Background: Chronic diseases among the adult population have increased rapidly worldwide. Chronically ill adults use health services more frequently; they are hospitalized more often and for a longer time than the average. Although counseling is an essential part of the care of chronically ill adults, there is no clear conception of counseling elements in healthcare settings. The aim of this integrative review is to describe the key elements of counseling of adults with chronic diseases. Methods:This integrative literature review describes elements of the counseling of chronically ill adults. The study was conducted by means of a systematic search of CINAHL (1981 to April 2010), Medline (1973 to March 2010 and Medic (1978 to April 2010) databases. Three reviewers selected the studies and two reviewers independently assessed the quality of studies. 31 studies were included in the data extraction and narrative synthesis. Results:The review identifies the following typical elements in the counseling of adults with chronic disease: the counseling needs of chronically ill adults; the implementation of counseling; and the impact of counseling. The counseling needs of chronically ill adults included 1) gaining an understanding of the disease and treatment in relation to everyday life, 2) handling of emotions, 3) social support. The implementation of counseling concerned 1) need-based and goal-oriented counseling, 2) the content of counseling, 3) the nature of interaction and atmosphere of counseling, 4) counseling time, 5) counseling methods and materials, and 6) challenges of implementation. The impact of counseling included increased 1) compliance with medication, 2) ability to cope with feelings, 3) understanding of the disease, and 4) quality of life. Conclusions:This study found that effective counseling should be based on the individual needs of chronically ill adults and it should include more knowledge about social services and provide support in handling emotions. The study also revealed it is important to plan counseling and to set goals in conjunction with chronically ill adults. The results of this review are useful for the development of counseling of chronically ill adults in a variety of healthcare settings.

Objective: The aim of this study was to describe Chronic Obstructive Pulmonary Disease (COPD) patients' adherence to care and to identify quality of counseling in tertiary care. The objective was to improve the quality of care of COPD patients and receive baseline information factors which improve their adherence to care. Background: It has been reported that the treatment of patients with COPD may not be optimal. It is also known that COPD-patients have various limitations in daily life due their disease, and may experience emotional distress, which can reduce adherence to care. Methods: The data were collected during COPD-patients' (n = 141) visits or admissions to a tertiary hospital between November 2007-June 2009. This study was cross-sectional survey and the data analysed by descriptive statistics, averaged variables and multivariate regression analysis. Results: The response rate was 62%. Most of patients were men and they have been COPD patients for several years. Nearly all patients were adherent to their care and medication, but support from health care providers was inadequate. Counseling had been benefit about half of COPD-patients and it increased self-care activities and coping at home. Counselling was not implemented in a patient-centred way and mutual goal setting was insufficient. Multidisciplinary counseling and quality care transition were both significantly factors with adherence to care and the support of the health care providers. Conclusions: The patient with COPD adhere well to care, but support health care providers were in adequate. Multidisciplinary team and high quality counseling is crucial, although in practice delivery is not always appropriate for the patient.