title: Improving patient-clinician communication about chronic conditions: description of an internet-based nurse E-coach intervention.
abstract: BACKGROUND
  Studies show that patients who have higher self-efficacy and participate actively in their care have better disease management. Patient-provider Internet portals offer an exciting new venue for empowering and engaging patients in better management of chronic conditions.
  
  
  OBJECTIVE
  To describe development of an Internet-based health coaching intervention.
  
  
  METHODS
  An Internet-based health coaching intervention to enhance patient-provider communication regarding three common conditions, chronic pain, depression, and impaired mobility, was developed. Using principles of self-management, the intervention aimed to engage and empower patients to collaborate with their primary care physician in managing their health conditions. Delivered online by nurse electronic coaches (e-coaches), the intervention involved a standardized set of e-mails and worksheets targeting self-efficacy, patient education, and motivation to improve health.
  
  
  RESULTS
  Participants in the intervention (N = 121) primarily used the automated elements of the program, although 35% exchanged e-mails with the nurse e-coach. Most patients (88%) who contacted the e-coach were interested in further coaching. Patients who viewed the online worksheets did so repeatedly; 42 patients opened the worksheets 107 times prior to the visit.
  
  
  CONCLUSIONS
  The Internet-based coaching intervention departs substantially from usual nursing care but warrants further study given its potential to offer considerable benefits to large numbers of patients. Several challenges were identified to providing patient coaching and self-management support via the Internet, but this efficient and low-cost approach offers an innovative opportunity to improve patient-clinician partnerships in managing chronic conditions. As patients become more accustomed to electronic communication, nurses can play an important role, joining efforts to develop this new realm to promote patients as partners in managing their health conditions.
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Marybeth
authors.initials: M
authors.lastname: Allen
authors.forename: Lisa I
authors.initials: LI
authors.lastname: Iezzoni
authors.forename: Annong
authors.initials: A
authors.lastname: Huang
authors.forename: Linchang
authors.initials: L
authors.lastname: Huang
authors.forename: Suzanne G
authors.initials: SG
authors.lastname: Leveille
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000451:nursing* / Q000534:rehabilitation; D003142:Communication; D003863:Depression / Q000451:nursing; D034742:Electronic Mail; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D010146:Pain / Q000451:nursing; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation; D011320:Primary Health Care; D011369:Professional-Patient Relations; D012648:Self Care / Q000523:psychology; D012944:Social Support; D014481:United States