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Liemburg GB, Korevaar JC, Logtenberg M, Berendsen AJ, Berger MY, Brandenbarg D. Cancer follow-up in primary care after treatment with curative intent: Views of patients with breast and colorectal cancer. Patient Educ Couns 2024; 122:108139. [PMID: 38232673 DOI: 10.1016/j.pec.2024.108139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024]
Abstract
OBJECTIVE Increased cancer survival leads to more patients requiring oncological follow-up. Debate about how best to coordinate this care has led to the proposed involvement of general practitioners (GPs) rather than continued reliance on hospital care. However, we still require patient opinions to inform this debate. METHODS This qualitative interview study explored opinions about organization of follow-up care of patients treated curatively for breast and colorectal cancer. Thematic analysis was applied. RESULTS We interviewed 29 patients and identified three themes concerning care substitution: "benefits and barriers," "requirements," and "suitable patient groups." Benefits included accessibility, continuity, contextual knowledge, and psychosocial support. Barriers included concerns about cancer-specific expertise of GPs and longer waiting times. Requirements were sufficient time and remuneration, sufficient training, clear protocols, and shared-care including efficient communication with specialists. CONCLUSIONS According to patients with cancer, formal GP involvement appears feasible, although important barriers must be overcome before instituting care substitution. A possible solution are personalized follow-up plans based on three-way conversations with the specialist and the GP after the initial hospital care. PRACTICE IMPLICATIONS With adequate training, time, and remuneration, formal GP involvement could ensure more comprehensive care, possibly starting with less complex cases.
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Affiliation(s)
- Geertje B Liemburg
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Joke C Korevaar
- NIVEL Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Mariëlle Logtenberg
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Annette J Berendsen
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marjolein Y Berger
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Daan Brandenbarg
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Huizinga F, Kieboom EAM, de Greef MHG, Walenkamp AME, Berendsen AJ, Berger MY, Brandenbarg D. Cancer survivors' experiences of a physical activity program in primary care: a qualitative study. J Cancer Surviv 2024:10.1007/s11764-024-01571-w. [PMID: 38517578 DOI: 10.1007/s11764-024-01571-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/15/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE This study aimed to gain insight into the experiences of, and reasons for, cancer survivors participating in a primary care PA program. METHODS We interviewed 17 patients from 11 Dutch GP practices. Patients were selected by purposive sampling based on their general practice, gender, educational level, motivation for PA, and change in PA. Interviews were audio recorded, transcribed verbatim, and pseudonymized for inductive thematic analysis. RESULTS Three domains were identified with five themes: institutional domain: GP practice; program-specific domain: content sessions and PA, and activity tracker and goal setting; individual domain: experienced benefits, and personalized care needs. Participants valued the PA program because it was offered close to home, without additional costs, and by a trusted practice nurse familiar with the patients' medical background. Activity tracker use and goal setting motivated many participants but also led to demotivation and feelings of failure in others. Reported benefits included behavior change and favorable health outcomes. Many patients expressed the need to personalize psychological support and the program's timing. CONCLUSIONS Access to a PA program in a primary care setting is valued for its accessibility and experienced health benefits, but also seems to meet an unmet need for support in picking up life during cancer recovery. IMPLICATIONS FOR CANCER SURVIVORS Primary care is important for continued care of cancer survivors. An accessible PA program in this setting may fulfil a need for not only lifestyle support but also continuing life after cancer treatment.
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Affiliation(s)
- Famke Huizinga
- Department of Primary and Long-Term Care, University Medical Centre Groningen, University of Groningen, PO Box 196, FA 21, 9700 AD, Groningen, The Netherlands.
| | - Eleonora A M Kieboom
- Department of Human Movement Sciences, University Medical Centre Groningen, University of Groningen, PO Box 196, FA 23, 9700 AD, Groningen, The Netherlands
| | - Mathieu H G de Greef
- Department of Human Movement Sciences, University Medical Centre Groningen, University of Groningen, PO Box 196, FA 23, 9700 AD, Groningen, The Netherlands
| | - Annemiek M E Walenkamp
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, DA 11, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Annette J Berendsen
- Department of Primary and Long-Term Care, University Medical Centre Groningen, University of Groningen, PO Box 196, FA 21, 9700 AD, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of Primary and Long-Term Care, University Medical Centre Groningen, University of Groningen, PO Box 196, FA 21, 9700 AD, Groningen, The Netherlands
| | - Daan Brandenbarg
- Department of Primary and Long-Term Care, University Medical Centre Groningen, University of Groningen, PO Box 196, FA 21, 9700 AD, Groningen, The Netherlands
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Huizinga F, Westerink NDL, Berendsen AJ, Walenkamp AME, de Greef MHG, de Bock GH, Berger MY, Brandenbarg D. Implementation and evaluation of a physical activity counselling programme in primary care among cancer survivors: SoDA study protocol. BMJ Open 2022; 12:e060098. [PMID: 35236736 PMCID: PMC8896033 DOI: 10.1136/bmjopen-2021-060098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Physical activity (PA) favourably affects various health outcomes in cancer survivors, but little is known about how to implement a PA programme in primary care. We therefore aim to implement and evaluate such a programme for cancer survivors in general practice. METHODS AND ANALYSES The Stimulation of Daily Activity study is an implementation study with a single-arm longitudinal design in 15 Dutch general practices. Patients aged ≥18 years who finished cancer treatment more than 6 months ago will be eligible for inclusion. The intervention will comprise six coaching sessions with the practice nurse in 9 months, seeking to increase PA in daily activities and using an activity tracker for goal setting and feedback. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework will be used to evaluate implementation in terms of the health outcomes, extent of implementation and barriers and facilitators to implementation, using a mixed methods approach. Descriptive analyses and linear mixed model analyses will be performed on the quantitative data, while qualitative data from focus groups and interviews will be analysed by thematic analyses. ETHICS AND DISSEMINATION The Medical Research Ethics Committee of the University Medical Centre Groningen, the Netherlands, concluded that this study was not subject to the Dutch Medical Research Involving Human Subjects Act (registration number: 201900586). The study results will be made available to patients and general practitioners via (inter)national publications and conferences, newsletters, public summaries and via (social) media.
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Affiliation(s)
- Famke Huizinga
- General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Annette J Berendsen
- General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Mathieu H G de Greef
- Human Movement Sciences, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Marjolein Y Berger
- General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Daan Brandenbarg
- General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
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Stegmann ME, Brandenbarg D, Reyners AKL, van Geffen WH, Hiltermann TJN, Berendsen AJ. Treatment goals and changes over time in older patients with non-curable cancer. Support Care Cancer 2021; 29:3849-3856. [PMID: 33354736 PMCID: PMC8163677 DOI: 10.1007/s00520-020-05945-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/10/2020] [Indexed: 12/05/2022]
Abstract
PURPOSE To investigate the treatment goals of older patients with non-curable cancer, whether those goals changed over time, and if so, what triggered those changes. METHODS We performed a descriptive and qualitative analysis using the Outcome Prioritization Tool (OPT) to assess patient goals across four conversations with general practitioners (GPs) over 6 months. Text entries from electronic patient records (hospital and general practice) were then analyzed qualitatively for this period. RESULTS Of the 29 included patients, 10 (34%) rated extending life and 9 (31%) rated maintaining independence as their most important goals. Patients in the last year before death (late phase) prioritized extending life less often (3 patients; 21%) than those in the early phase (7 patients; 47%). Goals changed for 16 patients during follow-up (12 in the late phase). Qualitative analysis revealed three themes that explained the baseline OPT scores (prioritizing a specific goal, rating a goal as unimportant, and treatment choices related to goals). Another three themes related to changes in OPT scores (symptoms, disease course, and life events) and stability of OPT scores (stable situation, disease-unrelated motivation, and stability despite symptoms). CONCLUSION Patients most often prioritized extending life as the most important goal. However, priorities differed in the late phase of the disease, leading to changed goals. Triggers for change related to both the disease (e.g., symptoms and course) and to other life events. We therefore recommend that goals should be discussed repeatedly, especially near the end of life. TRIAL REGISTRATION OPTion study: NTR5419.
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Affiliation(s)
- M E Stegmann
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, FA 21, 9713 AV, Groningen, The Netherlands.
| | - D Brandenbarg
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, FA 21, 9713 AV, Groningen, The Netherlands
| | - A K L Reyners
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W H van Geffen
- Department of Pulmonary Diseases, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - T J N Hiltermann
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A J Berendsen
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, FA 21, 9713 AV, Groningen, The Netherlands
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Maass SWMC, Brandenbarg D, Boerman LM, Verhaak PFM, de Bock GH, Berendsen AJ. Fatigue among Long-Term Breast Cancer Survivors: A Controlled Cross-Sectional Study. Cancers (Basel) 2021; 13:cancers13061301. [PMID: 33803966 PMCID: PMC8001130 DOI: 10.3390/cancers13061301] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 01/22/2023] Open
Abstract
Simple Summary The number of long-term breast cancer survivors is increasing. Earlier research showed that many breast cancer survivors suffer from fatigue during and shortly after treatment. Fatigue is distressing and can severely impact quality of life. In this research, we assessed whether the prevalence of fatigue is also elevated long after breast cancer treatment. We showed that even ten years after diagnosis, one in four breast cancer survivors experience fatigue. This is more than women of the same age without a history of cancer. In addition, we found that fatigue among long-term breast cancer survivors was associated with symptoms of depression and anxiety. Abstract Background: Fatigue is the most common and persistent symptom among women in the first five years after a breast cancer diagnosis. However, long-term prevalence of fatigue, among breast cancer survivors, needs further investigation. Aim: To compare fatigue experienced by long-term breast cancer survivors with that in a reference population and to evaluate the determinants of that fatigue. Design and Setting: A cross-sectional cohort study of 350 breast cancer survivors ≥5 years after diagnosis and a reference population of 350 women matched by age and general practitioner. Method: Fatigue was measured using the Multidimensional Fatigue Inventory (MFI-20), and a sum score of >60 (multidimensional fatigue) was the primary outcome. Logistic regression was applied to compare the prevalence of multidimensional fatigue between the survivor and reference populations, adjusted for body mass index (BMI) and for cardiovascular and psychological variables. Odds ratios (ORs) and 95% confidence intervals (95%CIs) were estimated. Logistic regression was applied to evaluate the determinants of multidimensional fatigue among the survivors. Results: Breast cancer survivors (median 10 years after diagnosis), more often experienced multidimensional fatigue than the reference population (26.6% versus 15.4%; OR, 2.0 [95%CI, 1.4–2.9]), even after adjusting for confounders. The odds of multidimensional fatigue were also higher among survivors with symptoms of depression (32.2% versus 2.7%; OR, 17.0 [95%CI, 7.1–40.5]) or anxiety (41.9% versus 10.1%; OR, 6.4 [95%CI, 3.6–11.4]). Conclusion: One in four breast cancer survivors experience multidimensional fatigue and fatigue occurs more frequently than in women of the same age and general practitioner. This fatigue appears to be associated with symptoms of depression and anxiety.
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Affiliation(s)
- Saskia W. M. C. Maass
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands; (D.B.); (L.M.B.); (A.J.B.)
- Correspondence: ; Tel.: +31-50-3616151; Fax: +31-50-3610739
| | - Daan Brandenbarg
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands; (D.B.); (L.M.B.); (A.J.B.)
| | - Liselotte M. Boerman
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands; (D.B.); (L.M.B.); (A.J.B.)
| | - Peter F. M. Verhaak
- NIVEL, Netherlands Institute of Health Services Research, 3513 CR Utrecht, The Netherlands;
| | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands;
| | - Annette J. Berendsen
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands; (D.B.); (L.M.B.); (A.J.B.)
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Liemburg GB, Brandenbarg D, Berger MY, Duijts SFA, Holtman GA, de Bock GH, Korevaar JC, Berendsen AJ. Diagnostic accuracy of follow-up tests for detecting colorectal cancer recurrences in primary care: A systematic review and meta-analysis. Eur J Cancer Care (Engl) 2021; 30:e13432. [PMID: 33704843 PMCID: PMC8518902 DOI: 10.1111/ecc.13432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/11/2021] [Accepted: 02/25/2021] [Indexed: 01/16/2023]
Abstract
Introduction Traditionally, follow‐up of colorectal cancer (CRC) is performed in secondary care. In new models of care, the screening part care could be replaced to primary care. We aimed to synthesise evidence on the diagnostic accuracy of commonly used screeners in CRC follow‐up applicable in primary care: carcinoembryonic antigen (CEA), ultrasound and physical examination. Methods Medline, EMBASE, Cochrane Trial Register and Web of Science databases were systematically searched. Studies were included if they provided sufficient data for a 2 × 2 contingency tables. QUADAS‐2 was used to assess methodological quality. We performed bivariate random effects meta‐analysis, generated a hypothetical cohort, and reported sensitivity and specificity. Results We included 12 studies (n = 3223, median recurrence rate 19.6%). Pooled estimates showed a sensitivity for CEA (≤ 5 μg/l) of 59% [47%–70%] and a specificity of 89% [80%–95%]. Only few studies reported sensitivities and specificities for ultrasound (36–70% and 97–100%, respectively) and clinical examination (23% and 27%, respectively). Conclusion In practice, GPs could perform CEA screening. Radiological examination in a hospital setting should remain part of the surveillance strategy. Personalised algorithms accounting for recurrence risk and changes of CEA‐values over time might add to the diagnostic value of CEA in primary care.
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Affiliation(s)
- Geertje B Liemburg
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daan Brandenbarg
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Saskia F A Duijts
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gea A Holtman
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joke C Korevaar
- NIVEL Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Annette J Berendsen
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Maass SWMC, Boerman LM, Brandenbarg D, Verhaak PFM, Maduro JH, de Bock GH, Berendsen AJ. Symptoms in long-term breast cancer survivors: A cross-sectional study in primary care. Breast 2020; 54:133-138. [PMID: 33035934 PMCID: PMC7554212 DOI: 10.1016/j.breast.2020.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/20/2020] [Accepted: 09/25/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose Various long-term symptoms can manifest after breast cancer treatment, but we wanted to clarify whether these are more frequent among long-term breast cancer survivors than matched controls and if they are associated with certain diagnoses. Methods This was a cross-sectional, population-based study of 350 breast cancer survivors treated with chemo- and/or radiotherapy ≥5 years (median 10) after diagnosis and 350 women without cancer matched by age and primary care physician. All women completed a questionnaire enquiring about symptoms, underwent echocardiography to assess the left ventricle ejection fraction, and completed the Hospital Anxiety and Depression Scale. Cardiovascular diseases were diagnosed from primary care records. In a multivariable logistic regression analysis, symptoms were adjusted for the long-term effects and compared between cohorts and within the survivor group. Results Concentration difficulties, forgetfulness, dizziness, and nocturia were more frequent among breast cancer survivors compared with controls, but differences could not be explained by cardiac dysfunction, cardiovascular diseases, depression, or anxiety. Intermittent claudication and appetite loss were more frequent among breast cancer survivors than controls and associated with cardiac dysfunction, depression, and anxiety. Breast cancer survivors treated with chemotherapy with/without radiotherapy were at significantly higher odds of forgetfulness and nocturia, but significantly lower odds of dizziness, compared with breast cancer survivors treated with radiotherapy alone. Conclusions Intermittent claudication and appetite loss are common among breast cancer survivors and are associated with cardiac dysfunction and mood disorders. Other symptoms varied by whether the patient underwent chemotherapy with/without radiotherapy (forgetfulness and nocturia) radiotherapy alone (dizziness). Even 10 years after diagnosis, breast cancer survivors experience various long-term symptoms. Some symptoms are more common among breast cancer survivors than among controls without cancer. Not all symptoms are associated with known cardiovascular or psychological diagnoses. A symptom-specific approach may be appropriate. This study does not evaluate a causal relation.
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Affiliation(s)
- S W M C Maass
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, PO Box 196, 9700 AD, Groningen, the Netherlands.
| | - L M Boerman
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, PO Box 196, 9700 AD, Groningen, the Netherlands
| | - D Brandenbarg
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, PO Box 196, 9700 AD, Groningen, the Netherlands
| | - P F M Verhaak
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, PO Box 196, 9700 AD, Groningen, the Netherlands; NIVEL, Netherlands Institute of Health Services Research, Postbus 1568, 3500 BN, Utrecht, the Netherlands
| | - J H Maduro
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - G H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - A J Berendsen
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, PO Box 196, 9700 AD, Groningen, the Netherlands
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Geerse OP, Lamas DJ, Bernacki RE, Sanders JJ, Paladino J, Berendsen AJ, Hiltermann TJN, Lindvall C, Fromme EK, Block SD. Adherence and Concordance between Serious Illness Care Planning Conversations and Oncology Clinician Documentation among Patients with Advanced Cancer. J Palliat Med 2020; 24:53-62. [PMID: 32580676 DOI: 10.1089/jpm.2019.0615] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Serious illness conversations are part of advance care planning (ACP) and focus on prognosis, values, and goals in patients who are seriously ill. To be maximally effective, such conversations must be documented accurately and be easily accessible. Objectives: The two coprimary objectives of the study were to assess concordance between written documentation and recorded audiotaped conversations, and to evaluate adherence to the Serious Illness Conversation Guide questions. Methods: Data were obtained as part of a trial in patients with advanced cancer. Clinicians were trained to use a guide to conduct and document serious illness conversations. Conversations were audiotaped. Two researchers independently compared audiorecordings with the corresponding documentation in an electronic health record (EHR) template and free-text progress notes, and rated the degree of concordance and adherence. Results: We reviewed a total of 25 audiorecordings. Clinicians addressed 87% of the conversation guide elements. Prognosis was discussed least frequently, only in 55% of the patients who wanted that information. Documentation was fully concordant with the conversation 43% of the time. Concordance was best when documenting family matters and goals, and least frequently concordant when documenting prognostic communication. Most conversations (64%) were documented in the template, a minority (28%) only in progress notes and two conversations (8%) were not documented. Concordance was better when the template was used (62% vs. 28%). Conclusion: Clinicians adhered well to the conversation guide. However, key information elicited was documented and fully concordant less than half the time. Greater concordance was observed when clinicians used a prespecified template. The combined use of a guide and EHR template holds promise for ACP conversations.
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Affiliation(s)
- Olaf P Geerse
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Daniela J Lamas
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rachelle E Bernacki
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Justin J Sanders
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joanna Paladino
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Annette J Berendsen
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Thijo J N Hiltermann
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Erik K Fromme
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Susan D Block
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Tromp J, Boerman LM, Sama IE, Maass SWMC, Maduro JH, Hummel YM, Berger MY, de Bock GH, Gietema JA, Berendsen AJ, van der Meer P. Long-term survivors of early breast cancer treated with chemotherapy are characterized by a pro-inflammatory biomarker profile compared to matched controls. Eur J Heart Fail 2020; 22:1239-1246. [PMID: 32078215 PMCID: PMC7540448 DOI: 10.1002/ejhf.1758] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/24/2019] [Accepted: 01/17/2020] [Indexed: 12/25/2022] Open
Abstract
Background Chemo‐ and radiotherapy for breast cancer (BC) can lead to cardiotoxicity even years after the initial treatment. The pathophysiology behind these late cardiac effects is poorly understood. Therefore, we studied a large panel of biomarkers from different pathophysiological domains in long‐term BC survivors, and compared these to matched controls. Methods and results In total 91 biomarkers were measured in 688 subjects: 342 BC survivors stratified either to treatment with chemotherapy ± radiotherapy (n = 170) or radiotherapy alone (n = 172) and matched controls. Mean age was 59 ± 9 years and 65 ± 8 years for women treated with chemotherapy ± radiotherapy and radiotherapy alone, respectively, with a mean time since treatment of 11 ± 5.5 years. No biomarkers were differentially expressed in survivors treated with radiotherapy alone vs. controls (P for all >0.1). In sharp contrast, a total of 19 biomarkers were elevated, relative to controls, in BC survivors treated with chemotherapy ± radiotherapy after correction for multiple comparisons (P <0.05 for all). Network analysis revealed upregulation of pathways relating to collagen degradation and activation of matrix metalloproteinases. Furthermore, several inflammatory biomarkers including growth differentiation factor 15, monocyte chemoattractant protein 1, chemokine (C‐X‐C motif) ligand 16, tumour necrosis factor super family member 13b and proprotein convertase subtilisin/kexin type 9, elevated in survivors treated with chemotherapy, showed an independent association with lower left ventricular ejection fraction. Conclusion Breast cancer survivors treated with chemotherapy ± radiotherapy show a distinct biomarker profile associated with mild cardiac dysfunction even 10 years after treatment. These results suggest that an ongoing pro‐inflammatory state and activation of matrix metalloproteinases following initial treatment with chemotherapy might play a role in the observed cardiac dysfunction in late BC survivors.
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Affiliation(s)
- Jasper Tromp
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Liselotte M Boerman
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Iziah E Sama
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Saskia W M C Maass
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - John H Maduro
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yoran M Hummel
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jourik A Gietema
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annette J Berendsen
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter van der Meer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Stegmann ME, Festen S, Brandenbarg D, Schuling J, van Leeuwen B, de Graeff P, Berendsen AJ. Using the Outcome Prioritization Tool (OPT) to assess the preferences of older patients in clinical decision-making: A review. Maturitas 2019; 128:49-52. [DOI: 10.1016/j.maturitas.2019.07.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/05/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
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van den Bogaard VA, van Luijk P, Hummel YM, van der Meer P, Schuit E, Boerman LM, Maass SW, Nauta JF, Steggink LC, Gietema JA, de Bock GH, Berendsen AJ, Smit WG, Sijtsema NM, Kierkels RG, Langendijk JA, Crijns AP, Maduro JH. Cardiac Function After Radiation Therapy for Breast Cancer. Int J Radiat Oncol Biol Phys 2019; 104:392-400. [DOI: 10.1016/j.ijrobp.2019.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/25/2019] [Accepted: 02/04/2019] [Indexed: 12/25/2022]
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12
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Stegmann ME, Meijer JM, Nuver J, Havenga K, Hiltermann TJN, Maduro JH, Berendsen AJ. [Correspondence between primary and secondary healthcare providers about patients with cancer; how can it be improved?]. Ned Tijdschr Geneeskd 2019; 163:D3616. [PMID: 31187961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To explore the correspondence between primary and secondary healthcare providers about patients with lung, breast or colorectal cancer. DESIGN Qualitative research. METHOD We collected the medical files of 50 patients with lung, breast or colorectal cancer by purposive sampling and selected the correspondence-related items from them. These concerned referral letters from primary to secondary caregivers and letters from specialists. A qualitative content analysis of these documents was performed. In addition, 4 general practitioners, 4 oncologists and 1 nurse specialist were interviewed. RESULTS We analysed 50 referral letters and 369 letters from specialists. Content could be divided into 6 main themes in the referral letters, and it was noticeable that highly relevant information regarding the past medical history was often mixed with less relevant information. The same was true for the medication list and case history to a certain extent. We could distinguish 9 themes in the letters from specialists. All the letters from specialists did include information about the current treatment, but information about treatment intent (curative or palliative) or alternative treatment options was rarely available. Interviews with the healthcare providers confirmed these findings. CONCLUSION The study findings indicate that referral letters and specialist correspondence are not sufficiently tailored to the needs of the recipient.
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Affiliation(s)
- Mariken E Stegmann
- Rijksuniversiteit Groningen-Universitair Medisch Centrum Groningen, afd. Huisartsgeneeskunde, Groningen
- Contact: M.E. Stegmann
| | - Jiska M Meijer
- Rijksuniversiteit Groningen-Universitair Medisch Centrum Groningen, afd. Huisartsgeneeskunde, Groningen
| | - Janine Nuver
- Rijksuniversiteit Groningen-Universitair Medisch Centrum Groningen, afd. Medische Oncologie, Groningen
| | - Klaas Havenga
- Rijksuniversiteit Groningen-Universitair Medisch Centrum Groningen, afd. Abdominale Chirurgie, Groningen
| | - T Jeroen N Hiltermann
- Rijksuniversiteit Groningen-Universitair Medisch Centrum Groningen, afd. Longziekten, Groningen
| | - John H Maduro
- Rijksuniversiteit Groningen-Universitair Medisch Centrum Groningen, afd. Radiotherapie, Groningen
| | - Annette J Berendsen
- Rijksuniversiteit Groningen-Universitair Medisch Centrum Groningen, afd. Huisartsgeneeskunde, Groningen
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Geerse OP, Brandenbarg D, Kerstjens HAM, Berendsen AJ, Duijts SFA, Burger H, Holtman GA, Hoekstra-Weebers JEHM, Hiltermann TJN. The distress thermometer as a prognostic tool for one-year survival among patients with lung cancer. Lung Cancer 2019; 130:101-107. [PMID: 30885329 PMCID: PMC7026622 DOI: 10.1016/j.lungcan.2019.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The use of patient-reported outcome measures is increasingly advocated to support high-quality cancer care. We therefore investigated the added value of the Distress Thermometer (DT) when combined with known predictors to assess one-year survival in patients with lung cancer. METHODS All patients had newly diagnosed or recurrent lung cancer, started systemic treatment, and participated in the intervention arm of a previously published randomised controlled trial. A Cox proportional hazards model was fitted based on five selected known predictors for survival. The DT-score was added to this model and contrasted to models including the EORTC-QLQ-C30 global QoL score (quality of life) or the HADS total score (symptoms of anxiety and depression). Model performance was evaluated through improvement in the -2 log likelihood, Harrell's C-statistic, and a risk classification. RESULTS In total, 110 patients were included in the analysis of whom 97 patients accurately completed the DT. Patients with a DT score ≥5 (N = 51) had a lower QoL, more symptoms of anxiety and depression, and a shorter median survival time (7.6 months vs 10.0 months; P = 0.02) than patients with a DT score <5 (N = 46). Addition of the DT resulted in a significant improvement in the accuracy of the model to predict one-year survival (P < 0.001) and the discriminatory value (C-statistic) marginally improved from 0.69 to 0.71. The proportion of patients correctly classified as high risk (≥85% risk of dying within one year) increased from 8% to 28%. Similar model performance was observed when combining the selected predictors with QoL and symptoms of anxiety or depression. CONCLUSIONS Use of the DT allows clinicians to better identify patients with lung cancer at risk for poor outcomes, to further explore sources of distress, and subsequently personalize care accordingly.
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Affiliation(s)
- O P Geerse
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands.
| | - D Brandenbarg
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands
| | - H A M Kerstjens
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands
| | - A J Berendsen
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands
| | - S F A Duijts
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands
| | - H Burger
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands; Amsterdam University Medical Center, Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands
| | - G A Holtman
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands
| | - J E H M Hoekstra-Weebers
- University of Groningen, University Medical Center Groningen, Wenckebach Institute, Groningen, the Netherlands; Netherlands Comprehensive Cancer Organization (IKNL), The Netherlands
| | - T J N Hiltermann
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands
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14
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Stegmann ME, Homburg TM, Meijer JM, Nuver J, Havenga K, Hiltermann TJN, Maduro JH, Schuling J, Brandenbarg D, Berendsen AJ. Correspondence between primary and secondary care about patients with cancer: a Delphi consensus study. Support Care Cancer 2019; 27:4199-4205. [PMID: 30825025 PMCID: PMC6803614 DOI: 10.1007/s00520-019-04712-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/22/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To provide optimal care for patients with cancer, timely and efficient communication between healthcare providers is essential. In this study, we aimed to achieve consensus regarding the desired content of communication between general practitioners (GPs) and oncology specialists before and during the initial treatment of cancer. METHODS In a two-round Delphi procedure, three expert panels reviewed items recommended for inclusion on referral and specialist letters. RESULTS The three panels comprised 39 GPs (42%), 42 oncology specialists (41%) (i.e. oncologists, radiotherapists, urologists and surgeons) and 18 patients or patient representatives (69%). Final agreement was by consensus, with 12 and 35 items included in the GP referral and the specialist letters, respectively. The key requirements of GP referral letters were that they should be limited to medical facts, a short summary of symptoms and abnormal findings, and the reason for referral. There was a similar requirement for letters from specialists to include these same medical facts, but detailed information was also required about the diagnosis, treatment options and chosen treatment. After two rounds, the overall content validity index (CVI) for both letters was 71%, indicating that a third round was not necessary. DISCUSSION This is the first study to differentiate between essential and redundant information in GP referral and specialist letters, and the findings could be used to improve communication between primary and secondary care.
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Affiliation(s)
- M E Stegmann
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands.
| | - T M Homburg
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands
| | - J M Meijer
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands
| | - J Nuver
- University Medical Center Groningen, Department of Medical Oncology, University of Groningen, Groningen, The Netherlands
| | - K Havenga
- University Medical Center Groningen, Department of Surgery, University of Groningen, Groningen, The Netherlands
| | - T J N Hiltermann
- University Medical Center Groningen, Department of Pulmonary Diseases, University of Groningen, Groningen, The Netherlands
| | - J H Maduro
- University Medical Center Groningen, Department of Radiation Oncology, University of Groningen, Groningen, The Netherlands
| | - J Schuling
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands
| | - D Brandenbarg
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands
| | - A J Berendsen
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands
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15
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Geerse OP, Lamas DJ, Sanders JJ, Paladino J, Kavanagh J, Henrich NJ, Berendsen AJ, Hiltermann TJN, Fromme EK, Bernacki RE, Block SD. A Qualitative Study of Serious Illness Conversations in Patients with Advanced Cancer. J Palliat Med 2019; 22:773-781. [PMID: 30724693 DOI: 10.1089/jpm.2018.0487] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Conversations with seriously ill patients about their values and goals have been associated with reduced distress, a better quality of life, and goal-concordant care near the end of life. Yet, little is known about how such conversations are conducted. Objective: To characterize the content of serious illness conversations and identify opportunities for improvement. Design: Qualitative analysis of audio-recorded, serious illness conversations using an evidence-based guide and obtained through a cluster randomized controlled trial in an outpatient oncology setting. Setting/Measurements: Clinicians assigned to the intervention arm received training to use the "Serious Illness Conversation Guide" to have a serious illness conversation about values and goals with advanced cancer patients. Conversations were de-identified, transcribed verbatim, and independently coded by two researchers. Key themes were analyzed. Results: A total of 25 conversations conducted by 16 clinicians were evaluated. The median conversation duration was 14 minutes (range 4-37), with clinicians speaking half of the time. Thematic analyses demonstrated five key themes: (1) supportive dialogue between patients and clinicians; (2) patients' openness to discuss emotionally challenging topics; (3) patients' willingness to articulate preferences regarding life-sustaining treatments; (4) clinicians' difficulty in responding to emotional or ambiguous patient statements; and (5) challenges in discussing prognosis. Conclusions: Data from this exploratory study suggest that seriously ill patients are open to discussing values and goals with their clinician. Yet, clinicians may struggle when disclosing a time-based prognosis and in responding to patients' emotions. Such skills should be a focus for additional training for clinicians caring for seriously ill patients.
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Affiliation(s)
- Olaf P Geerse
- 1 Serious Illness Care Program, Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,2 Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daniela J Lamas
- 1 Serious Illness Care Program, Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,4 Division of Palliative Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Justin J Sanders
- 1 Serious Illness Care Program, Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,4 Division of Palliative Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,5 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joanna Paladino
- 1 Serious Illness Care Program, Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,4 Division of Palliative Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jane Kavanagh
- 1 Serious Illness Care Program, Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,5 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Natalie J Henrich
- 1 Serious Illness Care Program, Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Annette J Berendsen
- 6 Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thijo J N Hiltermann
- 2 Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik K Fromme
- 1 Serious Illness Care Program, Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,4 Division of Palliative Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,5 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rachelle E Bernacki
- 1 Serious Illness Care Program, Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,4 Division of Palliative Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,5 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Susan D Block
- 1 Serious Illness Care Program, Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,4 Division of Palliative Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,5 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,7 Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
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16
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Geerse OP, Stegmann ME, Kerstjens HAM, Hiltermann TJN, Bakitas M, Zimmermann C, Deal AM, Brandenbarg D, Berger MY, Berendsen AJ. Effects of Shared Decision Making on Distress and Health Care Utilization Among Patients With Lung Cancer: A Systematic Review. J Pain Symptom Manage 2018; 56:975-987.e5. [PMID: 30145213 DOI: 10.1016/j.jpainsymman.2018.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 12/25/2022]
Abstract
CONTEXT Lung cancer is associated with significant distress, poor quality of life, and a median prognosis of less than one year. Benefits of shared decision making (SDM) have been described for multiple diseases, either by the use of decisions aids or as part of supportive care interventions. OBJECTIVES The objective of this study was to summarize the effects of interventions facilitating SDM on distress and health care utilization among patients with lung cancer. METHODS We performed a systematic literature search in the CINAHL, Cochrane, EMBASE, MEDLINE, and PsychINFO databases. Studies were eligible when conducted in a population of patients with lung cancer, evaluated the effects of an intervention that facilitated SDM, and measured distress and/or health care utilization as outcomes. RESULTS A total of 12 studies, detailed in 13 publications, were included: nine randomized trials and three retrospective cohort studies. All studies reported on a supportive care intervention facilitating SDM as part of their intervention. Eight studies described effects on distress, and eight studies measured effects on health care utilization. No effect was found in studies measuring generic distress. Positive effects, in favor of the intervention groups, were observed in studies using anxiety-specific measures (n = 1) or depression-specific measures (n = 3). Evidence for reductions in health care utilization was found in five studies. CONCLUSION Although not supported by all studies, our findings suggest that facilitating SDM in the context of lung cancer may lead to improved emotional outcomes and less aggressive therapies. Future studies, explicitly studying the effects of SDM by using decision aids, are needed to better elucidate potential benefits.
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Affiliation(s)
- Olaf P Geerse
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Mariken E Stegmann
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Huib A M Kerstjens
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thijo Jeroen N Hiltermann
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre and Department of Medicine, University of Toronto, Toronto, Canada
| | - Allison M Deal
- Department of Biostatistics and Clinical Data Management Core, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Daan Brandenbarg
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annette J Berendsen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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17
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Geerse OP, Lakin JR, Berendsen AJ, Alfano CM, Nekhlyudov L. Cancer survivorship and palliative care: Shared progress, challenges, and opportunities. Cancer 2018; 124:4435-4441. [DOI: 10.1002/cncr.31723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Olaf P. Geerse
- Department of Pulmonary Diseases University Medical Center Groningen, University of Groningen Groningen the Netherlands
- Ariadne Labs Brigham and Women’s Hospital, Harvard T. H. Chan School of Public Health Boston Massachusetts
| | - Joshua R. Lakin
- Ariadne Labs Brigham and Women’s Hospital, Harvard T. H. Chan School of Public Health Boston Massachusetts
- Department of Medicine Brigham and Women’s Hospital Boston Massachusetts
- Department of Psychosocial Oncology and Palliative Care Dana‐Farber Cancer Institute Boston Massachusetts
| | - Annette J. Berendsen
- Department of General Practice and Elderly Medicine University Medical Center Groningen, University of Groningen Groningen the Netherlands
| | | | - Larissa Nekhlyudov
- Department of Medicine Brigham and Women’s Hospital Boston Massachusetts
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18
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Stegmann ME, Meijer JM, Nuver J, Havenga K, Hiltermann TJN, Maduro JH, Schuling J, Berendsen AJ. Correspondence between primary and secondary care about patients with cancer: A qualitative mixed-methods analysis. Eur J Cancer Care (Engl) 2018; 28:e12903. [PMID: 30138956 PMCID: PMC6588262 DOI: 10.1111/ecc.12903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 04/24/2018] [Accepted: 07/10/2018] [Indexed: 11/28/2022]
Abstract
Cancer care is complex and involves many different healthcare providers, especially during diagnosis and initial treatment, and it has been reported that both general practitioners and oncology specialists experience difficulties with interdisciplinary communication. The aim of this qualitative study was to explore information sharing between primary and secondary care for patients with lung, breast or colorectal cancer. A qualitative content analysis of 50 medical files (419 documents) was performed, which identified 70 correspondence‐related items. Six main topics were identified in most referral letters from primary to secondary care, but it was particularly notable that highly relevant information regarding the past medical history was often mixed with less relevant information. To lesser extents, the same held true for the medication list and presenting history. In the letters from specialists, nine topics were identified in most letters. Although information about actual treatment was always present, only limited detail, if any, was given about the intent of the treatment (curative or palliative) or the treatment alternatives. Interviews with nine healthcare providers confirmed these issues. These findings indicate that neither the initial referral nor the specialist correspondence is tailored to the needs of the recipient.
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Affiliation(s)
- Mariken E Stegmann
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands
| | - Jiska M Meijer
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands
| | - Janine Nuver
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - Klaas Havenga
- University of Groningen, University Medical Center Groningen, Department of Abdominal Surgery, Groningen, The Netherlands
| | - Thijo J N Hiltermann
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - John H Maduro
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, The Netherlands
| | - Jan Schuling
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands
| | - Annette J Berendsen
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands
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19
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Geerse O, Stegmann M, Kerstjens HA, Hiltermann TJN, Bakitas M, Zimmermann C, Deal AM, Berger M, Berendsen AJ. Systematic review on shared decision making for patients with lung cancer: Effects on distress and health care utilization. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.31_suppl.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
31 Background: Lung cancer is associated with significant distress, poor quality of life, and a median prognosis of less than one year. Shared decision making (SDM) has been recommended as a strategy to help guide patients facing difficult treatment trade-offs. Potential benefits of SDM include enhanced knowledge and better congruence between treatment decisions and patients’ personal values and have been described in multiple diseases. We investigated the impact of SDM on distress and healthcare utilization among patients with lung cancer. Methods: We performed a systematic literature search in the CINAHL, Cochrane, EMBASE, MEDLINE, and PsychINFO databases. Studies were eligible when conducted among patients with lung cancer, evaluated SDM, and measured distress and/or health care utilization as outcomes. Risk of bias was assessed using the Cochrane risk of bias tool. Results: A total of 11 articles were identified: two retrospective cohort studies and nine articles reporting on eight randomized controlled trials. Overall, the risk of bias of included studies was low, except for a high risk of bias concerning blinding of participants or personnel. All studies reported on a broad supportive care intervention with SDM as a component of the intervention. No beneficial effect was found in five studies measuring generic distress, while one study reported beneficial effects on depression. There was conflicting evidence regarding the effects of SDM on healthcare utilization; of the seven studies analyzing this, five studies found evidence for a reduction in healthcare utilization. Conclusions: Although relevant, only scarce evidence is currently available on the effects of SDM on distress and healthcare utilization among patients with lung cancer. Thus, additional research is needed before SDM can be recommended in the lung cancer context.
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Affiliation(s)
- Olaf Geerse
- University Medical Centre Groningen, Groningen, Netherlands
| | | | | | | | | | - Camilla Zimmermann
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Allison Mary Deal
- Biostatistics Core Facility, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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20
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Brandenbarg D, Korsten JHWM, Berger MY, Berendsen AJ. The effect of physical activity on fatigue among survivors of colorectal cancer: a systematic review and meta-analysis. Support Care Cancer 2017; 26:393-403. [PMID: 29058127 PMCID: PMC5752739 DOI: 10.1007/s00520-017-3920-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/02/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE Favorable health outcomes among cancer survivors are increasingly being attributed to lifestyle factors like physical activity, which is now promoted in clinical guidelines. However, the available evidence indicates that physical activity may also reduce fatigue in this patient group. In this systematic review, we aimed to examine whether physical activity could reduce fatigue among survivors of colorectal cancer. METHODS The databases of Medline, CINAHL, and PsycINFO were systematically searched, using combinations of MeSH and free-text terms for colorectal cancer, physical activity, and fatigue. Randomized controlled trials and cohort studies with longitudinal data collection were included. We performed a random-effect meta-analysis. RESULTS Seven studies were included, five were randomized controlled trials, and two were cohort studies. A meta-analysis of the randomized controlled trials, which comprised 630 survivors in total, failed to show that physical activity had a significant effect on fatigue (standardized mean difference = 0.21 (- 0.07 to 0.49)); however, reduced levels of fatigue were observed in all studies. The results for the cohort studies were inconclusive: one showed that increasing levels of physical activity were significantly associated with decreasing levels of fatigue; the other showed that decreasing levels of fatigue were not associated with increasing levels of physical activity. CONCLUSIONS Based on the data reviewed, we cannot draw definitive conclusions about the effects of physical activity on fatigue. None of the included studies were performed among fatigued survivors of colorectal cancer. More research is needed in this population, ensuring that the trials are appropriately powered to find differences in fatigue.
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Affiliation(s)
- D Brandenbarg
- Department of General Practice, University of Groningen, University Medical Center Groningen, P.O. Box 196, 9700 AD, Groningen, The Netherlands.
| | - J H W M Korsten
- Department of General Practice, University of Groningen, University Medical Center Groningen, P.O. Box 196, 9700 AD, Groningen, The Netherlands
| | - M Y Berger
- Department of General Practice, University of Groningen, University Medical Center Groningen, P.O. Box 196, 9700 AD, Groningen, The Netherlands
| | - A J Berendsen
- Department of General Practice, University of Groningen, University Medical Center Groningen, P.O. Box 196, 9700 AD, Groningen, The Netherlands
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Boerman LM, Maass SW, van der Meer P, Gietema JA, Maduro JH, Hummel YM, Berger MY, de Bock GH, Berendsen AJ. Long-term outcome of cardiac function in a population-based cohort of breast cancer survivors: A cross-sectional study. Eur J Cancer 2017; 81:56-65. [DOI: 10.1016/j.ejca.2017.05.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/28/2017] [Accepted: 05/06/2017] [Indexed: 12/28/2022]
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Brandenbarg D, Berendsen AJ, de Bock GH. Patients' expectations and preferences regarding cancer follow-up care. Maturitas 2017; 105:58-63. [PMID: 28705438 DOI: 10.1016/j.maturitas.2017.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/04/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Most survivors of cancer enter a follow-up routine after their treatment, the aim of which is to detect recurrence, provide psychological support, monitor treatment-related side-effects, and to evaluate care. Due to rising numbers of people with cancer and better survival of these patients, current follow-up routines are under pressure. We reviewed the literature on patients' expectations and preferences regarding this care. METHODS We systematically searched the databases of Pubmed, CINAHL, and PsychInfo. Studies were screened and data extraction was double performed by three authors. Data were collected from quantitative and qualitative studies and described thematically. RESULTS After screening, 12 full-text articles were included, comprising 849 patients aged from 28 to 90 years. Patients expect follow-up visits to detect recurrence of cancer. They want to undergo extensive testing to get reassurance. Furthermore, patients expect relevant information to be provided and to get advice about different aspects of their illness. Psychosocial support is also expected. Patients express a desire for consistency of care as well as continuity of care, and prefer long and intensive follow-up. DISCUSSION AND CONCLUSION After cancer, patients appear to lose confidence in their bodies and fear cancer recurrence after the end of treatment, which may lead to intensive screening wishes. This is not desirable, since care for cancer is already under pressure due to rising numbers of survivors. We have to ensure that follow-up routines are sustainable and effective. Patients should receive good information about the need for follow-up tests. Doctors should be trained to give this information.
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Affiliation(s)
- D Brandenbarg
- University of Groningen, University Medical Center Groningen, Department of General Practice, P.O. Box 196, 9700 AD Groningen, The Netherlands
| | - A J Berendsen
- University of Groningen, University Medical Center Groningen, Department of General Practice, P.O. Box 196, 9700 AD Groningen, The Netherlands
| | - G H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
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23
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Boer H, Lubberts S, Bunskoek S, Nuver J, Lefrandt JD, Steursma G, Sluiter WJ, Siesling S, Berendsen AJ, Gietema JA. Safety and usefulness of patient-centered shared survivorship care after chemotherapy for testicular cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.4561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4561 Background: Testicular cancer (TC) survivors are at risk to develop early cardiovascular morbidity. Close collaboration between oncologists and primary care physicians (PCPs) is mandatory for optimal cardiovascular risk management. We designed a simple shared survivorship care program in which TC patients regularly visit their PCP instead of their oncologist. The primary aim of this study was to test safety and feasibility of shared-care follow-up after chemotherapy for metastatic TC. Methods: TC patients with complete remission after chemotherapy and age ≥18 years were eligible. Participants received a personalized survivorship care plan with scheduled visits to the oncologist and PCP, which was available both on paper and as a mobile application. During PCP visits, signals indicating cancer recurrence, cardiovascular risk and psychosocial issues were assessed. Safety boundaries were defined for the occurrence of failed response to signals indicating cancer recurrence. Patient data were monitored real-time to check if the shared-care follow-up was carried out within these boundaries. Secondary outcomes were satisfaction among TC patients and PCPs, measured with an evaluation questionnaire, and anxiety levels, measured with the Hospital Anxiety and Depression Scale. Results: 64% of eligible TC patients and 99% of the approached PCPs were willing to participate; 162 patients were enrolled in the shared-care program and 241 primary care visits took place. No failures occurred in the detection of relapsed TC. Therefore, the safety boundary was crossed, indicating that shared-care follow-up is a safe alternative to hospital-only follow-up. Four primary care visits were deemed as failed visits because of logistic issues.Anxiety levels did not increase during shared-care follow-up (3.6 vs 3.3 (p = 0.38). Patients were satisfied with the knowledge of PCPs and appreciated this regular contact. 78% of the PCPs would like to extend their role in shared-care follow-up. Conclusions: This easy to use shared survivorship care program is safe and feasible in the follow-up of TC patients. Communication within this patient-centered follow-up program may be further supported with e-health tools. Clinical trial information: NCT01783145.
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Affiliation(s)
- Hink Boer
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | - Sjoukje Lubberts
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | - Sophie Bunskoek
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | - Janine Nuver
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | - Joop D. Lefrandt
- Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, Groningen, Netherlands
| | - Gerrie Steursma
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | - Wim J. Sluiter
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Sabine Siesling
- Department of Research, Comprehensive Cancer Center the Netherlands, Utrecht, Netherlands
| | - Annette J. Berendsen
- Department of General Practice, University Medical Center Groningen, Groningen, Netherlands
| | - Jourik A. Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
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van der Velde JL, Blanker MH, Stegmann ME, de Bock GH, Berger MY, Berendsen AJ. A systematic review of the psychological impact of false-positive colorectal cancer screening: What is the role of the general practitioner? Eur J Cancer Care (Engl) 2017; 26. [PMID: 28493375 DOI: 10.1111/ecc.12709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 12/28/2022]
Abstract
Screening for colorectal cancer (CRC) has both advantages (e.g. reduction in morbidity and mortality) and disadvantages (e.g. false positives and distress). A systematic review was therefore performed to improve our understanding of how false-positive CRC screening results affect patients psychologically (and to make recommendations for primary care). The PubMed, Embase, PsychINFO, CINAHL and Cochrane databases were searched in October 2014 and supplemented in December 2016 to identify studies on the psychological impact of false-positive CRC screening. Original studies were eligible when they assessed psychological impact in a screening setting, provided they also included false-positive CRC screening results. Two authors independently assessed 2,367 available manuscripts and included seven. Heterogeneity in their outcome measures meant that data could not be pooled. Two studies showed that a false-positive CRC screening result caused some moderate psychological distress shortly before and after colonoscopy. The remaining five studies illustrated that the psychological distress of patients with true-positive and false-positive CRC screening results was comparable. We conclude that a false-positive CRC screening result may cause some moderate psychological distress, especially just before or after colonoscopy. We recommend that general practitioners mention this when discussing CRC screening with patients and monitor those with a false-positive outcome for psychological distress.
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Affiliation(s)
- J L van der Velde
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M H Blanker
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M E Stegmann
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M Y Berger
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A J Berendsen
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Brandenbarg D, Roorda C, Stadlander M, de Bock GH, Berger MY, Berendsen AJ. Patients' views on general practitioners' role during treatment and follow-up of colorectal cancer: a qualitative study. Fam Pract 2017; 34:234-238. [PMID: 27920118 DOI: 10.1093/fampra/cmw124] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To clarify experiences and preferences of patients regarding the current and future role of GPs during treatment and follow-up care of colorectal cancer (CRC). METHODS Qualitative semi-structured, audio-recorded, face-to-face interviews in patients' homes in the north of the Netherlands were performed. Patients were sampled purposively on age, gender, time since diagnoses and primary health care use. Data were transcribed verbatim and analysed thematically by two independent researchers until saturation was reached. RESULTS Twenty-two patients were interviewed. GPs played a significant and highly valued role directly after surgery by proactively contacting their patients and offered support in clarification of medical issues, lifestyle advice and care for treatment-related side effects. During follow-up, GPs provided psychosocial support for patients and family members, besides routine health care. Concerning the organization of future follow-up care, most patients expressed a preference for specialist-led services; some said that primary care-led care would be more accessible and less expensive. CONCLUSION Although at present patients perceived their GP is involved in CRC care, they would prefer their follow-up care in a hospital setting. If, in line with recent insights, future follow-up care might become more relying on testing for markers instead of imaging, there may be scope for incorporating this care in current GP routines.
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Affiliation(s)
- Daan Brandenbarg
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carriene Roorda
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michelle Stadlander
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annette J Berendsen
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Geerse OP, Wynia K, Kruijer M, Schotsman MJ, Hiltermann TJN, Berendsen AJ. Health-related problems in adult cancer survivors: development and validation of the Cancer Survivor Core Set. Support Care Cancer 2016; 25:567-574. [PMID: 27743119 PMCID: PMC5196012 DOI: 10.1007/s00520-016-3439-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/02/2016] [Indexed: 12/28/2022]
Abstract
Purpose Improved survival rates from cancer have increased the need to understand the health-related problems of cancer treatment. We aimed to develop and validate the “Cancer Survivor Core Set” representing the most relevant health-related problems in adult cancer survivors using the International Classification of Functioning, Disability, and Health (ICF). Methods First, a Delphi study was conducted to select ICF categories representing the most relevant health-related problems. There were three Dutch expert panels, one each for lung, colorectal, and breast cancer. Each panel comprised lay experts and professionals. The experts reached within- and between-panel consensus in two rounds (≥70 % agreement). Second, a validation study was performed. Generic cancer survivorship questionnaires assessing health-related problems or quality of life among cancer survivors were selected. Items of selected questionnaires were linked to the best-fitting ICF category and to the selected ICF categories from the Delphi study, respectively. Results In total, 101 experts were included, of which 76 participated in both rounds, reaching consensus on 18 ICF categories. The Distress Thermometer and Problem List, the Impact of Cancer (v2), and the Quality of Life in Adult Cancer Survivors questionnaires were selected for the validation study, which led to the inclusion of one additional ICF category. Conclusions The developed Cancer Survivor Core Set consisted of 19 ICF categories representing the most relevant health-related problems in adult cancer survivors: five from the “body functions and structures” component, eight from the “activities and participation” component, and six from the “environmental factors” component. Highlights • Many adult cancer survivors have persistent health-related problems. • The Cancer Survivor Core Set was developed using the Delphi method. • The patients’ perspectives were prioritized in this Delphi study • Content validity was confirmed by validated cancer survivorship questionnaires. • The Cancer Survivor Core Set may help optimize care for cancer survivors. Electronic supplementary material The online version of this article (doi:10.1007/s00520-016-3439-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- O P Geerse
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - K Wynia
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M Kruijer
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M J Schotsman
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T J N Hiltermann
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - A J Berendsen
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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27
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Berendsen AJ, Roorda C, Jansen L, de Bock GH. Patients’ beliefs about the aims of breast cancer follow-up: A qualitative study. Maturitas 2016; 91:140-4. [DOI: 10.1016/j.maturitas.2016.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/14/2016] [Accepted: 06/22/2016] [Indexed: 12/24/2022]
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Zijlstra TJ, Leenman-Dekker SJ, Oldenhuis HKE, Bosveld HEP, Berendsen AJ. Knowledge and preferences regarding cardiopulmonary resuscitation: A survey among older patients. Patient Educ Couns 2016; 99:160-163. [PMID: 26243059 DOI: 10.1016/j.pec.2015.07.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/16/2015] [Accepted: 07/24/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Survival rates following cardiopulmonary resuscitation (CPR) are low for older people, and are associated with a high risk of neurological damage. This study investigated the relationship between the preferences, knowledge of survival chances, and characteristics among older people regarding CPR. METHODS A cross-sectional, self-administrated survey was distributed by researchers to 600 patients aged at least 50 years. The 14-question survey tool was used to collect basic demographic data, knowledge about CPR, and preference for CPR. We performed binary logistic regression analysis to predict whether patients wanted to receive CPR or not. RESULTS The response rate was 48%. Most respondents (84%) predicted the estimated survival rate to be higher than the actual rate. Patients were significantly less likely to want to receive CPR if they correctly estimated the survival rate, had ever contemplated CPR, were older, or female. Discussing CPR with a doctor had no influence on patient preference for CPR. CONCLUSION Older patients choose to receive CPR based on incorrect knowledge. PRACTICE IMPLICATIONS Doctors should be aware of the impact of knowing the true chances of survival on patient preference for CPR. Knowledge and skills need to be updated to provide this information to patients.
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Affiliation(s)
- Trudy J Zijlstra
- Department of General Practice, University of Groningen, University Medical Center Gro-ningen, Groningen, The Netherlands.
| | - Sonja J Leenman-Dekker
- Department of General Practice, University of Groningen, University Medical Center Gro-ningen, Groningen, The Netherlands.
| | - Hilbrand K E Oldenhuis
- School of Social Studies, Hanze University of Applied Sciences, Groningen, The Netherlands.
| | - Henk E P Bosveld
- Department of General Practice, University of Groningen, University Medical Center Gro-ningen, Groningen, The Netherlands.
| | - Annette J Berendsen
- Department of General Practice, University of Groningen, University Medical Center Gro-ningen, Groningen, The Netherlands.
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Berendsen AJ, Joeloemsingh S, Schuling J, Bosveld HEP. Physician-assisted death is less frequently performed among women with a lower education: a survey among general practitioners. Palliat Med 2014; 28:1161-2. [PMID: 25228001 DOI: 10.1177/0269216314535828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Annette J Berendsen
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Singh Joeloemsingh
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Schuling
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk E P Bosveld
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Abstract
OBJECTIVE The view that the general practitioner (GP) should be more involved during the curative treatment of cancer is gaining support. This study aimed to assess the current role of the GP during treatment of patients with colorectal cancer (CRC). DESIGN Historical prospective study, using primary care data from two cohorts. SETTING Registration Network Groningen (RNG) consisting of 18 GPs in three group practices with a dynamic population of about 30,000 patients. SUBJECTS Patients who underwent curative treatment for CRC (n = 124) and matched primary care patients without CRC (reference population; n = 358). MAIN OUTCOME MEASURES Primary healthcare use in the period 1998-2009. FINDINGS Patients with CRC had higher primary healthcare use in the year after diagnosis compared with the reference population. After correction for age, gender, and consultation behaviour, CRC patients had 54% (range 23-92%) more face-to-face contacts, 68% (range 36-108%) more drug prescriptions, and 35% (range -4-90%) more referrals compared with reference patients. Patients consulted their GP more often for reasons related to anaemia, abdominal pain, constipation, skin problems, and urinary infections. GPs also prescribed more acid reflux drugs, laxatives, anti-anaemic preparations, analgesics, and psycholeptics for CRC patients. CONCLUSIONS The GP plays a significant role in the year after CRC diagnosis. This role may be associated with treatment-related side effects and psychological problems. Formal guidelines on the involvement of the GP during CRC treatment might ensure more effective allocation and communication of care between primary and secondary healthcare services.
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Affiliation(s)
- Daan Brandenbarg
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Carriene Roorda
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Feikje Groenhof
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Klaas Havenga
- Department of Surgery, Division of Abdominal Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjolein Y. Berger
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Annette J. Berendsen
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Roorda C, de Bock GH, Scholing C, van der Meer K, Berger MY, de Fouw M, Berendsen AJ. Patients' preferences for post-treatment breast cancer follow-up in primary care vs. secondary care: a qualitative study. Health Expect 2014; 18:2192-201. [PMID: 24661322 DOI: 10.1111/hex.12189] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To explore patients' preferences for follow-up in primary care vs. secondary care. METHODS A cross-sectional design was employed, involving semi-structured interviews with 70 female patients with a history of early-stage breast cancer. Using descriptive content analysis, interview transcripts were analysed independently and thematically by two researchers. FINDINGS Patients expressed the strongest preference for annual visits (31/68), a schedule with a decreasing frequency over time (27/68), and follow-up > 10 years, including lifelong follow-up (20/64). The majority (56/61) preferred to receive follow-up care from the same care provider over time, for reasons related to a personal doctor-patient relationship and the physician's knowledge of the patient's history. About 75% (43/56) preferred specialist follow-up to other follow-up models. However, primary care-based follow-up would be accepted by 57% (39/68) provided that there is good communication between GPs and specialists, and sufficient knowledge among GPs about follow-up. Perceived benefits of primary care-based follow-up referred to the personal nature of the GP-patient relationship and the easy access to primary care. Perceived barriers included limited oncology knowledge and skills, time available, motivation among GPs to provide follow-up care and patients' confidence with the present specialist follow-up. CONCLUSIONS More than half of the patients were open to primary care-based follow-up. Patients' confidence with this follow-up model may increase by using survivorship care plans to facilitate communication across the primary/secondary interface and with patients. Training GPs to improve their oncology knowledge and skills might also increase patients' confidence.
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Affiliation(s)
- Carriene Roorda
- Department of General Practice, Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Christian Scholing
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Klaas van der Meer
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marlieke de Fouw
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annette J Berendsen
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Boer H, Nuver J, Lefrandt JD, Duijzer AW, Bunskoek S, Berendsen AJ, Siesling S, Gietema JA. Easy Navigating Through the Forest of Survivorship Care. J Clin Oncol 2014; 32:61-2. [DOI: 10.1200/jco.2013.52.9933] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hink Boer
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Janine Nuver
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joop D. Lefrandt
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Sophie Bunskoek
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Annette J. Berendsen
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sabine Siesling
- Comprehensive Cancer Center of the Netherlands, Amsterdam, the Netherlands
| | - Jourik A. Gietema
- University Medical Center Groningen, University of Groningen, Groningen
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Abstract
BACKGROUND One of the long-term effects in childhood cancer survivors (CCS) is the development of second cancers. In a cohort of CCS, this study describes how second cancers were presented, the way they were diagnosed, and the knowledge CCS had about their increased risk to develop a second cancer. PATIENTS AND METHODS Selected participants were all adult five-year CCS (n = 1275) who were treated at the University Medical Center Groningen since 1965. Of these, 84 (6.6%) had developed a second cancer, of which 27 had died. The 57 survivors were asked to participate in a telephone interview. RESULTS Of the 57 CCS, 35 (61%) participated. Together they had developed 45 second cancers. Most participants (97%) were seen at the long-term follow-up clinic. Of all second cancers, 89% caused symptoms. Of all second cancers, the majority (56%) were first presented at the general practitioner's (GP's) office and 20% at follow-up testing. Of these CCS, only 28% were aware of their increased risk of developing a second cancer. CONCLUSIONS It is important to inform CCS continuously regarding their increased risk, as a relatively small percentage are aware of this. Since most of these patients first reported their symptoms to the GP, all GPs should be aware of this increased risk, in particular because this concerns cancer at a younger age than normally expected. A survivor care plan might be an effective way of communication with both CCS and GPs.
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Affiliation(s)
- A J Berendsen
- Department of General Practice, University of Groningen, University Medical Center Groningen, the Netherlands.
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de Graaf-Ruizendaal WA, Berendsen AJ, de Boer D, de Bakker DH. Do patient and practice characteristics confound age-group differences in preferences for general practice care? A quantitative study. BMC Fam Pract 2013; 14:90. [PMID: 23800156 PMCID: PMC3699367 DOI: 10.1186/1471-2296-14-90] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 06/18/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Previous research showed inconsistent results regarding the relationship between the age of patients and preference statements regarding GP care. This study investigates whether elderly patients have different preference scores and ranking orders concerning 58 preference statements for GP care than younger patients. Moreover, this study examines whether patient characteristics and practice location may confound the relationship between age and the categorisation of a preference score as very important. METHODS Data of the Consumer Quality Index GP Care were used, which were collected in 32 general practices in The Netherlands. The rank order and preference score were calculated for 58 preference statements for four age groups (0-30, 31-50, 51-74, 75 years and older). Using chi-square tests and logistic regression analyses, it was investigated whether a significant relationship between age and preference score was confounded by patient characteristics and practice location. RESULTS Elderly patients did not have a significant different ranking order for the preference statements than the other three age groups (r = 0.0193; p = 0.41). However, in 53% of the statements significant differences were found in preference score between the four age groups. Elderly patients categorized significantly less preference statements as 'very important'. In most cases, the significant relationships were not confounded by gender, education, perceived health, the number of GP contacts and location of the GP practice. CONCLUSION The preferences of elderly patients for GP care concern the same items as younger patients. However, their preferences are less strong, which cannot be ascribed to gender, education, perceived health, the number of GP contacts and practice location.
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Affiliation(s)
- Willemijn A de Graaf-Ruizendaal
- Department of primary care organization, NIVEL: Netherlands Institute for Health Service Research, PO Box 1568, 3500 BN Utrecht, The Netherlands
| | - Annette J Berendsen
- Department of General Practice, University of Groningen, University Medical Center Groningen, 9713 AV Groningen, The Netherlands
| | - Dolf de Boer
- Department of quality of care, NIVEL: Netherlands Institute for Health Service Research, the Dutch Centre for Consumer Experience in Health Care housed at NIVEL, PO Box 1568, 3500 BN Utrecht, The Netherlands
| | - Dinny H de Bakker
- Department of primary care organization, NIVEL: Netherlands Institute for Health Service Research, PO Box 1568, 3500 BN Utrecht, The Netherlands
- Department of Social and behavioural science, Tranzo Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
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Roorda C, Berendsen AJ, Haverkamp M, van der Meer K, de Bock GH. Discharge of breast cancer patients to primary care at the end of hospital follow-up: a cross-sectional survey. Eur J Cancer 2013; 49:1836-44. [PMID: 23453936 DOI: 10.1016/j.ejca.2013.01.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 12/06/2012] [Accepted: 01/18/2013] [Indexed: 11/29/2022]
Abstract
AIM The present study explored (a) the discharge of breast cancer patients to primary care by specialists, at the end of hospital follow-up and (b) the experiences and views of general practitioners (GPs) regarding transfer of follow-up to the primary care setting. METHODS A cross-sectional survey was performed by sending a self-administered questionnaire to 960 GPs working in the three northern provinces of the Netherlands. Data were analysed using descriptive statistics. RESULTS Of 949 eligible questionnaires, 502 were returned, providing an adjusted response rate of 53%. In the year before the survey took place, one or more patients aged >60 years, and 5 years after breast-conserving therapy, were discharged to 22% of GPs (n=112) for follow-up. According to 56% of these GPs, transfer of follow-up was communicated by the hospital. The initiative to arrange follow-up visits and mammography appointments was mainly taken by patients. In this survey, 40% of GPs (n=200) were willing to accept exclusive responsibility for follow-up earlier than 5 years after completion of active treatment. Perceived barriers in current and future primary care-based follow-up included: communication with breast cancer specialists, patients' preference for specialist follow-up, GPs' oncology knowledge and skills and the organisation of follow-up in general practice. CONCLUSIONS Primary care-based follow-up might be improved if breast cancer specialists discharge patients more actively to their GPs. Survivorship care plans are needed to facilitate communication across the primary/secondary interface and with patients. Training of GPs and developing administrative tools may be helpful in arranging follow-up care and using guidelines in general practice.
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Affiliation(s)
- Carriene Roorda
- Department of General Practice, University of Groningen, University Medical Center Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands.
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Berendsen AJ. [Discharge from hospital: left in limbo]. Ned Tijdschr Geneeskd 2013; 157:A6394. [PMID: 23920237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
An article pertaining to a large European qualitative study into the discharge of patients from hospital was published in the Dutch Journal of Medicine (Nederlands Tijdschrift voor Geneeskunde). Earlier qualitative and quantitative research in the Netherlands had resulted in the same findings: patients wish to receive more information upon discharge. Improvements have been realised, but not at every hospital or department. There is considerable variation as to how much information is desired by individual patients. Healthcare providers should take these differences into account and provide personalised information. For some patients, too much information increases their anxiety. We agree with the recommendations of the authors of the article. It is very important that nurses and doctors communicate with patients who are to be discharged. The elderly and patients who live alone need extra attention. GPs and specialists should discuss amongst themselves how to best compose a format for the specialist's report, including what type of information the GPs need to inform their patients adequately. As performance indicators, the telephone accessibility of GPs and the time it takes to receive the specialist's report could be considered as options.
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Affiliation(s)
- Annette J Berendsen
- Universitair Medisch Centrum, afd. Huisartsgeneeskunde, Groningen, the Netherlands.
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Schuling J, Sytema R, Berendsen AJ. [Adjusting medication: elderly patient's preference counts]. Ned Tijdschr Geneeskd 2013; 157:A6491. [PMID: 24252406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Elderly patients with multimorbidity treated in accordance with disease-specific guidelines use a large number of drugs. As this approach may harm the patient's wellbeing, our care should evolve from disease-oriented to patient-oriented. A simple tool has been introduced to facilitate this type of consultation. On a visual analogue scale (VAS; 0-100) four generic treatment goals are presented to the patient: extending life, maintaining independence, pain relief and relief of other symptoms. The patient is invited to weigh the importance of these outcomes using the 'trade-off' principle, and asked to rank these goals in such a way that the score reflects the patient's preference profile. With the help of this decision aid, the medication of two female patients aged 85 and 94 was reviewed. Embedding this tool in the first step of the medication review process may help to shift the focus from the disease to the patient.
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Affiliation(s)
- Jan Schuling
- Universitair Medisch Centrum Groningen, afd. Huisartsgeneeskunde, Groningen
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Hoexum M, Bosveld HEP, Schuling J, Berendsen AJ. Out-of-hours medical care for terminally ill patients: A survey of availability and preferences of general practitioners. Palliat Med 2012; 26:986-93. [PMID: 22126846 DOI: 10.1177/0269216311428527] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Continuity of care is one of the core values of good medical care for terminally ill patients. The availability of one's own general practitioner (GP) out of hours is regarded as important for personal continuity. Few data are available about the extent of out-of-hours care given by GPs to their terminally ill patients. AIM The objective of this study was to determine to which level GPs are available out of hours for their own terminally ill patients and to elicit what factors are relevant to this availability. DESIGN AND SETTING The research questions were investigated using a cross-sectional study of Dutch GPs. A questionnaire was sent to a random sample of 691 Dutch GPs. RESULTS The response rate was 47% (n = 327). Of the respondents, 86% was willing to provide out-of-hours care for their own terminally ill patients. These figures are higher than reported in previous studies. This study shows that out-of-hours availability correlates most strongly with the GPs' perception of duties of care. Availability is negatively influenced if the GP is in a salaried job, if he or she works in a city based practice, or if home is far from the practice. A correlation between age, sex, and experience of GPs and availability for out-of- hours care for their terminally ill patients was not confirmed. CONCLUSIONS The reported out-of-hours availability of GPs for terminally ill patients is still high. GPs' perception of their duty of care might change in the next generations, and the increasing number of salaried GPs, living far from their practice, might threaten out-of-hours availability for terminally ill patients. GPs' perception of their duty of care might change in the next generations, and the increasing number of salaried GPs living far from their practice might threaten out-of-hours availability for terminally ill patients.
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Affiliation(s)
- Marjan Hoexum
- University Medical Centre Groningen, Department of General Practice, Groningen, Netherlands.
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de Vries M, Berendsen AJ, Bosveld HEP, Kerstjens HAM, van der Molen T. COPD exacerbations in general practice: variability in oral prednisolone courses. BMC Fam Pract 2012; 13:3. [PMID: 22239907 PMCID: PMC3323421 DOI: 10.1186/1471-2296-13-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 01/12/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND The use of oral corticosteroids as treatment of COPD exacerbations in primary care is well established and evidence-based. However, the most appropriate dosage regimen has not been determined and remains controversial. Corticosteroid therapy is associated with a number of undesirable side effects, including hyperglycaemias, so differences in prescribing might be relevant. This study examines the differences between GPs in dosage and duration of prednisolone treatment in patients with a COPD exacerbation. It also investigates the number of general practitioners (GPs) who adjust their treatment according to the presence of diabetic co-morbidity. METHODS Cross-sectional study among 219 GPs and 25 GPs in training, located in the Northern part of the Netherlands. RESULTS The response rate was 69%. Nearly every GP prescribed a continuous dose of prednisolone 30 mg per day. Among GPs there were substantial differences in treatment duration. GPs prescribed courses of five, seven, ten, or fourteen days. A course of seven days was most common. The duration of treatment depended on exacerbation and disease severity. A course of five days was especially prescribed in case of a less severe exacerbation. In a more severe exacerbation duration of seven to fourteen days was more common. Hardly any GP adjusted treatment to the presence of diabetic co-morbidity. CONCLUSION Under normal conditions GPs prescribe prednisolone quite uniformly, within the range of the current Dutch guidelines. There is insufficient guidance regarding how to adjust corticosteroid treatment to exacerbation severity, disease severity and the presence of diabetic co-morbidity. Under these circumstances, there is a substantial variation in treatment duration.
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Affiliation(s)
- Marianne de Vries
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, FA 20, 9700 AD Groningen, the Netherlands
| | - Annette J Berendsen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, FA 20, 9700 AD Groningen, the Netherlands
| | - Henk EP Bosveld
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, FA 20, 9700 AD Groningen, the Netherlands
| | - Huib AM Kerstjens
- Department of Pulmonology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Thys van der Molen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, FA 20, 9700 AD Groningen, the Netherlands
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Poelmann TAJ, van der Heide WK, Berendsen AJ. [Skin tumours underexposed in general practice]. Ned Tijdschr Geneeskd 2012; 156:A5279. [PMID: 23114178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
General practitioners (GPs) in the Netherlands frequently assess skin tumours such as moles. However, the training of medical students, GP trainees and postgraduate training of GPs in evaluating these skin lesions is limited. Furthermore, literature is scarce and no guidelines are available. It is still unclear when histopathological evaluation of an excised skin lesion should be performed. Additional research in primary care populations and the development of a guideline would promote a more unambiguous approach. More (postgraduate) education is needed on this topic. Dermatoscopy and teledermatology might also play a role in improving care.
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Affiliation(s)
- Tibor A J Poelmann
- Universitair Medisch Centrum Groningen, afd. Huisartsgeneeskunde, Groningen, the Netherlands.
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Kollen BJ, Groenier KH, Berendsen AJ. Patients' experiences with continuum of care across hospitals. A multilevel analysis of Consumer Quality Index Continuum of Care. Patient Educ Couns 2011; 83:269-272. [PMID: 20570080 DOI: 10.1016/j.pec.2010.04.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 03/27/2010] [Accepted: 04/28/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Communication between professionals is essential because it contributes to an optimal continuum of care. Whether patients experience adequate continuum of care is uncertain. To address this, a questionnaire was developed to elucidate this care process from a patients' perspective. In this study, the instrument's ability to measure differences in "Consumer Quality Index Continuum of Care" scores between hospitals was investigated. METHODS The questionnaire was mailed to a random sample of 2159 patients and comprised of 22 items divided over four domains, GP approach, GP referral, specialist and collaboration. Multilevel analysis was conducted to identify case-mix and determine this questionnaire's ability to measure differences in domain scores between hospitals. RESULTS Based on a 65% response rate, 1404 questionnaires were available for analysis. Case-mix of patient characteristics across hospitals could not be demonstrated. Some differences in scores between hospitals were observed. At most two in eight hospitals showed different domain scores. CONCLUSION The ability of this questionnaire to measure differences in continuum of care scores between hospitals is limited. The outcome of this survey suggests that hospitals provide a similar level of continuum of care from a patient's perspective. PRACTICAL IMPLICATIONS This questionnaire is especially useful for measuring differences between patients.
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Affiliation(s)
- Boudewijn J Kollen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, The Netherlands.
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Berkelmans PGJ, Berendsen AJ, Verhaak PFM, van der Meer K. Characteristics of general practice care: what do senior citizens value? A qualitative study. BMC Geriatr 2010; 10:80. [PMID: 21044316 PMCID: PMC2984451 DOI: 10.1186/1471-2318-10-80] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 11/02/2010] [Indexed: 11/16/2022] Open
Abstract
Background In view of the increasing number of senior citizens in our society who are likely to consult their GP with age-related health problems, it is important to identify and understand the preferences of this group in relation to the non-medical attributes of GP care. The aim of this study is to improve our understanding about preferences of this group of patients in relation to non-medical attributes of primary health care. This may help to develop strategies to improve the quality of care that senior citizens receive from their GP. Methods Semi-structured interviews (N = 13) with senior citizens (65-91 years) in a judgement sample were recorded and transcribed verbatim. The analysis was conducted according to qualitative research methodology and the frame work method. Results Continuity of care providers, i.e. GP and practice nurses, GPs' expertise, trust, free choice of GP and a kind open attitude were highly valued. Accessibility by phone did not meet the expectations of the interviewees. The interviewees had difficulties with the GP out-of-office hours services. Spontaneous home visits were appreciated by some, but rejected by others. They preferred to receive verbal information rather than collecting information from leaflets. Distance to the practice and continuity of caregiver seemed to conflict for respondents. Conclusions Preferences change in the process of ageing and growing health problems. GPs and their co-workers should be also aware of the changing needs of the elderly regarding non-medical attributes of GP care. Meeting their needs regarding non-medical attributes of primary health care is important to improve the quality of care.
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Affiliation(s)
- P G J Berkelmans
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
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Berendsen AJ, Benneker WHGM, Groenier KH, Schuling J, Grol RPTM, Meyboom-de Jong B. DOC questionnaire: measuring how GPs and medical specialists rate collaboration. Int J Health Care Qual Assur 2010; 23:516-26. [PMID: 20845681 DOI: 10.1108/09526861011050547] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This paper aims to assess the validity of a questionnaire aimed at assessing how general practitioners (GPs) and specialists rate collaboration. DESIGN/METHODOLOGY/APPROACH Primary data were collected in The Netherlands during March to September 2006. A cross-sectional study was conducted among 259 GPs and 232 specialists. Participants were randomly selected from The Netherlands Medical Address Book. Specialists rarely contacting a GP were not invited to participate. FINDINGS Exploratory factor analysis indicated that the questionnaire, consisting of 20 items, measured five domains: organisation; communication; professional expertise; image; and knowing each other. Cronbach's alpha coefficients ranged from 0.64 to 0.83 indicating sufficient internal consistency. Correlation coefficients between domains were all < 0.4. All but "communication" clearly produced distinguishing scores for different respondent groups. RESEARCH LIMITATIONS/IMPLICATIONS This study shows that the doctors' opinions on collaboration (DOC) questionnaire is valid and that it may have the potential to give feedback to both medical professionals and policy makers. Such feedback creates an opportunity to improve collaboration. ORIGINALITY/VALUE The DOC questionnaire is a useful instrument for assessing collaboration among GPs and specialists. It can provide feedback to both medical professionals and policy makers. Such feedback creates an opportunity to improve collaboration.
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Affiliation(s)
- Annette J Berendsen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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Berendsen AJ, de Jong GM, Schuling J, Bosveld HEP, de Waal MWM, Mitchell GK, van der Meer K, Meyboom-de Jong B. Patient's need for choice and information across the interface between primary and secondary care: a survey. Patient Educ Couns 2010; 79:100-105. [PMID: 19713065 DOI: 10.1016/j.pec.2009.07.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 07/20/2009] [Accepted: 07/22/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Hospitals in The Netherlands have recently made certain performance data public, allowing patients to choose the location of their care. The objective of this study is to assess (a) patient preferences and experiences concerning the transition between primary and secondary health care, (b) patients' needs for choice and information and how these are influenced by personal and morbidity factors. METHODS Two different types of questionnaires were used. The first questionnaire concerns the importance that patients attach to the care provided. The second questionnaire concerns the actual experiences of the patient with the care provided. For the selection of patients, we used the databases of the registration networks of the Departments of General Practice of the Universities of Groningen and Leiden. The questionnaires were returned by 513 patients (Importance 69%) and 1404 patients (Experience 65%). RESULTS Many patients prefer the GP advising them regarding which hospital or specialist they should be referred to: a quarter of the patients preferred that the GP decided for them. Patients with a curable condition and patients aged between 25 and 65, highly educated and with stable personal characteristics as measured by a purposive scale, more often wished to use information from internet or newspapers to make a decision. The amount of information that was needed on illness or treatment varied greatly. Young people, older people, and those with less stable personal characteristics more often desired only practical information. CONCLUSIONS In spite of making performance data of different health care institutions public, only a limited number of patients want to use this information on a limited number of health problems. PRACTICE IMPLICATIONS Care providers should take differences into account concerning patients' need for information on their illness.
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Affiliation(s)
- Annette J Berendsen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, The Netherlands.
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Berendsen AJ, Groenier KH, de Jong GM, Meyboom-de Jong B, van der Veen WJ, Dekker J, de Waal MWM, Schuling J. Assessment of patient's experiences across the interface between primary and secondary care: Consumer Quality Index Continuum of care. Patient Educ Couns 2009; 77:123-127. [PMID: 19375266 DOI: 10.1016/j.pec.2009.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 01/07/2009] [Accepted: 01/25/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Development and validation of a questionnaire that measures patients' experiences of collaboration between general practitioners (GPs) and specialists. METHODS A questionnaire was developed using the method of the consumer quality index and validated in a cross-sectional study among a random sample of patients referred to medical specialists in the Netherlands. Validation included factor analysis, ascertain internal consistency, and the discriminative ability. RESULTS The response rate was 65% (1404 patients). Exploratory factor analysis indicated that four domains could be distinguished (i.e. GP Approach; GP Referral; Specialist; Collaboration). Cronbach's alpha coefficients ranged from 0.51 to 0.93 indicating sufficient internal consistency to make comparison of groups of respondents possible. The Pearson correlation coefficients between the domains were <0.4, except between the domains GP Approach and GP Referral. All domains clearly produced discriminating scores for groups with different characteristics. CONCLUSIONS The Consumer Quality Index (CQ-index) Continuum of Care can be a useful instrument to assess aspects of the collaboration between GPs and specialists from patients' perspective. PRACTICE IMPLICATIONS It can be used to give feedback to both medical professionals and policy makers. Such feedback creates an opportunity for implementing specific improvements and evaluating quality improvement projects.
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Affiliation(s)
- Annette J Berendsen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, The Netherlands.
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Berendsen AJ, Kuiken A, Benneker WHGM, Meyboom-de Jong B, Voorn TB, Schuling J. How do general practitioners and specialists value their mutual communication? A survey. BMC Health Serv Res 2009; 9:143. [PMID: 19664238 PMCID: PMC2736936 DOI: 10.1186/1472-6963-9-143] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 08/08/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Communication between general practitioners (GPs) and specialists is important, if we want patients to receive the right type of care at the right moment. Most communication takes place through telephone contact, letters concerning information on patients more recently also by email, and joint postgraduate training. As much research has been aimed at the content of communication between GPs and specialists, we wished to address the procedural aspects of this communication. We addressed the following research question. How do GPs and specialists assess their mutual communication through telephone, letters and postgraduate courses? METHODS A cross-sectional study was conducted among a random sample of 550 GPs and 533 specialists selected from the Netherlands Medical Address Book. The response rate was 47% GPs (n = 259) and 44% specialists (n = 232). RESULTS Specialists qualify the GPs' telephone accessibility as poor; while GPs themselves do not. Specialists think poorly of the GPs' referral letter. Merely half of GPs feels their questions are addressed appropriately by the specialist, whereas specialists think this number is considerably higher. According to specialists, GPs often do not follow the advice given by them. GPs rate their compliance much higher. Less than a quarter of GPs feel the specialist's letter arrives on time. Specialists have a different perception of this.Both parties wish to receive feedback from one and other, while in practice they do so very little. CONCLUSION GPs and specialists disagree on several aspects of their communication. This impedes improvements. Both GP's accessibility by phone and time span to the specialist's report could be earmarked as performance indicators. GPs and specialists should discuss amongst themselves how best to compose a format for the referral letter and the specialist's report and how to go about exchanging mutual feedback.
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Affiliation(s)
- Annette J Berendsen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Ant, Deusinglaan 1, 9713 AV Groningen, The Netherlands.
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Berendsen AJ, de Jong GM, Meyboom-de Jong B, Dekker JH, Schuling J. Transition of care: experiences and preferences of patients across the primary/secondary interface - a qualitative study. BMC Health Serv Res 2009; 9:62. [PMID: 19351407 PMCID: PMC2674593 DOI: 10.1186/1472-6963-9-62] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 04/07/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coordination between care providers of different disciplines is essential to improve the quality of care, in particular for patients with chronic diseases. The way in which general practitioners (GP's) and medical specialists interact has important implications for any healthcare system in which the GP plays the role of gatekeeper to specialist care. Patient experiences and preferences have proven to be increasingly important in discussing healthcare policy. The Dutch government initiated the development of a special website with information for patients on performance indicators of hospitals as well as information on illness or treatment.In the present study we focus on the transition of care at the primary - secondary interface with reference to the impact of patients' ability to make choices about their secondary care providers. The purpose of this study is to (a) explore experiences and preferences of patients regarding the transition between primary and secondary care, (b) study informational resources on illness/treatment desired by patients and (c) determine how information supplied could make it easier for the patient to choose between different options for care (hospital or specialist). METHODS We conducted a qualitative study using semi-structured focus group interviews among 71 patients referred for various indications in the north and west of The Netherlands. RESULTS Patients find it important that they do not have to wait, that they are taken seriously, and receive adequate and individually relevant information. A lack of continuity from secondary to primary care was experienced. The patient's desire for free choice of type of care did not arise in any of the focus groups. CONCLUSION Hospital discharge information needs to be improved. The interval between discharge from specialist care and the report of the specialist to the GP might be a suitable performance indicator in healthcare. Patients want to receive information, tailored to their own situation. The need for information, however, is quite variable. Patients do not feel strongly about self-chosen healthcare, contrary to what administrators presently believe.
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Affiliation(s)
- Annette J Berendsen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Ant. Deusinglaan 1, 9713 AV Groningen, the Netherlands.
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Mulder J, Groenier KH, Dekker JJ, Berendsen AJ, Schuling J. Is there a need for a GP consultant at a university hospital? BMC Fam Pract 2008; 9:55. [PMID: 18823571 PMCID: PMC2564948 DOI: 10.1186/1471-2296-9-55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 09/30/2008] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients in hospital can develop complaints unrelated to the condition they are admitted for. The treating specialist will then call upon a co-specialist who is specialized in the clinical picture associated with the new complaint. For such a complaint, the GP is usually the first contact, when the patient is not in hospital. Normally specialists only encounter patients GPs have selected for referral. The risk of the specialist overestimating the predictive value of 'unselected' complaints and symptoms of a serious condition is high. This may lead to an overuse of diagnostic treatments. Such treatments weigh more heavily on the patient, cause inadequate use of hospital facilities and, as a consequence, generate higher costs. Because of these considerations, we wished to investigate if there is a need for the GP as a consultant for new complaints during hospital admittance. METHOD The files of a random sample of patients who had an interdisciplinary consultation during their stay in hospital were judged by an expertpanel whether the consultation fitted the expertise of a GP. RESULTS In 28 out of 84 files the consultation fitted the expertise of a GP; most cases concerned a specific condition that is not part of the specialist's expertise, most frequently dermatological problems. In a minority of cases the specialist is confronted with a clinical problem with symptoms of which the cause is not clear, for example fever. CONCLUSION Generally, the consultations concern serious, often very complex conditions, i.e. cases that should be assessed by a specialist. Nevertheless, the expert panel's judgment of the interdisciplinary consultations shows that in more than half of the dermatological cases and in a limited number of consultations by a specialist of internal medicine and geriatrics the problems fit the GP's expertise. Given the morbidity in academic hospitals we suppose that the results of a similar study in a peripheral hospital might even show more perspective for a GP consultant. These results offer sufficient arguments to start a pilotstudy into the role of a GP consultant in hospital.
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Berendsen AJ, Benneker WHGM, Meyboom-de Jong B, Klazinga NS, Schuling J. Motives and preferences of general practitioners for new collaboration models with medical specialists: a qualitative study. BMC Health Serv Res 2007; 7:4. [PMID: 17207278 PMCID: PMC1774564 DOI: 10.1186/1472-6963-7-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 01/05/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Collaboration between general practitioners (GPs) and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates GPs to initiate and continue participating with medical specialists in new collaborative care models. The following two questions are addressed in this study: What motivates GPs to initiate and sustain new models for collaborating with medical specialists? What kind of new collaboration models do GPs suggest? METHODS A qualitative study design was used. Starting in 2003 and finishing in 2005, we conducted semi-structured interviews with a purposive sample of 21 Dutch GPs. The sampling criteria were age, gender, type of practice, and practice site. The interviews were recorded, fully transcribed, and analysed by two researchers working independently. The resulting motivational factors and preferences were grouped into categories. RESULTS 'Developing personal relationships' and 'gaining mutual respect' appeared to dominate when the motivational factors were considered. Besides developing personal relationships with specialists, the GPs were also interested in familiarizing specialists with the competencies attached to the profession of family medicine. Additionally, they were eager to increase their medical knowledge to the benefit of their patients. The GPs stated a variety of preferences with respect to the design of new models of collaboration. CONCLUSION Developing personal relationships with specialists appeared to be one of the dominant motives for increased collaboration. Once the relationships have been formed, an informal network with occasional professional contact seemed sufficient. Although GPs are interested in increasing their knowledge, once they have reached a certain level of expertise, they shift their focus to another specialty. The preferences for new collaboration models are diverse. A possible explanation for the differences in the preferences is that professionals are more knowledge driven than organisation driven as the acquiring of new knowledge is considered more important than the route by which this is achieved. A new collaboration model seems a way to acquire knowledge. Once this is achieved the importance of a model possibly diminishes, whereas the professional relationships last.
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Affiliation(s)
- Annette J Berendsen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Wim HGM Benneker
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Betty Meyboom-de Jong
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Niek S Klazinga
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Jan Schuling
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
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Berendsen AJ, Benneker WHGM, Schuling J, Rijkers-Koorn N, Slaets JPJ, Meyboom-de Jong B. Collaboration with general practitioners: preferences of medical specialists--a qualitative study. BMC Health Serv Res 2006; 6:155. [PMID: 17144921 PMCID: PMC1698481 DOI: 10.1186/1472-6963-6-155] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 12/04/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Collaboration between general practitioners (GPs) and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates medical specialists to initiate and continue participating with GPs in new collaborative care models. The following question is addressed in this study: What motivates medical specialists to initiate and sustain new models for collaborating with GPs? METHODS We conducted semi-structured interviews with eighteen medical specialists in the province of Groningen, in the North of The Netherlands. The sampling criteria were age, gender, type of hospital in which they were practicing, and specialty. The interviews were recorded, fully transcribed, and analysed by three researchers working independently. The resulting motivational factors were grouped into categories. RESULTS 'Teaching GPs' and 'regulating patient flow' (referrals) appeared to dominate when the motivational factors were considered. In addition, specialists want to develop relationships with the GPs on a more personal level. Most specialists believe that there is not much they can learn from GPs. 'Lack of time', 'no financial compensation', and 'no support from colleagues' were considered to be the main concerns to establishing collaborative care practices. Additionally, projects were often experienced as too complex and time consuming whereas guidelines were experienced as too restrictive. CONCLUSION Specialists are particularly interested in collaborating because the GP is the gatekeeper for access to secondary health care resources. Specialists feel that they are able to teach the GPs something, but they do not feel that they have anything to learn from the GPs. With respect to professional expertise, therefore, specialists do not consider GPs as equals. Once personal relationships with the GPs have been established, an informal network with incidental professional contact seems to be sufficient to satisfy the collaborative needs of the specialist. The concerns seem to outweigh any positive motivational forces to developing new models of collaborative practice.
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Affiliation(s)
- Annette J Berendsen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Wim HGM Benneker
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Jan Schuling
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Nienke Rijkers-Koorn
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Joris PJ Slaets
- Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Betty Meyboom-de Jong
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
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