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Koot A, Hermens R, Ottevanger P, Netea-Maier R, Stalmeier P. Patient decision aids for patients with differentiated thyroid carcinoma: development process and alpha and beta testing. Front Endocrinol (Lausanne) 2023; 14:1162537. [PMID: 37324263 PMCID: PMC10264809 DOI: 10.3389/fendo.2023.1162537] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Background Patient decision aids (PtDAs) are structured clinical tools that facilitate shared decision-making. Two important treatment decisions for patients with differentiated thyroid cancer (DTC), which could benefit from PtDAs, are as follows (1): the extent of surgery decision in patients with low-risk DTC and (2) the decision to start or delay starting the treatment with tyrosine kinase inhibitors (TKIs) in patients with advanced tumors. Material and methods PtDAs for these two decisions were developed using the International Patient Decision Aids Standards (IPDAS) quality criteria in an iterative process of prototype development via alpha and beta testing by patients and physicians. The information content of the PtDAs was based on the available literature, current guidelines, and patient's needs, preferences, and values. Results The web-based PtDAs underwent two rounds of alpha testing, revisions, and beta testing. The PtDAs have the same structure, consisting of six steps: a general introduction, information about the treatment options, comparing the treatment options, knowledge questions, a values clarification exercise, and saving the information. The alpha testing (n = 8 patients, n = 10 physicians) showed that the PtDAs were highly acceptable and usable for decision-making. Results of the beta testing in 20 patients showed that two patients did not use the PtDA; the other 18 patients found that the PtDAs were readable (n = 17) and helpful (n = 14) for decision-making. All patients recommend using the PtDAs. Conclusions Evidence-based PtDAs were created for patients with DTC for two different treatment decisions. Our final version was judged to be clear, balanced, and helpful in decision-making.
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Affiliation(s)
- Anna Koot
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rosella Hermens
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, Netherlands
| | - Petronella Ottevanger
- Department of Internal Medicine, Division of Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Romana Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peep Stalmeier
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
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Feldman E, Pos FJ, Smeenk RJ, van der Poel H, van Leeuwen P, de Feijter JM, Hulshof M, Budiharto T, Hermens R, de Ligt KM, Walraven I. Selecting a PRO-CTCAE-based subset for patient-reported symptom monitoring in prostate cancer patients: a modified Delphi procedure. ESMO Open 2023; 8:100775. [PMID: 36652781 PMCID: PMC10024147 DOI: 10.1016/j.esmoop.2022.100775] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Clinician-based reporting of adverse events leads to underreporting and underestimation of the impact of adverse events on prostate cancer patients. Therefore, interest has grown in capturing adverse events directly from patients using the Patient-Reported Outcomes (PROs) version of the Common Terminology Criteria for Adverse Events (CTCAE). We aimed to develop a standardized PRO-CTCAE subset tailored to adverse event monitoring in prostate cancer patients. MATERIALS AND METHODS We used a mixed-method approach based on the 'phase I guideline for developing questionnaire modules' by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life group, including a literature review, and interviews with patients (n = 30) and health care providers (HCPs, n = 16). A modified Delphi procedure was carried out to reach consensus on the final subset selected from the complete PRO-CTCAE item library. RESULTS Fourteen multidisciplinary HCPs and 12 patients participated in the Delphi rounds. Ninety percent agreed on the final subset, consisting of: 'ability to achieve and maintain erection', 'decreased libido', 'inability to reach orgasm', 'urinary frequency', 'urinary urgency', 'urinary incontinence', 'painful urination', 'fecal incontinence', 'fatigue', 'hot flashes', 'feeling discouraged', 'sadness', and 'concentration'. From 16 articles identified in the literature review, the following adverse events for which no PRO-CTCAE items are available, were included to the recommendation section: 'nocturia', 'blood and/or mucus in stool', 'hemorrhoids', 'hematuria', 'cystitis', 'neuropathy', and 'proctitis'. CONCLUSIONS The obtained PRO-CTCAE-subset can be used for multidisciplinary adverse event monitoring in prostate cancer care. The described method may guide development of future PRO-CTCAE subsets.
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Affiliation(s)
- E Feldman
- Department for Health Evidence, Radboud University Medical Center, Nijmegen
| | - F J Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam
| | - R J Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen
| | - H van der Poel
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam; Department of Urology, Amsterdam University Medical Centers, Amsterdam
| | - P van Leeuwen
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam
| | - J M de Feijter
- Department of Internal Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam
| | - M Hulshof
- Department of Radiation Oncology, Academical Medical Center, University of Amsterdam, Amsterdam
| | - T Budiharto
- Department of Radiation Oncology, Catharina Hospital, Eindhoven
| | - R Hermens
- Scientific Institute for Quality in Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen
| | - K M de Ligt
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - I Walraven
- Department for Health Evidence, Radboud University Medical Center, Nijmegen.
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Koot A, Soares P, Robenshtok E, Locati LD, de la Fouchardiere C, Luster M, Bongiovanni M, Hermens R, Ottevanger P, Geenen F, Bartѐs B, Rimmele H, Durante C, Nieveen-van Dijkum E, Stalmeier P, Dedecjus M, Netea-Maier R. Position paper from the Endocrine Task Force of the European Organisation for Research and Treatment of Cancer (EORTC) on the management and shared decision making in patients with low-risk micro papillary thyroid carcinoma. Eur J Cancer 2023; 179:98-112. [PMID: 36521335 DOI: 10.1016/j.ejca.2022.11.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
The incidence of differentiated thyroid cancer (DTC) has been increasing worldwide, mostly, as an increase in the incidental detection of micro papillary thyroid carcinomas (microPTCs), many of which are potentially overtreated, as suggested by the unchanged mortality. Several international guidelines have suggested a less aggressive approach. More recently, it has been shown that active surveillance or minimally invasive treatments (MIT) are good alternatives for the management of these patients. In this context, patient participation in the decision-making process is paramount. The Endocrine Task Force of the European Organisation for Research and Treatment of Cancer (EORTC) has undertaken the task to establish consensus and define its position based on the scientific evidence concerning, 1) the current state of diagnostic and management options in microPTCs, including the current opinion of physicians about shared decision making (SDM), 2) the available evidence concerning patients' needs and the available decision instruments, and 3) to provide practical suggestions for implementation of SDM in this context. To improve SDM and patients' participation, knowledge gaps and research directions were highlighted.
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Affiliation(s)
- Anna Koot
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands; Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands.
| | - Paula Soares
- Institute for Research and Innovation in Health - i3S/Institute of Molecular Pathology and Immunology of the University of Porto-IPATIMUP, 4200-135 Porto, Portugal; Faculty of Medicine of the University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
| | - Eyal Robenshtok
- Endocrinology and Metabolism Institute, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Laura D Locati
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Translational Oncology Unit, IRCCS Instituti Clinici Scientifici Maugeri, Pavia, Italy
| | | | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Massimo Bongiovanni
- Internal Medicine Unit, Department of Medicine, Ospedale di Circolo di Rho, ASST Rhodense, Milan, Italy
| | - Rosella Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Petronella Ottevanger
- Department of Internal Medicine, Division of Oncology, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands
| | - Frans Geenen
- Schildklierorganisatie Nederland (SON), the Netherlands
| | | | - Harald Rimmele
- Bundesverband Schilddrüsenkrebs - Ohne Schilddrüse Leben e.V., Germany
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Els Nieveen-van Dijkum
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Cancer Center Amsterdam, the Netherlands
| | - Peep Stalmeier
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Marek Dedecjus
- Department of Endocrine Oncology and Nuclear Medicine, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Romana Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands
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van Bommel M, Bogaerts J, Hermens R, Steenbeek M, de Hullu J, van der Laak J, Simons M. 2022-RA-646-ESGO Consensus based recommendations for the diagnosis of serous tubal intraepithelial carcinoma, an international delphi study. Pathology 2022. [DOI: 10.1136/ijgc-2022-esgo.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Gelderblom M, Piek JM, Briet J, Bullens L, Coppus S, Ebisch I, van Ginkel A, van de Laar R, de Lange N, Ngo H, Maassen M, Oei A, Pijlman B, Slangen B, Smedts D, Vos M, De Hullu J, Hermens R. Evaluation of patient decision aid for opportunistic salpingectomy and salpingectomy as sterilization method to prevent ovarian cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.379] [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
379 Background: The fallopian tubes play an important role in the pathogenesis of epithelial ovarian cancer. This has led to recommendations for performing bilateral salpingectomy as primary prevention of ovarian cancer, the opportunistic salpingectomy (OS). OS has gained territory globally, however with unwanted practice variation. Since all women have the right to be informed on OS, a patient decision aid (PtDA) on OS and salpingectomy as sterilization method has been developed to provide uniform counseling and reduce this practice variation. The aim of this study was to evaluate the effect of the PtDA on the decision-making process. Methods: As part of the STOPOVCA-implementation-study we conducted a multicenter observational prospective study between July 2020 until now. Women who were eligible for OS were invited to use the PtDA while they considered whether or not to undergo OS during gynecological surgery. Evaluation was performed using digital questionnaires regarding their decision, the decision process, and the PtDA. Preliminary. Results: In total 84 women participated to the questionnaire of which 71 used the PtDA. The majority chose to undergo OS (90%). Main reasons for women choosing OS were the risk reducing effect of ovarian cancer and the unnecessary preservation of the fallopian tubes after childbearing. After using the PtDA, from patients perspective the extent to which they were involved in the decision-making process was high, and the decisional conflict low. Patients thought it is a usable aid and recommend other women who face the decision regarding OS to use it with an 8.4 out of 10. Conclusions: The PtDA supports the decision-making on whether or not to undergo OS among patients who have completed childbearing and undergo abdominal gynecological surgery.
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Affiliation(s)
| | - Jurgen M.J. Piek
- Department of Obstetrics and Gynecology, Catharina Cancer Institute, Catharina Hospital, Eindhoven, Netherlands
| | | | | | | | - Inge Ebisch
- Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | | | | | | | - Huy Ngo
- Elkerliek Hospital, Helmond, Netherlands
| | | | | | | | - Brigitte Slangen
- GROW-School for Oncology and Developmental Biology Maastricht University Medical Center, Maastricht, Netherlands
| | | | - M.Caroline Vos
- Department of Obstetrics and Gynecology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Joanne De Hullu
- Radboud Institute for Health Sciences, Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rosella Hermens
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
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Swillens J, Voorham Q, Akkermans RP, Nagtegaal ID, Hermens R. Nationwide implementation of a multifaceted, tailored strategy to improve uptake of standardized structured reporting in oncological pathology: An effect and process evaluation. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.336] [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
336 Background: Implementation strategies improve guideline adherence. Effect and process evaluations are conducted to provide insights into success or failure of implementation strategies. We conducted both evaluations to determine nationwide implementation of standardized structured reporting (SSR) in pathology, to facilitate optimal treatment decisions in oncology care. Methods: We conducted an interrupted time series analysis to evaluate the effect of a fully digital nationwide implementation strategy on SSR use in pathology laboratories. We further conducted a process evaluation to evaluate the exposure to the strategy elements, the experiences of the users with the implementation strategy and remaining barriers of SSR implementation. We also tested whether being exposed to a specific element of the strategy resulted in more increase of average SSR use. Results: There was a significant increase in average SSR use directly after the strategy introduction for reporting of gastrointestinal ( p =.018) and urological ( p =.003) oncological diagnoses. A significant increase was present for all oncological resections as a group ( p =.007). The “Feedback button”, an option within the templates used for standardized structured reporting to provide feedback to the provider and one of the elements of the implementation strategy, was most frequently used by the SSR users and effectiveness results showed that it increased average SSR use after strategy introduction. Remaining barriers most related to rigidity, time consumption and content of SSR. Conclusions: Nationwide SSR implementation improved for specific tumor types and retrieval methods. Next step will be to further improve the use of SSR, and simultaneously, to further develop potential benefits of high SSR use, focusing on re-using discrete pathology data. In this way, we can eventually facilitate proper treatment decisions in oncology.
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Affiliation(s)
- Julie Swillens
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, Netherlands
| | | | - Reinier P. Akkermans
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, Netherlands
| | - Iris D. Nagtegaal
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rosella Hermens
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
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7
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Van den Berg M, Beerendonk C, Kaal S, Mandigers C, Schuurman T, Tol J, Tromp J, Van der Vorst M, Braat D, Hermens R. P-452 Suboptimal quality of integrated female oncofertility care is associated with a lowered quality of life and more decisional conflict and regret in female cancer survivors. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.016] [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: 11/13/2022] Open
Abstract
Abstract
Study question
Is quality of female oncofertility care associated with quality of life, decisional conflict, regret, reproductive concerns, and fertility preservation knowledge in female cancer survivors?
Summary answer
Receiving high-quality integrated female oncofertility care is associated with an improved quality of life, and with less decisional conflict and regret in female cancer survivors.
What is known already
Female adolescent and young adult cancer patients should be informed about their infertility risks due to cancer treatment. However, adherence to oncofertility guidelines is far from optimal. At this moment, it is not known whether adherence to oncofertility guidelines measured with quality indicators is associated with a better quality of life, less decisional conflict, regret, and reproductive concerns in female cancer survivors
Study design, size, duration
A multicenter cross-sectional survey study was conducted to measure the association between quality of oncofertility care and patient-reported outcome measures (PROMs).
Participants/materials, setting, methods
Female AYA cancer survivors (18-40 years) who were diagnosed in 2016 or 2017, and received a (potential) gonadotoxic treatment were eligible to participate. They were recruited from six hospitals across the Netherlands and were asked to fill in a survey. Quality indicators were used to assess quality of care, and validated scales to assess PROMs. Quality indicator and PROM scores were calculated, and associations were analyzed by T-tests and multilevel multivariate analyses
Main results and the role of chance
In total, 121 out of 344 female cancer survivors participated. Female cancer survivors received a suboptimal quality of care with 8 out of 11 quality indicators scoring <90% adherence. Of all patients, 72,7% was informed about their infertility, 51,2% was offered a referral, with 18,8% all aspects were discussed in counselling, and 35,5% received written and/or digital information. When survivors were informed about infertility risks, and were offered fertility preservation counseling, and received digital/written information (i.e. adherence to three quality indicators), their quality of life was highest, and levels of decisional conflict and regret were lowest. Physical quality of life, decision regret, reproductive concerns, and fertility preservation knowledge scores were significantly influenced by female cancer survivor’s age, relationship status, strength of wish to conceive, and type of cancer.
Limitations, reasons for caution
Selection bias could have occurred as we have no insight into reasons for non-responding and we have a low response rate. Furthermore, recall bias could have played a role as patients were asked to fill in questions three to four years after their diagnosis, treatment, and consultation.
Wider implications of the findings
As quality of oncofertility care is suboptimal, strategies should be developed and tailored to the current gaps, and to guideline-specific barriers, to improve quality of care and, importantly, quality of life in female cancer survivors.
Trial registration number
N/A
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Affiliation(s)
- M Van den Berg
- Radboud university medical center, Obstetrics and Gynaecology , Nijmegen, The Netherlands
| | - C Beerendonk
- Radboud university medical center, Obstetrics and Gynaecology , Nijmegen, The Netherlands
| | - S Kaal
- Radboud university medical center, Medical Oncology , Nijmegen, The Netherlands
| | - C Mandigers
- Canisius-Wilhelmina Hospital, Medical Oncology , Nijmegen, The Netherlands
| | - T Schuurman
- The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Center for Gynecologic Oncology Amsterdam , Amsterdam, The Netherlands
| | - J Tol
- Jeroen Bosch Hospital, Medical Oncology , Den Bosch, The Netherlands
| | - J Tromp
- Amsterdam University Medical Center, Medical Oncology , Amsterdam, The Netherlands
| | - M Van der Vorst
- Rijnstate Hospital, Medical Oncology , Arnhem, The Netherlands
| | - D Braat
- Radboud university medical center, Obstetrics and Gynaecology , Nijmegen, The Netherlands
| | - R Hermens
- Radboud university medical center, IQ Healthcare , Nijmegen, The Netherlands
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8
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Koppes DM, van Hees MSF, Koenders VM, Oudijk MA, Bekker MN, Franssen MTM, Smits LJ, Hermens R, van Kuijk SMJ, Scheepers HC. Nationwide implementation of a decision aid on vaginal birth after cesarean: a before and after cohort study. J Perinat Med 2021; 49:783-790. [PMID: 34049425 DOI: 10.1515/jpm-2021-0007] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/26/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Woman with a history of a previous cesarean section (CS) can choose between an elective repeat CS (ERCS) and a trial of labor (TOL), which can end in a vaginal birth after cesarean (VBAC) or an unplanned CS. Guidelines describe women's rights to make an informed decision between an ERCS or a TOL. However, the rates of TOL and vaginal birth after CS varies greatly between and within countries. The objective of this study is to asses nation-wide implementation of counselling with a decision aid (DA) including a prediction model, on intended delivery compared to care as usual. We hypothesize that this may result in a reduction in practice variation without an increase in cesarean rates or complications. METHODS In a multicenter controlled before and after cohort study we evaluate the effect of nation-wide implementation of a DA. Practice variation was defined as the standard deviation (SD) of TOL percentages. RESULTS A total of 27 hospitals and 1,364 women were included. A significant decrease was found in practice variation (SD TOL rates: 0.17 control group vs. 0.10 intervention group following decision aid implementation, p=0.011). There was no significant difference in the ERCS rate or overall CS rates. A 21% reduction in the combined maternal and perinatal adverse outcomes was seen. CONCLUSIONS Nationwide implementation of the DA showed a significant reduction in practice variation without an increase in the rate of cesarean section or complications, suggesting an improvement in equality of care.
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Affiliation(s)
- Dorothea M Koppes
- Department of Obstetrics and Gynecology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Obstetrics and Gynecology, GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Merel S F van Hees
- Department of Obstetrics and Gynecology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Obstetrics and Gynecology, GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | | | - Martijn A Oudijk
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maureen T M Franssen
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Luc J Smits
- Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Rosella Hermens
- Scientific Centre for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Hubertina C Scheepers
- Department of Obstetrics and Gynecology, Maastricht University Medical Center+, Maastricht, The Netherlands
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9
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Van Den Bulck S, Spitaels D, Vaes B, Goderis G, Hermens R, Vankrunkelsven P. The effect of electronic audits and feedback in primary care and factors that contribute to their effectiveness: a systematic review. Int J Qual Health Care 2021; 32:708-720. [PMID: 33057648 DOI: 10.1093/intqhc/mzaa128] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/21/2020] [Accepted: 10/06/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The aim of this systematic review was (i) to assess whether electronic audit and feedback (A&F) is effective in primary care and (ii) to evaluate important features concerning content and delivery of the feedback in primary care, including the use of benchmarks, the frequency of feedback, the cognitive load of feedback and the evidence-based aspects of the feedback. DATA SOURCES The MEDLINE, Embase, CINAHL and CENTRAL databases were searched for articles published since 2010 by replicating the search strategy used in the last Cochrane review on A&F. STUDY SELECTION Two independent reviewers assessed the records for their eligibility, performed the data extraction and evaluated the risk of bias. Our search resulted in 8744 records, including the 140 randomized controlled trials (RCTs) from the last Cochrane Review. The full texts of 431 articles were assessed to determine their eligibility. Finally, 29 articles were included. DATA EXTRACTION Two independent reviewers extracted standard data, data on the effectiveness and outcomes of the interventions, data on the kind of electronic feedback (static versus interactive) and data on the aforementioned feedback features. RESULTS OF DATA SYNTHESIS Twenty-two studies (76%) showed that electronic A&F was effective. All interventions targeting medication safety, preventive medicine, cholesterol management and depression showed an effect. Approximately 70% of the included studies used benchmarks and high-quality evidence in the content of the feedback. In almost half of the studies, the cognitive load of feedback was not reported. Due to high heterogeneity in the results, no meta-analysis was performed. CONCLUSION This systematic review included 29 articles examining electronic A&F interventions in primary care, and 76% of the interventions were effective. Our findings suggest electronic A&F is effective in primary care for different conditions such as medication safety and preventive medicine. Some of the benefits of electronic A&F include its scalability and the potential to be cost effective. The use of benchmarks as comparators and feedback based on high-quality evidence are widely used and important features of electronic feedback in primary care. However, other important features such as the cognitive load of feedback and the frequency of feedback provision are poorly described in the design of many electronic A&F intervention, indicating that a better description or implementation of these features is needed. Developing a framework or methodology for automated A&F interventions in primary care could be useful for future research.
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Affiliation(s)
- Steve Van Den Bulck
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok J, 3000, Leuven, Belgium
| | - David Spitaels
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok J, 3000, Leuven, Belgium
| | - Bert Vaes
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok J, 3000, Leuven, Belgium
| | - Geert Goderis
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok J, 3000, Leuven, Belgium
| | - Rosella Hermens
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok J, 3000, Leuven, Belgium.,Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Science (RIHS), Radboud University Medical Center, Radboud University Nijmegen, PO Box 9101, Nijmegen, 6500, HB, The Netherlands
| | - Patrik Vankrunkelsven
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok J, 3000, Leuven, Belgium
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Koot A, Netea-Maier R, Ottevanger P, Hermens R, Stalmeier P. Needs, Preferences, and Values during Different Treatment Decisions of Patients with Differentiated Thyroid Cancer. J Pers Med 2021; 11:jpm11070682. [PMID: 34357149 PMCID: PMC8304194 DOI: 10.3390/jpm11070682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/07/2021] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The purpose of this study was to identify the needs, preferences, and values of patients with differentiated thyroid cancer (DTC) and the physicians treating patients with DTC regarding two different treatment decisions, namely: the extent of primary surgery (low-risk patients) and the tyrosine kinase inhibitor (TKI) treatment (high-risk patients). Methods: A qualitative study was conducted. There were two physician focus groups discussing the extent of primary surgery. One included endocrinologists (n = 4) and surgeons (n = 5), and the other included nuclear medicine physicians (n = 3) treating patients with low-risk DTC. The physicians focus group discussing waiting or starting TKIs included endocrinologists (n = 2) and oncologists (n = 5) treating patients with advanced radioactive iodide (RAI) refractory DTC. Moreover, one patient focus group per treatment decision took place. In total 13 patients and 19 physicians participated. Interviews were audio-taped, fully transcribed verbatim, and analyzed. Results: Several themes were identified. Patients, but not physicians, mentioned the importance of a strong doctor–patient relationship. Patients in both treatment decision groups wanted to receive more detailed information, whereas physicians preferred providing more general information. Patients in the TKI decision group focused on palliative care, whereas physicians focused more on the effect and benefit of TKIs. Conclusions: Considering the identified themes in DTC, based on the patients’ needs, preferences, and values, enables us to improve doctor–patient communication and to develop decision support tools.
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Affiliation(s)
- Anna Koot
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
- Correspondence: ; Tel.: +31-651637081
| | - Romana Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Petronella Ottevanger
- Department of Internal Medicine, Division of Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Rosella Hermens
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Peep Stalmeier
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
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Van den Bulck S, De Burghgraeve T, Raat W, Mamouris P, Coursier P, Vankrunkelsven P, Goderis G, Hermens R, Van Pottelbergh G, Vaes B. The effect of automated audit and feedback on data completeness in the electronic health record of the general physician: protocol for a cluster randomized controlled trial. Trials 2021; 22:325. [PMID: 33947448 PMCID: PMC8097814 DOI: 10.1186/s13063-021-05259-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/20/2020] [Accepted: 04/10/2021] [Indexed: 12/12/2022] Open
Abstract
Background The electronic health record (EHR) of the general physician (GP) is an important tool that can be used to assess and improve the quality of healthcare. However, there are some problems when (re) using the data gathered in the EHR for quality assessments. One problem is the lack of data completeness in the EHR. Audit and feedback (A&F) is a well-known quality intervention that can improve the quality of healthcare. We hypothesize that an automated A&F intervention can be adapted to improve the data completeness of the EHR of the GP, more specifically, the number of correctly registered diagnoses of type 2 diabetes and chronic kidney disease. Methods This study is a pragmatic cluster randomized controlled trial with an intervention at the level of GP practice. The intervention consists of an audit and extended electronically delivered feedback with multiple components that will be delivered 4 times electronically to general practices over 12 months. The data will be analyzed on an aggregated level (per GP practice). The primary outcome is the percentage of correctly registered diagnoses of type 2 diabetes. The key secondary outcome is the registration of chronic kidney disease. Exploratory secondary outcomes are the registration of heart failure, biometric data and lifestyle habits, and the evolution of 4 different EHR-extractable quality indicators. Discussion This cluster randomized controlled trial intends to primarily improve the registration of type 2 diabetes in the EHR of the GP and to secondarily improve the registration of chronic kidney disease. In addition, the registration of heart failure, lifestyle parameters, and biometric data in the EHR of the GP are explored together with 4 EHR-extractable quality indicators. By doing so, this study aims to improve the data completeness of the EHR, paving the way for future quality assessments. Trial registration ClinicalTrials.gov NCT04388228. Registered on May 14, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05259-9.
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Affiliation(s)
- Steve Van den Bulck
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium.
| | - Tine De Burghgraeve
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | - Willem Raat
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | - Pavlos Mamouris
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | - Patrick Coursier
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | - Patrik Vankrunkelsven
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | - Geert Goderis
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | - Rosella Hermens
- IQ Healthcare, Radboud University Medical Center Nijmegen, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Gijs Van Pottelbergh
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | - Bert Vaes
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
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Bojoga A, Koot A, Bonenkamp J, de Wilt J, IntHout J, Stalmeier P, Hermens R, Smit J, Ottevanger P, Netea-Maier R. The Impact of the Extent of Surgery on the Long-Term Outcomes of Patients with Low-Risk Differentiated Non-Medullary Thyroid Cancer: A Systematic Meta-Analysis. J Clin Med 2020; 9:jcm9072316. [PMID: 32708218 PMCID: PMC7408649 DOI: 10.3390/jcm9072316] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/10/2020] [Indexed: 12/15/2022] Open
Abstract
Recently, the management of patients with low-risk differentiated non-medullary thyroid cancer (DTC), including papillary and follicular thyroid carcinoma subtypes, has been critically appraised, questioning whether these patients might be overtreated without a clear clinical benefit. The American Thyroid Association (ATA) guideline suggests that thyroid lobectomy (TL) could be a safe alternative for total thyroidectomy (TT) in patients with DTC up to 4 cm limited to the thyroid, without metastases. We conducted a meta-analysis to assess the clinical outcomes in patients with low-risk DTC based on the extent of surgery. The risk ratio (RR) of recurrence rate, overall survival (OS), disease-free survival (DFS) and disease specific survival (DSS) were estimated. In total 16 studies with 175,430 patients met the inclusion criteria. Overall, low recurrence rates were observed for both TL and TT groups (7 vs. 7%, RR 1.10, 95% CI 0.61-1.96, I2 = 72%), and no statistically significant differences for OS (TL 94.1 vs. TT 94.4%, RR 0.99, CI 0.99-1.00, I2 = 53%), DFS (TL 87 vs. TT 91%, RR 0.96, CI 0.89-1.03, I2 = 85%), and DSS (TL 97.2 vs. TT 95.4%, RR 1.01, CI 1.00-1.01, I2 = 74%). The high degree of heterogeneity of the studies is a notable limitation. Conservative management and appropriate follow-up instead of bilateral surgery would be justifiable in selected patients. These findings highlight the importance of shared-decision making in the management of patients with small, low-risk DTC.
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Affiliation(s)
- Andreea Bojoga
- National Institute of Endocrinology “C.I. Parhon”, 011863 Bucharest, Romania;
| | - Anna Koot
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (J.I.); (P.S.)
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.S.); (R.N.-M.)
- Correspondence: ; Tel.: +31-651-637-081
| | - Johannes Bonenkamp
- Department of Surgical Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.B.); (J.d.W.)
| | - Johannes de Wilt
- Department of Surgical Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.B.); (J.d.W.)
| | - Joanna IntHout
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (J.I.); (P.S.)
| | - Peep Stalmeier
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (J.I.); (P.S.)
| | - Rosella Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Johannes Smit
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.S.); (R.N.-M.)
| | - Petronella Ottevanger
- Department of Internal Medicine, Division of Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Romana Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.S.); (R.N.-M.)
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Van den Bulck SA, Vankrunkelsven P, Goderis G, Van Pottelbergh G, Swerts J, Panis K, Hermens R. Developing quality indicators for Chronic Kidney Disease in primary care, extractable from the Electronic Medical Record. A Rand-modified Delphi method. BMC Nephrol 2020; 21:161. [PMID: 32370742 PMCID: PMC7201612 DOI: 10.1186/s12882-020-01788-8] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common chronic condition and a rising public health issue with increased morbidity and mortality, even at an early stage. Primary care has a pivotal role in the early detection and in the integrated management of CKD which should be of high quality. The quality of care for CKD can be assessed using quality indicators (QIs) and if these QIs are extractable from the electronic medical record (EMR) of the general physician, the number of patients whose quality of care can be evaluated, could increase vastly. Therefore the aim of this study is to develop QIs which are evidence based, EMR extractable and which can be used as a framework to automate quality assessment. METHODS We used a Rand-modified Delphi method to develop QIs for CKD in primary care. A questionnaire was designed by extracting recommendations from international guidelines based on the SMART principle and the EMR extractability. A multidisciplinary expert panel, including patients, individually scored the recommendations for measuring high quality care on a 9-point Likert scale. The results were analyzed based on the median Likert score, prioritization and agreement. Subsequently, the recommendations were discussed in a consensus meeting for their in- or exclusion. After a final appraisal by the panel members this resulted in a core set of recommendations, which were then transformed into QIs. RESULTS A questionnaire composed of 99 recommendations was extracted from 10 international guidelines. The consensus meeting resulted in a core set of 36 recommendations that were translated into 36 QIs. This final set consists of QIs concerning definition & classification, screening, diagnosis, management consisting of follow up, treatment & vaccination, medication & patient safety and referral to a specialist. It were mostly the patients participating in the panel who stressed the importance of the QIs concerning medication & patient safety and a timely referral to a specialist. CONCLUSION This study provides a set of 36 EMR extractable QIs for measuring the quality of primary care for CKD. These QIs can be used as a framework to automate quality assessment for CKD in primary care.
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Affiliation(s)
- Steve A Van den Bulck
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium.
| | - Patrik Vankrunkelsven
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | - Geert Goderis
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | - Gijs Van Pottelbergh
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | - Jonathan Swerts
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | - Karolien Panis
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | - Rosella Hermens
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
- Radboud Institute for Health Sciences, Scientific Institute for Quality in Healthcare, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
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Van den Bulck SA, Vankrunkelsven P, Goderis G, Broekx L, Dreesen K, Ruijten L, Mpoukouvalas D, Hermens R. Development of quality indicators for type 2 diabetes, extractable from the electronic health record of the general physician. A rand-modified Delphi method. Prim Care Diabetes 2020; 14:75-84. [PMID: 31204263 DOI: 10.1016/j.pcd.2019.05.002] [Citation(s) in RCA: 4] [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: 03/14/2019] [Revised: 05/01/2019] [Accepted: 05/12/2019] [Indexed: 11/17/2022]
Abstract
AIMS Type 2 diabetes mellitus is a worldwide cause of significant morbidity and mortality. The general physician (GP) plays an important role in managing this disease and the use of the electronic health record (EHR) can improve quality for type 2 diabetes care. We aimed to develop a set of evidence-based and EHR extractable quality indicators for type 2 diabetes, enabling an automated quality assessment. METHODS We used a Rand-modified Delphi method. Recommendations were selected from (inter)national guidelines using the 'SMART' principle and scored by a multidisciplinary expert panel. After analysis of the median score, prioritization and consensus, recommendations were discussed during a consensus meeting. A final validation round resulted in a core set of recommendations, which were transformed into quality indicators. RESULTS A total of 101 recommendations originating from 10 (inter)national guidelines were presented to the expert panel, which resulted in a core set of 50 recommendations that were merged and modified into 36 recommendations after the consensus meeting. The panel added 3 recommendations. This resulted in a final set of 39 quality indicators. CONCLUSIONS Our study presents a set of 39 quality indicators for type 2 diabetes in primary care that are EHR extractable, enabling automated quality assessment.
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Affiliation(s)
- Steve A Van den Bulck
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Patrik Vankrunkelsven
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Geert Goderis
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Lien Broekx
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Kathleen Dreesen
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Laura Ruijten
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Dimitri Mpoukouvalas
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Rosella Hermens
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Scientific Institute for Quality in Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
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Abstract
OBJECTIVES The present study investigated (1) trends in the prevalence and incidence of knee osteoarthritis over a 20-year period (1996-2015); (2) trends in multimorbidity and (3) trends in drug prescriptions. DESIGN Registry-based study. SETTING Primary healthcare, Flanders, Belgium. PARTICIPANTS Data were collected from Intego, a general practice-based morbidity registration network. In the study period between 1996 and 2015, data from 440 140 unique patients were available. OUTCOME MEASURES Trends in prevalence and incidence rate of knee osteoarthritis were computed using joinpoint regression analysis. The mean disease count was calculated to assess trends in multimorbidity. In addition, the number of drug prescriptions was identified by the Anatomical Therapeutic Chemical Classification code and trends were equally recorded with joinpoint regression. RESULTS The total age-standardised prevalence of knee osteoarthritis increased from 2.0% in 1996 to 3.6% in 2015. An upward trend was observed with an average annual percentage change (AAPC) of 2.5 (95% CI 2.2 to 2.9). In 2015, the prevalence rates in the 10 year age groups from the 45-54 years age group onwards were 3.1%, 5.6%, 9.0% and 13.9%, to reach 15.0% in people aged 85 years and older. The incidence remained stable with 3.75‰ in 2015 (AAPC=-0.5, 95% CI -1.4 to 0.5). The mean disease count significantly increased from 1.63 to 2.34 (p<0.001) for incident cases with knee osteoarthritis. Finally, we observed a significantly positive trend in the overall prescription of acetaminophen (AAPC=6.7, 95% CI 5.6 to 7.7), weak opioids (AAPC=4.0, 95% CI 0.9 to 7.3) and glucosamine (AAPC=8.6, 95% CI 2.4 to 15.1). Oral non-steroidal anti-inflammatory drugs were most prescribed, with a prevalence rate of 29.8% in 2015, but remained stable during the study period (AAPC=0.0, 95% CI -1.1 to 1.1). CONCLUSIONS Increased prevalence, multimorbidity, and number of drug prescriptions confirm an increased burden of knee osteoarthritis. In future, these trends can be used to prioritise initiatives for improvement in care.
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Affiliation(s)
- David Spitaels
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Pavlos Mamouris
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
- Louvain Drug Research Institute, Universite catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Miek Smeets
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Frank Luyten
- Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Rosella Hermens
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
- Radboud Institute for Health Sciences (RIHS), Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, Netherlands
| | - Patrik Vankrunkelsven
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
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Vankan E, Schoorel E, van Kuijk S, Nijhuis J, Hermens R, Scheepers H. The effect of the use of a decision aid with individual risk estimation on the mode of delivery after a caesarean section: A prospective cohort study. PLoS One 2019; 14:e0222499. [PMID: 31557177 PMCID: PMC6763212 DOI: 10.1371/journal.pone.0222499] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/20/2019] [Indexed: 11/19/2022] Open
Abstract
Objective After one previous caesarean section (CS), pregnant women can deliver by elective repeat CS or have a trial of labor which can end in a vaginal birth after caesarean (VBAC) or an unplanned CS. Despite guidelines describing women’s rights to make an informed choice, trial of labor and VBAC rates vary greatly worldwide. Many women are inadequately informed due to caregivers’ fear of an increase in CS rates in a high VBAC rate setting. We compared counseling with a decision aid (DA) including a prediction model on VBAC to care as usual. We hypothesize that counselling with the DA does not decrease VBAC rates. In addition, we aimed to study the effects on unplanned CS rate, patient involvement in decision-making and elective repeat CS rates. Methods We performed a prospective cohort study. From 2012 to 2014, 483 women in six hospitals, where the DA was used (intervention group), were compared with 441 women in six matched hospitals (control group). Women with one previous CS, pregnant of a singleton in cephalic presentation, delivering after 37 weeks 0 days were eligible for inclusion. Results There was no significant difference in VBAC rates between the intervention (45%) and control group (46%) (adjusted odds ratio 0,92 (95% Confidence interval 0.69–1.23)). In the intervention group more women (42%) chose an elective repeat CS compared to the control group (31%) (adjusted odds ratio 1.6 (95% Confidence interval 1.18–2.17)). Of women choosing trial of labor, in the intervention group 77% delivered vaginally compared to 67% in the control group, resulting in an unplanned CS adjusted odds ratio of 0,57 (0.40–0.82) in the intervention group. In the intervention group, more women reported to be involved in decision-making (98% vs. 68%, P< 0.001). Conclusions Implementing a decision aid with a prediction model for risk selection suggests unchanged VBAC rates, but 40% reduction in unplanned CS rates, increase in elective repeat CS and improved patient involvement in decision-making.
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Affiliation(s)
- Emy Vankan
- GROW-School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- * E-mail:
| | - Ellen Schoorel
- GROW-School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jan Nijhuis
- GROW-School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rosella Hermens
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Hubertina Scheepers
- GROW-School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Hermens R, Swillens JEM, Voorham R, Nagtegaal ID. Improving implementation of standardized structured reporting: Development of an implementation toolkit. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.265] [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
265 Background: Although standardized structured reporting (SSR) usage is recommended in national and international evidence-based guidelines (warranting quality & safety), actual use varies widely in oncology related medical disciplines. Previous research showed multiple impeding factors regarding SSR-implementation. The aim of this study is to develop an implementation toolkit, based on the impeding factors found. Methods: We organized an expert meeting a. to explore experts’ opinions on the impeding factors found in a previous study; and b. to discuss possibilities for a tailored implementation toolkit. The expert-panel consisted of three pathologists, three multidisciplinary-team (MDT) members, three patient organization delegates, two delegates of the Dutch nationwide network and registry of histo- and cytopathology(PALGA), two delegates of the Netherlands Comprehensive Cancer Organization (IKNL), one PALGA-liaison, and one implementation expert. A literature study was performed to obtain evidence on the most effective implementation tools. All selected tools were included in an implementation toolkit. Results: The expert meeting and literature study yielded eight tools to be developed: 1. Two communication tools of both the benefits of SSR and of the development and updates of SSR-templates; 2. Consultation and simulation sessions with MDT-members to optimize the development and feedback process of the standardized structured reports and to increase familiarity with these reports; 3. A tailored e-learning for pathologists to increase the familiarity, knowledge and skills of SSR-usage; 4. IT-solutions, such as incorporation of speech recognition to improve the usability and content of both the SSR templates and the generated reports; 5. A sustainable feedback-system to support SSR-template usage; 6. Agenda setting success to encourage use of SSR. Conclusions: Experts proposed several tools to improve the implementation of SSR. The next step is to test this toolkit in a pilot study.
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Affiliation(s)
- Rosella Hermens
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - Julie Elisa Maria Swillens
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - Rinus Voorham
- PALGA Foundation, Houten, The Netherlands, Houten, Netherlands
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Swillens JEM, Voorham R, Nagtegaal ID, Hermens R. Improving interdisciplinary communication in MDT-meetings: Identification of barriers and facilitators in nationwide implementation of standardized structured reporting. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.321] [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
321 Background: Standardized structured reporting (SSR) improves quality of diagnostic reporting for cancer patients, resulting in improved interdisciplinary communication in multidisciplinary-team meetings (MTMs) and subsequently better health outcomes and patient safety. In addition, SSR is important to secondary users including (tumor) registry organizations. Nevertheless, SSR-template usage, for example in pathology, varies widely among oncology related medical disciplines. Because of the advantages during MTMs, multidisciplinary-team (MDT) members could play an important role in encouraging and supporting pathologists to use SSR-templates. Therefore, the objective is to identify both barriers and facilitators for SSR-implementation from a MDT-member perspective. Methods: We used a mixed method design. Four focus group interviews with MDT-members, operating in the field of urological, gynecological or gastrointestinal oncology were performed, to identify barriers and facilitators in SSR in relation to the MTMs. Findings were classified into the domains of Flottorp et al. (2013). We used a web-based survey among Dutch MDT-members to quantify the findings. Results: Twenty-three MDT-members of nine medical disciplines participated in the focus group interviews. The survey yielded 211 responses. Main barriers of SSR among MDT-members were lack of information in the standardized structured report, particularly lack of information to retrieve doubts of the pathologist (56%, n = 211); lack of nuances (39%, n = 184); and lack of transparency on development of SSR-templates (50%, n = 211). Pathologists (59%, n = 54) also mentioned the numerous clicking when using SSR-templates as a barrier. Main facilitator was to expand the recommendation of SSR-usage in national guidelines (81%, n = 174). Conclusions: Although the use of SSR by multiple disciplines has benefits, as diagnostic reports are more complete, this study shows important barriers that have to be dealt with in the implementation process of SSR. The next step is to use the barriers for developing and testing implementation tools to encourage SSR-implementation.
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Affiliation(s)
- Julie Elisa Maria Swillens
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - Rinus Voorham
- PALGA Foundation, Houten, The Netherlands, Houten, Netherlands
| | | | - Rosella Hermens
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
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Geurtzen R, van Heijst A, Draaisma J, Ouwerkerk L, Scheepers H, Hogeveen M, Hermens R. Prenatal counseling in extreme prematurity - Insight into preferences from experienced parents. Patient Educ Couns 2019; 102:1541-1549. [PMID: 30948203 DOI: 10.1016/j.pec.2019.03.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 09/05/2018] [Revised: 03/19/2019] [Accepted: 03/22/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE In-depth analysis of parental preferences in prenatal counseling in extreme prematurity. METHODS A nationwide qualitative interview study among experienced parents of extremely premature babies born at 24+0/7 - 24+6/7 weeks of gestation. Semi-structured interviews were held until saturation, transcribed and qualitatively analyzed to search for parental counseling preferences. RESULTS Thirteen parents were included, most parents decided on active care. Organisation: Parents wanted counseling as soon as possible, and for various reasons they wanted more than one conversation. Supportive material to help visualize complex information was suggested to be helpful, preferably with adjustable levels of detail. An empathetic, honest style with commitment of the counselor was regarded important. CONTENT Understandable statistics should be used for those who want it. Parents needed different information with respect to the decision-making as opposed to being prepared for future situations. Decision-making: The preferred share of parents' and doctors' input in decision-making varied among parents and among situations. Parents expressed that their roles were to take responsibility for and protect their infant. CONCLUSIONS Various parental preferences for prenatal counseling were found. PRACTICE IMPLICATIONS Common parental preferences for the organisation, content and decision-making elements can provide a starting point for personalized prenatal counseling.
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Affiliation(s)
- Rosa Geurtzen
- Amalia Children's Hospital, Radboud university medical center, Nijmegen, the Netherlands.
| | - Arno van Heijst
- Amalia Children's Hospital, Radboud university medical center, Nijmegen, the Netherlands
| | - Jos Draaisma
- Amalia Children's Hospital, Radboud university medical center, Nijmegen, the Netherlands
| | - Laura Ouwerkerk
- Amalia Children's Hospital, Radboud university medical center, Nijmegen, the Netherlands
| | | | - Marije Hogeveen
- Amalia Children's Hospital, Radboud university medical center, Nijmegen, the Netherlands
| | - Rosella Hermens
- Scientific Institute for Quality of Care, Radboud university medical center, Nijmegen, the Netherlands
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Geurtzen MR, Van Heijst A, Hermens R, Scheepers H, Woiski M, Draaisma J, Hogeveen M. Correction to: Preferred prenatal counselling at the limits of viability: a survey among Dutch perinatal professionals. BMC Pregnancy Childbirth 2018; 18:54. [PMID: 29458341 PMCID: PMC5817849 DOI: 10.1186/s12884-018-1680-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 11/21/2022] Open
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Geurtzen R, Draaisma J, Hermens R, Scheepers H, Woiski M, van Heijst A, Hogeveen M. Various experiences and preferences of Dutch parents in prenatal counseling in extreme prematurity. Patient Educ Couns 2018; 101:2179-2185. [PMID: 30029812 DOI: 10.1016/j.pec.2018.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 03/09/2018] [Revised: 05/28/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate experienced and preferred prenatal counseling among parents of extremely premature babies. METHODS A Dutch nationwide, multicenter, cross-sectional study using an online survey. Surveys were sent to all parents of extremely premature babies born between 2010 and 2013 at 24+0/7-24+6/7 weeks of gestation. RESULTS Sixty-one out of 229 surveys were returned. A minority (14%) had no counseling conversation. Conversations were done more often by neonatologists (90%) than by obstetricians (39%) and in 37% by both these experts. Supportive material was rarely used (19%). Mortality (92%) and short-term morbidity (88%) were discussed the most, and more frequently than long-term morbidity (65%), practical items (63%) and delivery mode (52%). Most decisions on active care or palliative comfort care were perceived as decisions by doctor and parents together (61%). 80% felt they were involved in decision-making. The preferred way of involvement in decision-making varied among parents. CONCLUSION The vast majority of parents were counseled: mostly by neonatologists, and mainly about mortality and short-term morbidity. Parents wanted to be involved in the decision-making process but differed on the preferred extent of involvement. Practice implications Understanding of shared decision-making may contribute to meet the various preferences of parents.
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Affiliation(s)
- Rosa Geurtzen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Department of Pediatrics, Nijmegen, The Netherlands.
| | - Jos Draaisma
- Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Department of Pediatrics, Nijmegen, The Netherlands
| | - Rosella Hermens
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of IQ Healthcare, Nijmegen, The Netherlands
| | | | - Mallory Woiski
- Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Department of Gynecology, Nijmegen, The Netherlands
| | - Arno van Heijst
- Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Department of Pediatrics, Nijmegen, The Netherlands
| | - Marije Hogeveen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Department of Pediatrics, Nijmegen, The Netherlands
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Van den Bulck SA, Hermens R, Slegers K, Vandenberghe B, Goderis G, Vankrunkelsven P. Designing a Patient Portal for Patient-Centered Care: Cross-Sectional Survey. J Med Internet Res 2018; 20:e269. [PMID: 30287416 PMCID: PMC6231862 DOI: 10.2196/jmir.9497] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 11/26/2017] [Revised: 05/09/2018] [Accepted: 06/29/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In recent literature, patient portals are considered as important tools for the delivery of patient-centered care. To date, it is not clear how patients would conceptualize a patient portal and which health information needs they have when doing so. OBJECTIVE This study aimed (1) to investigate health information needs, expectations, and attitudes toward a patient portal and (2) to assess whether determinants, such as patient characteristics, health literacy, and empowerment status, can predict two different variables, namely the importance people attribute to obtaining health information when using a patient portal and the expectations concerning personal health care when using a patient portal. METHODS We conducted a cross-sectional survey of the Flemish population on what patients prefer to know about their digital health data and their expectations and attitudes toward using a patient portal to access their electronic health record. People were invited to participate in the survey through newsletters, social media, and magazines. We used a questionnaire including demographics, health characteristics, health literacy, patient empowerment, and patient portal characteristics. RESULTS We received 433 completed surveys. The health information needs included features such as being notified when one's health changes (371/396, 93.7%), being notified when physical parameters increase to dangerous levels (370/395, 93.7%), observing connections between one's symptoms or diseases or biological parameters (339/398, 85.2%), viewing the evolution of one's health in function of time (333/394, 84.5%), and viewing information about the expected effect of treatment (349/395, 88.4%). Almost 90% (369/412) of respondents were interested in using a patient portal. Determinants of patients' attachment for obtaining health information on a patient portal were (1) age between 45 and 54 years (P=.05); (2) neutral (P=.03) or interested attitude (P=.008) toward shared decision making; and (3) commitment to question physicians' decisions (P=.03, R2=0.122). Determinants of patients' expectations on improved health care by accessing a patient portal were (1) lower education level (P=.04); (2) neutral (P=.03) or interested attitude (P=.008) toward shared decision making; and (3) problems in understanding health information (P=.04; R2=0.106). CONCLUSIONS The interest in using a patient portal is considerable in Flanders. People would like to receive alerts or some form of communication from a patient portal in case they need to act to manage their health. Determinants such as education, attached importance to shared decision making, difficulties in finding relevant health information, and the attached importance in questioning the decisions of physicians need to be considered in the design of a patient portal.
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Affiliation(s)
- Steve Alfons Van den Bulck
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Rosella Hermens
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Scientific Institute for Quality in Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Karin Slegers
- Meaningful Interactions Lab, Imec, KU Leuven, Leuven, Belgium
| | | | - Geert Goderis
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Patrik Vankrunkelsven
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Geurtzen R, Van Heijst A, Hermens R, Scheepers H, Woiski M, Draaisma J, Hogeveen M. Preferred prenatal counselling at the limits of viability: a survey among Dutch perinatal professionals. BMC Pregnancy Childbirth 2018; 18:7. [PMID: 29298669 PMCID: PMC5751814 DOI: 10.1186/s12884-017-1644-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 05/31/2016] [Accepted: 12/21/2017] [Indexed: 01/10/2023] Open
Abstract
Background Since 2010, intensive care can be offered in the Netherlands at 24+0 weeks gestation (with parental consent) but the Dutch guideline lacks recommendations on organization, content and preferred decision-making of the counselling. Our aim is to explore preferred prenatal counselling at the limits of viability by Dutch perinatal professionals and compare this to current care. Methods Online nationwide survey as part of the PreCo study (2013) amongst obstetricians and neonatologists in all Dutch level III perinatal care centers (n = 205).The survey regarded prenatal counselling at the limits of viability and focused on the domains of organization, content and decision-making in both current and preferred practice. Results One hundred twenty-two surveys were returned out of 205 eligible professionals (response rate 60%). Organization-wise: more than 80% of all professionals preferred (but currently missed) having protocols for several aspects of counselling, joint counselling by both neonatologist and obstetrician, and the use of supportive materials. Most professionals preferred using national or local data (70%) on outcome statistics for the counselling content, in contrast to the international statistics currently used (74%). Current decisions on initiation care were mostly made together (in 99% parents and doctor). This shared decision model was preferred by 95% of the professionals. Conclusions Dutch perinatal professionals would prefer more protocolized counselling, joint counselling, supportive material and local outcome statistics. Further studies on both barriers to perform adequate counselling, as well as on Dutch outcome statistics and parents’ opinions are needed in order to develop a national framework. Trial registration Clinicaltrials.gov, NCT02782650, retrospectively registered May 2016. Electronic supplementary material The online version of this article (10.1186/s12884-017-1644-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Geurtzen
- Amalia Children's Hospital, Department of Pediatrics, Radboud university Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands.
| | - Arno Van Heijst
- Amalia Children's Hospital, Department of Pediatrics, Radboud university Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Rosella Hermens
- Scientific Institute for Quality of Care, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Mallory Woiski
- Amalia Children's Hospital, Department of Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos Draaisma
- Amalia Children's Hospital, Department of Pediatrics, Radboud university Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Marije Hogeveen
- Amalia Children's Hospital, Department of Pediatrics, Radboud university Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
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Abstract
116 Background: Optimal follow-up care for head and neck cancer (HCN) patients has been subject of an ongoing debate. In the Netherlands, the current follow-up schedule is based on a ‘one-size fits all’ concept, and lacks evidence. Additionally, this standardized follow-up fails to reflect the heterogeneity of tumors within HNC. Besides the need of more evidence, improvements should be made by using a more person-centred approach. In this study, we aimed to explore the needs, preferences and values of HNC patient regarding sub-components of follow-up care (form, content, duration, frequency, and type of care provider). Methods: Semi-structured interviews were held with 13 HNC patients (inclusion until saturation) in order to explore the needs, preferences and values of HNC regarding their follow-up care. Interviews were transcribed verbatim and qualitatively analyzed using the eight-dimension Picker model. Results: During follow-up, patients prefer traditional face-to-face appointments, where they have to be physically present at the hospital. Alternative forms (e.g. telephone or Skype-related forms) may only be preferable under certain circumstances ( form). Physical examinations should be leading during these appointments, to look for signs of recurrence ( content). Patients mentioned that information on prognoses and the physical constraints as a consequence of treatment is important during follow-up appointments ( content). In the beginning of the follow-up, a high frequency of appointments was preferred ( duration & frequency). Preferably, follow-up care takes place in the specialized centers ( location). A predominant role has been assigned to the primary treating physician. Additionally, qualified personnel is needed in the continuation and relocation of follow-up care for HNC patient ( type of care provider). Conclusions: The results of this study will enable us to better tailor care to the specific needs, preferences and values of HNC patients. Further research is needed to determine if the results are representative. In the new personalized follow-up, there should be a balance between evidence based options and the needs, preferences and values of patients and different care providers within HNC care.
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Affiliation(s)
- Sven Thomas Alders
- IQ Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - Rosella Hermens
- IQ Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
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Geurtzen R, Draaisma J, Hermens R, Scheepers H, Woiski M, van Heijst A, Hogeveen M. Prenatal (non)treatment decisions in extreme prematurity: evaluation of Decisional Conflict and Regret among parents. J Perinatol 2017; 37:999-1002. [PMID: 28617426 DOI: 10.1038/jp.2017.90] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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] [Received: 12/09/2016] [Revised: 05/01/2017] [Accepted: 05/15/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate Decisional Conflict and Regret among parents regarding the decision on initiating comfort or active care in extreme prematurity and to relate these to decision-making characteristics. STUDY DESIGN A nationwide, multicenter, cross-sectional study using an online survey in the Netherlands. Data were collected from March 2015 to March 2016 among all parents with infants born at 24+0/7-24+6/7 weeks gestational age in 2010-2013. The survey contained a Decisional Conflict and Decision Regret Scale (potential scores range from 0 to 100) and decision-making characteristics. RESULTS Sixty-one surveys were returned (response rate 27%). The median Decisional Conflict score was 28. From the subscores within Decisional Conflict, 'values clarity' revealed the highest median score of 42-revealing that parents felt unclear about personal values for benefits and risks of the decision on either comfort care or active care. The median Decision Regret score was 0. Regret scores were influenced by the actual decision made and by outcome: Decision Regret was lower in the active care group and in the survivor group. CONCLUSION We found little Decisional Conflict and no Decision Regret among parents regarding decision-making at 24 weeks gestation.
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Affiliation(s)
- R Geurtzen
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - J Draaisma
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - R Hermens
- Scientific Institute for Quality of Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Scheepers
- Department of Gynecology, Maastricht UMC+, Maastricht, The Netherlands
| | - M Woiski
- Department of Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A van Heijst
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - M Hogeveen
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
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Abstract
6570 Background: Providing patient-centred care is an essential component of high quality integrated care. A method to get insight in patients perspectives about the quality of health care they received, is measuring Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs). We aimed to determine the outcomes of, and differences between PROs and PREs over time and between treatment groups for patients with head and neck cancer (HNC). Methods: Patientswere recruited from nine hospitals participating in the DHNA. Validated questionnaires were distributed at baseline, 3, 6 and 12 months follow-up. Included PROMs were EuroQol 5 Dimension 3 Level (EQ-5D-3L), EORTC QLQ-C30 and -H&N35. Included PREMs, Consumer Quality index for Oncologic care (CQO) and Radiotherapeutic care (CQR), have similar domains with different questions. With descriptive analysis, ANOVA and mixed model analysis, differences over time and between treatment groups were analyzed. Results: Questionnaires were filled in by 426 patients. Pain decreased significantly at 6 and 12 months follow-up (14 and 21 points on a scale of 0-100) and dry mouth increased significantly at 3, 6 and 12 months follow-up compared to baseline (35, 27 and 20 points). Sticky Salvia, problems with social eating and sense problems increased at 3 and 6 months follow-up, but were similar to the baseline score at 12 months follow-up. Pain and sticky saliva differed between radiotherapy and chemoradiotherapy or surgery and radiotherapy respectively (p≤0.05). Regarding the CQO domain scores, all treatment groups differed significantly from each other (p≤0.05), especially for the domain Personal input. There was no difference regarding the CQR domain scores. Recognizing the emotional side of HNC and guidance after the treatment scored low in patients. Conclusions: This study gives clues to improve healthcare according the experiences of the patient and we can predict more carefully the outcomes of the patients with different treatment types. PROMs according to the ICHOM criteria and PREMs are promising for measuring and improving quality and personalization of HNC care. However, recognizing the emotional side of HNC and intensifying guidance after the treatment period needs improvement.
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Affiliation(s)
- Rosella Hermens
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | | | - Robert P. Takes
- Department of Otolaryngology, Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jozé C.C. Braspenning
- The Netherlands Federation of Univerisity Medical Centres, NFU, Utrecht, Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek Nederlands Kanker Instituut, Amsterdam, Netherlands
| | - Matthias A.W. Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
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Spitaels D, Hermens R, Van Assche D, Verschueren S, Luyten F, Vankrunkelsven P. Are physiotherapists adhering to quality indicators for the management of knee osteoarthritis? An observational study. Musculoskelet Sci Pract 2017; 27:112-123. [PMID: 27852532 DOI: 10.1016/j.math.2016.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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] [Received: 07/13/2016] [Revised: 10/20/2016] [Accepted: 10/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Osteoarthritis (OA) is a common musculoskeletal condition that often leads to pain, stiffness and disability. Physiotherapy plays an important role in the management of knee OA, however we hypothesize discordance between physiotherapists' practice and existing guideline recommendations. OBJECTIVES This study aimed to measure physiotherapists' guideline adherence for knee OA. Additionally, determinants for guideline adherence at the professional and organizational level were explored, to find clues for improvement. METHOD A survey was performed among Belgian physiotherapists. Guideline adherence was measured with a set of 9 quality indicators, developed for the Belgian primary healthcare system, applicable for physiotherapists and extracted from evidence-based guidelines. Treatment modalities that do not contribute to high quality care were also examined. RESULTS 284 Physiotherapists responded to the survey. Compliance to the quality indicators varied between 27% and 98%. Quality indicator compliance above 80% was found for: education on the importance of exercise, delivering functional and strength exercise therapy, patient tailored exercise program, instruction of patients in appropriate exercises and referral for sports activities after therapy. Quality indicator compliance less than 50% was found for: education on the importance of weight loss, providing self-management strategies, spreading treatment session over longer periods and regular evaluations of the exercise therapy. For treatment modalities that do not contribute to high quality care, massage (49%) and cold application (24%) were most frequently applied. CONCLUSIONS This study showed large variations in adherence to quality indicators in OA management by physiotherapists. Improvement strategies should focus on quality indicators related to long-term treatment options.
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Affiliation(s)
- David Spitaels
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000 Leuven, Belgium.
| | - Rosella Hermens
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000 Leuven, Belgium; IQ Healthcare, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Dieter Van Assche
- Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.
| | - Sabine Verschueren
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.
| | - Frank Luyten
- Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Patrik Vankrunkelsven
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000 Leuven, Belgium.
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Spitaels D, Vankrunkelsven P, Desfosses J, Luyten F, Verschueren S, Van Assche D, Aertgeerts B, Hermens R. Barriers for guideline adherence in knee osteoarthritis care: A qualitative study from the patients' perspective. J Eval Clin Pract 2017; 23:165-172. [PMID: 27859970 DOI: 10.1111/jep.12660] [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] [Received: 04/28/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Guidelines for patients with knee osteoarthritis (OA) are suboptimally implemented in clinical care. To improve guideline adherence, patients' perceived barriers and facilitators in current care were investigated. METHODS Eleven patients with knee OA were extensively interviewed using a semistructured script based on quality indicators. Directed content analysis, within the framework of Grol and Wensing, was performed to describe barriers and facilitators in 6 domains: guideline, health care professional, patient, social environment, organization, and financial context. Data were analyzed using NVIVO 10 software. RESULTS In total, 38 barriers, at all 6 domains, were identified. The most frequently mentioned barriers were in the domains of the patient and the health care professional, namely, patients' disagreement with guidelines recommendations, negative experience with drugs, patients' limited comprehension of the disease process, and poor communication by the health care professional. The patients' disagreement with recommendations is further explained by the following barriers: "insistence on medical imaging," "fear that physiotherapy aggravates pain," and "perception that knee OA is not a priority health issue". Patients also reported 20 facilitators, all of which are listed as opposing barriers. CONCLUSIONS Patients indicate that both personal factors and factors related to health care professionals play an important role in nonadherence. An interview script, based on quality indicators, was a significant aid to structurally formulate barriers and facilitators in the perceived knee OA care. Future guideline implementation strategies should take the identified barriers and facilitators into account.
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Affiliation(s)
- David Spitaels
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | - Patrik Vankrunkelsven
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | | | - Frank Luyten
- Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Sabine Verschueren
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium
| | - Dieter Van Assche
- Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium
| | - Bert Aertgeerts
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium
| | - Rosella Hermens
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium.,IQ Healthcare, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Geurtzen R, van Heijst A, Draaisma J, Ouwerkerk L, Scheepers H, Woiski M, Hermens R, Hogeveen M. Professionals' preferences in prenatal counseling at the limits of viability: a nationwide qualitative Dutch study. Eur J Pediatr 2017; 176:1107-1119. [PMID: 28687856 PMCID: PMC5511326 DOI: 10.1007/s00431-017-2952-6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/12/2017] [Accepted: 06/13/2017] [Indexed: 11/27/2022]
Abstract
UNLABELLED Prenatal counseling practices at the limits of viability do vary, and constructing a counseling framework based on guidelines, professional and parental preferences, might achieve more homogeneity. We aimed to gain insight into professionals' preferences on three domains of counseling, particularly content, organization, and decision making and their influencing factors. A qualitative, nationwide in-depth exploration among Dutch perinatal professionals by semi-structured interviews in focus groups was performed. Regarding content of prenatal counseling, preparing parents on the short-term situation (delivery room care) and revealing their perspectives on "quality of life" were considered important. Parents should be informed on the kind of decision, on the difficulty of individual outcome predictions, on survival and mortality figures, short- and long-term morbidity, and the burden of hospitalization. For organization, the making of and compliance with agreements between professionals may promote joint counseling by neonatologists and obstetricians. Supportive materials were considered useful but only when up-to-date, in addition to the discussion and with opportunity for personalization. Regarding decision making, it is not always clear to parents that a prenatal decision needs to be made and they can participate, influencing factors could be, e.g., unclear language, directive counseling, overload of information, and an immediate delivery. There is limited familiarity with shared decision making although it is the preferred model. CONCLUSION This study gained insight into preferred content, organization, and decision making of prenatal counseling at the limits of viability and their influencing factors from a professionals' perspective. What is Known: • Heterogeneity in prenatal counseling at the limits of viability exists • Differences between preferred counseling and actual practice also exists What is New: • Insight into preferred content, organization, and decision making of prenatal periviability counseling and its influencing factors from a professionals' perspective. Results should be taken into account when performing counseling. • Particularly the understanding of true shared decision making needs to be improved. Furthermore, implementation of shared decision making in daily practice needs more attention.
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Affiliation(s)
- Rosa Geurtzen
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, PO Box 9101, 6500HB, Nijmegen, Internal Code 804, The Netherlands.
| | - Arno van Heijst
- Department of Pediatrics, Radboud University Medical Center Amalia Children’s Hospital, PO Box 9101, 6500HB Nijmegen, Internal Code 804, The Netherlands
| | - Jos Draaisma
- Department of Pediatrics, Radboud University Medical Center Amalia Children’s Hospital, PO Box 9101, 6500HB Nijmegen, Internal Code 804, The Netherlands
| | - Laura Ouwerkerk
- Department of Pediatrics, Radboud University Medical Center Amalia Children’s Hospital, PO Box 9101, 6500HB Nijmegen, Internal Code 804, The Netherlands
| | | | - Mallory Woiski
- Department of Gynecology, Radboud university medical center, Nijmegen, The Netherlands
| | - Rosella Hermens
- Scientific Institute for Quality of Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Marije Hogeveen
- Department of Pediatrics, Radboud University Medical Center Amalia Children’s Hospital, PO Box 9101, 6500HB Nijmegen, Internal Code 804, The Netherlands
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Hermens R, Stienen J, Krieken HV, Blijlevens N, Ottevanger PB. Improving hospital care for patients with non-Hodgkin's lymphomas. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.6593] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rosella Hermens
- Radboud University Medical Center, Department IQ Healthcare, Nijmegen, Netherlands
| | - Jozette Stienen
- Radboud University Medical Center, Department IQ Healthcare, Nijmegen, Netherlands
| | - Han van Krieken
- Radboud University Medical Center, Department of Pathology, Nijmegen, Netherlands
| | - Nicole Blijlevens
- Radboud University Medical Center, Department of Hematology, Nijmegen, Netherlands
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van der Post RS, Vogelaar IP, Carneiro F, Guilford P, Huntsman D, Hoogerbrugge N, Caldas C, Schreiber KEC, Hardwick RH, Ausems MGEM, Bardram L, Benusiglio PR, Bisseling TM, Blair V, Bleiker E, Boussioutas A, Cats A, Coit D, DeGregorio L, Figueiredo J, Ford JM, Heijkoop E, Hermens R, Humar B, Kaurah P, Keller G, Lai J, Ligtenberg MJL, O'Donovan M, Oliveira C, Pinheiro H, Ragunath K, Rasenberg E, Richardson S, Roviello F, Schackert H, Seruca R, Taylor A, ter Huurne A, Tischkowitz M, Joe STA, van Dijck B, van Grieken NCT, van Hillegersberg R, van Sandick JW, Vehof R, van Krieken JH, Fitzgerald RC. Hereditary diffuse gastric cancer: updated clinical guidelines with an emphasis on germline CDH1 mutation carriers. J Med Genet 2015; 52:361-74. [PMID: 25979631 PMCID: PMC4453626 DOI: 10.1136/jmedgenet-2015-103094] [Citation(s) in RCA: 365] [Impact Index Per Article: 40.6] [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: 02/26/2015] [Accepted: 03/18/2015] [Indexed: 02/06/2023]
Abstract
Germline CDH1 mutations confer a high lifetime risk of developing diffuse gastric (DGC) and lobular breast cancer (LBC). A multidisciplinary workshop was organised to discuss genetic testing, surgery, surveillance strategies, pathology reporting and the patient's perspective on multiple aspects, including diet post gastrectomy. The updated guidelines include revised CDH1 testing criteria (taking into account first-degree and second-degree relatives): (1) families with two or more patients with gastric cancer at any age, one confirmed DGC; (2) individuals with DGC before the age of 40 and (3) families with diagnoses of both DGC and LBC (one diagnosis before the age of 50). Additionally, CDH1 testing could be considered in patients with bilateral or familial LBC before the age of 50, patients with DGC and cleft lip/palate, and those with precursor lesions for signet ring cell carcinoma. Given the high mortality associated with invasive disease, prophylactic total gastrectomy at a centre of expertise is advised for individuals with pathogenic CDH1 mutations. Breast cancer surveillance with annual breast MRI starting at age 30 for women with a CDH1 mutation is recommended. Standardised endoscopic surveillance in experienced centres is recommended for those opting not to have gastrectomy at the current time, those with CDH1 variants of uncertain significance and those that fulfil hereditary DGC criteria without germline CDH1 mutations. Expert histopathological confirmation of (early) signet ring cell carcinoma is recommended. The impact of gastrectomy and mastectomy should not be underestimated; these can have severe consequences on a psychological, physiological and metabolic level. Nutritional problems should be carefully monitored.
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Affiliation(s)
- Rachel S van der Post
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ingrid P Vogelaar
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Fátima Carneiro
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Department of Pathology and Oncology, Medical Faculty of the University of Porto, Porto, Portugal
- Centro Hospitalar São João, Porto, Portugal
| | - Parry Guilford
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - David Huntsman
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carlos Caldas
- Department of Oncology, University of Cambridge, Cambridge, UK
| | | | - Richard H Hardwick
- Department of Oesophago-Gastric Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Margreet G E M Ausems
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Linda Bardram
- Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Tanya M Bisseling
- Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Eveline Bleiker
- Division of Psychosocial Research and Epidemiology/Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alex Boussioutas
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Annemieke Cats
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute/ Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Daniel Coit
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Lynn DeGregorio
- The DeGregorio Family Foundation for Stomach and Esophageal Cancer Research, Pleasantville, New York, USA
| | - Joana Figueiredo
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - James M Ford
- Division of Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Esther Heijkoop
- Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Rosella Hermens
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bostjan Humar
- Division of Surgical Research, University of Zurich, Zurich, Suisse
| | - Pardeep Kaurah
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gisella Keller
- Institute of Pathology, Technische Universität, Munich, Germany
| | - Jennifer Lai
- No Stomach For Cancer, Inc., Madison, Wisconsin, USA
| | - Marjolijn J L Ligtenberg
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria O'Donovan
- Department of Histopathology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Carla Oliveira
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Department of Pathology and Oncology, Medical Faculty of the University of Porto, Porto, Portugal
| | - Hugo Pinheiro
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Krish Ragunath
- NIHR Biomedical Research Unit, Nottingham Digestive Diseases Centre, Queens Medical Centre campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Susan Richardson
- Department of Oncology, Familial Gastric Cancer Registry, Cambridge University Hospital, Cambridge, UK
| | - Franco Roviello
- Department of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Hans Schackert
- Department of Surgical Research, Technical University Dresden, Dresden, Germany
| | - Raquel Seruca
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Department of Pathology and Oncology, Medical Faculty of the University of Porto, Porto, Portugal
| | - Amy Taylor
- Cambridge University Hospital, Cambridge, UK
| | | | - Marc Tischkowitz
- Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Sheena Tjon A Joe
- Division of Oncology, Stanford University School of Medicine, Stanford, California, USA
| | | | | | | | - Johanna W van Sandick
- Department of Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Rianne Vehof
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Han van Krieken
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rebecca C Fitzgerald
- Cambridge NIHR Biomedical Research Centre, University of Cambridge NHS Foundation Trust
- MRC Cancer Unit, Hutchison/MRC Research Centre, Cambridge, UK
- Department Gastroenterology, Cambridge University Hospitals, UK
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Vankan E, Schoorel E, van Kuijk S, Aardenburg R, Delemarre F, Dirksen C, van Dooren I, Kuppens S, Kwee A, Langenveld J, Mol BW, Hermens R, Scheepers H. 472: Patient decision aid with individual risk estimation: an effective tool in choosing the mode of delivery after cesarean section. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Faber MJ, Grande S, Wollersheim H, Hermens R, Elwyn G. Narrowing the gap between organisational demands and the quest for patient involvement: The case for coordinated care pathways. International Journal of Care Coordination 2014. [DOI: 10.1177/2053435414540616] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
To improve healthcare, we currently observe two major developments. On the one hand, there is an increasing emphasis on including the patients’ perspective, for example in treatment decision making, during development of clinical guidelines and evaluation of care delivery services. On the other hand, healthcare providers are moving towards evidence-based care and standardising operating procedures, exemplified by the development of documented coordinated care pathways. These pathways typically focus on organisational and system requirements, which usually do not refer to patient involvement, nor indicate the need to be sensitive to differing patient needs. As a result, the structured process of developing and documenting care pathways seems to be at odds with the call to personalise care around the needs and preferences of the individual patient. The purpose of this paper is to illustrate the conspicuous mismatch and show promising opportunities to address it.
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Affiliation(s)
| | - Stuart Grande
- The Dartmouth Center for Health Care Delivery Science, USA
| | | | | | - Glyn Elwyn
- The Dartmouth Center for Health Care Delivery Science, USA
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Grypdonck L, Luyten F, Hermens R, Vankrunkelsven P. SAT0424 Barriers in Primary Care to Use Guidelines for Osteoarthritis of the Knee. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Grypdonck L, Aertgeerts B, Luyten F, Wollersheim H, Bellemans J, Peers K, Verschueren S, Vankrunkelsven P, Hermens R. Development of quality indicators for an integrated approach of knee osteoarthritis. J Rheumatol 2014; 41:1155-62. [PMID: 24737907 DOI: 10.3899/jrheum.130680] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 11/22/2022]
Abstract
OBJECTIVE Osteoarthritis (OA) is a common cause of disability worldwide. Knee OA care is often suboptimal. A first necessary step in quality improvement is to gain a clear insight into usual care. We developed a set of evidence-based quality indicators for multidisciplinary high-quality knee OA care. METHODS A Rand-modified Delphi method was used to develop quality indicators for knee OA diagnosis, therapy, and followup. Recommendations were extracted from international guidelines as well as existing sets of quality indicators and scored by a multidisciplinary expert panel. Based on median score, prioritization, and agreement, recommendations were labeled as having a high, uncertain, or low potential to measure quality of care and were discussed in a consensus meeting for inclusion or exclusion. Two final validation rounds yielded a core set of recommendations, which were translated into quality indicators. RESULTS From a total of 86 recommendations and existing indicators, a core set of 29 recommendations was derived that allowed us to define high-quality knee OA care. From this core set, 22 recommendations were considered to be measurable in clinical practice and were transformed into a final set of 21 quality indicators regarding diagnosis, lifestyle/education/devices, therapy, and followup. CONCLUSION Our study provides a robust set of 21 quality indicators for high-quality knee OA care, measurable in clinical practice. These process indicators may be used to measure usual care and evaluate quality improvement interventions across the entire spectrum of disciplines involved in knee OA care.
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Affiliation(s)
- Lies Grypdonck
- From the Academic Center for General Practice, KU Leuven, Leuven; Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium; IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Division of Orthopedics and Traumatology, Department of Development and Regeneration, University Hospitals Leuven; Physical Medicine and Rehabilitation, University Hospitals Leuven, Pellenberg; and Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium.
| | - Bert Aertgeerts
- From the Academic Center for General Practice, KU Leuven, Leuven; Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium; IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Division of Orthopedics and Traumatology, Department of Development and Regeneration, University Hospitals Leuven; Physical Medicine and Rehabilitation, University Hospitals Leuven, Pellenberg; and Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium
| | - Frank Luyten
- From the Academic Center for General Practice, KU Leuven, Leuven; Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium; IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Division of Orthopedics and Traumatology, Department of Development and Regeneration, University Hospitals Leuven; Physical Medicine and Rehabilitation, University Hospitals Leuven, Pellenberg; and Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium
| | - Hub Wollersheim
- From the Academic Center for General Practice, KU Leuven, Leuven; Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium; IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Division of Orthopedics and Traumatology, Department of Development and Regeneration, University Hospitals Leuven; Physical Medicine and Rehabilitation, University Hospitals Leuven, Pellenberg; and Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium
| | - Johan Bellemans
- From the Academic Center for General Practice, KU Leuven, Leuven; Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium; IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Division of Orthopedics and Traumatology, Department of Development and Regeneration, University Hospitals Leuven; Physical Medicine and Rehabilitation, University Hospitals Leuven, Pellenberg; and Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium
| | - Koen Peers
- From the Academic Center for General Practice, KU Leuven, Leuven; Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium; IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Division of Orthopedics and Traumatology, Department of Development and Regeneration, University Hospitals Leuven; Physical Medicine and Rehabilitation, University Hospitals Leuven, Pellenberg; and Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium
| | - Sabine Verschueren
- From the Academic Center for General Practice, KU Leuven, Leuven; Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium; IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Division of Orthopedics and Traumatology, Department of Development and Regeneration, University Hospitals Leuven; Physical Medicine and Rehabilitation, University Hospitals Leuven, Pellenberg; and Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium
| | - Patrik Vankrunkelsven
- From the Academic Center for General Practice, KU Leuven, Leuven; Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium; IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Division of Orthopedics and Traumatology, Department of Development and Regeneration, University Hospitals Leuven; Physical Medicine and Rehabilitation, University Hospitals Leuven, Pellenberg; and Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium
| | - Rosella Hermens
- From the Academic Center for General Practice, KU Leuven, Leuven; Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium; IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Division of Orthopedics and Traumatology, Department of Development and Regeneration, University Hospitals Leuven; Physical Medicine and Rehabilitation, University Hospitals Leuven, Pellenberg; and Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium
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Schoorel E, Scheepers H, Hunen D, Kuijk S, Augustijn B, Mol B, Kwee A, Nijhuis J, Smits L, Hermens R. 575: Probability of vaginal birth after caesarean: don’t ask the obstetrician. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ottevanger N, Hilbink M, Weenk M, Janssen R, Vrijmoeth T, de Vries A, Hermens R. Oncologic multidisciplinary team meetings: evaluation of quality criteria. J Eval Clin Pract 2013; 19:1035-43. [PMID: 23441961 DOI: 10.1111/jep.12022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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] [Accepted: 01/11/2013] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES To develop a guideline with quality criteria for an optimal structure and functioning of a multidisciplinary team meeting (MTM), and to assess to what extent the Dutch MTMs complied with these criteria. METHOD A literature search and expert opinions were used to develop a guideline for optimal MTMs. In order to assess adherence to the guideline, we conducted interviews with MTM chairs and observed general and tumour-specific MTMs in seven hospitals. RESULTS The new guideline included the following domains: (i) organization of the MTMs; (ii) membership of the MTM and roles and responsibilities of the members; (iii) the meeting itself; and (iv) documentation of meeting-recommendations. We observed good adherence to the quality criteria on the organization of the MTMs. Only the required coordinator/administrative support was often absent, particularly during general MTMs. Regarding membership of MTMs and roles, the recommended average attendance of 100% of the core disciplines was never reached and particularly the role of the chair needs improvement. Regarding the meeting itself, many interruptions took place and relevant information about the diagnoses of the cases was not available in 4-5% of the cases. Concerning the documentation of meeting-recommendations, only in a quarter of the meetings a specific form was used for the documentation. CONCLUSIONS We found a lot of diversity in the organization of MTMs. The variation in compliance with the quality criteria may decrease with better knowledge about the quality criteria around MTMs and by overcoming practical barriers for the effective organization of MTMs.
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Affiliation(s)
- Nelleke Ottevanger
- Department of Medical Oncology, Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen, The Netherlands
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Stienen J, Hermens R, Krieken HV, Schans SVD, Dekker H, Maazen RVD, Wennekes L, Blijlevens N, Ottevanger N. P030 E-Tool For Patients with Non-Hodgkin’s Lymphoma to Improve Guideline Adherence. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kersten F, Nelen W, Goddijn M, Braat D, Mol B, Hermens R. P198 Adherence To Infertility Guidelines With Regard To Treatment Policy. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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De Visser S, Woiski M, Hulscher M, Vandenbussche F, Scheepers L, Hermens R. P244 Development Of A Tailor-Made Implementation Strategy To Facilitate Adherence To The Dutch Postpartum Hemorrhage Guideline And Moet-Instructions. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Grypdonck L, Hermens R, Vankrunkelsven P, Luyten F. AB0777 Knee osteoarthritis: widespread use of treatments that are not considered essential for high quality care. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.3099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Melman S, Schoorel E, Vrouenraets F, Kwee A, Franssen M, Smid-Koopman E, Woiski M, Mol BW, Doornbos H, Visser H, Huisjes A, Porath M, Delemarre F, Kuppens S, Aardenburg R, Dooren van I, Kleiverda G, Salm van der P, Boer de K, Sikkema M, Dirksen C, van SK, Nijhuis J, Scheepers L, Hermens R. 780: Analysis of current Dutch practice on cesarean deliveries. Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Luitjes S, Wouters M, Franx A, Bolte A, de Groot C, van Tulder M, Hermens R. PP095. Guideline-based development of quality indicators for hypertensive diseases in pregnancy. Pregnancy Hypertens 2012; 2:291-2. [PMID: 26105417 DOI: 10.1016/j.preghy.2012.04.206] [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: 11/16/2022]
Abstract
INTRODUCTION Hypertensive disorders in pregnancy are one of the main causes of maternal morbidity and mortality. Internationally, several organizations have developed clinical guidelines to assist professionals and to supply patients with the best possible care. To improve the care for this group of patients, insight into the application of clinical guidelines in daily practice is needed. Valid quality indicators are necessary to estimate actual guideline adherence. In this study, we developed a set of valid guidelines based quality indicators for hypertensive diseases in pregnancy. OBJECTIVES None. METHODS A systematic RAND-modified Delphi method was used to develop a set of quality indicators based on evidence-based guidelines and the literature, about hypertension and pregnancy. Experts' opinions were used to select the indicators regarding specific criteria such as efficacy, level of health gain and potential for care improvement. RESULTS A representative set of 14 quality indicators was selected from 48 initial guideline recommendations. Indicators concerned both professional performance and organisation of care for patients with hypertension in pregnancy. CONCLUSION This study describes the systematic, stepwise method used to develop quality indicators that can be used to monitor care for hypertensive diseases in pregnancy.
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Affiliation(s)
- S Luitjes
- EMGO+ Institute for Health and Care Research, VU University, Amsterdam, the Netherlands; Obstetrics and Gynaecology, Vrije University Medical Centre Amsterdam, Amsterdam, the Netherlands
| | - M Wouters
- Obstetrics and Gynaecology, Vrije University Medical Centre Amsterdam, Amsterdam, the Netherlands
| | - A Franx
- Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - A Bolte
- Obstetrics and Gynaecology, Vrije University Medical Centre Amsterdam, Amsterdam, the Netherlands
| | - C de Groot
- Obstetrics and Gynaecology, Vrije University Medical Centre Amsterdam, Amsterdam, the Netherlands
| | - M van Tulder
- EMGO+ Institute for Health and Care Research, VU University, Amsterdam, the Netherlands; Department of Health Sciences, Faculty of Earth & Life Sciences, VU University, Amsterdam, the Netherlands
| | - R Hermens
- Scientific Institute for Quality of Health Care (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Luitjes S, Mesri K, Wouters M, van Tulder M, Hermens R. PP167. A process evaluation of an innovative implementation strategy of the Dutch guidelines on hypertensive disorders in pregnancy using a computerized decision support system. Pregnancy Hypertens 2012; 2:329-30. [DOI: 10.1016/j.preghy.2012.04.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schoorel E, Melman S, van Kuijk S, Grobman W, Mol BW, Smits L, Nijhuis J, Hermens R, Scheepers H. 326: Mode of delivery after previous cesarean section in the Netherlands. Am J Obstet Gynecol 2012. [DOI: 10.1016/j.ajog.2011.10.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Schoorel E, Melman S, van Kuijk S, Grobman W, Mol BW, Smits L, Nijhuis J, Hermens R, Scheepers H. 625: Predicting the probability of a vaginal birth after previous cesarean section: validation of two prediction models in a western European cohort. Am J Obstet Gynecol 2012. [DOI: 10.1016/j.ajog.2011.10.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Melman S, Hermens R, Nijhuis J, Scheepers L. 636: Development of indicators to determine the quality of cesarean section care. Am J Obstet Gynecol 2012. [DOI: 10.1016/j.ajog.2011.10.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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van Peperstraten A, Nelen W, Grol R, Zielhuis G, Adang E, Stalmeier P, Hermens R, Kremer J. The effect of a multifaceted empowerment strategy on decision making about the number of embryos transferred in in vitro fertilisation: randomised controlled trial. BMJ 2010; 341:c2501. [PMID: 20884700 PMCID: PMC2948112 DOI: 10.1136/bmj.c2501] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the effects of a multifaceted empowerment strategy on the actual use of single embryo transfer after in vitro fertilisation. DESIGN Randomised controlled trial. SETTING Five in vitro fertilisation clinics in the Netherlands. PARTICIPANTS 308 couples (women aged <40) on the waiting list for a first in vitro fertilisation cycle. INTERVENTIONS The multifaceted strategy aimed to empower couples in deciding how many embryos should be transferred. The strategy consisted of a decision aid, support of a nurse specialising in in vitro fertilisation, and the offer of reimbursement by way of an extra treatment cycle. The control group received standard care for in vitro fertilisation. MAIN OUTCOME MEASURES Use of single embryo transfer in the first and second treatment cycles as well as decision making variables and costs of the empowerment strategy. RESULTS After the first treatment cycle, single embryo transfer was used by 43% (65/152) of couples in the intervention group and 32% (50/156) in the control group (difference 11%, 95% confidence interval 0% to 22%; P=0.05). After the second treatment cycle, single embryo transfer was used by 26% (14/154) of couples in the intervention group compared with 16% (8/51) in the control group (difference 10%, -6% to 26%; P=0.20). Compared with couples receiving standard care, those receiving the empowerment strategy had significantly higher empowerment and knowledge levels but no differences in anxiety levels. Mean total savings per couple in the intervention group were calculated to be €169.75 (£146.77; $219.12). CONCLUSIONS A multifaceted empowerment strategy encouraged use of single embryo transfer, increased patients' knowledge, reduced costs, and had no effect on levels of anxiety or depression. This strategy could therefore be an important tool to reduce the twin pregnancy rate after in vitro fertilisation. This trial did not, however, demonstrate the anticipated 25% difference in use of single embryo transfer of the power calculation. TRIAL REGISTRATION ClinicalTrials.gov NCT00315029.
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Affiliation(s)
- Arno van Peperstraten
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, Netherlands.
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Wolters R, Grol R, Schermer T, Akkermans R, Hermens R, Wensing M. Improving initial management of lower urinary tract symptoms in primary care: Costs and patient outcomes. ACTA ACUST UNITED AC 2009; 40:300-6. [PMID: 16916771 DOI: 10.1080/00365590600641657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Guidelines for primary care management of lower urinary tract symptoms in older men recommend shared decision making regarding the choice of treatment. In this study we aimed to determine the costs and patient outcomes of an implementation strategy designed to enhance uptake of these guidelines. MATERIAL AND METHODS The intervention comprised a distance learning programme for general practitioners, comprising evidence-based information, assessment of learning needs, a knowledge test and patient education materials. The control group only received the written guidelines. A cluster randomized trial in 187 older male patients compared costs and outcomes in the two study groups. A healthcare perspective was taken in the economic evaluation, with a 3-month time horizon. The primary health outcome was patient-reported urinary symptoms at 3 months. Costs relating to the distance learning package and the healthcare provided were considered, using undiscounted standardized prices. RESULTS Patient-reported urinary symptoms at 3 months did not differ between the study groups: 66% and 61% with moderate symptoms and 7% and 11% with severe symptoms in the intervention and control groups, respectively. The mean total costs per patient were euro28.15 lower in the intervention group (euro93.11) compared to the control group (euro121.26), mainly because of a lower number of referrals to the urologist. A bootstrap analysis showed an incremental cost-effectiveness ratio of euro111.98 (95% CI -euro423 to +euro329). CONCLUSIONS The distance learning programme did not change health outcomes, but it reduced costs in the first 3 months after an initial consultation compared to written guidelines. Studies with a longer follow-up period are needed.
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Affiliation(s)
- René Wolters
- Centre for Quality of Care Research (WOK), Department of General Practice, Radboud University Nijmegen Medical Centre, The Netherlands
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Ouwens M, Hermens R, Hulscher M, Vonk-Okhuijsen S, Tjan-Heijnen V, Termeer R, Marres H, Wollersheim H, Grol R. Development of indicators for patient-centred cancer care. Support Care Cancer 2009; 18:121-30. [PMID: 19387693 PMCID: PMC2778774 DOI: 10.1007/s00520-009-0638-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [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: 09/15/2008] [Accepted: 04/02/2009] [Indexed: 12/30/2022]
Abstract
Purpose Assessment of current practice with a valid set of indicators is the key to successfully improving the quality of patient-centred care. For improvement purposes, we developed indicators of patient-centred cancer care and tested them on a population of patients with non-small cell lung cancer (NSCLC). Methods Recommendations for patient-centred care were extracted from clinical guidelines, and patients were interviewed to develop indicators for assessing the patient-centredness of cancer care. These indicators were tested with regard to psychometric characteristics (room for improvement, applicability, discriminating capacity and reliability) on 132 patients with NSCLC treated in six hospitals in the east Netherlands. Data were collected from patients by means of questionnaires. Results Eight domains of patient-centred cancer care were extracted from 61 oncology guidelines and 37 patient interviews and were translated into 56 indicators. The practice test amongst patients with NSCLC showed the most room for improvement within the domains ‘emotional and psychosocial support’, ‘physical support’ and ‘information supply’. Overall, 26 of the 56 indicators had good psychometric characteristics. Conclusions Developing a valid set of patient-centred indicators is a first step towards improving the patient centredness of cancer care. Indicators can be based on recommendations from guidelines, but adding patient opinions leads to a more complete picture of patient centredness. The practice test on patients with NSCLC showed that the patient centredness of cancer care can be improved. Our set of indicators may also be useful for future quality assessments for other patients with cancers or chronic diseases.
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Affiliation(s)
- Mariëlle Ouwens
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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