Objective Examine the efficacy of a personalized, modular cognitive-behavioral therapy (CBT) protocol among early adolescents with high-functioning autism spectrum disorders (ASD) and co-occurring anxiety relative to treatment as usual (TAU). Method Thirty-one children (11–16 years) with ASD and clinically significant anxiety were randomly assigned to receive 16 weekly CBT sessions or an equivalent duration of TAU. Participants were assessed by blinded raters at screening, post-treatment, and 1-month follow-up. Results Youth randomized to CBT demonstrated superior improvement across primary outcomes relative to those receiving TAU. Eleven of 16 adolescents randomized to CBT were treatment responders, versus 4/15 in the TAU condition. Gains were maintained at 1-month follow-up for CBT responders. Conclusions These data extend findings of the promising effects of CBT in anxious youth with ASD to early adolescents. Clinicaltrials.gov trial reference number NCT01563003. Internet links: http://clinicaltrials.gov/show/NCT01563003
Background Patient decision aids should help people make evidence-informed decisions aligned with their values. There is limited guidance about how to achieve such alignment. Purpose To describe the range of values clarification methods available to patient decision aid developers, synthesize evidence regarding their relative merits, and foster collection of evidence by offering researchers a proposed set of outcomes to report when evaluating the effects of values clarification methods. Data Sources MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, and CINAHL. Study Selection We included articles that described randomized trials of 1 or more explicit values clarification methods. From 30,648 records screened, we identified 33 articles describing trials of 43 values clarification methods. Data Extraction Two independent reviewers extracted details about each values clarification method and its evaluation. Data Synthesis Compared to control conditions or to implicit values clarification methods, explicit values clarification methods decreased the frequency of values-incongruent choices (risk difference, –0.04; 95% confidence interval [CI], –0.06 to –0.02; P < 0.001) and decisional conflict (standardized mean difference, –0.20; 95% CI, –0.29 to –0.11; P < 0.001). Multicriteria decision analysis led to more values-congruent decisions than other values clarification methods (χ2 = 9.25, P = 0.01). There were no differences between different values clarification methods regarding decisional conflict (χ2 = 6.08, P = 0.05). Limitations Some meta-analyses had high heterogeneity. We grouped values clarification methods into broad categories. Conclusions Current evidence suggests patient decision aids should include an explicit values clarification method. Developers may wish to specifically consider multicriteria decision analysis. Future evaluations of values clarification methods should report their effects on decisional conflict, decisions made, values congruence, and decisional regret.
This study provides an analysis of the structure of the initial cancer consultation, the consultation styles of medical and radiation oncologists, and their effect on patient outcomes. One hundred and fifty-five cancer patients attending their first consultation with either a medical or radiation oncologist were audiotaped and the transcripts were analysed using the Cancode computer interaction analysis system. Findings revealed that medical oncologists allowed patients and their families more input into the consultation and were rated as warmer and more patient-centred compared with radiation oncologists. However, radiation oncologists spent a longer period discussing, and were more likely to bring up, social support issues with patients. Both medical and radiation oncologists varied their consultation style according to the patient's gender, age, anxiety levels, prognosis, and education. Patients seeing an oncologist who was rated as warmer and discussed a greater number of psychosocial issues had better psychological adjustment and reduced anxiety after consultation. These findings provide current evidence that may be used to inform improvements of communication skills training for oncologists and highlight the need for future communication research to separately consider oncologists from different disciplines. The most widely recommended model of medical interactions in clinical practise is patient-centred care. A patient-centred approach is one in which the doctor listens to patients attentively and sympathetically, talks about psychosocial and non-medical issues (Arora, 2003), appears warm and caring towards the patient rather than hurried, and allows the patient to have input into the consultation (Butow et al, 1995). Researchers have identified the importance of doctors varying their consultation style in response to differing patient characteristics (Butow et al, 1995). For example, researchers suggest that doctors should match their style to patient preferences for involvement in decision-making (Keisler and Auerbach, 2006), and recommend responding flexibly to patients' emotional and informational cues (Butow et al, 2002). Others have found that male and female patients may benefit from different communication strategies (Butow et al, 1997;Parker et al, 2001).Many studies have shown an association between patients receiving patient-centred care in their consultation and subsequent positive patient outcomes (Fogarty et al, 1999). However, previous studies have suggested that patient-centred care and flexibility in consultation style are used inconsistently in medical consultations. Oncologists have been shown to be poor judges of patient preferences for participation, significantly underestimating cancer patients' preference for a shared approach to decision-making (Bruera et al, 2002) and desire for information. They also tend to overestimate the amount of information they believe they have given (Chaitchik et al, 1992) and cancer patients' understanding of this information (Gattellari et al, 1999). O...
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