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Randomized Trial of Telegenetics vs. In-Person Cancer Genetic Counseling: Cost, Patient Satisfaction and Attendance
Telegenetics—genetic counseling via live videoconferencing—can improve access to cancer genetic counseling (CGC) in underserved areas, but studies on cancer telegenetics have not applied randomized methodology or assessed cost. We report cost, patient satisfaction and CGC attendance from a randomized trial comparing telegenetics with in-person CGC among individuals referred to CGC in four rural oncology clinics. Participants (
n
= 162) were randomized to receive CGC at their local oncology clinic in-person or via telegenetics. Cost analyses included telegenetics system; mileage; and personnel costs for genetic counselor, IT specialist, and clinic personnel. CGC attendance was tracked via study database. Patient satisfaction was assessed 1 week post-CGC via telephone survey using validated scales. Total costs were $106 per telegenetics patient and $244 per in-person patient. Patient satisfaction did not differ by group on either satisfaction scale. In-person patients were significantly more likely to attend CGC than telegenetics patients (89 vs. 79 %,
p
= 0.03), with bivariate analyses showing an association between lesser computer comfort and lower attendance rate (Chi-square = 5.49,
p
= 0.02). Our randomized trial of telegenetics vs. in-person counseling found that telegenetics cost less than in-person counseling, with high satisfaction among those who attended. This study provides support for future randomized trials comparing multiple service delivery models on longer-term psychosocial and behavioral outcomes.
Journal Article
Narrative therapy : an introduction for counsellors
Drawing on the ideas of Michael White and David Epston, this fully revised, extended and updated Second Edition incorporates the progression of their thinking over the past five years and introduces developments initiated by other narrative therapists worldwide. New material has been added around counseling for post-traumatic reactions, couples conflict and a sense of personal failure.
eBook
Experiences of Women Participating in a Student-Led, Virtual Group Counseling Program for Maternal Mental Health During the COVID-19 Pandemic
Purpose
To describe the experiences of women with perinatal mood and anxiety disorders (PMADs) who participated in a virtual group counseling program for maternal mental health during the coronavirus disease 2019 (COVID-19) pandemic.
Method
A qualitative descriptive design was used. Participants were recruited from Facebook parenting groups targeted to women with children in Indiana. One-on-one, semi-structured interviews were conducted in a virtual setting. Transcribed interviews were analyzed using content analysis to yield themes.
Results
Nine women with PMADs participated in the virtual group counseling program. Three themes were identified: (1) The Program Reduced Symptoms of PMADs Amplified by the COVID-19 Pandemic, (2) The Program Advanced Practical Solutions, and (3) The Program Bolstered Social Support.
Conclusion
Participants experienced heightened symptoms of PMADs during the pandemic. Participants' experiences in the student-led, virtual counseling program suggest that providers could enhance social support and screening for PMADs for women in the perinatal period through virtual programs. Graduate-level psychology students could be considered to decrease the national shortage of mental health providers. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx–xx.]
Journal Article
Effects of sexual counseling and education based on self-efficacy theory on the sexual function of women with breast cancer
Background
Given the negative impact of breast cancer and its treatment on women’s self-efficacy in various areas, including sexual function, investigating and understanding ways to enhance sexual function is crucial. The current study aimed to examine the impact of sexual counseling and education based on self-efficacy theory on the sexual function of women with breast cancer.
Method
The trial was a randomized controlled trial with a parallel design, including a pre-test, post-test, and one-month follow-up. Fifty married breast cancer survivors, having a disorder in at least one domain of sexual function (score below 3.9) and meeting other research criteria, visited clinics and hematology departments of hospitals in Bushehr (a city in southern Iran) between 2023 and 2024 were purposefully selected and randomly assigned to intervention and control groups using block randomization. The intervention group received two educational sessions and three counseling sessions based on the self-efficacy theory. Data collection utilized demographic information forms and a sexual function index for women, which consists of 19 questions that assess six domains of women’s sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain during intercourse) over a period of 4 weeks and completed by participants during the pre-test, post-test, and follow-up stages. Descriptive statistics (mean, standard deviation, percentage, frequency) and analytical tests, including the independent t-test, Mann‒Whitney U test, Chi-square test, and Fisher’s exact test and repeated-measures analysis of variance (ANOVA) followed by post hoc LSD test were used for data analysis, considering a significance level of less than 0.05 in all cases.
Result
The mean age of patients in the intervention and control groups was 44.42 ± 4.88 and 43.44 ± 5.20, respectively. The two groups did not have statistically significant differences in demographic and disease-related variables (
P
> 0.05). An independent t-test showed no significant difference between the two groups in terms of the average pre-test sexual function score and its domains (
P
> 0.05). Changes in overall sexual function and the arousal, orgasm, lubrication, and satisfaction domains from pre-test to post-test and from pre-test to follow-up increased in the intervention group and decreased in the control group, with statistically significant differences between the two groups (
P
< 0.05). However, the average changes from post-test to follow-up were not statistically significant between the two groups.
Conclusion
The total FSFI scores and most of its domains in the intervention group were higher than those in the control group, which can be attributed to the impact of sexual education and counseling. Therefore, the use of this non-invasive, cost-effective, and straightforward method along with other medical approaches is recommended.
Trial registration
IRCT20231102059930N1, 4 December 2023, Prospectively registered, at http//www.irct.ir.
Journal Article
Working with bereavement : a practical guide
\"A practical guide for those who work with the bereaved in a variety of settings, from nurses and social workers to volunteers. Covering ethics, cultural issues and support networks, an essential text for those seeking to build understanding and skills in order to offer better support to the dying and the bereaved\"--Provided by publisher.
Book
Does Type 2 Diabetes Genetic Testing and Counseling Reduce Modifiable Risk Factors? A Randomized Controlled Trial of Veterans
Objective
We examined the clinical utility of supplementing type 2 diabetes mellitus (DM) risk counseling with DM genetic test results and counseling.
Research Design and Methods
In this randomized controlled trial, non-diabetic overweight/obese veteran outpatients aged 21 to 65 years received DM risk estimates for lifetime risk, family history, and fasting plasma glucose, followed by either genetic test results (CR+G; N = 303) or control eye disease counseling (CR+EYE; N = 298). All participants received brief lifestyle counseling encouraging weight loss to reduce the risk of DM.
Results
The mean age was 54 years, 53% of participants were black, and 80% were men. There was no difference between arms in weight (estimated mean difference between CR+G vs. CR+EYE at 3 months = 0.2 kg, 95% CI: −0.3 to 0.7; at 6 months = 0.4 kg, 95 % CI: −0.3 to 1.1), insulin resistance, perceived risk, or physical activity at 3 or 6 months. Calorie and fat intake were lower in the CR+G arm at 3 months (p’s ≤ 0.05) but not at 6 months (p’s > 0.20).
Conclusions
Providing patients with genetic test results was not more effective in changing patient behavior to reduce the risk of DM compared to conventional risk counseling.
Trial registration: ClinicalTrials.gov NCT01060540
http://clinicaltrials.gov/show/NCT01060540
Journal Article