PDF(Pubmed)
Abstract：
BACKGROUND: An emerging focus on person-centered care has prompted the need to understand how shared decision-making (SDM) and health coaching could support self-management of diabetes and hypertension.
OBJECTIVE: This study aims to explore preferences for the scope of involvement of health coaches and health care professionals (HCPs) in SDM and the factors that may influence optimal implementation of SDM from the perspectives of patients and HCPs.
METHODS: We conducted focus group discussions with 39 patients with diabetes and hypertension and 45 HCPs involved in their care. The main topics discussed included the roles of health coaches and HCPs in self-management, views toward health coaching and SDM, and factors that should be considered for optimal implementation of SDM that involves health coaches. All focus group discussions were audio recorded, transcribed verbatim, and analyzed using thematic analysis.
RESULTS: Participants agreed that the main responsibility of HCPs should be identifying the patient\'s stage of change and medication education, while health coaches should focus on lifestyle education, monitoring, and motivational conversation. The health coach was seen to be more effective in engaging patients in lifestyle education and designing goal management plans as health coaches have more time available to spend with patients. The importance of a health coach\'s personal attributes (eg, sufficient knowledge of both medical and psychosocial management of disease conditions) and credentials (eg, openness, patience, and empathy) was commonly emphasized. Participants viewed that addressing the following five elements would be necessary for the optimal implementation of SDM: (1) target population (newly diagnosed and less stable patients), (2) commitment of all stakeholders (discrepancy on targeted times and modality), (3) continuity of care (familiar faces), (4) philosophy of care (person-centered communication), and (5) faces of legitimacy (physician as the ultimate authority).
CONCLUSIONS: The findings shed light on the appropriate roles of health coaches vis-à-vis HCPs in SDM as perceived by patients and HCPs. Findings from this study also contribute to the understanding of SDM on self-management strategies for patients with diabetes and hypertension and highlight potential opportunities for integrating health coaches into the routine care process.
OBJECTIVE: This study aims to explore preferences for the scope of involvement of health coaches and health care professionals (HCPs) in SDM and the factors that may influence optimal implementation of SDM from the perspectives of patients and HCPs.
METHODS: We conducted focus group discussions with 39 patients with diabetes and hypertension and 45 HCPs involved in their care. The main topics discussed included the roles of health coaches and HCPs in self-management, views toward health coaching and SDM, and factors that should be considered for optimal implementation of SDM that involves health coaches. All focus group discussions were audio recorded, transcribed verbatim, and analyzed using thematic analysis.
RESULTS: Participants agreed that the main responsibility of HCPs should be identifying the patient\'s stage of change and medication education, while health coaches should focus on lifestyle education, monitoring, and motivational conversation. The health coach was seen to be more effective in engaging patients in lifestyle education and designing goal management plans as health coaches have more time available to spend with patients. The importance of a health coach\'s personal attributes (eg, sufficient knowledge of both medical and psychosocial management of disease conditions) and credentials (eg, openness, patience, and empathy) was commonly emphasized. Participants viewed that addressing the following five elements would be necessary for the optimal implementation of SDM: (1) target population (newly diagnosed and less stable patients), (2) commitment of all stakeholders (discrepancy on targeted times and modality), (3) continuity of care (familiar faces), (4) philosophy of care (person-centered communication), and (5) faces of legitimacy (physician as the ultimate authority).
CONCLUSIONS: The findings shed light on the appropriate roles of health coaches vis-à-vis HCPs in SDM as perceived by patients and HCPs. Findings from this study also contribute to the understanding of SDM on self-management strategies for patients with diabetes and hypertension and highlight potential opportunities for integrating health coaches into the routine care process.
摘要：
背景：对以人为本的护理的关注促使人们需要了解共享决策（SDM）和健康指导如何支持糖尿病和高血压的自我管理。
目的：本研究旨在从患者和HCP的角度探讨健康教练和卫生保健专业人员（HCP）参与SDM范围的偏好，以及可能影响SDM最佳实施的因素。
方法：我们对39名糖尿病和高血压患者和45名参与其护理的HCP进行了焦点小组讨论。讨论的主要主题包括健康教练和HCP在自我管理中的作用，对健康指导和SDM的看法，以及最佳实施涉及健康教练的SDM应考虑的因素。所有焦点小组讨论都被录音，逐字转录，并使用专题分析法进行分析。
结果：参与者同意，HCPs的主要职责应该是确定患者的变化阶段和药物教育，虽然健康教练应该关注生活方式教育，监测,和励志谈话。健康教练被认为在让患者参与生活方式教育和设计目标管理计划方面更有效，因为健康教练有更多的时间与患者在一起。健康教练个人属性的重要性(例如，对疾病状况的医学和社会心理管理有足够的了解)和证书(例如，开放性,耐心,和同理心)被普遍强调。与会者认为，解决以下五个要素对于最佳实施SDM是必要的：（1）目标人群（新诊断和不稳定的患者），(2)所有利益相关者的承诺(目标时间和方式的差异)，（3）护理的连续性（熟悉的面孔），（4）关怀哲学（以人为本的沟通），和（5）面临的合法性（医生作为最终的权威）。
结论：这些发现揭示了患者和HCP在SDM中相对于HCP的健康教练的适当作用。这项研究的发现也有助于理解SDM对糖尿病和高血压患者的自我管理策略，并强调将健康教练纳入常规护理过程的潜在机会。
目的：本研究旨在从患者和HCP的角度探讨健康教练和卫生保健专业人员（HCP）参与SDM范围的偏好，以及可能影响SDM最佳实施的因素。
方法：我们对39名糖尿病和高血压患者和45名参与其护理的HCP进行了焦点小组讨论。讨论的主要主题包括健康教练和HCP在自我管理中的作用，对健康指导和SDM的看法，以及最佳实施涉及健康教练的SDM应考虑的因素。所有焦点小组讨论都被录音，逐字转录，并使用专题分析法进行分析。
结果：参与者同意，HCPs的主要职责应该是确定患者的变化阶段和药物教育，虽然健康教练应该关注生活方式教育，监测,和励志谈话。健康教练被认为在让患者参与生活方式教育和设计目标管理计划方面更有效，因为健康教练有更多的时间与患者在一起。健康教练个人属性的重要性(例如，对疾病状况的医学和社会心理管理有足够的了解)和证书(例如，开放性,耐心,和同理心)被普遍强调。与会者认为，解决以下五个要素对于最佳实施SDM是必要的：（1）目标人群（新诊断和不稳定的患者），(2)所有利益相关者的承诺(目标时间和方式的差异)，（3）护理的连续性（熟悉的面孔），（4）关怀哲学（以人为本的沟通），和（5）面临的合法性（医生作为最终的权威）。
结论：这些发现揭示了患者和HCP在SDM中相对于HCP的健康教练的适当作用。这项研究的发现也有助于理解SDM对糖尿病和高血压患者的自我管理策略，并强调将健康教练纳入常规护理过程的潜在机会。
