{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T02:56:44Z","timestamp":1784170604648,"version":"3.55.0"},"reference-count":19,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2016,4,26]],"date-time":"2016-04-26T00:00:00Z","timestamp":1461628800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Patient education is an important intervention to prevent an adrenal crisis in patients with adrenal insufficiency. The objective of this study was to assess the knowledge of adjusting the dose of glucocorticoids in special circumstances in patients with adrenal insufficiency who had previously been educated on this topic. In patients with insufficient knowledge, we tried to identify the underlying causes and care needs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Quantitative and qualitative study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adult patients with chronic primary and secondary adrenal insufficiency who received glucocorticoid stress management education were invited to participate in a telephone interview in which we tested their knowledge using hypothetical situations of physical and mental stress. In respondents with insufficient knowledge, we conducted a qualitative semistructured interview to elicit the underlying reasons from patients\u2019 perspective for their lack of knowledge and determine their care needs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010three of the 83 patients who previously received education had insufficient knowledge about how to act during stressful situations. We found a significant association between education level and level of knowledge after the educational consult. The following underlying factors were identified: unawareness of the seriousness of their condition, ineffective coping strategies, the lack of experience with self\u2010management skills and misconceptions. The most important care needs were repetition of education, the use of guidelines, learning from experience and optimizing social support.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>One or two educational consults are not effective to achieve adequate self\u2010management skills. There is a need for structural follow\u2010up where education is repeated and practical implementation of this knowledge is tested in order to identify the potential inadequate action.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.13083","type":"journal-article","created":{"date-parts":[[2016,4,11]],"date-time":"2016-04-11T07:42:43Z","timestamp":1460360563000},"page":"652-659","source":"Crossref","is-referenced-by-count":23,"title":["Self\u2010management support in patients with adrenal insufficiency"],"prefix":"10.1111","volume":"85","author":[{"given":"Nick T.M.","family":"van der Meij","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Endocrinology University Medical Center Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel S.","family":"van Leeuwaarde","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Endocrinology University Medical Center Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigrid C.J.M.","family":"Vervoort","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Endocrinology University Medical Center Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre M.J.","family":"Zelissen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Endocrinology University Medical Center Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,4,26]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-13-0450"},{"key":"e_1_2_9_3_1","first-page":"331","article-title":"Adrenal crisis: still a deadly event in the 21 century","volume":"3","author":"Puar T.H.","year":"2015","journal-title":"American Journal of Medicine"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-14-0824"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-09-0884"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12865"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.301.6764.1312"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.69.810.282"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2796.1999.00538.x"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2753.2009.01149.x"},{"key":"e_1_2_9_11_1","first-page":"61","article-title":"Much to be desired in self\u2010management of patients with adrenal insufficiency","volume":"1","author":"Eck J.P.","year":"2014","journal-title":"International Journal of Nursing Practice"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-3191"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-12-1094"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.54.7.493"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732305276687"},{"key":"e_1_2_9_16_1","volume-title":"winMaX Scientific Text Analysis for the Social Sciences","author":"Kuckartz U.","year":"1998"},{"key":"e_1_2_9_17_1","unstructured":"AdrenalNET(2016).Teaching films. 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