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  • 1.
    Alders, Iréne
    et al.
    Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
    Smits, Carolien
    Program Older Adults and Health, Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, Netherlands.
    Brand, Paul
    Department of Innovation and Research, Isala Hospital, Zwolle, The Netherlands, Postgraduate School of Medicine, University Medical Centre Groningen, Groningen, Netherlands.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands, Nivel (Netherlands institute for health services research), Utrecht, Netherlands, Faculty of Caring Science.
    Patient coaching: What do patients want? A mixed methods study in waiting rooms of outpatient clinics2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 6, article id e0269677Article in journal (Refereed)
    Abstract [en]

    Introduction Effective communication in specialist consultations is difficult for some patients. These patients could benefit from support from a coach who accompanies them to and during medical specialist consultations to improve communication in the consultation room. This study aims to investigate patients' perspective on interest in support from a patient coach, what kind of support they would like to receive and what characterizes an ideal patient coach. Methods We applied a mixed method design to obtain a realistic understanding of patients' perspectives on a patient coach. Patients in the waiting rooms of outpatient clinics were asked to fill out a short questionnaire which included questions about demographic characteristics, perceived efficacy in patient-provider interaction and patients' interest in support from a patient coach. Subsequently, patients interested in a patient coach were asked to participate in a semi-structured interview. The quantitative data were examined using univariate analysis and the qualitative interview data were analysed using content analysis. Results The survey was completed by 154 patients and eight of them were interviewed. Perceived efficacy in patient-physician interactions was the only variable that showed a significant difference between patients with and without an interest in support from a patient coach. The interviews revealed that a bad communication experience was the main reason for having an interest in support from a patient coach. Before the consultation, a patient coach should take the time to get to know the patient, build trust, and help the patient create an agenda, so take the patient seriously and recognize the patient as a whole person. During the consultation, a patient coach should support the patient by intervening and mediating when necessary to elicit the patient's agenda. After the consultation, a patient coach should be able to explain and discuss medical information and treatment consequences. An ideal patient coach should have medical knowledge, a strong personality and good communication skills. Conclusion Especially patients who had a bad communication experience in a specialist consultation would like support from a patient coach. The kind of support they valued most was intervening and mediating during the consultation. To build the necessary trust, patient coaches should take time to get to know the patient and take the patient seriously. Medical knowledge, good communication skills and a strong personality were considered prerequisites for patient coaches to be capable to intervene in specialist consultations.

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  • 2.
    Engelen, Marscha
    et al.
    IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
    van Gaal, Betsie
    IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands; School of Health Studies, HAN University of Applied Sciences, Nijmegen, Netherlands.
    Vermeulen, Hester
    IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands; School of Health Studies, HAN University of Applied Sciences, Nijmegen, Netherlands.
    Zuidema, Rixt
    Research Group Proactive Care for Older People, Faculty of Health Care, University of Applied Sciences Utrecht, Utrecht, Netherlands.
    Bredie, Sebastian
    Division of Vascular Medicine, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands; Nivel - Netherlands Institute for Health Services Research, Department of Communication in Healthcare, Utrecht, Netherlands.
    The Influencing Contexts and Potential Mechanisms Behind the Use of Web-Based Self-management Support Interventions: Realistic Evaluation2022In: JMIR Human Factors, E-ISSN 2292-9495, Vol. 9, no 3, article id e34925Article in journal (Refereed)
    Abstract [en]

    Background:

    Self-management can increase self-efficacy and quality of life and improve disease outcomes. Effective self-management may also help reduce the pressure on health care systems. However, patients need support in dealing with their disease and in developing skills to manage the consequences and changes associated with their condition. Web-based self-management support programs have helped patients with cardiovascular disease (CVD) and rheumatoid arthritis (RA), but program use has been low.

     

    Objective:

    This study aimed to identify the patient, disease, and program characteristics that determine whether patients use web-based self-management support programs or not.

     

    Methods:

    A realistic evaluation methodology was used to provide a comprehensive overview of context (patient and disease characteristics), mechanism (program characteristics), and outcome (program use). Secondary data of adult patients with CVD (n=101) and those with RA (n=77) were included in the study. The relationship between context (sex, age, education, employment status, living situation, self-management [measured using Patient Activation Measure-13], quality of life [measured using RAND 36-item health survey], interaction efficacy [measured using the 5-item perceived efficacy in patient-physician interactions], diagnosis, physical comorbidity, and time since diagnosis) and outcome (program use) was analyzed using logistic regression analyses. The relationship between mechanism (program design, implementation strategies, and behavior change techniques [BCTs]) and outcome was analyzed through a qualitative interview study.

     

    Results:

    This study included 68 nonusers and 111 users of web-based self-management support programs, of which 56.4% (101/179) were diagnosed with CVD and 43.6% (78/179) with RA. Younger age and a lower level of education were associated with program use. An interaction effect was found between program use and diagnosis and 4 quality of life subscales (social functioning, physical role limitations, vitality, and bodily pain). Patients with CVD with higher self-management and quality of life scores were less likely to use the program, whereas patients with RA with higher self-management and quality of life scores were more likely to use the program. Interviews with 10 nonusers, 10 low users, and 18 high users were analyzed to provide insight into the relationship between mechanisms and outcome. Program use was encouraged by an easy-to-use, clear, and transparent design and by recommendations from professionals and email reminders. A total of 5 BCTs were identified as potential mechanisms to promote program use: tailored information, self-reporting behavior, delayed feedback, providing information on peer behavior, and modeling.

     

    Conclusions:

    This realistic evaluation showed that certain patient, disease, and program characteristics (age, education, diagnosis, program design, type of reminder, and BCTs) are associated with the use of web-based self-management support programs. These results represent the first step in improving the tailoring of web-based self-management support programs. Future research on the interaction between patient and program characteristics should be conducted to improve the tailoring of participants to program components.

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  • 3. Hafskjold, Linda
    et al.
    Sundler J, Annelie
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Holmström, Inger K
    Sundling, Vibeke
    van Dulmen, Sandra
    Eide, Hilde
    A cross-sectional study on person-centred communication in the care of older people: the COMHOME study protocol.2015In: BMJ Open, E-ISSN 2044-6055, Vol. 5, no 4Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: This paper presents an international cross-sectional study on person-centred communication with older people receiving healthcare (COMHOME). Person-centred care relies on effective communication, but few studies have explored this with a specific focus on older people. The main aim of the COMHOME study is to generate knowledge on person-centred communication with older people (>65 years) in home healthcare services, radiographic and optometric practice.

    METHODS AND ANALYSIS: This study will explore the communication between care providers and older persons in home care services. Home healthcare visits will be audiorecorded (n=500) in Norway, the Netherlands and Sweden. Analyses will be performed with the Verona Coding Definitions for Emotional Sequences (VR-CoDES), the Roter Interaction Analysis System (RIAS) and qualitative methods. The content of the communication, communicative challenging situations as well as empathy, power distance, decision-making, preservation of dignity and respect will be explored. In Norway, an additional 100 encounters, 50 in optometric practice (video recorded) and 50 in radiographic practice (audiorecorded), will be analysed. Furthermore, healthcare providers' self-reported communication skills, empathy, mindfulness and emotional intelligence in relation to observed person-centred communication skills will be assessed using well-established standardised instruments.

    ETHICS AND DISSEMINATION: Depending on national legislation, approval of either the central ethical committees (eg, nation or university), the national data protection officials or the local ethical committees (eg, units of home healthcare) was obtained. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. The research findings will add knowledge to improve services provided to this vulnerable group of patients. Additionally, the findings will underpin a training programme for healthcare students and care providers focusing on communication with older people.

  • 4.
    Heyn, Lena Günterberg
    et al.
    Center for Health and Technology University of South‐Eastern Norway Drammen Norway.
    Løkkeberg, Stine Torp
    Faculty of Health and Welfare Studies Østfold University College Halden Norway.
    Ellington, Lee
    College of Nursing University of Utah Salt Lake City Utah USA.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Nivel (Netherlands Institute for Health Services Research) Utrecht Netherlands;Department of Primary and Community Care Radboud University Medicalcenter, Radboud Institute for Health Sciences Nijmegen Netherlands;Faculty of Caring Science Work Life and Social Welfare, University of Borås Borås Sweden.
    Eide, Hilde
    Center for Health and Technology University of South‐Eastern Norway Drammen Norway.
    Understanding the role of positive emotions in healthcare communication – A realist review2023In: Nursing Open, E-ISSN 2054-1058Article, review/survey (Refereed)
    Abstract [en]

    Aim

    To explore how the expression of positive emotions during the interaction between patients and providers can cultivate the patient-provider relationship.

    Design

    We conducted a realist review guided by the Realist and Meta-narrative Evidence Syntheses: Evolving Standards.

    Methods

    We systematically searched CINAHL, MEDLINE, PsychINFO and Scopus from inception to March 2019. Study selection and data extraction were performed blinded in pairs. From 3146 abstracts blinded in pairs, 15 papers were included and analysed. From each included paper, we extracted contexts, mechanisms and outcomes that were relevant to answer our research questions, creating a configuration between these elements (CMO configuration).

    Results

    Our findings suggest that in the contexts of person orientation and positive outlook, patient-provider relationships improve by communication conveying and eliciting positive emotions. We found six underlying mechanisms for this that form either direct or indirect pathways between the context and the outcome. 

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  • 5. Höglander, J
    et al.
    Holmström, IK
    Lövenmark, A
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Eide, H
    Sundler, Annelie Johansson
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Nurse-patient communication: An integrative review for future direction in nursing research.2022Conference paper (Refereed)
  • 6. Höglander, J
    et al.
    Sundler, Annelie Johansson
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Spreeuwenberg, P
    Holmström, I K
    Eide, H
    van Dulmen, Sandra
    Håkansson Eklund, J
    Female gender explains emotional communication in home care2018Conference paper (Refereed)
  • 7.
    Höglander, Jessica
    et al.
    School of Health, Care and Social Welfare Mälardalen University Västerås Sweden.
    Holmström, Inger K.
    School of Health, Care and Social Welfare Mälardalen University Västerås Sweden;Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden.
    Lövenmark, Annica
    School of Health, Care and Social Welfare Mälardalen University Västerås Sweden.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Nivel (Netherlands Institute for Health Services Research) Utrecht the Netherlands;Department of Primary and Community Care, Radboud Institute for Health Sciences Radboud University Medical Center Nijmegen the Netherlands;Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden.
    Eide, Hilde
    Centre for Health and Technology, Faculty of Health and Social Sciences University of South‐Eastern Norway Drammen Norway.
    Sundler, Annelie Johansson
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden.
    Registered nurse–patient communication research: An integrative review for future directions in nursing research2023In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 79, no 2, p. 539-562Article, review/survey (Refereed)
    Abstract [en]

    Aim

    To explore communication research in nursing by investigating the theoretical approaches, methods, content and perspectives in research on real-time registered nurse (RN)–patient communication.

    Design

    An integrative review of real-time communication between RNs and patients.

    Data Sources

    Empirical research papers were searched in PubMed, CINAHL Plus and Medline. The results from the database searches were supplemented with results from manual searches in reference lists.

    Review Methods

    A total of 1369 articles published between January 1996 and December 2021 were screened, which resulted in the inclusion of 52 articles.

    Results

    The integration of various theories, such as nursing or communication theories, is weak in most of the included studies. RN–patient communication appears to influence relationship building. Even when nurses strive to meet patients' needs, they often focus primarily on nursing routines and physical care. The topic of the communication varies depending on the situation and different communication styles are used. When a patient-centred approach is adopted, the interpersonal communication becomes quite symmetrical, with complementary roles of nurses and patients. Within a more asymmetric communication context, nurses dominate communication, choose topics and function as instructors. How the nurses communicated subsequently influenced the patients' communication styles and strategies.

    Conclusion

    Communication is multifaceted, contains different strategies and is important for building trust and facilitating patient-centred care. The importance of RNs' communication for interaction and relationship-building seems to be well established within research, but few studies focused on patients' communication with RNs.

    Impact

    This integrative review gives an overview of the width and depth of observational studies on RN–patient communication research. The variety of studies indicates that this area is a less well-grounded field of research. Future research is warranted to support nurses in their communication, especially regarding the exploration of patients' communication and desired communication skills in nurse–patient interactions.

    Patient or Public Contribution

    No patient or public contribution was included in this integrative review.

     

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  • 8.
    Höglander, Jessica
    et al.
    School of Health, Care and Social Welfare, Mälardalen University.
    Sundler, Annelie Johansson
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Spreeuwenberg, Peter
    Netherlands Institute for Health Services Research, Utrecht.
    Holmström, Inger K
    School of Health, Care and Social Welfare, Mälardalen University.
    Eide, Hilde
    Science Centre Health and Technology, University of South‐Eastern Norway.
    van Dulmen, Sandra
    Science Centre Health and Technology, University of South‐Eastern Norway.
    Eklund, Jakob H
    School of Health, Care and Social Welfare, Mälardalen University.
    Emotional communication with older people: A cross-sectional study of home care.2019In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 21, no 3, p. 382-389Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore the influence of characteristics of nurses and older people on emotional communication in home care settings. A generalized, linear, mixed model was used to analyze 188 audio-recorded home care visits coded with Verona Coding Definitions of Emotional Sequences. The results showed that most emotional distress was expressed by older females or with female nurses. The elicitation of an expression of emotional distress was influenced by the nurses' native language and profession. Older women aged 65-84 years were given the most space for emotional expression. We found that emotional communication was primarily influenced by sex for nurses and older people, with an impact on the frequency of expressions of and responses to emotional distress. Expressions of emotional distress by older males were less common and could risk being missed in communication. The results have implications for students' and health professionals' education in increasing their knowledge of and attentiveness to the impacts of their and others' characteristics and stereotypes on emotional communication with older people.

  • 9.
    Makoul, Gregory
    et al.
    Department of Medicine, Yale School of Medicine, New Haven, USA; Human Understanding Institute, NRC Health, Lincoln, USA.
    Noble, Lorraine
    UCL Medical School, University College London, London, UK; EACH: International Association for Communication in Healthcare, Salisbury, UK.
    Gulbrandsen, Pål
    Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Akershus University Hospital, Nordbyhagen, Norway.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. NIVEL – Netherlands Institute for Health Services Research, Utrecht, Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands.
    Reinforcing the humanity in healthcare: The Glasgow Consensus Statement on effective communication in clinical encounters2024In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 122, article id 108158Article in journal (Refereed)
    Abstract [en]

    Contemporary healthcare is characterized by multidisciplinary teamwork across a vast array of primary, secondary and tertiary services, augmented by progressively more technology and data. While these developments aim to improve care, they have also created obstacles and new challenges for both patients and health professionals. Indeed, the increasingly fragmented and transactional nature of clinical encounters can dehumanize the care experience across disciplines and specialties. Effective communication plays a pivotal role in reinforcing the humanity of healthcare through the delivery of person-centered care – compassionate, collaborative care that focuses on the needs of each patient as a whole person. After convening at the International Conference on Communication in Healthcare (Glasgow, 2022), an interdisciplinary group of researchers, educators and health professionals worked together to develop a framework for effective communication that both acknowledges critical challenges in contemporary health services and reinforces the humanity of healthcare. The Glasgow Consensus Statement is intended to function as a useful international touchstone for the training and practice of health professionals, fully recognizing and respecting that different countries are at different stages when it comes to teaching, assessment and policy. It also provides a vocabulary for monitoring the impact of system-level challenges. While effective communication may not change the structure of healthcare, it can improve the process if health professionals are supported in infusing the system with their own innate humanity and applying the framework offered within this consensus statement to reinforce the humanity in everyday practice.

  • 10.
    McGhie-Fraser, Brodie
    et al.
    Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, Netherlands.
    Lucassen, Peter
    Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, Netherlands.
    Ballering, Aranka
    University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, Netherlands.
    Abma, Inger
    Radboud University Medical Center, Radboud Institute of Health Sciences, IQ Healthcare, Nijmegen, Netherlands.
    Brouwers, Evelien
    Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, Netherlands; Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands.
    olde Hartman, Tim
    Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, Netherlands.
    Persistent somatic symptom related stigmatisation by healthcare professionals: A systematic review of questionnaire measurement instruments2023In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 166, article id 111161Article in journal (Refereed)
    Abstract [en]

    Objective

    Patients with persistent somatic symptoms (PSS) experience stigmatising attitudes and behaviours by healthcare professionals. While previous research has focussed on individual manifestations of PSS related stigma, less is known about sound ways to measure stigmatisation by healthcare professionals towards patients with PSS. This review aims to assess the quality of questionnaire measurement instruments and make recommendations about their use.

    Methods

    A systematic review using six databases (PubMed, Embase, CINAHL, PsycINFO, Open Grey and EThOS). The search strategy combined three search strings related to healthcare professionals, PSS and stigma. Additional publications were identified by searching bibliographies. Three authors independently extracted the data. Data analysis and synthesis followed COSMIN methodology for reviews of outcome measurement instruments.

    Results

    We identified 90 publications that met the inclusion criteria using 62 questionnaire measurement instruments. Stereotypes were explored in 92% of instruments, prejudices in 52% of instruments, and discrimination in 19% of instruments. The development process of the instruments was not rated higher than doubtful. Construct validity, structural validity, internal consistency and reliability were the most commonly investigated measurement properties. Evidence around content validity was inconsistent or indeterminate.

    Conclusion

    No instrument provided acceptable evidence on all measurement properties. Many instruments were developed for use within a single publication, with little evidence of their development or establishment of content validity. This is problematic because stigma instruments should reflect the challenges that healthcare professionals face when working with patients with PSS. They should also reflect the experiences that patients with PSS have widely reported during clinical encounters.

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  • 11.
    Mentink, Marit
    et al.
    Nivel (Netherlands Institute of Health Services Research), Otterstraat 118, 3512 CR Utrecht, The Netherlands;Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 21, 6525 EZ Nijmegen, The Netherlands.
    Verbeek, Daniëlle
    Praktijk Integratieve Oncologie, Heesterpoort 18, 9713 KZ Groningen, The Netherlands.
    Noordman, Janneke
    Nivel (Netherlands Institute of Health Services Research), Otterstraat 118, 3512 CR Utrecht, The Netherlands.
    Timmer-Bonte, Anja
    Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
    von Rosenstiel, Ines
    Department of Integrative Oncology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Nivel (Netherlands Institute of Health Services Research), Otterstraat 118, 3512 CR Utrecht, The Netherlands;Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 21, 6525 EZ Nijmegen, The Netherlands;Faculty of Caring Science, University of Borås, Work Life and Social Welfare, Allégatan 1, 501 90 Borås, Sweden.
    The Effects of Complementary Therapies on Patient-Reported Outcomes: An Overview of Recent Systematic Reviews in Oncology2023In: Cancers, E-ISSN 2072-6694, Vol. 15, no 18, article id 4513Article, review/survey (Refereed)
    Abstract [en]

    Many patients with cancer make use of complementary medicine alongside conventional medicine, but clinicians in oncology often lack the knowledge to adequately advise patients on the evidence base for complementary therapies. This study aims to provide an overview of recently published systematic reviews that assess the effects of complementary therapies on patient-reported health outcomes in patients with cancer. Systematic reviews, including a meta-analysis of at least two randomized controlled trials, were identified from the PubMed, Embase, Cochrane Library, CINAHL and PsycINFO databases. The methodological quality was assessed with AMSTAR 2. One hundred systematic reviews were included. The results suggest that several complementary therapies can improve health outcomes reported by patients with cancer, such as acupuncture to relieve pain, music interventions to reduce anxiety and yoga to improve cancer-related fatigue. The side effects related to complementary therapy use are generally mild. The results remain inconclusive for some intervention–outcome combinations. Many of the included systematic reviews insufficiently assessed the causes and impact of bias in their interpretation of the results. This overview of systematic reviews can support clinicians in counselling their patients on this topic and provide directions for future research and clinical practice guidelines in the field of complementary medicine.

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  • 12.
    Noordman, Janneke
    et al.
    Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands.
    Roodbeen, Ruud
    Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands.
    Gach, Leonie
    Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands.
    Schulze, Lotte
    Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands.
    Rademakers, Jany
    Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands.
    van den Muijsenbergh, Maria
    Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands.
    Boland, Gudule
    Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
    ‘A basic understanding’; evaluation of a blended training programme for healthcare providers in hospital-based palliative care to improve communication with patients with limited health literacy2022In: BMC Medical Education, E-ISSN 1472-6920, Vol. 22, no 1, article id 613Article in journal (Refereed)
    Abstract [en]

    Background

    The non-curative setting makes communication and shared decision-making in palliative care extremely demanding. This is even more so for patients with limited health literacy. So far, research in palliative care focusing on shared decision-making with patients with limited health literacy is lacking. Recent research from our team indicates that the assessment of these patients’ understanding of their situation and the implementation of shared decision-making in palliative care, needs improvement.

     

    Methods

    To improve communication and decision-making, especially with patients with limited health literacy, we developed and evaluated a blended training programme for healthcare providers. The training programme comprised of an e-learning and a team training. The evaluation was performed by 1. conducting interviews (n = 15) focused on evaluating the whole programme and, 2. coding video-recorded outpatient consultations on the extent to which providers involved patients in decision-making before (n = 19) and after (n = 20) the intervention, using the 5-item OPTION coding instrument.

     

    Results

    The interviews showed that healthcare providers valued the skills they had learned during the e-learning and team training. Providers specifically valued the teach-back technique, learned to use simpler wording and felt better able to recognize patients with limited health literacy. Many providers reported a change in communication behaviour as a consequence of the training programme. Suggestions for improvement for both e-learning and training were, amongst others, a follow-up team training course and a new scenarios for the e-learning about discussing palliative care. For both the pre- and the post-measurement, involving patients in decision-making lies between a minimal and a moderate effort; differences were not significant.

     

    Conclusions

    The e-learning and team training were valued positively by the healthcare providers. Adaptations to the e-learning have been made after evaluation. The e-learning has been implemented in several hospitals and medical education. To improve shared decision-making in practice a more sustained effort is needed.

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  • 13.
    Plug, Ilona
    et al.
    10.1370/afm.2846.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands; Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
    Stommel, Wyke
    Centre for Language Studies, Radboud University, Nijmegen, The Netherlands.
    olde Hartman, Tim C.
    Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands.
    Das, Enny
    Centre for Language Studies, Radboud University, Nijmegen, The Netherlands.
    Physicians' and Patients' Interruptions in Clinical Practice: A Quantitative Analysis2022In: Annals of Family Medicine, ISSN 1544-1709, E-ISSN 1544-1717, Vol. 20, no 5, p. 423-429Article in journal (Refereed)
    Abstract [en]

    PURPOSE Physicians’ interruptions have long been considered intrusive, masculine actions that inhibit patient participation, but a systematic analysis of interruptions in clinical interaction is lacking. This study aimed to examine when and how primary care physicians and patients interrupt each other during consultations.

    METHODS We coded and quantitatively analyzed interruption type (cooperative vs intrusive) in 84 natural interactions between 17 primary care physicians and 84 patients with common somatic symptoms. Data were analyzed using a mixed-effects logistic regression model, with role, gender, and consultation phase as predictors.

    RESULTS Of the 2,405 interruptions observed, 82.9% were cooperative. Among physicians, men were more likely to make an intrusive interruption than women (β = 0.43; SE, 0.21; odds ratio [OR] = 1.54; 95% CI, 1.03-2.31), whereas among patients, men were less likely to make an intrusive interruption than women (β = −0.35; SE, 0.17; OR = 0.70; 95% CI, 0.50-0.98). Patients’ interruptions were more likely to be intrusive than physicians’ interruptions in the phase of problem presentation (β = 0.71; SE, 0.23; OR = 2.03; 95% CI, 1.30-3.20), but not in the phase of diagnosis and/or treatment plan discussion (β = −0.17; SE, 0.15; OR = 0.85; 95% CI, 0.63-1.15).

    CONCLUSIONS Most interruptions in clinical interaction are cooperative and may enhance the interaction. The nature of physicians’ and patients’ interruptions is the result of an interplay between role, gender, and consultation phase.

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  • 14.
    Pouls, Bart P H
    et al.
    Research & Innovation, Sint Maartenskliniek, Ubbergen, Gelderland, The Netherlands; 2 Department of Pharmacy Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands.
    Bekker, Charlotte L
    Department of Pharmacy Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands.
    Gundogan, Fatma
    Pharmacy, Gelre Ziekenhuizen Apeldoorn, Apeldoorn, Gelderland, The Netherlands.
    Hebing, Renske CF
    Pharmacy, Amsterdam Rheumatology and immunology Centre Reade, Amsterdam, Noord Holland, The Netherlands.
    van Onzenoort, Hein AW
    Department of Pharmacy Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands; Pharmacy, Amphia Hospital, Breda, North Brabant, The Netherlands.
    van de Ven, Liesbeth I
    Pharmacy, Maastricht UMC+, Maastricht, Limburg, The Netherlands.
    Vonkeman, Harald E
    Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands.
    Tieben, Rob
    Research, Development and Innovation, Game Solutions Lab, Eindhoven, The Netherlands.
    Vriezekolk, Johanna E
    Research & Innovation, Sint Maartenskliniek, Ubbergen, Gelderland, The Netherlands.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Healthcare Communication, Netherlands Institute for Health Services Research, Utrecht, The Netherlands; Department of Primary and Community Care Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands.
    Van den Bemt, Bart
    Research & Innovation, Sint Maartenskliniek, Ubbergen, Gelderland, The Netherlands; 2 Department of Pharmacy Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands.
    Gaming for Adherence to Medication using Ehealth in Rheumatoid arthritis (GAMER) study: a randomised controlled trial2022In: RMD Open, Vol. 8, article id e002616Article in journal (Refereed)
    Abstract [en]

    Objective To examine the effect on adherence to disease modifying anti-rheumatic drugs (DMARDs) in participants with rheumatoid arthritis (RA) of a serious game that targeted implicit attitudes toward medication.

    Methods A multicentre randomised controlled trial (RCT) was performed with adults with RA that used DMARDs and possessed a smartphone/tablet. Control and intervention groups received care as usual. The intervention group played the serious game at will during 3 months. Game play data and online questionnaires Compliance Questionnaire on Rheumatology (CQR), Beliefs about Medicine Questionnaire (BMQ), Health Assessment Questionnaire (HAQ) and Rheumatoid Arthritis Disease Activity Index (RADAI) were collected. Primary outcome was DMARD implementation adherence operationalised as the difference in proportion of non-adherent participants (<80% taking adherence) between intervention and control group after 3 months using a Chi-squared test. Two sample t-tests and Wilcoxon rank-sum test were performed to test for differences on secondary outcomes.

    Results Of the 110 intervention participants that started the study, 87 participants (79%) installed the game and had a median playtime of 9.7 hours at 3 months. Overall, 186 participants completed the study. Adherence in intervention group (63%) and control group (54%) did not differ significantly (p=0.13) at 3 months. Neither were there differences oberved in CQR continuous score, beliefs about medication (BMQ) or clinical outcomes (HAQ and RADAI).

    Conclusion A serious game aimed at reinterpreting attitudes toward medication failed to show an effect on adherence to DMARDs or clinical outcomes in patients with RA. The game was played frequently indicating that it can be an effective channel for reaching patients.

    Trial registration number NL7217.

    Data are available upon reasonable request. The data underlying this article will be shared on reasonable request to the corresponding author.

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  • 15.
    Scheffer, M
    et al.
    Department of Care and Participation of People with Chronic Conditions, Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands.
    Menting, J
    Department of Care and Participation of People with Chronic Conditions, Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands.
    Roodbeen, R
    Department of Research, Breuer&Intraval Research and Consultancy, Groningen, The Netherlands.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Communication in Healthcare, Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
    van Hecke, M
    Department of Ophthalmology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands.
    Schlingemann, R
    Department of Ophthalmology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Bergman Clinics Ogen, Amsterdam, The Netherlands; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland.
    van Nispen, R
    Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
    Boeije, H
    Department of Care and Participation of People with Chronic Conditions, Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands.
    Patients' and health professionals' views on shared decision-making in age-related macular degeneration care: A qualitative study2022In: Ophthalmic & physiological optics, ISSN 0275-5408, E-ISSN 1475-1313, Vol. 42, no 5, p. 1015-1022Article in journal (Refereed)
    Abstract [en]

    Background Age-related macular degeneration (AMD) is one of the principal causes of irreversible visual impairment in the older adult population. Recent evidence indicates that there are signs of undertreatment and overtreatment, underdiagnosis and insufficient information provision in AMD care. Shared decision-making (SDM) can aid information sharing between patients and health professionals and enhances high-quality care. This research aimed to gain insight into patients' and professionals' views on SDM in AMD care. Methods Semi-structured interviews were conducted with 20 patients with AMD and 19 health professionals in June and July 2020. Participants were recruited through hospitals, professional and patient associations and (social) networks. Sample representativeness was ensured in terms of sociodemographic and disease characteristics for patients, and profession-related characteristics for health professionals. Interviews were analysed according to a predetermined coding framework. Results Although SDM is receiving attention in AMD care, health professionals and patients experienced barriers in making shared decisions. The most common barriers reported included limitations in treatment options, time constraints, strict treatment guidelines and patients' comorbidity. Furthermore, most patients indicated that they were not (fully) informed about all aspects of AMD trajectory, such as the possibility to discontinue therapy or the long-term and invasive character of treatment. Some patients expressed the need for a more empathic and person-centred communication style from their health professional. Conclusion The concerns raised by patients and health professionals suggest that there is room for improvement in delivery of SDM in AMD care. Findings from this study indicate that information provision and communication can be improved.

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  • 16.
    Schouten, Aniek E.M.
    et al.
    Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands.
    Mentink, Marit D.C.
    Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands;Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands.
    Timmer-Bonte, Johanna (Anja) N.H.
    Radboud university medical center, Department of Medical Oncology, Nijmegen, Netherlands.
    Noordman, Janneke
    Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands;Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands;Faculty of Caring Science, University of Borås, Borås, Sweden.
    Perspectives and Attitudes of Dutch Healthcare Professionals Regarding the Integration of Complementary Medicine in Oncology2023In: Integrative Cancer Therapies, ISSN 1534-7354, E-ISSN 1552-695X, Vol. 22, article id 153473542311646Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Almost half of all patients with cancer use complementary medicine (CM) alongside conventional cancer treatment. Further integration of CM into clinical practice could enhance communication and ensure improved coordination between complementary medicine and conventional care. This study assessed the perspectives of healthcare professionals on the current status of integration of CM in oncology, as well as their attitudes and beliefs toward CM.

    METHODS: A convenience, volunteer sample of healthcare providers and healthcare managers working in oncology in the Netherlands were surveyed, using a self-reporting, anonymous, online questionnaire. The perspectives on the current status of integration and barriers to implementing complementary medicine were characterized in part 1, while part 2 assessed respondents' attitudes and beliefs regarding CM.

    RESULTS: A total of 209 people completed part 1 of the survey and 159 people completed the entire questionnaire. Two-thirds (68.4%) of the respondents indicated that their organization has implemented complementary medicine in oncology, or envisions implementation, while 49.3% stated they were missing something to implement CM in oncology. About 86.8% of the respondents (completely) agreed that complementary medicine is an important supplement to oncological treatment. Female respondents were more likely to express positive attitudes, as well as respondents whose institutions have implemented CM.

    CONCLUSION: The findings of this study indicate that attention is being paid to the integration of CM into oncology. Overall, the attitudes of respondents toward CM were positive. The main barriers for implementing CM activities were missing knowledge, experience, financial support, and support from management. To improve the ability of healthcare providers to guide patients in their use of complementary medicine, these issues should be delved into in future research.

  • 17.
    Stommel, Wyke
    et al.
    Centre for Language Studies, Radboud University Nijmegen, Erasmusplein 1, 6525 HT Nijmegen, the Netherlands.
    Plug, Ilona
    Centre for Language Studies, Radboud University Nijmegen, Erasmusplein 1, 6525 HT Nijmegen, the Netherlands.
    olde Hartman, Tim C.
    Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Geert Grooteplein Zuid 21, 6525 EZ Nijmegen, the Netherlands.
    Lucassen, Peter L.B.J.
    Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Geert Grooteplein Zuid 21, 6525 EZ Nijmegen, the Netherlands.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Geert Grooteplein Zuid 21, 6525 EZ Nijmegen, the Netherlands; NIVEL (Netherlands institute for health services research), Otterstraat 118, 3513 CR Utrecht, the Netherlands.
    Das, Enny
    Centre for Language Studies, Radboud University Nijmegen, Erasmusplein 1, 6525 HT Nijmegen, the Netherlands.
    Gender stereotyping in medical interaction: A Membership Categorization Analysis2022In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 105, no 11, p. 3242-3248Article in journal (Refereed)
    Abstract [en]

    Objective: Gender can be a valuable resource in communication but also a problem, perpetuating gender stereotypes. So far, there has been little attention for how healthcare professionals and patients make gender relevant in medical interactions. The approach of Membership Categorization Analysis (MCA) is particularly pertinent to meticulously analyze gender in medical communication. Applying MCA, this study analyzes how activity descriptions implicitly associated with gender stereotypes, e.g., “carrying a laundry basket up the stairs”, feature in the course of GPs’ explanations of a question or diagnosis. The aim is to provide a new perspective on the relationship between gender and medical interaction, and to increase our understanding of how gender stereotypes are reproduced in the medical setting. 

    Method: Two cases of GPs using gendered explanations in Dutch general practice interactions are analyzed turn-by-turn using MCA. 

    Results: The findings show how GPs’ descriptions of gendered activities serve the exemplification of technical terms, designed for the specific patient, while also casting the patient in a traditional gender role. 

    Conclusion: Invoking gender in medical interaction may serve a communicative goal while also perpetuating stereotypes. 

    Practice implications: Insight in the subtleties of gender construction in medical interactions could enhance gender awareness and sensitivity in healthcare.

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  • 18.
    Stortenbeker, Inge
    et al.
    Centre for Language Studies, Radboud University, Nijmegen, the Netherlands.
    Salm, Lisa
    Centre for Language Studies, Radboud University, Nijmegen, the Netherlands.
    olde Hartman, Tim
    Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands.
    Stommel, Wyke
    Centre for Language Studies, Radboud University, Nijmegen, the Netherlands.
    Das, Enny
    Centre for Language Studies, Radboud University, Nijmegen, the Netherlands.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands.
    Coding linguistic elements in clinical interactions: a step-by-step guide for analyzing communication form2022In: BMC Medical Research Methodology, E-ISSN 1471-2288, Vol. 22, no 1, article id 191Article in journal (Refereed)
    Abstract [en]

    Background

    The quality of communication between healthcare professionals (HCPs) and patients affects health outcomes. Different coding systems have been developed to unravel the interaction. Most schemes consist of predefined categories that quantify the content of communication (the what). Though the form (the how) of the interaction is equally important, protocols that systematically code variations in form are lacking. Patterns of form and how they may differ between groups therefore remain unnoticed. To fill this gap, we present CLECI, Coding Linguistic Elements in Clinical Interactions, a protocol for the development of a quantitative codebook analyzing communication form in medical interactions.

    Methods

    Analyzing with a CLECI codebook is a four-step process, i.e. preparation, codebook development, (double-)coding, and analysis and report. Core activities within these phases are research question formulation, data collection, selection of utterances, iterative deductive and inductive category refinement, reliability testing, coding, analysis, and reporting.

    Results and conclusion

    We present step-by-step instructions for a CLECI analysis and illustrate this process in a case study. We highlight theoretical and practical issues as well as the iterative codebook development which combines theory-based and data-driven coding. Theory-based codes assess how relevant linguistic elements occur in natural interactions, whereas codes derived from the data accommodate linguistic elements to real-life interactions and contribute to theory-building. This combined approach increases research validity, enhances theory, and adjusts to fit naturally occurring data. CLECI will facilitate the study of communication form in clinical interactions and other institutional settings.

     

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  • 19.
    Sundler, Annelie Johansson
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Hedén, Lena
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Holmström, Inger K
    School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.
    Bergman, Karin
    Östensson, Sofia
    Östman, Malin
    School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden; Region Västra Götaland, Närhälsan Källstorp Healthcare Centre, Trollhättan, Sweden; Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Research, Sweden; General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    The patient’s first point of contact (PINPOINT) – protocol of a prospective multicenter study of communication and decision-making during patient assessments by primary care registered nurses2023In: BMC Primary Care, E-ISSN 2731-4553, Vol. 24, no 1, article id 249Article in journal (Refereed)
    Abstract [en]

    Background

    A major challenge for primary care is to set priorities and balance demands with available resources. The registered nurses in this study are practice nurses working in primary care offices, playing a large role in initial assessments. The overall objective of this research is to investigate practices of communication and decision-making during nurses’ initial assessment of patients’ health problems in primary care, examine working mechanisms in good practices and develop feasible solutions.

    Methods

    Project PINPOINT aims for a prospective multicenter study using various methods for data collection and analysis. A purposive sample of 150 patient‒nurse consultations, including 30 nurses and 150 patients, will be recruited at primary care centers in three different geographic areas of southwest Sweden. The study will report on outcomes of communication practices in relation to patient-reported expectations and experiences, communication processes and patient involvement, assessment and decision-making, related priorities and value conflicts with data from patient questionnaires, audio-recorded real-time communication, and reflective interviews with nurses.

    Discussion

    This research will contribute to the knowledge needed for the guidance of first-line decision-making processes to best meet patient and public health needs. This knowledge is necessary for the development of assessments and decisions to be better aligned to patients and to set priorities. Insights from this research can empower patients and service providers and help understand and enhance feasible person-centered communication strategies tailored to patients’ level of health literacy. More specifically, this research will contribute to knowledge that can strengthen nurses’ communication, assessments, and clinical decision-making in primary care. In the long term, this will contribute to how the competencies of practice nurses and other professionals are organized and carried out to make the best use of the resources within primary care.

    Trial registration

    ClinicalTrials.gov Identifier: NCT06067672.

     

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  • 20.
    Sundler J, Annelie
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Eide, Hilde
    van Dulmen, Sandra
    Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway; NIVEL (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.
    Holmström, Inger K
    Communicative challenges in the home care of older persons - a qualitative exploration.2016In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 10, p. 2435-2444Article in journal (Refereed)
    Abstract [en]

    AIM: To explore communicative challenges in encounters between nurse assistants and older persons during home care visits.

    BACKGROUND: The older population is increasing worldwide. Currently, there is a shift in care for older people from institutional care to home care. Providing home care in a person's home involves several challenges, including the complexity of communication.

    DESIGN: A descriptive observational design with a qualitative approach was used.

    METHODS: The data consisted of audio recordings of real-life encounters during home care visits between nurse assistants and older persons, collected in 2014. A hermeneutic phenomenological analysis was conducted.

    RESULTS: Communicative challenges were identified: (a) in situations where the older persons had a different view than the nurse assistants on the care task and its content; and (b) when unexpected actions or turns occurred in the communication. Challenges included older person's existential issues, fragility and worries and concerns, which often appeared to be only vaguely expressed and difficult to verbally detect and tackle. This engendered a risk of misinterpretation or ignorance of these challenges.

    CONCLUSION: The findings point to the importance of communication as the key to facilitate person-centred home care. Communication training should focus more on addressing needs and existential issues in older persons. Person-centred home care for older persons needs to be addressed at both an individual and an organizational level.

  • 21.
    Sundling, Vibeke
    et al.
    Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway.
    Hafskjold, Linda
    Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway.
    Eklund, Jakob Håkansson
    School of Health, Care and Social Welfare, Mälardalen Universit.
    Holmström, Inger K
    School of Health, Care and Social Welfare, Mälardalen Universit.
    Höglander, Jessica
    School of Health, Care and Social Welfare, Mälardalen Universit.
    Sundler, Annelie Johansson
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen.
    Eide, Hilde
    Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway.
    Emotional communication in home care: A comparison between Norway and Sweden.2020In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, article id S0738-3991(20)30117-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Given the free movement of workers across countries, knowledge regarding communication differences between countries is imperative. In this study, we explored and compared the supportive responses of nursing staff to older persons' emotions in home care in Norway and Sweden.

    METHODS: The study had an observational, cross-sectional, comparative design, which included 383 audio-recorded home-care visits. Communication was coded using Verona Coding Definitions of Emotional Sequences. Worries and responses were categorised with regard to reference, communicative function and level of person-centredness. Standard statistical tests were used to analyse the data.

    RESULTS: The Swedish nursing staff provided space for further disclosure of worry more frequently than the Norwegian nursing staff (75.0 % versus 60.2 %, χ2 = 20.758, p < 0.01). In all, 65 % of the responses were supportive. Multiple logistic regression analyses showed that highly person-centred responses were independently associated with worries phrasing an emotion, OR (95 % CI) 3.282 (1.524-7.067).

    CONCLUSION: The level of person-centredness was associated with the way in which older persons expressed their distress. The Swedish nursing staff provided opportunities for further disclosure of worries more frequently than the Norwegian nursing staff.

    PRACTICE IMPLICATIONS: Findings of intercultural differences should be incorporated into the training of nursing staff.

  • 22.
    van der Smissen, Doris
    et al.
    Department of Public Health, Erasmus MC, University Medical Center Rotterdam , Rotterdam , NL.
    Rietjens, Judith A C
    Department of Public Health, Erasmus MC, University Medical Center Rotterdam , Rotterdam , NL.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Public Health, Erasmus MC, University Medical Center Rotterdam , Rotterdam , NL; Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen , NL.
    Drenthen, Ton
    Dutch College of General Practitioners , Utrecht , NL.
    Vrijaldenhoven-Haitsma, F Ragnhild M D
    Department of Public Health, Erasmus MC, University Medical Center Rotterdam , Rotterdam , NL.
    Wulp, Marijke
    Agora , Bunnik , NL.
    van der Heide, Agnes
    Department of Public Health, Erasmus MC, University Medical Center Rotterdam , Rotterdam , NL.
    Korfage, Ida J
    Department of Public Health, Erasmus MC, University Medical Center Rotterdam , Rotterdam , NL.
    The Web-Based Advance Care Planning Program "Explore Your Preferences for Treatment and Care": Development, Pilot Study, and Before-and-After Evaluation2022In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 24, no 12, article id e38561Article in journal (Refereed)
    Abstract [en]

    Background:

    Web-based advance care planning (ACP) programs may support patients in thinking about and discussing their preferences for future treatment and care. However, they are not widely available, and only a limited number of programs are evidence based.

    Objective:

    We aimed to develop and evaluate an evidence-based, interactive web-based ACP program that guides users through the process of thinking about, discussing, and recording of preferences for treatment and care.

    Methods:

    The program “Explore your preferences for treatment and care” was developed, pilot-tested on feasibility, and subsequently evaluated; engagement in ACP was assessed before program completion and 2 months after program completion using the ACP Engagement Survey (score 1-5) among 147 persons with chronic disease. Usability (score 0-100) and user satisfaction (score 1-5) were also assessed.

    Results:

    ACP engagement increased from 2.8 before program completion to 3.0 two months after program completion (P<.001); contemplation about ACP increased from 2.6 to 2.8 (P=.003), and readiness for ACP increased from 2.2 to 2.5 (P<.001). No changes were found for knowledge about ACP (3.0-3.2; P=.07) and self-efficacy for ACP (3.8-3.8; P=.25). The program was perceived as usable (mean 70, SD 13), attractive (mean 3.8, SD 0.7), and comprehensible (mean 4.2, SD 0.6).

    Conclusions:

    We developed an evidence-based, interactive web-based ACP program in cocreation with patients, relatives, and health care professionals. Before-and-after evaluation showed that the program can support people in taking first steps in ACP and in reflecting on preferences for treatment and care, by guiding them through the process of ACP using a stepwise approach. Participants perceived the program as usable and understandable, and they were satisfied with the program and with the amount of information. Health care professionals may use the program as a tool to start ACP discussions with their patients. The program may increase awareness of ACP.

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  • 23.
    van Dulmen, Sandra
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands.
    Eide, Hilde
    Centre for Health and Technology Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
    Finset, Arnstein
    Patient Education and Counseling and Department of Behavioural Medicine University of Oslo, Norway.
    Implementing lifestyle interventions in clinical practice: The importance of adherence2023In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 109, article id 107651Article in journal (Other academic)
  • 24.
    van Dulmen, Sandra
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Nivel (Netherlands institute for health services research), PO Box 1568, BN, Utrecht, 3500, Netherlands; Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, Netherlands.
    Roodbeen, Ruud
    Breuer&Intraval, Research and Consultancy, Groningen, Netherlands.
    Schulze, Lotte
    Nivel (Netherlands institute for health services research), PO Box 1568, BN, Utrecht, 3500, Netherlands.
    Prantl, Karen
    Dutch Kidney Patients Association, Bussum, Netherlands.
    Rookmaaker, Maarten
    Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands.
    van Jaarsveld, Brigit
    Department of Nephrology Amsterdam UMC, Vrije Universiteit Amsterdam location, Amsterdam, Netherlands; Diapriva Dialysis Center, Amsterdam, Netherlands.
    Noordman, Janneke
    Nivel (Netherlands institute for health services research), Utrecht, Netherlands.
    Abrahams, Alferso
    Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands.
    Practices and perspectives of patients and healthcare professionals on shared decision-making in nephrology2022In: BMC Nephrology, ISSN 1471-2369, E-ISSN 1471-2369, Vol. 23, no 1, article id 258Article in journal (Refereed)
    Abstract [en]

    Background

    Given the complexity and variety in treatment options for advanced chronic kidney disease (CKD), shared decision-making (SDM) can be a challenge. SDM is needed for making decisions that best suit patients’ needs and their medical and living situations. SDM might be experienced differently by different stakeholders. This study aimed to explore clinical practice and perspectives on SDM in nephrology from three angles: observers, patients and healthcare professionals (HCPs).

     

    Methods

    An explanatory sequential mixed methods design was used. First, in the quantitative part of the study, outpatient consultations with patients with advanced chronic kidney disease (eGFR < 20 ml/min) were video recorded and SDM was assessed using the OPTION5 instrument. Subsequently, in the qualitative part, patients and HCPs reflected on their own SDM behaviour during individual stimulated recall interviews which were analysed using deductive thematic content analysis.

     

    Results

    Twenty nine consultations were recorded and observed in seven hospitals. The mean SDM score was 51 (range 25–80), indicating that SDM was applied to a moderate extent. The stimulated recall interviews with patients showed that they rely on the information provision and opinion of HCPs, expect consistency and support, and desire a proactive role. They also expect to be questioned by the HCP about their SDM preferences. HCPs said they were willing to incorporate patients’ preferences in SDM, as long as there are no medical contraindications. They also prefer patients to take a prominent role in SDM. HCPs ascribe various roles to themselves in supporting patients’ decision-making.

     

    Conclusions

    Although SDM was applied by HCPs to a moderate extent, improvement is needed, especially in helping patients get the information they need and in making sure that every patient is involved in SDM. This is even more important given the complex nature of the disease and the relatively high prevalence of limited health literacy among patients with chronic kidney disease.

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  • 25.
    van Dulmen, Sandra
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Smits, Lies
    Palliative care benefits from careful use of words2023In: Nederlands Tijdschrift voor Geneeskunde, E-ISSN 1876-8784, Vol. Nov 1, no 167, article id D7748Article in journal (Other academic)
  • 26.
    VAN Gaal, Betsie G.I.
    et al.
    HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
    Engelen, Marscha M.
    Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
    Adriaansen, Marian J.M.
    HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands.
    Vermeulen, Hester
    HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
    Laat, Erik DE.
    Radboud university medical center, Department of Plastic Surgery, Nijmegen, the Netherlands.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Nivel (Netherlands institute for health services research), Utrecht, the Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands.
    Lessons learned from patients with spinal cord injury in managing pressure ulcers: A qualitative study2022In: Journal of Tissue Viability, ISSN 0965-206X, Vol. 31, no 4, p. 794-799Article in journal (Refereed)
    Abstract [en]

    Objectives

    To explore how individuals with spinal cord injury self-manage the prevention and treatment of pressure ulcers and to provide insight into experiences with self-management support.

    Design

    Qualitative study using semi-structured interview and a deductive thematic analysis.

    Setting

    Community

    Participants

    Twelve of the 14 participating adults with a spinal cord injury had experience with pressure ulcers, and eight of these had a current pressure ulcer.

    Results

    Respondents suggested to tailor treatment of pressure ulcers to patients’ individual wishes and capabilities of patients. Patients and caregivers need to be aware of the importance of determining the cause of pressure ulcers to prevent deterioration. Patients often depend on informal caregivers for follow-up and prevention, and healthcare professionals in non-SCI specialties often lack the knowledge needed to manage pressure ulcers in this specific patient group. Tailored education and peer support are important for patients to set boundaries, be assertive, and cultivate a positive attitude when dealing with pressure ulcers. It is difficult to combine treatment of severe pressure ulcers and preventive measures with work roles. Managing the social impact of pressure ulcers requires more coordination with caregivers.

    Conclusions

    To support self-management of pressure ulcers in patients with a spinal cord injury, they must find out which preventive measures and treatments suit them best. Healthcare professionals play an important role in the self-management of pressure ulcers and can help patients deal with the emotional and social impact of pressure ulcers. To know patient's needs and tailor their education, healthcare professionals of non SCI organizations need to have knowledge of pressure ulcers management of this specific patient group.

  • 27.
    van Vliet, Liesbeth M
    et al.
    Department of Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands.
    Leeuwenburgh, Margot L R
    Department of Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands.
    Westendorp, Janine
    Department of Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands.
    van Dulmen, Sandra
    Department of Communication, NIVEL, Utrecht, The Netherlands, Institute for Healh Sciences, Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands.
    de Jong, Paul C
    Department of Medical Oncology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands.
    Stouthard, Jacqueline M L
    Department of Medical Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands.
    Good versus bad news consultations in advanced breast cancer: the role of empathy in information recall – an observational study2023In: BMJ Supportive & Palliative Care, ISSN 2045-435X, E-ISSN 2045-4368Article in journal (Refereed)
    Abstract [en]

    Objective 

    We explored, in advanced breast cancer, whether: (1) patients recall less information following bad versus good news consultations; (2) empathy has a greater effect on recalled information following bad versus good news consultations.

     

    Methods 

    Observational study using audio-recorded consultations. Participants’ recall of provided information about treatment options, aims/positive effects and side-effects was assessed. Clinician-expressed empathy and consultation type were determined. Regression analyses assessed associations between consultation type and recall, exploring moderating influences of clinician-expressed empathy.

     

    Results

    For 41 consultations (18 bad news, 23 good news), recall data were completed; total recall (47% vs 73%, p=0.03) and recall about treatment options (67% vs 85%, p=0.08, trend) were significantly worse following bad news compared with good news consultations. Recall about treatment aims/positive effects (53% vs 70%, p=0.30) and side-effects (28% vs 49%, p=0.20) was not significantly worse following bad news. Empathy moderated the relationship between consultation type and total recall (p<0.01), recall about treatment options (p=0.03) and about aims/positive effects (p<0.01) but not about side-effects (p=0.10). Only following good news consultations empathy influenced recall favourably.

     

    Conclusions 

    This explorative study suggests that in advanced cancer, information recall is especially impaired following bad news consultations, for which empathy does not improve remembered information.

  • 28.
    Wegstapel, Joep
    et al.
    Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands, --- Select a Country ---.
    den Hartog, Thymen
    Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands, --- Select a Country ---.
    Sneekes, Mick
    Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands, --- Select a Country ---.
    Staal, Bart
    Department of Physiotherapy, HAN University of Applied Sciences, Nijmegen, The Netherlands, --- Select a Country ---.
    van der Scheer-Horst, Ellis
    Department of Physiotherapy, HAN University of Applied Sciences, Nijmegen, The Netherlands, --- Select a Country ---.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Nivel (Netherlands institute for health services research), Utrecht, The Netherlands, --- Select a Country ---.
    Brinkkemper, Sjaak
    Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands, --- Select a Country ---.
    Automated Identification of Yellow Flags and Their Signal Terms in Physiotherapeutic Consultation Transcripts2023In: Proceedings of the 16th International Joint Conference on Biomedical Engineering Systems and Technologies BIOSTEC - (Volume 5) / [ed] Federico Cabitza, Ana Fred and Hugo Gamboa, SciTePress, 2023, Vol. 5, p. 530-537Conference paper (Refereed)
    Abstract [en]

    This paper investigates the possibility of automating the process of identifying yellow flags and their signal terms in physiotherapeutic consultation transcripts from patients with low back pain, using Automated Text Identification. It is part of the Automated Medical Reporting research domain. In physiotherapy focused on low back pain, yellow flags are considered psycho-social predictors of poor recovery and risk factors for chronic disability development. This paper uses a 6-step mixed method approach. Consultation transcripts and yellow flag assessment guidelines were collected, an automated identification tool was built and the OSPRO assessment guideline was used to test the tool for accuracy. It was found that it is possible to identify Yellow Flags and their Signal Terms automatically with the tool developed in this experiment. However, this is just the beginning, and much more research must be done in the future to further enhance the tool, mainly to improve precision.

  • 29.
    Östman, Malin
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Hedén, Lena
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    van Dulmen, Sandra
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sundler, Annelie Johansson
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Holmström, Inger K
    The patient's first point-of-contact in primary care – registered nurse – patient communication coded by VR-CoDES2023Conference paper (Refereed)
1 - 29 of 29
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