Background Clinicians’ information tailoring may improve patient outcomes by ensuring that information aligns with each patient’s need for information or understanding. However, no studies have examined how clinicians actually tailor medical information during clinical consultations. Objective We aimed to identify and characterize how clinicians tailor medical information to patients’ needs for information or understanding in oncology consultations. Methods A convenience sample of video-recordings of Dutch (n = 7) and Norwegian (n = 5) clinical oncology consultations was selected and analyzed using microanalysis of clinical interaction. Analytical steps involved identifying sensitizing concepts for “clinicians’ medical information tailoring” and “patients’ needs for information or understanding”, collaboratively watching the video-recordings to extract relevant information tailoring sequences, and iteratively characterizing tailoring practices and categories. Operational definitions for clinicians’ medical information tailoring, analytical choices, procedures and examples, were documented in a coding manual. Results Based on 370 potential information tailoring sequences, five information tailoring categories were created. Cases of “no tailoring” (category 0) showed no match between patients’ needs for information or understanding and clinicians’ information provision. In cases of “attempted tailoring” (category 1), clinicians provided limited, extensive, or ambiguous information. In other cases, clinicians performed partial tailoring (category 2), meaning that they disregarded affective needs accompanying patients’ needs for information or understanding. Finally, “full tailoring” involved clinicians matching information to patients’ needs for information or understanding and accompanying affective needs if present (category 3) and using “add-ons” to deliver information, namely, co-constructing patients’ needs for information or understanding, using matching language or requested additional aids (category 4). Practice recommendations Practice recommendations: Clinicians are encouraged to address patients’ needs for information or understanding and if present, affective needs, using co-construction, matching language, or requested additional aids. Conclusions This empirical work may support clinicians in navigating the complex task of providing patients with information that is helpful to them.
Objectives For kidney transplant recipients, education is vital for developing knowledge and health literacy skills necessary for successful post-transplant outcomes. However, as the transplant population has become increasingly multicultural and multilingual, a gap has emerged between the growing diversity of patients and the educational resources designed to support them. Understanding nurses' perspectives and competence needs is essential for accurately estimating time and resources required to enhance their capabilities. This study therefore explores transplant nurses' experiences, perceived competence, and competence needs when providing post-transplant education to immigrant transplant recipients. Methods We used a qualitative explorative design with focus group interviews. Twenty-nine nurses from three wards participated in five focus groups. Interviews were analysed using thematic analysis. Results Analysis resulted in three main themes: (1) Communication barriers when using an interpreter— participants experienced uncertainty, disrupted conversations, and inability to verify understanding. The nurses lacked formal training in interpreter-mediated communication and communication strategies; (2) Balancing cultural insecurity, respect and expectations—cultural insecurity led nurses to avoid sensitive topics, struggle with differing expectations, and lack the knowledge and confidence to adapt information to diverse contexts; (3) Transplant education in a limited time window —fixed interpreter schedules created patient vulnerability, as patients could not access the ongoing, informal information exchange available to Norwegian-speaking patients. Lack of translated materials intensified pressure and responsibility on the nurses. Conclusion Nurses articulated a need for formal training in interpreter-mediated communication and tools like teach-back in multilingual contexts. They also requested cultural competence training to navigate sensitive topics and adapt educational materials to diverse cultural contexts. Practice implications The findings demonstrate that achieving health literacy and health equity in transplant care requires moving beyond individual-focused interventions towards system-level changes. Future interventions must address health literacy responsiveness and cultural sensitivity to ensure equitable care and optimal outcomes for all transplant recipients.
Objective HIV Counseling and Testing Centers play an important role in reaching populations at increased risk for HIV infection. Although different counseling modalities are used in these settings, little is known about the relational quality of brief HIV counseling encounters. Working alliance (WA), a core indicator of relationship quality in psychotherapy and health care, has not previously been examined in HIV counseling. This study investigated whether WA can be established during brief HIV counseling sessions and whether it differs across counseling modalities, professional backgrounds, and testing settings. Methods A quasi-experimental study was conducted with 253 first-time users of an HIV testing center in Portugal. Participants were allocated to one of three counseling conditions (team counseling, nurse-led counseling, psychologist-led counseling) or to a control condition (information only). Sessions took place in a stand-alone center or a mobile unit. Users and professionals completed the Working Alliance Inventory, and WA scores were analyzed using MANOVA and post-hoc tests. Results Working alliance was established across all counseling modalities and settings. From the users’ perspective, team counseling resulted in higher WA scores, whereas professionals rated WA lower in team sessions than in individual sessions. No significant differences in WA were found between stand-alone and mobile settings or between nurse- and psychologist-led counseling. All counseling conditions also showed significantly higher WA scores than the information-only condition (p < .001). Conclusion Meaningful working alliance can be established during a single HIV counseling session, regardless of setting or professional background. From the user perspective, team-based counseling was associated with higher relational quality, while mobile counseling appeared to support relational quality comparably to stand-alone services. Practice implications Working alliance may serve as a useful indicator of relational quality in HIV counseling and testing services, with potential implications for patient engagement, stigma reduction, and service delivery.
Objectives Individuals with familial cancer risk often experience emotional strain and face complex decisions. Empowerment enables patients to engage actively and make informed choices. Although the Genetic Counselling Outcome Scale (GCOS-24) measures empowerment in genetic counseling, no tailored instrument exists for individuals with familial cancer risk. The aim of this study was to develop and evaluate a concise scale for this purpose based on the GCOS. Methods The Familial Cancer Empowerment Scale (FCES) was developed using the TRAPD method. The GCOS-24 was translated, adapted and shortened by an expert panel including patient representatives. Comprehensibility and relevance were assessed in cognitive interviews and were analysed using structured content analysis. The final FCES was evaluated in a cross-sectional online survey. Acceptability was assessed alongside a psychometric evaluation comprising item characteristics, exploratory factor analysis, and internal consistency. Results The FCES comprised ten items. Seven cognitive interviews indicated high comprehensibility and relevance. Evaluation in the cross-sectional survey (n = 194) showed good acceptability and generally satisfactory item performance. Overall internal consistency was satisfactory (ω = 0.82). Exploratory factor analysis supported a three-factor solution, although the factorial allocation of Items 7 and 10 remained ambiguous. Internal consistency was satisfactory for factors 2 and 3 (ω = 0.80 and ω = 0.74, respectively), while the two items defining factor 1 showed a moderate correlation (ρ = 0.53). Conclusion The FCES is the first brief German-language instrument specifically developed to assess empowerment in individuals with familial cancer risk. Initial psychometric findings support its potential utility, while independent validation of the factorial structure and further psychometric evaluation are warranted. Practice implications The FCES can support systematic assessment of patient empowerment in clinical counselling and research, helping identify areas where individuals may need additional information or support. It may also support evaluation of genetic counselling outcomes and inform patient-centred care.
