Providers' shared decision-making as a predictor of healthcare outcomes for college-aged adults managing upper respiratory tract infections.

OBJECTIVES: Strategies that assist patients with upper respiratory tract infections (URTIs) to endorse non-antibiotic treatments are vital to curbing antibiotic resistance. This study examines the potential of shared decision-making (SDM) for improving stewardship-relevant outcomes and investigates patient affect as a mechanism that explains the beneficial impact of perceived SDM. METHOD: Patients (N = 433) seeking care for URTIs at a university student health center and not prescribed antibiotics completed a pre-visit questionnaire and two surveys one day and 14 days post-visit. The day-one survey assessed perceived SDM, affect, and immediate stewardship-relevant outcomes, and the day-14 survey assessed long-term stewardship-relevant outcomes. RESULTS: Perceived SDM was negatively associated with negative affect and positively associated with positive affect, favorable perceptions of non-antibiotic treatments and providers, and self-efficacy to manage symptoms and obtain follow-up care. Patient affect and day-one outcomes were mediators between perceived SDM and retrospective self-efficacy two weeks post-visit. CONCLUSION: The study illustrated the beneficial influence of patient perceived SDM on antibiotic stewardship in both short and long terms and elucidated the mechanisms through which the influence occurs. PRACTICE IMPLICATIONS: SDM can be an effective strategy for primary care providers to improve patients' outcomes with URTI visits without prescribing unwarranted antibiotics.

What Does Patient-Centered Communication Look Like?: Linguistic Markers of Provider Compassionate Care and Shared Decision-Making and Their Impacts on Patient Outcomes.

Patient-centered communication promotes positive patient outcomes. This study examines the linguistic markers of two key dimensions of patient-centered communication (i.e., provider compassionate care and shared decision-making) and their mediating effects on patient perceived quality of and affective responses to the provider's treatment recommendations. Transcripts (N = 343) of provider talk from provider-patient interactions in medical visits for upper respiratory infection symptoms where patients were not prescribed with antibiotics were analyzed with the Linguistic Inquiry and Word Count (LIWC) dictionary. Results showed that providers' use of affiliation words positively predicted patients' perceptions of their providers' compassionate care. Providers' use of insight words negatively predicted patients' perceptions of provider shared decision-making. Meanwhile, providers' use of first-person singular pronouns, causation and differentiation words, and clout words were positively related to perceived provider shared decision-making. Patient perceived compassionate care and shared decision-making further increased patients' positive affect toward and perceived quality of non-antibiotic treatment recommendations. These perceptions also reduced their negative affect toward the recommendations. Implications of the findings are discussed with regard to patient-centered communication in relation to the promotion of antibiotic stewardship.

Use of a Smartphone Medication Reminder Application to Support Emerging Adult Adherence to Non-Antibiotic Treatment for Viral Upper Respiratory Tract Infection.

OBJECTIVE: This research study is a test of the efficacy of a smartphone-installed medication reminder application to support provider-recommended treatment plans for young adult patients who were seen for upper respiratory tract infections (URTIs) and were not prescribed an antibiotic. METHODS: Two hundred seventy-five patients seen at a university student health center for URTI symptoms were randomly assigned to the medication reminder app intervention or a control group and then surveyed both 1 and 14 days after their medical visits with questions about the treatment plan, their satisfaction with medical care, and the electronic support tools. RESULTS: Compared to the control condition, patients using the reminder app reported more adherence to provider-recommended treatment plans. Patients with lower social support availability benefited more from being provided with these tools. CONCLUSION: These findings suggest that medication reminder apps have utility for increasing patient adherence to non-antibiotic URTI treatment plans, particularly among patients who lack high-quality informational and tangible social support. INNOVATION: This study demonstrates innovation in use of the medication reminder app to promote antibiotic stewardship with young adult patients in primary care.

Targeting Perceptions of Risk from Injudicious Antibiotic Use: An Application of the Risk Information Seeking and Processing Model.

Enhancing knowledge about antibiotic-associated risks is key to reducing injudicious antibiotic use and slowing antibiotic resistance. Using the Risk Information Seeking and Processing (RISP) model, the study identified predictors of individuals' seeking and avoidance of information about antibiotic risks and tested the effectiveness of exposure to a RISP-informed video intervention against exposure to a CDC-produced video and a control group. In a national sample (N = 1000), risk judgment led to greater negative affect toward risks of antibiotics and lower positive affect toward antibiotic usefulness. In turn, positive and negative affect shaped information insufficiency, which interacted with perceived information gathering capacity to influence risk information seeking and avoidance. In addition, informational subjective norms and affective responses directly shaped individuals' information behavior. Results showed that relative to the control group, participants viewing the RISP-informed video had greater risk judgment, perceived current knowledge about antibiotic risks, perceived information gathering capacity, and informational subjective norms, as well as lower levels of positive affect toward antibiotics. The RISP-informed video and CDC-produced video performed equivalently well. Implications of the findings for the design of antibiotic stewardship messages are discussed.

Parents' relationship maintenance as a buffer for the stress of their adolescent's type 1 diabetes.

Having an adolescent with Type 1 diabetes (T1D) can be stressful for the entire family. This study examined the impact of parents' relationship maintenance on their ability to manage the conflict associated with their child's T1D, the parents' physiological health (inflammation), and the relationships within the family. Sixty couples and their adolescent children with T1D participated. The couples engaged in a stressful conversation about their child's T1D in their home, followed by random assignment to a 2-week intervention designed to increase the relationship maintenance in the marriage. Results from the home visit revealed that when husbands and wives received greater maintenance from each other the past month, they perceived less conflict when talking about their adolescent's T1D, which was associated with less relational load and lower levels of C-reactive protein (CRP). For wives, greater relationship maintenance was also directly associated with less relational load and lower CRP levels. In addition, the relationship maintenance received was directly and positively associated with parent-child relationship quality for fathers, but this association was mediated by interparental conflict for mothers. Finally, the 2-week intervention reduced parents' relational load and the number of stressful conversations and improved the mother-adolescent relationship but did not significantly reduce parents' CRP. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Testing the Theory of Resilience and Relational Load (TRRL) in Families with Type I Diabetes.

The theory of resilience and relational load was tested with 60 couples and their adolescent children (ages 11-18) with type I diabetes (T1D). The couples participated in a stress-inducing conversation task in their home, followed by a random assignment to a two-week intervention designed to increase their relationship maintenance. Before the intervention, stronger communal orientation predicted greater maintenance for husbands and wives, but maintenance only reduced T1D stress for wives. The wives' and adolescents' T1D stress were also correlated, but the husbands' T1D stress was not significantly associated with either of them. Better maintenance was associated with less conflict during couples' conversations. Maintenance was also directly associated with less perceived and physiological stress (cortisol) from the conversation. Finally, wives in the intervention reported the most thriving, communal orientation and the least loneliness. The intervention also reduced adolescents' general life stress, but it did not influence their T1D stress or thriving.

The Functionality of Communal Coping in Chronic Uncertainty Environments: The Context of Palestinian Refugees in Lebanon.

Most research suggests that communal coping, where a group of people own and act upon a shared stressor or uncertainty together, enhances mental health and fosters coping efficacy. The majority of this research, however, has been conducted in the United States in contexts where stress and uncertainty are relatively short-lived and with samples that are economically secure and moderately to highly educated. The purpose of this study was to understand how socio-emotional conditions, such as exposure to trauma and interparental conflict, influence the functionality of communal coping for adolescents in Palestinian refugee camps in Lebanon, where chronic uncertainty is normative. One hundred eighty-five Palestinian adolescents (M age = 15.75) residing in two refugee camps in Beirut, Lebanon completed a cross-sectional survey. The results showed that communal coping with immediate family members was only beneficial for adolescents' mental health and hopelessness when their parents had moderate to little conflict and not high levels of conflict. Similarly, when adolescents had experienced trauma, engaging in high levels of communal coping accentuated, as opposed to buffered, the harmful effects of uncertainty on mental health.

Stress, Frequency of Challenges, and Coping for Partners of Individuals with Mental Health Conditions.

This study applied Lazarus and Folkman's stress and coping framework to understand how romantic partners cope with the challenges of a significant other's mental health condition at three levels (i.e., individual, dyadic, and social), how coping at each of these three levels contributes to the association between stress and relational quality for these partners, and how these associations depend upon the frequency of challenges partners experience. We predicted that stress would be negatively associated with relational quality, and that individual (i.e., emotion and problem-focused), dyadic, and social coping would mediate this association. We also posited that the extent to which partners cope would depend on the frequency of challenges they face. We analyzed data from 325 individuals with a moderated multiple-mediation model. Findings provided support for the mediating role of dyadic coping and its positive association with relational quality; partial support for the mediating role of emotion-focused coping and its negative association with relational quality; and partial support for the moderating role of frequency of challenges. We discuss the study's findings and contributions.