session, adherence to the PSM program, and participation in phone interviews. Clinical outcomes (INR time in therapeutic range and safety outcomes), patient portal functionality, and family experience were assessed. The hospital human research ethics committee approved the study and consent was obtained from parents/guardians. ResultsTwenty-four families undertook PSM. The median age of children was 11 years and all children had congenital heart disease. A median of 13 INRs was uploaded to the portal per family (range, 8-47) across a 10-month period. Before PSM, the mean time the INR was in therapeutic range was 71%; this increased to 79.9% during PSM (difference: P < .001). No adverse events were encountered. Eight families participated in a phone interview. The major theme identified was empowerment; minor themes that emerged included “gaining knowledge,” “trust and responsibility builds confidence,” “saving time,” and “resources as a safety net.” ConclusionThis study demonstrates that communication via the Epic Patient Portal is satisfactory to families and offers a suitable option for PSM for children. Importantly, PSM empowers and builds confidence in families to facilitate management of their child’s health.

Heart Failure-Smart Life: a randomized controlled trial of a mobile app for self-management in patients with heart failure

BackgroundIt is an important strategy for healthcare providers to support heart failure patients with comprehensive aspects of self-management. A practical alternative to a comprehensive and user-friendly self-management program for heart failure patients is needed. This study aimed to develop a mobile self-management app program for patients with heart failure and to identify the impact of the program.MethodsWe developed a mobile app, called Heart Failure-Smart Life. The app was to provide educational materials using a daily health check-up diary, Q & A, and 1:1 chat, considering individual users’ convenience. An experimental study was employed using a randomized controlled trial to evaluate the effects of the program in patients with heart failure from July 2018 to June 2019. The experimental group (n = 36) participated in using the mobile app that provided feedback on their self-management and allowed monitoring of their daily health status by cardiac nurses for 3 months, and the control group (n = 38) continued to undergo their usual care. The differences in the physical, psychosocial, and behavioral factors between the two groups over time were analyzed using the analysis of covariance.ResultsAfter 3 months of intervention, significant differences between experimental and control groups were shown in the New York Heart Association functional class (p = 0.003) and cardiac diastolic function (p = 0.024). The improvements over time in the experimental group tended to be higher than those in the control group in considered variables. However, no changes in psychosocial and behavioral variables were observed between the groups over time.ConclusionsThis study provides evidence that the mobile app program may provide benefits to its users, specifically improvements of symptom and cardiac diastolic function in patients with heart failure. Healthcare providers can effectively and practically guide and support patients with heart failure using comprehensive and convenient self-management tools such as smartphone apps.

Overcoming barriers to implementing new guideline-directed therapies for chronic kidney disease.

For the first time in many years, guideline-directed drug therapies have emerged that offer substantial cardiorenal benefits, improved quality of life and longevity in patients with chronic kidney disease (CKD) and type 2 diabetes. These treatment options include sodium-glucose cotransporter-2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists and glucagon-like peptide-1 receptor agonists. However, despite compelling evidence from multiple clinical trials, their uptake has been slow in routine clinical practice, reminiscent of the historical evolution of angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use. The delay in implementation of these evidence-based therapies highlights the many challenges to optimal CKD care, including: (i) clinical inertia; (ii) low CKD awareness; (iii) suboptimal kidney disease education among patients and providers; (iv) lack of patient and community engagement; (v) multimorbidity and polypharmacy; (vi) challenges in the primary care setting; (vii) fragmented CKD care; (viii) disparities in underserved populations; (ix) lack of public policy focused on health equity; and (x) high drug prices. These barriers to optimal cardiorenal outcomes can be ameliorated by a multifaceted approach, using the Chronic Care Model framework, to include patient and provider education, patient self-management programs, shared decision making, electronic clinical decision support tools, quality improvement initiatives, clear practice guidelines, multidisciplinary and collaborative care, provider accountability, and robust health information technology. It is incumbent on the global kidney community to take on a multidimensional perspective of CKD care by addressing patient-, community-, provider-, healthcare system- and policy-level barriers.

Pilot Testing in the Wild: Feasibility, Acceptability, Usage Patterns, and Efficacy of an Integrated Web and Smartphone Platform for Bipolar II Disorder.

BackgroundBipolar II disorder (BD-II) is associated with significant burden, disability, and mortality; however, there continues to be a dearth of evidence-based psychological interventions for this condition. Technology-mediated interventions incorporating self-management have untapped potential to help meet this need as an adjunct to usual clinical care.ObjectiveThe objective of this pilot study is to assess the feasibility, acceptability, and clinical utility of a novel intervention for BD-II (Tailored Recovery-oriented Intervention for Bipolar II Experiences; TRIBE), in which mindfulness-based psychological content is delivered via an integrated web and smartphone platform. The focus of the study is evaluation of the dynamic use patterns emerging from ecological momentary assessment and intervention to assist the real-world application of mindfulness skills learned from web-delivered modules.MethodsAn open trial design using pretest and posttest assessments with nested qualitative evaluation was used. Individuals (aged 18-65 years) with a diagnosis of BD-II were recruited worldwide and invited to use a prototype of the TRIBE intervention over a 3-week period. Data were collected via web-based questionnaires and phone interviews at baseline and 3-week follow-up.ResultsA total of 25 participants completed baseline and follow-up assessments. Adherence rates (daily app use) were 65.6% across the 3-week study, with up to 88% (22/25) of participants using the app synergistically alongside the web-based program. Despite technical challenges with the prototype intervention (from user, hardware, and software standpoints), acceptability was adequate, and most participants rated the intervention positively in terms of concept (companion app with website: 19/25, 76%), content (19/25, 76%), and credibility and utility in supporting their management of bipolar disorder (17/25, 68%). Evaluation using behavioral archetypes identified important use pathways and a provisional model to inform platform refinement. As hypothesized, depression scores significantly decreased after the intervention (Montgomery-Asberg Depression Rating Scale baseline mean 8.60, SD 6.86, vs follow-up mean 6.16, SD 5.11; t24=2.63; P=.01; Cohen d=0.53, 95% CI 0.52-4.36).ConclusionsOur findings suggest that TRIBE is feasible and represents an appropriate and acceptable self-management program for patients with BD-II. Preliminary efficacy results are promising and support full development of TRIBE informed by the present behavioral archetype analysis. Modifications suggested by the pilot study include increasing the duration of the intervention and increasing technical support.

Retraction: Development and Evaluation of Self-Management Program for Patients with Coronary Artery Disease

Retraction: Development and Evaluation of Self-Management Program for Patients with Coronary Artery Disease

Self-management program for patients with chronic kidney disease (SMP-CKD) in Southern China: protocol for an ambispective cohort study

BackgroundChronic kidney disease (CKD) is a major global health problem. Short-term self-management has been considered to effect some renal and psychological endpoints. However, there are currently very few studies about self-management for CKD that a) have been scientifically designed by a theory-based framework and b) that evaluate the long-term effects and working mechanism. This study presents the rationale and design of a theory-based cohort study to explore how this self-management intervention works and its effectiveness on the Chinese CKD population.MethodsIn this ambispective intervention cohort study,1,200 patients with CKD stages 1–5 will be recruited from July 2015 to July 2024 in 3 branches of Guangdong Provincial Hospital of Chinese Medicine (GPHCM) in Guangdong province, China. The patients in the self-management cohort will choose to receive an intervention that consists of education, nutrition/diet modification, lifestyle change recommendation, medication review, and psychology support based on Social Cognition Theory (SCT). The patients in the control cohort will do regular follow-ups based on the clinic rules. All the patients will be followed up for 5 years, or until the occurrence of a primary outcome. Detailed clinical, laboratory markers, nutritional status, psychological exposures and outcome questionaries will be collected semiannually in CKD stage 1–2 and trimonthly in stage 3–5 patients. The primary outcome is the occurrence of composite clinical endpoints (doubling of serum creatinine level, ESKD, loss of renal function (≥ 40% decline in GFR from baseline), death, major cardiovascular or cerebrovascular events). The main secondary outcomes include the absolute change and slope of eGFR, absolute changes of urinary protein creatinine ratio, 24-h urine proteinuria, intact parathyroid hormone level, and self-management adherence rate and quality of life from baseline to end of the study. The effectiveness of self-management will be analyzed and the association between longitudinal trajectories of self-management and renal outcomes will be evaluated.DiscussionThis study aims to provide further evidence for the effectiveness of theory-based self-management in CKD patients and to improve the lives of patients with CKD by slowing progression, improving psychological well-being and overall quality of life.Trial registrationChinese Clinical Trial Register (ChiCTR1900024633). 19 July, 2019. http://www.chictr.org.cn/showproj.aspx?proj=38378

Improving management of needle distress during the journey to dialysis through psychological education and training\u2014the INJECT study feasibility pilot protocol

BackgroundNeedle-related distress is a common yet poorly recognised and managed problem among haemodialysis (HD) patients. The aim of this pilot study is to test the feasibility and acceptability of the INJECT Intervention—an innovative psychology-based intervention to empower patients to self-manage needle distress with the support of dialysis nurses.MethodsThis investigator-initiated, single-arm, non-randomised feasibility study will take place in a large dialysis service in Adelaide, Australia. Participants will include patients aged ≥ 18 years, commencing or already receiving maintenance HD, recruited through dialysis physicians and nursing staff as individuals believed to be at risk of needle distress. They will be screened for inclusion using the Dialysis Fear of Injection Questionnaire (DFIQ) and enrolled into the study if the score is ≥ 2. The multi-pronged intervention encompasses (i) psychologist review, (ii) patient self-management program and (iii) nursing education program. The primary aim is to evaluate feasibility and acceptability of the intervention from patient and dialysis nurse perspectives, including recruitment, retention, engagement with the intervention and completion. Secondary exploratory outcomes will assess suitability of various tools for measuring needle distress, evaluate acceptability of the nursing education program and measure cannulation-related trauma and vascular access outcomes.ConclusionThe results will inform the protocol for larger trials addressing needle distress in HD patients.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000229875, approved 4 April 2021, https://www.anzctr.org.au/.

The influence of the significant other on treatment adherence in chronic pain management: a qualitative analysis

Objectives. Adherence to treatment recommendations is critical for optimising quality of life for individuals with chronic pain, however adherence rates are low. This study explores the role that significant others are perceived to play in supporting or impeding treatment adherence, as well as examining patient views of the impact of their adherence regimes on their significant others. Design. 25 treatment seeking adults with chronic pain, who were currently living with a romantic partner or adult family member, took part in individual semi-structured interviews. Main outcome measures Interviews were transcribed verbatim and analysed using thematic analysis. Results. Three treatment adherence support themes emerged: social support (emotional, instrumental), positive social control, and supporting autonomy. Participants did not perceive significant others as having any negative influence on their adherence. By contrast, patients perceived that their adherence behaviors had both positive and negative effects on their significant others. Conclusions. These data present an encouraging perspective on the interpersonal context of coping with chronic pain. Significant others facilitated adherence in a range of ways. Future research identifying how best to integrate significant other support into patient self-management programs is needed, in order to lift the poor treatment adherence rates that are noted in the literature.

Developing an Operational System to Ensure Proper Functioning of the Patient Self-management Program: Reinforcing Nurses’ Helping Behaviors

目的：患者のセルフマネジメントプログラムを機能させるために，看護師に対する強化の原理を活用した運用システムの効果を検討した．方法：運用システムは，患者にプログラムに基づく判断の正否を看護師がFeedbackする行動（以下，FB行動）をリーダーが分化強化する．セルフマネジメントプログラムに運用システムを組み込み，病院A・Bに導入し，Standard-care期（S期），Intervention期（I期），Follow-up期（FU期）を設定した．結果：I期に看護師のFB行動実行率は増加し，FU期で維持され，患者の判断実行率も増加した．病院A・Bで看護師のFB行動適正率は78.0%，70.9%に増加し，患者の判断適正率が69.5%，74.7%に増加した．結論：運用システムは，セルフマネジメントプログラムに基づく看護師の適正なFB行動を増加させ，患者の適正な判断を増加させた．

Mobile web-based self-management program for breast cancer patients with chemotherapy-induced amenorrhoea: A quasi-experimental study.

AimThe aim of this study was to examine the effects of a mobile web‐based self‐management program on menopausal symptoms, self‐efficacy and quality of life in breast cancer patients with chemotherapy‐induced amenorrhoea.DesignA quasi‐experimental pretest–posttest design with repeated measures.MethodsThe study was carried out at a university medical centre between October 2017 and September 2018. The intervention group received a 12‐week mobile web‐based self‐management program including education and coaching/support. Multiple instruments were used to measure menopausal symptoms, self‐efficacy, and quality of life at pre‐test, after the intervention (post‐test), and 3 months post‐intervention (follow‐up test). Repeated measure ANOVA was used to analyse the data.ResultsIn the intervention group, menopausal symptoms were significantly improved compared to the control group at the follow‐up test. In the follow‐up test, the intervention group's self‐efficacy and quality of life were significantly improved, whereas that of the control group was decreased.