Aim: Patient education that enhances one's self-management ability is of utmost importance for improving patient outcomes in chronic diseases. We developed a 12 month self-management education program for type 2 diabetes, based on a previous 6 month program, and examined its efficacy. Methods: A randomized controlled trial was carried out on outpatients with type 2 diabetes from two hospitals who met the criteria and gave consent to participate. They were randomly divided into an intervention group that followed the program and a control group that followed usual clinical practise. The intervention group received <30 min of monthly interviews based on the program's textbook and biweekly telephone calls from a nurse educator throughout the 12 months. Results: Of the 50 participants in the intervention group and the 25 participants in the control group, 42 and 23, respectively, completed the program (a completion rate of 84.0%). The body weight, HbA1c, self-efficacy, dietary and exercise stages, quality of life, diastolic blood pressure, and total cholesterol level were significant by two-way repeated-measures anova. As for changes over time within the groups, only the intervention group showed significant differences by Friedman's test. The complication prevention behaviors showed a high implementation rate in the intervention group. The overall evaluation of this program by the participants was very high and, therefore, they highly recognized the need for this type of program. Conclusions: Self-management education works successfully in relation to patients' behavior modification skills, degree of goal attainment, and self-efficacy, consequently improving their health outcomes.

AimTo investigate nurses' opinions and practices regarding psychological support and patient‐centered care (PCC) for patients with rheumatoid arthritis.MethodRegistered nurses engaged in rheumatic care in Japan were asked to complete the questionnaire regarding nurses' perceived necessity, understanding, and implementation of psychological support, and six patient supports related to PCC, using a seven‐point Likert scale. Correlation on practice between psychological support and PCC was evaluated.ResultsA total of 53 nurses participated. Nurses indicated high necessity of providing psychological support, whereas implementation was statistically significantly lower than necessity and motivation. Nurses' answers showed significantly lower implementation compared with understanding regarding basic concepts of psychological support: listening, empathy, acceptance, open questions, and closed questions. Most nurses (54.7%) sometimes provided psychological support, followed by often (34.0%), always (5.7%), and not at all (5.6%). Perceived necessity of PCC was rated high. However, its implementation was significantly lower than necessity for all evaluated cares, such as patients' need‐based support and support to patients' families, related to PCC. Positive correlations were observed between the implementation of psychological support and PCC. Nurses stressed the importance of psychological support for patient education and shared decision‐making.ConclusionThis preliminary study indicated that most nurses considered psychological support and PCC necessary, but their implementation was relatively low. As psychological support is also crucial to shared decision‐making, in addition to PCC, barriers to its implementation should be addressed to improve patients' outcomes and quality of life.

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BackgroundRheumatoid arthritis (RA) is a chronic disease with periods of flare-ups and remissions, affecting daily life. Therefore, this disease requires lifelong management and support by the patients social circle and health professionals (HP).ObjectivesThe aim of this study was to follow up the history of patients with RA, and demonstrate an improved understanding at each point in their disease trajectory, whilst encouraging them to cope, and enabling HP to optimize support provided.MethodsWe conducted two 30minute interviews with patients with RA. Interview questions included the patients perspective of their disease and disease information, effects on daily life, as well as psychological considerations using the Corbin and Strauss Chronic Illness Trajectory Framework approach [1].This study was approved by the ethics committee of our hospital and informed consent was obtained.ResultsThe first case; An unmarried 68 year old female living alone. The patients mother also suffered from RA. The patient was vaguely aware of the hereditary nature of RA (pretrajectory phase) and did not result in a big shock to her and she accepted her the diagnosis relatively smoothly (trajectory onset phase). She was prescribed initially prescribed methotrexate but this proved infective and infliximab was commenced. Remission was achieved and at that time she was satisfied with her relationship with her primary physician (stable phase).Two years after beginning infliximab, she developed chest pain. However, her primary physician did not explore the problem and advised her that she had depression. She began to distrust him (unstable). She asked for infliximab to be stopped and requested her care be transferred to B university hospital where her mother was being treated. However, she was refused treatment due to the non-severity of her condition. She was unable to come to terms with refusal, and her physical and mental state deteriorated (downward phase).Her mother advised the patient to go to D hospital, where she was put on Etanercept achieving remission with no complications (comeback phase). At D Hospital; (1) her condition and the need for treatment were clearly explained to her, and she was able to actively participate in shared decision making; and (2) she was given access to support from Health Professionals (HP) such as nurses, who offered a patient centered approach listening to her concerns and advising her appropriately whilst offering general psychological support.A further 4 patients were interviewed. We will show the key phases of trajectories of their illnesses, the patients opinions about sharing their information with HP through interviewing, and the possibility of behavior change in the patients journeys.ConclusionThis study shows that a patient centered approach taking into account the stages of the illness trajectory benefits patients perceptions of their disease and ability to cope with their condition. It also highlights the importance of having the support of ones social circle, particularly at challenging tim...

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