Patients’ Outcome Expectations Matter in Psychological Interventions for Patients with Diabetes and Comorbid Depressive Symptoms.

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Patients’ Outcome Expectations Matter in Psychological Interventions for Patients with Diabetes and Comorbid Depressive Symptoms.

Cognit Ther Res. 2015;39(3):307-317

Authors: Snippe E, Schroevers MJ, Annika Tovote K, Sanderman R, Emmelkamp PM, Fleer J

Abstract

This study examined whether patients’ expectations of treatment outcome predict treatment completion, homework compliance, and depressive symptom improvement in cognitive behavior therapy (CBT) and mindfulness-based cognitive therapy (MBCT). Study participants were patients with diabetes and comorbid depressive symptoms who were randomized to 8 sessions of either CBT (n = 45) or MBCT (n = 46), both individually delivered. The results showed that high outcome expectations were predictive of post-treatment depressive symptoms in CBT and MBCT, but not of early and mid-treatment symptoms. Patients’ outcome expectations predicted treatment completion in CBT and MBCT as well as homework compliance in MBCT. Homework compliance did not mediate the association between patients’ outcome expectations and post-treatment depressive symptom improvement. The findings do not support the hypothesis that patients’ expectations have an immediate impact on patients’ mental state and partially support the notion that patients are less involved in treatment when they hold low expectations for improvement.

PMID: 25983355 [PubMed - as supplied by publisher]

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Shared decision making in transplantation: how patients see their role in the decision process of accepting a donor liver.

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Shared decision making in transplantation: how patients see their role in the decision process of accepting a donor liver.

Liver Transpl. 2014 Sep;20(9):1072-80

Authors: Dries SO, Annema C, Berg AP, Ranchor AV, Porte RJ

Abstract

At the time of the organ offer for transplantation, donor-related risks such as disease transmission and graft failure are weighed against the patient’s risk of remaining on the waiting list. The patient’s commonly inactive role in decision making and the timing and extent of donor-specific risk information have been discussed in the medical literature. This is the first study revealing the opinions of liver patients on these issues. Forty patients listed for liver transplantation and 179 liver transplant patients participated in an anonymous questionnaire-based survey. The majority of the patients wanted to be informed about donor-related risks (59.8%-74.8%). The preferred timing for being informed about donor-related risks was the time of the organ offer for 53.3% of the patients. Among these patients, 79.8% wished to be involved in making the decision to accept or not accept a liver for transplantation, 10.6% wished to make the final decision alone, and only 9.6% did not want to be involved in the decision-making process. Implementing this knowledge through the standardization of the content, the manner of transfer, and the amount of information that we provide to our patients will improve opportunities for shared decision making at different time points during the transplant allocation process. This will enable us to provide the same opportunities and care to every patient on the waiting list.

PMID: 24863055 [PubMed - indexed for MEDLINE]

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Body issues, sexual satisfaction, and relationship status satisfaction in long-term childhood cancer survivors and healthy controls.

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Body issues, sexual satisfaction, and relationship status satisfaction in long-term childhood cancer survivors and healthy controls.

Psychooncology. 2015 May 8;

Authors: Lehmann V, Hagedoorn M, Gerhardt CA, Fults M, Olshefski RS, Sanderman R, Tuinman MA

Abstract

OBJECTIVE: Research on body image and sexual satisfaction after adult onset cancer has shown significant and lasting impairments regarding survivors’ sexuality and romantic relationships. However, knowledge about these topics and their associations in adult survivors of childhood cancer is largely lacking.

METHODS: Participants completed web-based questionnaires concerning body image, body dissociation, sexual satisfaction, and relationship status satisfaction (i.e., satisfaction with either being in a relationship or being single). Survivors (n = 87) and controls (n = 87) were matched on age and gender, with a mean age of 27 years (range: 20-40). Survivors were most often diagnosed with leukemia (46%), at an average of 16 years prior to study participation (range: 6-33 years).

RESULTS: Similar numbers of survivors and controls were single (n = 24/31), in a committed relationship (n = 33/23), or married (n = 30/33). Survivors and controls reported comparable levels of body image, body dissociation, sexual experiences, and sexual and status satisfaction (d = 0.15-0.28). Higher status satisfaction was associated with being in a relationship (compared with being single, β = 0.439), more positive body image (β = 0.196), and higher sexual satisfaction (β = 0.200).

CONCLUSIONS: Adult survivors of childhood cancer were comparable to healthy peers regarding views of their bodies and psychosexual development, which was unexpected. Independent of whether people experienced cancer or not, their status satisfaction was associated with their relationship status, body image, and sexual satisfaction. Future research should explore why sexual and body problems are identified after adult onset cancer, whereas this seems to be less of a problem in childhood cancer survivors. Copyright © 2015 John Wiley & Sons, Ltd.

PMID: 25959111 [PubMed - as supplied by publisher]

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Fracture diagnostics, unnecessary travel and treatment: a comparative study before and after the introduction of teleradiology in a remote general practice.

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Fracture diagnostics, unnecessary travel and treatment: a comparative study before and after the introduction of teleradiology in a remote general practice.

BMC Fam Pract. 2015 May 6;16(1):53

Authors: Jacobs JJ, Jacobs JP, van Sonderen E, van der Molen T, Sanderman R

Abstract

BACKGROUND: Teleradiology entails attainment of x-rays in one location, transfer over some distance and assessment at another location for diagnosis or consultation. This study documents fracture diagnostics, unnecessary trips to the hospital, treatment and number of x-rays for the years 2006 and 2009, before and after the introduction of teleradiology in a general practice on the island of Ameland in the north of the Netherlands.

METHODS: In a retrospective, descriptive, observational before and after study of the introduction of x-ray facilities in an island-based general practice, we compared the number of accurately diagnosed fractures, unnecessary trips, treatments and number of x-rays taken in 2006 when only a hospital x-ray facility was available 5 hours away with those in 2009 after an x-ray facility became available at a local general practice. All patients visiting a general practice on the island of Ameland in 2006 and 2009 with trauma and clinical suspicion of a fracture, dislocation or sprain were included in the study. The initial clinical diagnoses, including those based on the outcomes of x-rays, were compared for the two years and also whether the patients were treated at home or in hospital.

RESULTS: A total of 316 and 490 patients with trauma visited a general practice in 2006 and 2009, respectively. Of these patients, 66 and 116 were found to have fractures or dislocations in the two years, respectively. In 2006, 83 x-rays were ordered; in 2009, this was 284. In 2006, 9 fractures were missed; in 2009, this was only 2. In 2006, 15 patients with fractures or dislocations were treated at the general practice; in 2009, this had increased to 77.

CONCLUSION: Since the introduction of teleradiology the number of missed fractures in patients visiting the general practice with trauma and the number of the unnecessary trips to a hospital are reduced. In addition more patients with fractures and dislocations can be treated in the general practice as opposed to the hospital.

PMID: 25943473 [PubMed - as supplied by publisher]

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The impact of age on changes in quality of life among breast cancer survivors treated with breast-conserving surgery and radiotherapy.

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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 Feb 17;112(4):636-43

Authors: Bantema-Joppe EJ, de Bock GH, Woltman-van Iersel M, Busz DM, Ranchor AV, Langendijk JA, Maduro JH, van den Heuvel ER

Abstract

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.

PMID: 25602967 [PubMed - indexed for MEDLINE]

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Individual mindfulness-based cognitive therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: results of a randomized controlled trial.

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Individual mindfulness-based cognitive therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: results of a randomized controlled trial.

Diabetes Care. 2014 Sep;37(9):2427-34

Authors: Tovote KA, Fleer J, Snippe E, Peeters AC, Emmelkamp PM, Sanderman R, Links TP, Schroevers MJ

Abstract

OBJECTIVE: Depression is a common comorbidity of diabetes, undesirably affecting patients’ physical and mental functioning. Psychological interventions are effective treatments for depression in the general population as well as in patients with a chronic disease. The aim of this study was to assess the efficacy of individual mindfulness-based cognitive therapy (MBCT) and individual cognitive behavior therapy (CBT) in comparison with a waiting-list control condition for treating depressive symptoms in adults with type 1 or type 2 diabetes.

RESEARCH DESIGN AND METHODS: In this randomized controlled trial, 94 outpatients with diabetes and comorbid depressive symptoms (i.e., Beck Depression Inventory-II [BDI-II] ≥14) were randomized to MBCT (n = 31), CBT (n = 32), or waiting list (n = 31). All participants completed written questionnaires and interviews at pre- and postmeasurement (3 months later). Primary outcome measure was severity of depressive symptoms (BDI-II and Toronto Hamilton Depression Rating Scale). Anxiety (Generalized Anxiety Disorder 7), well-being (Well-Being Index), diabetes-related distress (Problem Areas In Diabetes), and HbA1c levels were assessed as secondary outcomes.

RESULTS: Results showed that participants receiving MBCT and CBT reported significantly greater reductions in depressive symptoms compared with patients in the waiting-list control condition (respectively, P = 0.004 and P < 0.001; d = 0.80 and 1.00; clinically relevant improvement 26% and 29% vs. 4%). Both interventions also had significant positive effects on anxiety, well-being, and diabetes-related distress. No significant effect was found on HbA1c values.

CONCLUSIONS: Both individual MBCT and CBT are effective in improving a range of psychological symptoms in individuals with type 1 and type 2 diabetes.

PMID: 24898301 [PubMed - indexed for MEDLINE]

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Telemedicine uptake among Genetics Professionals in Europe: room for expansion.

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Telemedicine uptake among Genetics Professionals in Europe: room for expansion.

Eur J Hum Genet. 2015 Apr 22;

Authors: Otten E, Birnie E, Lucassen AM, Ranchor AV, Van Langen IM

Abstract

Today’s economic challenges and the changing landscape of clinical genetics are forcing us to consider alternative ways of providing genetic services, to comply with budget limitations and at the same time meeting the demands of increasing patient numbers and patient-centered care delivery. Telegenetics could be an effective and efficient way of counseling, but its use in Europe is not widely reported, nor is there evidence of international collaboration. We conducted an online survey among 929 genetics professionals, to explore the current availability and use of different telegenetics modalities in Europe. Our questionnaire was completed by 104 clinically active European genetics professionals. Telephone genetic counseling was used by 17% of respondents. Videoconferencing facilities were available to 24%, but only 9% of them used these for patient counseling. Various barriers to availability and use were cited, ranging from practical constraints, lack of professional support/knowledge, to lack of perceived suitability and need. The results show that telegenetics modalities are not currently in widespread use by our respondents, in part due to perceived barriers. To meet the changing economic, genetic, and societal circumstances, we recommend consideration of greater integration of telegenetics into regular clinical genetic care, to supplement existing care modalities. Professional cooperation, sharing knowledge, and establishing guidelines on a national and international level could contribute to successful and more widespread implementation of telegenetics. However, the perceived practical and regulatory barriers have to be overcome.European Journal of Human Genetics advance online publication, 22 April 2015; doi:10.1038/ejhg.2015.83.

PMID: 25898928 [PubMed - as supplied by publisher]

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The role of goal adjustment in symptoms of depression, anxiety and fatigue in cancer patients receiving psychosocial care: a longitudinal study.

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The role of goal adjustment in symptoms of depression, anxiety and fatigue in cancer patients receiving psychosocial care: a longitudinal study.

Psychol Health. 2015;30(3):268-83

Authors: Zhu L, Ranchor AV, van der Lee M, Garssen B, Sanderman R, Schroevers MJ

Abstract

OBJECTIVE: This study examined whether cancer patients reported increases in their goal adjustment capacities while receiving psychosocial care and whether these increases were related to changes in symptoms of depression, anxiety and fatigue. Goal adjustment was conceptualised as two independent capacities: goal disengagement (i.e. disengage from unattainable goals) and goal reengagement (i.e. reengage into new goals).

DESIGN: This naturalistic, longitudinal study focused on 241 cancer patients receiving psychosocial care at one of the seven psycho-oncology institutions in the Netherlands. Data was collected before the start of psychosocial care (T1) and nine months thereafter (T2). Hierarchical regression analysis was used to examine the research questions.

MAIN OUTCOME MEASURES: Goal adjustment, symptoms of depression, anxiety and fatigue.

RESULTS: At group level, patients reported small increases in goal disengagement (d = .22) but no significant change in goal reengagement (d = .09). At an individual level, 34% of cancer patients reported an increase in goal disengagement and 30% reported an increase in goal reengagement. Increases in goal reengagement were significantly associated with decreases in both depressive and anxiety symptoms, but not to changes in fatigue.

CONCLUSION: Findings indicate that particularly improvements in goal reengagement are beneficial for cancer patients’ psychological functioning.

PMID: 25264270 [PubMed - indexed for MEDLINE]

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A web-based self-help intervention for partners of cancer patients based on Acceptance and Commitment Therapy: a protocol of a randomized controlled trial.

A web-based self-help intervention for partners of cancer patients based on Acceptance and Commitment Therapy: a protocol of a randomized controlled trial.

BMC Public Health. 2015;15(1):303

Authors: Köhle N, Drossaert CH, Schreurs KM, Hagedoorn M, Verdonck-de Leeuw IM, Bohlmeijer ET

Abstract

BACKGROUND: There is a growing recognition that cancer not only affects the lives of the patients, but also the lives of their partners. Partners of cancer patients are highly involved in the illness trajectory by providing informal care and they often experience distress. However, supporting interventions for this group are scarce and existing interventions bear several limitations. On the basis of the need for theory- and evidence-based supportive interventions for partners of cancer patients, the web-based self-help intervention Hold on, for each other has been developed. This intervention is based on Acceptance and Commitment Therapy. The primary objective of the RCT is to investigate the (cost-) effectiveness of the intervention. Additional goals are (1) to examine if psychological flexibility, self-compassion, mastery, supportive behavior, posttraumatic growth and resilience are mediators of the intervention’s effects on the partners’ mental health; (2) to examine the moderating effects of the socio demographics (age, gender, education, working situation, family situation) and disease-related characteristics of the patients (sort of cancer, stage of disease, duration and treatment of cancer); and (3) to investigate to what extend participants are satisfied with the intervention, which parts of the intervention are mostly used, and how adherent the users are.

METHODS/DESIGN: A three-armed randomized controlled trial (RCT) will be conducted to compare two versions of the intervention Hold on, for each other with a waiting list control condition. Both intervention conditions contain the same content and differ only with regard to the form of professional support (personal support versus automatic support). Adult partners of cancer patients with mild to moderate depressive and anxiety symptoms, will be recruited through a multi-component strategy. Online measurements by self-assessment will be made on four measurement points (prior to randomization (baseline-measurement) and 3, 6 and 12 months after baseline).

DISCUSSION: When proven effective, Hold on, for each other can be an invaluable contribution to the healthcare system and it could be offered to all partners of cancer patients who are in need for additional support.

TRIAL REGISTRATION: Dutch Trial Register, trial registration number NTR4035 , date of registration: 17 March 2013.

PMID: 25884187 [PubMed - as supplied by publisher]

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Sweet and sour after renal transplantation: a qualitative study about the positive and negative consequences of renal transplantation.

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Sweet and sour after renal transplantation: a qualitative study about the positive and negative consequences of renal transplantation.

Br J Health Psychol. 2014 Sep;19(3):580-91

Authors: Schipper K, Abma TA, Koops C, Bakker I, Sanderman R, Schroevers MJ

Abstract

OBJECTIVES: This qualitative study investigated the renal patients’ experience of positive and negative consequences of transplantation, as well as the strategies they use to adapt to the transplantation.

DESIGN AND METHODS: A qualitative design (30 participants in total), using individual interviews (18 participants) and two focus groups (12 participants in total), was used.

RESULTS: The results showed that patients experienced a wide range of positive and negative emotions, in particular, guilt, gratefulness, and fear, partly as a result of their normative persuasions. Normative persuasions may transform inherent positive emotions into negative emotions and subsequent maladaptive behaviour. Not only physical limitations but also physical improvements were found to be related to the experience of negative emotions. Finally, the results indicated that patients mainly used adaptive coping strategies to adjust to life after transplantation, such as looking for opportunities, setting different priorities, making own choices, trying to maintain control, taking good care of oneself, and appreciating other things in life.

CONCLUSIONS: This study offers several new insights regarding the range of experiences of renal patients after transplantation. Health professionals are invited to pay more attention to the full range of positive and negative experiences following transplantation, including the existence of normative persuasions. Health professionals may assist renal patients by helping them to recognize and acknowledge both positive and negative emotions and to encourage the use of more beneficial coping strategies.

STATEMENT OF CONTRIBUTION: What is already known on this subject? The quality of life (QoL) of renal patients significantly improves after transplantation but the post-transplant QoL is lower compared with the QoL in healthy populations. Patients on dialysis and those who have received a donor kidney tend to use mainly emotion-focused coping strategies. What does this study add? This study offers several new insights regarding experiences of renal patients after transplantation: Patients experience a range of positive and negative emotions like guilt, gratefulness, and fear. Emotions are partly a result of normative persuasions. Persuasions may transform positive emotions into negative emotions and maladaptive behaviour. Physical limitations and improvements can due to the persuasions lead to negative emotions. Patients mainly use adaptive coping strategies.

PMID: 23826640 [PubMed - indexed for MEDLINE]

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