Browsing by Author "Oles, Sylwia"

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    Agenda Setting in Psychiatric Consultations: An Exploratory Study
    (2013) Frankel, Richard M.; Salyers, Michelle P.; Bonfils, Kelsey; Oles, Sylwia; Matthias, Marianne S.
    Objective: Patient- or consumer-centeredness has been recognized as a critical component of quality in primary health care, but is only beginning to be recognized and studied in mental health. Among the first opportunities to be consumer-centered is collaboratively producing an agenda of topics to be covered during a clinic visit. Early agenda setting sets the stage for what is to come and can affect the course, direction, and quality of care. The purpose of this work is to study agenda setting practices among 8 prescribers (5 psychiatrists and 3 nurse practitioners) at the beginning of their encounters with 124 consumers diagnosed with schizophrenia spectrum disorders (56%), bipolar disorder (23%), major depression (15%), and other disorders (6%). Method: We modified an extant agenda-setting rubric by adding behaviors identified by a multidisciplinary team who iteratively reviewed transcripts of the visit openings. Once overall consensus was achieved, two research assistants coded all of the transcripts. Twenty-five transcripts were scored by both raters to establish interrater reliability. Results: We identified 10 essential elements of agenda setting. Almost 10% of visits had no agenda set, and only 1 of 3 encounters had partial or complete elicitation of a single concern. Few additional concerns (4%) were solicited, and no encounter contained more than 6 essential elements. Conclusions and implications for practice: Collaborative agenda setting represents a unique opportunity to translate the concept of consumer-centeredness into mental health care. Initial results suggest the rating system is reliable, but the essential elements are not being used in practice.
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    Consumer and Relationship Factors Associated with Shared Decision-Making in Mental Health Consultations
    (2014-12) Matthias, Marianne S.; Fukui, Sadaaki; Kukla, Marina; Eliacin, Johanne; Bonfils, Kelsey A.; Firmin, Ruth; Oles, Sylwia; Adams, Erin L.; Collins, Linda A.; Salyers, Michelle P.; Department of Psychology, IU School of Science
    Objective: This study explored the association between shared decision making and consumers’ illness management skills and consumer-provider relationships. Methods: Medication management appointments for 79 consumers were audio recorded. Independent coders rated overall shared decision making, minimum level of shared decision making, and consumer-provider agreement for 63 clients whose visit included a treatment decision. Mental health diagnoses, medication adherence, patient activation, illness management, working alliance, and length of consumer-provider relationships were also assessed. Correlation analyses were used to determine relationships among measures. Results: Overall shared decision making was not associated with any variables. Minimum levels of shared decision making were associated with higher scores on the bond subscale of the Working Alliance Inventory, indicating a higher degree of liking and trust, and with better medication adherence. Agreement was associated with shorter consumer-provider relationships. Conclusions: Consumer-provider relationships and shared decision making might have a more nuanced association than originally thought.
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    RELATIONSHIP BETWEEN HOPE AND PATIENT ACTIVATION IN CONSUMERS WITH SCHIZOPHRENIA
    (Office of the Vice Chancellor for Research, 2012-04-13) Oles, Sylwia; Salyers, Michelle P.
    Patient activation (necessary knowledge and confidence to self-manage one’s illness) and hope (goal-directed thinking and action) are both im-portant in managing chronic conditions like schizophrenia. The relationship between hope and patient activation has not been clearly defined. However, hope may be viewed as a motivating factor, providing reason to be involved in treatment. Higher hope then should lead to greater involvement in care and feelings of efficacy in being able to manage illness (patient activation). The purpose of the present study was to understand the relationship be-tween hope and patient activation in a sample of adults with schizophrenia (n = 119). This study was a secondary data analysis from a study on Illness Management and Recovery (IMR) – a curriculum-based approach to help people with schizophrenia learn to manage their illness. Data were collected at baseline, prior to any intervention, and at a 9-month follow up. As pre-dicted, patient activation and hope were significantly related with each other showing a strong positive correlation (r = .57, p < .001). Comparisons of hope across stages of activation also showed a significant relationship (F (3,112) = 18.49, p < .001). Post-hoc comparisons showed that people in the lowest stage of activation had significantly lower hope than the other ac-tivation groups. Demographics and background characteristics were not sig-nificantly related to patient activation. Longitudinal analyses suggest that hope was a better predictor of subsequent patient activation than the re-verse. Our findings underline the importance of recovery based practices and instilling hope as a potential factor getting patients more engaged in treat-ment.