Lower levels of trust in one’s physician is associated with more distress over time in more anxiously attached individuals with cancer.
Gen Hosp Psychiatry. 2014 Jul-Aug;36(4):382-7
Authors: Hinnen C, Pool G, Holwerda N, Sprangers M, Sanderman R, Hagedoorn M
OBJECTIVE: In the present study, we investigated individual differences in the outcome of patient-physician trust when confronted with cancer from an attachment theoretical perspective. We expected that lower levels of trust are associated with more emotional distress and more physical limitations within the first 15 months after diagnosis, especially in those who score relatively high on attachment anxiety. No such association was expected for more avoidantly attached individuals.
METHOD: A group of 119 patients with different types of cancer (breast, cervical, intestinal and prostate) completed questionnaires concerning trust (short version of the Wake Forest Physician Trust Scale) and attachment (Experiences in Close Relationship scale Revised) at 3 months after diagnosis. Emotional distress (Hospital Anxiety and Depression Scale) and physical limitations (physical functioning subscales of the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire-C30) were assessed at 3, 9 and 15 months after diagnosis. To test the hypotheses, multiple hierarchical regression analyses were performed.
RESULTS: Lower levels of trust were associated with more emotional distress and more physical limitations at 3, 9 and 15 months after diagnosis in more anxiously attached patients, but not in less anxiously attached patients.
DISCUSSION: These results indicate an attachment-dependent effect of trust in one’s physician. Explanations and clinical implications are discussed.
PMID: 24725971 [PubMed - indexed for MEDLINE]
Geographic Proximity of Adult Children and the Well-Being of Older Persons.
Res Aging. 2014 Aug 19;
Authors: van der Pers M, Mulder CH, Steverink N
This article aims to contribute to the discussion of how adult children affect the well-being of their older parents by investigating the importance of living in close geographic proximity. We investigate whether having children at all, and/or having them geographically proximate, contributes differently to the well-being of older persons living with and without a partner. We enriched survey data for the Netherlands (N = 8,379) with municipal register data and regressed life satisfaction of persons aged 65+ on having children and three different measures of geographic proximity. Having children contributes to the well-being of older men with a partner. There is evidence for a positive association between proximity of children and parental well-being, in particular for widowed and separated mothers and for separated fathers. Our findings suggest that close proximity may be a condition under which adult children can significantly add to the well-being of widowed and separated mothers and separated fathers.
PMID: 25651582 [PubMed - as supplied by publisher]
A group approach to genetic counselling of cardiomyopathy patients: satisfaction and psychological outcomes sufficient for further implementation.
Eur J Hum Genet. 2015 Feb 4;
Authors: Otten E, Birnie E, Ranchor AV, van Tintelen JP, van Langen IM
The introduction of next-generation sequencing in everyday clinical genetics practise is increasing the number of genetic disorders that can be confirmed at DNA-level, and consequently increases the possibilities for cascade screening. This leads to a greater need for genetic counselling, whereas the number of professionals available to provide this is limited. We therefore piloted group genetic counselling for symptomatic cardiomyopathy patients at regional hospitals, to assess whether this could be an acceptable alternative to individual counselling. We performed a cohort study with pre- and post-counselling patient measurements using questionnaires, supplemented with evaluations of the group counselling format by the professionals involved. Patients from eight regional hospitals in the northern part of the Netherlands were included. Questionnaires comprised patient characteristics, psychological measures (personal perceived control (PPC), state and trait anxiety inventory (STAI)), and satisfaction with counsellors, counselling content and design. In total, 82 patients (mean age 57.5 year) attended one of 13 group sessions. Median PPC and STAI scores showed significantly higher control and lower anxiety after the counselling. Patients reported they were satisfied with the counsellors, and almost 75% of patients were satisfied with the group counselling. Regional professionals were also, overall, satisfied with the group sessions. The genetics professionals were less satisfied, mainly because of their perceived large time investment and less-than-expected group interaction. Hence, a group approach to cardiogenetic counselling is feasible, accessible, and psychologically effective, and could be one possible approach to counselling the increasing patient numbers in cardiogenetics.European Journal of Human Genetics advance online publication, 4 February 2015; doi:10.1038/ejhg.2015.10.
PMID: 25649380 [PubMed - as supplied by publisher]
The Temporal Order of Change in Daily Mindfulness and Affect During Mindfulness-Based Stress Reduction.
J Couns Psychol. 2015 Jan 26;
Authors: Snippe E, Nyklíček I, Schroevers MJ, Bos EH
Increases in mindfulness are assumed to lead to improvements in psychological well-being during mindfulness-based treatments. However, the temporal order of this association has received little attention. This intensive longitudinal study examines whether within-person changes in mindfulness precede or follow changes in negative affect (NA) and positive affect (PA) during a mindfulness based stress reduction (MBSR) program. This study also examines interindividual differences in the association between mindfulness and affect and possible predictors of these differences. Mindfulness, NA, and PA were assessed on a daily basis in 83 individuals from the general population who participated in an MBSR program. Multilevel autoregressive models were used to investigate the temporal order of changes in mindfulness and affect. Day-to-day changes in mindfulness predicted subsequent day-to-day changes in both NA and PA, but reverse associations did not emerge. Thus, changes in mindfulness seem to precede rather than to follow changes in affect during MBSR. The magnitude of the effects differed substantially between individuals, showing that the strength of the relationship between mindfulness and affect is not the same for all participants. These between-subjects differences could not be explained by gender, age, level of education, average level of mindfulness home practice, or baseline levels of mindfulness and affect. Mindfulness home practice during the day did predict subsequent increases in mindfulness. The findings suggest that increasing mindfulness on a daily basis can be a beneficial means to improve daily psychological well-being. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
PMID: 25621590 [PubMed - as supplied by publisher]
The impact of age on changes in quality of life among breast cancer survivors treated with breast-conserving surgery and radiotherapy.
Br J Cancer. 2015 Jan 20;
Authors: Bantema-Joppe EJ, de Bock GH, Woltman-van Iersel M, Busz DM, Ranchor AV, Langendijk JA, Maduro JH, van den Heuvel ER
Background:The purpose of the study was to determine the impact of young age on health-related quality of life (HRQoL) by comparing HRQoL of younger and older breast cancer patients, corrected for confounding, and of young patients and a general Dutch population.Methods:The population consisted of breast cancer survivors (stage 0-III) after breast-conserving surgery and radiotherapy. Health-related quality of life was prospectively assessed using the EORTC QLQ-C30 and QLQ-BR23 questionnaires. The association between age (⩽50; 51-70; ⩾70 years) and HRQoL over time was analysed with mixed modelling. The clinical relevance of differences between/within age groups was estimated with Cohen’s D and consensus-based guidelines. The HRQoL data from the young patient cohort were compared with Dutch reference data at 3 years after radiotherapy.Results:A total of 1420 patients completed 3200 questionnaires. Median follow-up was 34 (range 6-70) months. Median age was 59 (range 28-85) years. Compared with older subjects, young women reported worse HRQoL in the first year after radiotherapy, but clinical relevance was limited. Three years after radiotherapy, HRQoL values in the younger group were equal to those in the reference population. Pain and fatigue after radiotherapy improved, with medium clinical relevance.Conclusions:Three years after radiotherapy for breast cancer, young age was not a risk factor for decreased HRQoL.British Journal of Cancer advance online publication, 20 January 2015; doi:10.1038/bjc.2014.632 www.bjcancer.com.
PMID: 25602967 [PubMed - as supplied by publisher]
Caregivers’ attentional bias to pain: does it affect caregiver accuracy in detecting patient pain behaviors?
Pain. 2015 Jan;156(1):123-130
Authors: Mohammadi S, Dehghani M, Khatibi A, Sanderman R, Hagedoorn M
Attentional bias to pain among family caregivers of patients with pain may enhance the detection of pain behaviors in patients. However, both relatively high and low levels of attentional bias may increase disagreement between patients and caregivers in reporting pain behaviors. This study aims to provide further evidence for the presence of attentional bias to pain among family caregivers, to examine the association between caregivers’ attentional bias to pain and detecting pain behaviors, and test whether caregivers’ attentional bias to pain is curvilinearly related to patient and caregiver disagreement in reporting pain behaviors. The sample consisted of 96 caregivers, 94 patients with chronic pain, and 42 control participants. Caregivers and controls completed a dot-probe task assessing attention to painful and happy stimuli. Both patients and caregivers completed a checklist assessing patients’ pain behavior. Although caregivers did not respond faster to pain congruent than pain incongruent trials, caregiver responses were slower in pain incongruent trials compared with happy incongruent trials. Caregivers showed more bias toward pain faces than happy faces, whereas control participants showed more bias toward happy faces than pain faces. Importantly, caregivers’ attentional bias to pain was significantly positively associated with reporting pain behaviors in patients above and beyond pain severity. It is reassuring that attentional bias to pain was not related to disagreement between patients and caregivers in reporting pain behaviors. In other words, attentional bias does not seem to cause overestimation of pain signals.
PMID: 25599308 [PubMed - as supplied by publisher]
Posted in Pain
Tagged R. Sanderman
Maximising the efficiency of clinical screening programmes: balancing predictive genetic testing with a right not to know.
Eur J Hum Genet. 2015 Jan 7;
Authors: Schuurman AG, van der Kolk DM, Verkerk MA, Birnie E, Ranchor AV, Plantinga M, van Langen IM
We explored the dilemma between patients’ right not to know their genetic status and the efficient use of health-care resources in the form of clinical cancer screening programmes. Currently, in the Netherlands, 50% risk carriers of heritable cancer syndromes who choose not to know their genetic status have access to the same screening programmes as proven mutation carriers. This implies an inefficient use of health-care resources, because half of this group will not carry the familial mutation. At the moment, only a small number of patients are involved; however, the expanding possibilities for genetic risk profiling means this issue must be addressed because of potentially adverse societal and financial impact. The trade-off between patients’ right not to know their genetic status and efficient use of health-care resources was discussed in six focus groups with health-care professionals and patients from three Dutch university hospitals. Professionals prefer patients to undergo a predictive DNA test as a prerequisite for entering cancer screening programmes. Professionals prioritise treating sick patients or proven mutation carriers over screening untested individuals. Participation in cancer screening programmes without prior DNA testing is, however, supported by most professionals, as testing is usually delayed and relatively few patients are involved at present. Reducing the number of 50% risk carriers undergoing screening is expected to be achieved by: offering more psychosocial support, explaining the iatrogenic risks of cancer screening, increasing out-of-pocket costs, and offering a less stringent screening programme for 50% risk carriers.European Journal of Human Genetics advance online publication, 7 January 2015; doi:10.1038/ejhg.2014.269.
PMID: 25564039 [PubMed - as supplied by publisher]
Feasibility and effectiveness of an Asthma/COPD service for primary care: a cross-sectional baseline description and longitudinal results.
NPJ Prim Care Respir Med. 2015;25:14101
Authors: Metting EI, Riemersma RA, Kocks JH, Piersma-Wichers MG, Sanderman R, van der Molen T
BACKGROUND: In 2007, an Asthma/chronic obstructive pulmonary disease (COPD) (AC) service was implemented in the North of the Netherlands to support General Practitioners (GPs) by providing advice from pulmonologists on a systematic basis.
AIMS: To evaluate the feasibility and effectiveness of this service on patient-related outcomes.
METHODS: We report baseline data on 11,401 patients and follow-up data from 2,556 patients. GPs can refer all patients with possible obstructive airway disease (OAD) to the service, which is conducted by the local laboratory. Patients are assessed in the laboratory using questionnaires and spirometry. Pulmonologists inspect the data through the internet and send the GP diagnosis and management advice.
RESULTS: A total of 11,401 patients were assessed by the service, covering almost 60% of all adult patients with projected asthma or COPD in the area. In all, 46% (n=5,268) of the patients were diagnosed with asthma, 18% (n=2,019) with COPD and 7% (n=788) with the overlap syndrome. A total of 740 (7%) patients were followed up after 3 months because the GP advised them to change medication. In this group, the proportion of unstable COPD patients (Clinical COPD Questionnaire (CCQ)⩾1) decreased from 63% (n=92) at baseline to 49% (n=72). The proportion of patients with uncontrolled asthma (Asthma Control Questionnaire (ACQ)⩾1.5) decreased from 41% (n=204) to 23% (n=115). In all, 938 (8%) patients were followed up after 12 months. From these patients, the proportion of unstable COPD patients (CCQ⩾1) decreased from 47% (n=115) to 44% (n=107). The proportion of patients with uncontrolled asthma (ACQ⩾1.5) decreased from 16% (n=95) to 14% (n=85).
CONCLUSION: The AC service assessed a considerable proportion of patients with OAD in the area, improved patients’ outcomes, and is considered to be feasible and effective.
PMID: 25569634 [PubMed - in process]
Cognitive behavioral therapy and mindfulness-based cognitive therapy for depressive symptoms in patients with diabetes: design of a randomized controlled trial.
BMC Psychol. 2013;1(1):17
Authors: Tovote KA, Fleer J, Snippe E, Bas IV, Links TP, Emmelkamp PM, Sanderman R, Schroevers MJ
BACKGROUND: Depressive symptoms are a common problem in patients with diabetes, laying an additional burden on both the patients and the health care system. Patients suffering from these symptoms rarely receive adequate evidence-based psychological help as part of routine clinical care. Offering brief evidence-based treatments aimed at alleviating depressive symptoms could improve patients’ medical and psychological outcomes. However, well-designed trials focusing on the effectiveness of psychological treatments for depressive symptoms in patients with diabetes are scarce. The Mood Enhancement Therapy Intervention Study (METIS) tests the effectiveness of two treatment protocols in patients with diabetes. Individually administered Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Cognitive Therapy (MBCT) are compared with a waiting list control condition in terms of their effectiveness in reducing the severity of depressive symptoms. Furthermore, we explore several potential moderators and mediators of change underlying treatment effectiveness, as well as the role of common factors and treatment integrity.
METHODS/DESIGN: The METIS trial has a randomized controlled design with three arms, comparing CBT and MBCT with a waiting list control condition. Intervention groups receive treatment immediately; the waiting list control group receives treatment three months later. Both treatments are individually delivered in 8 sessions of 45 to 60 minutes by trained therapists. Primary outcome is severity of depressive symptoms. Anxiety, well-being, diabetes-related distress, HbA1c levels, and intersession changes in mood are assessed as secondary outcomes. Assessments are held at pre-treatment, several time points during treatment, at post-treatment, and at 3-months and 9-months follow-up. The study has been approved by a medical ethical committee.
DISCUSSION: Both CBT and MBCT are expected to help improve depressive symptoms in patients with diabetes. If MBCT is at least equally effective as CBT, MBCT can be established as an alternative approach to CBT for treating depressive symptoms in patients with diabetes. By analyzing moderators and mediators of change, more information can be gathered for whom and why CBT and MBCT are effective.
TRIAL REGISTRATION: Clinical Trials NCT01630512.
PMID: 25566369 [PubMed]
Prevalence of psychological problems and associated transplant-related variables at different time periods after liver transplantation.
Liver Transpl. 2014 Dec 30;
Authors: Annema C, Roodbol PF, Stewart RE, Porte RJ, Ranchor AV
After liver transplantation, recipients often experience psychological problems that are influenced by demographic, personal and transplant-related variables. However, because previous studies have mostly reported on psychological problems and their influencing factors in the first years after transplantation, less is known about their prevalence and influence in the long run. The aim of this study was to examine point-prevalence rates of symptoms of anxiety, depression and posttraumatic stress at different time periods after transplantation, as well as transplant-related variables associated with these problems. A cross-sectional survey was performed among 373 liver transplant recipients transplanted between 1979 and 2009 at our center. Five clinically relevant time periods were identified: 0.5-<2 years, 2-<5 years, 5-<10 years, 10-<15 years, and ≥15 years after transplantation. The response rate was 75% (n=281). Overall, 33.4% of the respondents experienced clinically relevant symptom levels of anxiety (28.7%), depression (16.5%), or posttraumatic stress (10.0%). Symptoms of anxiety and depression were more prevalent in the first two years and at long-term after transplantation. Posttraumatic stress symptoms were more prevalent in the first five years after transplantation. However, the prevalence rates did not differ significantly between time periods. Viral hepatitis and the number of side-effects of the immunosuppressive medication were found to be associated with all psychological problems. Alcoholic liver disease was associated with anxiety and depression at short-term after transplantation. In conclusion, a significant subset of transplant recipients experience psychological problems, both shortly after transplantation and in the long run. These problems are often associated with side-effects of the immunosuppressive medication. Therefore monitoring of psychological problems, offering psychological counseling and managing medication side-effects should be part of the routine care of transplant recipients. This article is protected by copyright. All rights reserved.
PMID: 25556775 [PubMed - as supplied by publisher]