Biomedical subjects

Ellen M A Smets

Publications and source records attributed to Ellen M A Smets.

12 recordsLinked to original sources

PubMed2006

Patient participation in the medical specialist encounter: does physicians' patient-centred communication matter?

OBJECTIVE: Physicians' patient-centred communication is assumed to stimulate patients' active participation, thus leading to more effective and humane exchange in the medical consultation. We investigated the relationship between physicians' patient-centred communication and patient participation in a medical specialist setting. METHODS: Participants were 30 residents and specialists in internal medicine, and 323 of their patients. Participants completed a questionnaire prior to a (videotaped) follow-up consultation. Physicians' patient-centred communication was assessed by coding behaviours that facilitate or rather inhibit patients to express their perspective. Patient participation was determined by assessing (a) their relative contribution to the conversation, and (b) their active participation behaviour. Analyses accounted for relevant background characteristics. RESULTS: Physicians' facilitating behaviour was found to be positively associated with patients' relative contribution to the conversation as well as patients' active participation behaviour. Physicians' inhibiting behaviour was not related to patients' relative contribution, and was, unexpectedly, positively associated with patients' active participation behaviour. Physicians' behaviour was particularly associated with patients' expression of concerns and cues. CONCLUSIONS: Physicians in internal specialist medicine appear to be able to facilitate patients' active participation in the visit. The findings indicate that inhibiting behaviour may not have the expected blocking effect on patient participation: patients voiced their perspectives just the same and expressed even more concerns. Showing inhibiting behaviour may, alternatively, be a physician's response to the patient's increased participation in the encounter. PRACTICE IMPLICATIONS: The results may give directions for future medical education and specialist training.

Adolescent↗

PubMed2006

The perceived personal control (PPC) questionnaire as an outcome of genetic counseling: reliability and validity of the instrument.

The perceived personal control (PPC) questionnaire was developed by Berkenstadt and colleagues as an outcome measure for the evaluation of the process of genetic counseling. The present study aimed to further assess the psychometric properties of a Dutch version of the instrument. Data were used from two samples. A reproductive genetic counseling sample (n = 140), which included pregnant and non-pregnant women, and a cancer genetic counseling sample (n = 181), also consisting of women only. Counselees completed questionnaires before and following their first consultation. Besides the PPC these questionnaires addressed counselees' degree of concern, risk perception and satisfaction with the consultation. The following psychometric properties were assessed: acceptability, internal consistency, dimensionality, and validity. The instrument was well accepted as indicated by few missing items. The internal consistency was good for the total PPC (Cronbach's alpha: 0.79-0.81), reasonable for the original subscales of 'decisional' and 'behavioral control' (>0.60), but unacceptable for the subscale of 'cognitive control' (<0.60). The original three-factor solution was not confirmed; a one-factor solution proved most stable. Significant differences between pre- and post-counseling PPC scores support the PPC's construct validity. Concurrent validity was confirmed by positive associations with counselees' satisfaction although non-significant (concern) and unexpected (risk perception) results were also found. When used as a one-dimensional scale, the PPC has its value as an outcome measure in research addressing genetic counseling. However, the instrument's validity needs to be further assessed.

Adolescent↗

PubMed2006

Determinants of physicians' patient-centred behaviour in the medical specialist encounter.

It has been suggested that patient-centred communication does not necessarily translate into a 'one-size fits all' approach, but rather that physicians should use a flexible style and adapt to the particular needs of their patients. This paper examines variability in physicians' patient-centred behaviour in medical specialist encounters, and determines whether patient, visit, and physician characteristics influence this variability. Participants were 30 residents and specialists in internal medicine at an academic teaching hospital in The Netherlands, and 323 patients having a (videotaped) outpatient follow-up appointment. Physicians and patients completed a questionnaire prior to the encounter. Consultations were coded using the Patient-centred Behaviour Coding Instrument (PBCI); physicians' patient-centred behaviour was determined by behaviours that facilitated rather than inhibited the patient's expression of his/her perspective. The results show that physicians differ in their communicative behaviour (i.e. inter-individual variability): some internists had a more 'patient-centred' communication style and others less so. At the same time, physicians show intra-individual variation; apparently they adjust their style according to the situation. Physicians displayed more facilitating behaviour when patients were older, reported more physical symptoms, when they rated patients' health condition as more severe and when the physician was a woman. Physicians also displayed more inhibiting behaviour when patients reported more physical symptoms and when the physician rated patients' health condition as more severe. Apparently, sicker patients were targets of both greater facilitation and greater inhibition. Variability in physicians' facilitating and inhibiting behaviour was explained by patient characteristics, i.e. patients' age and health condition, and-with the exception of physician gender-not by physician or visit characteristics. This indicates that physician patient-centred behaviour is related to the type of patient visiting, especially in relation to the seriousness of symptoms.

Adult↗

PubMed2006

Counselor-counselee interaction in reproductive genetic counseling: Does a pregnancy in the counselee make a difference?

OBJECTIVE: To investigate the influence of a pregnancy and other counselee characteristics on several aspects of counselor-counselee interaction during the initial clinical genetic consultation. METHODS: The consultations, of a group of pregnant women (n = 82) and of a control group of non-pregnant women (n = 58), were compared specifically with regard to differences in global affective tone, extent of psychosocial exchange and women's participation in the decision-making process. Consultations were recorded, and subsequently coded from audiotape by 10 raters. RESULTS: Only two differences in outcome measures were found between the two study groups: the counselor was rated as slightly more nervous in consultations with pregnant women, and in consultations with non-pregnant women fewer decisions were taken. The length of the consultation, the contribution of a counselee's companion to the consultation and counselee characteristics (age, level of education, initiation of referral, affected person, degree of worry and preferred participation in decision-making) were more important in explaining the nature of the interaction. CONCLUSION: Our study yielded no important differences in counselor-counselee interaction during the initial clinical genetic consultation of pregnant versus non-pregnant women regarding the affective tone of the consultation, the degree to which psychosocial issues were discussed and the women's participation in the decision-making process. PRACTICE IMPLICATIONS: Our findings suggest that a negatively affected counselor-counselee interaction is not an important disadvantage in consultations with pregnant women. Given the limitations of our study, however, we advocate further studies on counselor-counselee interaction in reproductive genetic counseling, in order to improve the quality of reproductive genetic counseling.

Adolescent↗

PubMed2006

Smoking cessation may not improve quality of life in atherosclerotic patients.

The benefits of smoking cessation on patients' medical conditions are well documented. Cardiovascular patients who quit smoking significantly reduce their risk of a new event compared with those who continue smoking. Several studies have found that smoking is related to poor quality of life (QoL). In cardiovascular patients, however, less attention has been given to the effect of smoking cessation on patients' QoL. The present study examined the extent to which smoking cessation leads to changes in QoL in these patients within the first year of follow-up. Data were collected in the context of a randomized clinical trial. Smoking outpatients (N = 346) with atherosclerotic disease were included and received medical treatment. They were randomized to receive either nicotine replacement therapy (NRT) or NRT plus a behavioral intervention meant to promote smoking cessation. At baseline, sociodemographic and clinical characteristics were established. Generic and disease-specific QoL as well as smoking status were assessed at baseline and with three follow-up measurements. Multilevel modeling showed that generic and disease-specific QoL in atherosclerotic patients improved significantly within the first year of follow-up. No main differences were found between quitters and smokers in terms of improvement in QoL. In fact, some subgroups reported a poorer QoL after smoking cessation: More highly educated patients reported lower general QoL (p < .05), and patients suffering from coronary artery disease who had a low level of education (p < .01) and patients suffering from peripheral arterial disease who had low nicotine dependency (p < .01) reported lower disease-specific QoL. Atherosclerotic patients' QoL improved significantly but was not enhanced by smoking cessation activities.

Aged↗

PubMed2006

The effect of a minimal intervention strategy in addition to nicotine replacement therapy to support smoking cessation in cardiovascular outpatients: a randomized clinical trial.

BACKGROUND: Smoking is an important risk factor for recurrent events in cardiovascular patients. Evidence exists that nicotine replacement therapy (NRT) approximately doubles smoking cessation rates. The minimal intervention strategy (MIS) has been used successfully to assist patients to quit smoking in general practice, and was recently adapted for cardiology inpatients (C-MIS). It is hypothesized that in cardiovascular outpatients the combination of C-MIS and NRT significantly increases the number of quitters compared to NRT alone. METHODS: A randomized clinical trial in 385 smoking patients who attended the cardiovascular outpatient departments in the Academic Medical Centre, Amsterdam for the treatment of atherosclerotic disease. Patients were allocated to either NRT + C-MIS or NRT alone. Self-reported and biochemically validated abstinence rates were measured at 12 months' follow-up. RESULTS: Including patients with incomplete follow-up as smokers, abstinence was reported by 19% of the NRT + C-MIS group and 14% of the NRT group [absolute risk reduction (ARR) = 0.05; 95% confidence interval (CI) = -0.02; 0.12]. According to biochemical markers, abstinence rates were 28 and 24%, respectively (ARR = 0.04, 95% CI = -0.06; 0.14). Hence, no significant differences between groups were found. The number of cigarettes smoked a day decreased significantly at 12 months: from 21 to 15 a day in the experimental group, and from 21 to 14 in the control group (P<0.001), but did not differ between groups (P=0.32). CONCLUSIONS: The effectiveness of a minimal contact intervention was investigated in order to reach as many cardiovascular patients as possible in the setting of outpatient departments. This intervention was not found to be effective.

Administration, Cutaneous↗

PubMed2006

Adherence to nicotine replacement patch therapy in cardiovascular patients.

Nicotine Replacement Therapy (NRT) is the most frequently used pharmacological intervention for smoking cessation. Research on the effect of NRT showed serious nonadherence among users. We investigated adherence to NRT in cardiovascular patients. A number of 174 outpatients (N = 174), who smoked > 5 cigarettes a day, received free patches and intensive instructions from nurses. Questionnaires were sent to patients assessing patient characteristics, adherence to a 7-8 weeks time frame and appliance instructions, side effects/withdrawal symptoms, and reasons for nonadherence. Only 38% of the patients was adherent to the time frame. Appliance instructions were followed in 76-96% of the cases, except for smoking; 50% continued to smoke during NRT. In conclusion, despite considerable attention to appliance instructions, access to free patches and additional behavioral support, adherence to NRT in these patients is rather low.

Administration, Cutaneous↗

PubMed2005

Coding patient-centred behaviour in the medical encounter.

A patient-centred approach is increasingly advocated and incorporated in medical education. Due to its multi-dimensionality, however, the concept of patient-centredness appears to be hard to measure and, consequently, to evaluate. The objective of this study was to develop an instrument to measure patient-centredness in line with one central dimension, i.e. physicians' explorative communication skills: the tendency to encourage (or discourage) patients to express their perspective on illness and treatment, by displaying facilitating and inhibiting behaviours. The paper describes the development of the patient-centred behaviour coding instrument (PBCI), and first results of validity and reliability of the instrument. The study was conducted in the outpatient division of an academic teaching hospital in The Netherlands, where follow-up encounters were videotaped and coded. Participants were 30 residents and specialists in general internal medicine, rheumatology and gastro-enterology, and 323 patients having a (video-taped) follow-up appointment with one of these physicians. All recorded consultations were coded using the PBCI. Statistical analyses verified the existence of two dimensions of the PBCI: facilitating and inhibiting behaviours. Interestingly, open and closed questions generally appeared to be indicative of both the facilitating and the inhibiting dimension; only open and closed questions with a psycho-social content were unambiguously classified as facilitating behaviours. Reliability of the facilitating behaviours was high, while reliability of the inhibiting behaviours was moderate. Besides infrequent observations of the inhibiting behaviours, low reliability was partly due to individual inter-rater variability. A global rating of patient-centredness appeared to correlate with the two dimensions in the expected direction: positively with the facilitating and negatively with the inhibiting dimension, indicating the convergent validity of the instrument.

Academic Medical Centers↗

PubMed2004

Assessing inpatients' satisfaction with hospital care: should we prefer evaluation or satisfaction ratings?

Inpatients' satisfaction with hospital care is often assessed by questionnaire. From a psychometrical standpoint, this method has drawbacks, however. We further investigated which item response format would maximise desirable outcomes regarding characteristics of the sample obtained (response rate and representativeness) and psychometric properties of the instrument (e.g. missing items responses, variance, validity) as an initial study into this question was indecisive. Subjects were 1184 discharged inpatients, of which 728 patients (62%) responded. They filled out a 55-item satisfaction questionnaire, addressing 12 aspects of care, using either a 10-point Evaluation scale ranging from "very poor" to "excellent" (E10) or a 5-point Satisfaction scale ranging from "dissatisfied" to "very satisfied" (S5). Both E10 and S5 showed good psychometric properties, but S5 yielded a better score distribution. Other results also favoured S5, but differences were small. In conclusion, different response formats do not yield widely different results. Thus, in choosing between them, convenience could be a decisive factor.

Academic Medical Centers↗

PubMed2004

Satisfaction with the outpatient encounter: a comparison of patients' and physicians' views.

OBJECTIVE: To compare patients' and physicians' visit-specific satisfaction in an internal medicine outpatient setting, and to explain their respective views. DESIGN: Patients' and physicians' background characteristics were assessed prior to outpatient encounters. Immediately after the encounter, both patients and physicians completed a questionnaire assessing satisfaction with the visit. SETTING: The outpatient division of an academic teaching hospital. PARTICIPANTS: Thirty residents and specialists in general internal medicine, rheumatology, and gastroenterology, and 330 patients having a follow-up appointment with one of these physicians. MEASUREMENTS AND MAIN RESULTS: Patients' and physicians' visit-specific satisfaction was assessed using 5 Visual Analogue Scales (0 to 100). Patients' overall satisfaction was higher than physicians' satisfaction (mean 81 vs. 66), and correlation of patients' and physicians' overall satisfaction with the specific visit was medium sized (r= .28, P < .001). Patients' satisfaction ratings were associated with their previsit self-efficacy in communicating with their physician (P < .001) and with visiting a female physician (P < .01). Physicians' satisfaction was associated with patients' higher educational level (P < .05), primary language being Dutch (P < .001), better mental health (P < .05), and preference for receiving less than full information (P < .05). CONCLUSIONS: In an outpatient setting, patients' visit-specific satisfaction ratings were substantially higher than, and only moderately associated with, physicians' ratings of the same visit. The dissimilar predictors explaining patients' and physicians' satisfaction suggest that patients and physicians form their opinion about a consultation in different ways. Hence, when evaluating outpatient encounters, physicians' satisfaction has additional value to patients' satisfaction in establishing quality of care.

Adult↗

PubMed2003

Stress, satisfaction and burnout among Dutch medical specialists.

BACKGROUND: Stress and stress-related illnesses are increasing among medical specialists. This threatens the quality of patient care. In this study we investigated (a) levels of job stress and job satisfaction among medical specialists, (b) factors contributing to stress and satisfaction and (c) the effect of stress and satisfaction on burnout. METHODS: A questionnaire was mailed to a random sample of 2400 Dutch medical specialists. Measures included job stress, job satisfaction, burnout, personal characteristics, job characteristics and perceived working conditions. RESULTS: The final response rate was 63%. Of the respondents, 55% acknowledged high levels of stress, and 81% reported high job satisfaction. Personal and job characteristics explained 2%-6% of the variance in job stress and satisfaction. Perceived working conditions were more important, explaining 24% of the variance in job stress and 34% of the variance in job satisfaction. Among perceived working conditions, the interference of work on home life (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.35-1.76) and not being able to live up to one's professional standards (OR 1.57, 95% CI 1.37-1.80) were most related to stress. Feeling poorly managed and resourced (OR 2.07, 95% CI 1.76-2.43) diminished job satisfaction. Burnout was explained by both high stress and low satisfaction (41% of variance explained) rather than by stress alone. INTERPRETATION: Our study showed a protective effect of job satisfaction against the negative consequences of work stress as well as the importance of organizational rather than personal factors in managing both stress and satisfaction.

Adult↗

PubMed2003

Referral for genetic counselling during pregnancy: limited alertness and awareness about genetic risk factors among GPs.

BACKGROUND: In many countries, GPs play a key role in the referral to other medical specialists. Referral for reproductive genetic counselling during a pregnancy of women with a genetic risk factor already present before pregnancy has many disadvantages. Nevertheless, some 10-20% of the counsellees who attend a Department of Clinical Genetics for the first time are pregnant. OBJECTIVES: We aimed to explore the role of the GP in referring women for genetic counselling during, instead of before a pregnancy. METHOD: The GPs of 100 pregnant women who received genetic counselling were invited to participate in the study and asked to complete a questionnaire. The topics were: initiation and discussion of aspects of referral to the Department of Clinical Genetics; reasons for the referral during, instead of before a pregnancy; knowledge of genetic counselling; attitudes towards genetic counselling before a pregnancy; and attitudes towards abortion. RESULTS: To our surprise, 29% of the GPs indicated that they had not been involved in the referral to the Department of Clinical Genetics at all. Furthermore, the referral was initiated by the patient herself in most cases (40%) and by the GPs in 31% of the cases. Of the GPs who were involved in the referral, most of them (79%) talked to their patients to different extents about what to expect from their visit to the Department of Clinical Genetics; however, potential choices after an adverse outcome at prenatal diagnosis were discussed less often (60%). The main reason for referring the patient during, instead of before her pregnancy was because the GP was unaware of a potential risk factor before pregnancy (71%) and, consequently, never had a chance to talk about a referral before (71%). Other reasons for referral during pregnancy mentioned by the GPs were reassuring the patient about the health of her unborn child (32%) and the wish of the patient to be referred during pregnancy (31%). GPs considered their knowledge of clinical genetics to be limited (mean score 5, on a scale from 0 to 10). The majority of the GPs were in favour of genetic counselling taking place before, instead of during pregnancy, and they had no great objections to abortion. CONCLUSIONS: During pregnancy, the gatekeeper function of the GP in the referral for genetic counselling is undermined. Limited alertness and awareness among GPs about genetic risk factors in their patients played a major role in this undermined function and in the less appropriate timing of referral. Neither insufficient knowledge nor barriers to acceptance explained this lack of alertness and awareness. We advocate the implementation of routine family history taking in general practice.

Chi-Square Distribution↗