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Biomedical subjects

H B van de Wiel

Publications and source records attributed to H B van de Wiel.

At least 19 recordsLinked to original sources
PubMed2001

Communication skills of nurses during interactions with simulated cancer patients.

AIM: In this paper the balance of affective and instrumental communication employed by nurses during the admission interview with recently diagnosed cancer patients was investigated. RATIONALE: The balance of affective and instrumental communication employed by nurses appears to be important, especially during the admission interview with cancer patients. METHODS: For this purpose, admission interviews between 53 ward nurses and simulated cancer patients were videotaped and analysed using the Roter Interaction Analysis system, in which a distinction is made between instrumental and affective communication. RESULTS: The results reveal that more than 60% of nurses' utterances were of an instrumental nature. Affective communication occurred, but was more related to global affect ratings like giving agreements and paraphrases than to discussing and exploring actively patients feelings by showing empathy, showing concern and optimism. CONCLUSION: In future, nurses should be systematically provided with (continuing) training programmes, in which they learn how to communicate effectively in relation to patients' emotions and feelings, and how to integrate emotional care with practical and medical tasks.

Adult↗
PubMed2001

Communication between nurses and simulated patients with cancer: evaluation of a communication training programme.

In this paper the effect of a communication training programme on the instrumental and affective communication skills employed by ward nurses during the admittance interview with recently diagnosed cancer patients was investigated. The training focused on teaching nurses skills to discuss and handle patient emotions. For this purpose, 46 nurses participated in 92 videotaped admittance interviews with simulated patients. The study had a randomized pre-test-post-test design. Multi-level analysis was used to measure the effects of the training. The results revealed that the trained nurses significantly increased asking open-ended psychosocial questions, which indicates that they were actively exploring patients' feelings. Furthermore, the patients showed a significant increase in affective communication. In conclusion, the results of this study demonstrate that, although limited, training can induce favourable changes in the communication skills of nurses, and can even affect patient communication. Future studies should focus on the further evaluation of educational programmes to enhance communication skills.

Journal Article↗
PubMed2001

Conventional or adhesive external breast prosthesis? A prospective study of the patients' preference after mastectomy.

After having been subjected to radical mastectomy for breast cancer, women are usually fitted with an external breast prosthesis. Different types of prostheses are available, but oncology nurses have few data enabling them to advise their patients adequately. In this prospective randomized crossover study of 101 women undergoing one-sided mastectomy for breast cancer, the self-adhesive breast prosthesis was compared with the traditional external prosthesis. Questionnaires were used to evaluate the woman's judgment of the prosthesis in relation to her final preference for one type of prosthesis. Complete data were available for 91 women, 59.3% of whom finally preferred the self-adhesive type. Preference was independent of age, randomization, order, or the possible use of adjuvant chemotherapy. Satisfaction with the self-adhesive prosthesis was independent of randomization order but satisfaction with the traditional type was significantly more when it was the first type of prosthesis. Preference for the self-adhesive prosthesis over the traditional type mas mainly related to an increased perception of the prosthesis as a part of the body. Preference for the traditional prosthesis over the other type was mainly related to the greater ease of application and the lesser local irritation of the skin. Findings from this study can be useful in oncology nursing practice.

Adhesives↗
PubMed2000

Evaluation of communication training programs in nursing care: a review of the literature.

An important aspect of nursing care is communication with patients. Nurses' major communication tasks are not only to inform the patient about his/her disease and treatment, but also to create a therapeutically effective relationship by assessing patients' concerns, showing understanding, empathy, and providing comfort and support. In this review, 14 studies, which focus on the evaluation of the effects of communication training programs for nurses, have been evaluated. The selected studies were screened on several independent, process and outcome variables as described by Francke et al. [8]. In this way not only is the training program taken into account as a variable which may be responsible for nurses' behavioural change and for changes in patient outcomes, but also a range of other variables which can give more nuanced explanations for a training program's degree of effectiveness. On the whole, the studies reviewed showed limited or no effects on nurses' skills, on nurses' behavioural changes in practice, and on patient outcomes. Finally, the majority of the studies had a weak design. The use of experimental research designs should be pursued in future studies in order to eliminate the influence of confounding variables.

Clinical Competence↗
PubMed2000

Nurse-patient communication in cancer care. A review of the literature.

Patients with cancer seem to experience distress particularly in the first period after diagnosis, and are likely to develop an affective disorder in the first 2 to 3 months. Communicative behaviors of nurses seem to play an important role in meeting the cognitive and affective needs of patients with cancer. This review of the literature examines the communicative behaviors of nurses during care activities with patients who have cancer. The studies show that emphasis is placed on the affective side, in which facilitating behaviors such as empathy, touch, comforting, and supporting are considered essential in caring for patients with cancer. Unfortunately, further studies in this review demonstrate that communication in oncologic care is complicated by such emotionally laden issues as the consequences associated with the life-threatening character of the disease and the far-reaching consequences of the medical treatment. This results in barriers to effective communication between patients with cancer and nurses. It is important, therefore, that nurses working with patients who have cancer are provided both structurally and repeatedly with continuing education programs in communication. Finally, most of the studies covered in this review have an explorative character. Future research in this area should pay attention to the use of controlled studies, large sample sizes, and observational instruments.

Communication↗
PubMed2000

Sexual problems as a matter of course.

The two most fundamental aspects of sexual relationships, passion and intimacy, are complex concepts, with at least partly paradoxical contents. Intimacy, for example, stands for unity and security, but also for shifting boundaries and exposure. Passion in its turn, stands for enthusiasm and energy, but also for surrender and dependency. It is this 'two sides of the coin' phenomenon that makes sexual relationships as interesting as they are dangerous. In terms of development, a relationship often starts with 'setting each other on fire' and ends with 'sexual burn-out'. In this paper, an analysis is made of the way patients, but also health care providers such as gynecologists and sexologists, cope with these unavoidable phenomena in sexual relationships.

Adaptation, Psychological↗
PubMed1999

Objective and subjective effects of treatment for testicular cancer on sexual function.

OBJECTIVE: To determine whether the treatment of patients with testicular cancer, using cisplatin combined with etoposide and bleomycin (BEP) after orchidectomy in those with disseminated disease, causes changes in sex hormones and penile vascularization, possibly related to sexual dysfunction. PATIENTS AND METHODS: Ten patients treated with BEP were compared with 11 undergoing orchidectomy alone followed by surveillance. Sex hormone levels were analysed and cavernosal artery duplex ultrasonography performed before orchidectomy and at 6 and 12 months afterward. Patients were questioned about their sexual function. After 1 year, a visual erotic stimulation (VES) test was performed to assess penile rigidity. RESULTS: In contrast to the surveillance group, BEP-treated patients had higher follicle-stimulating hormone (4.6 vs 26.5 U/L) and luteinizing hormone (1.4 vs 8.2 U/L) levels, and lower testosterone levels (21.1 vs 14.7 nmol/L) at 6 months than at baseline. At 1 year, most patients had compensated hypergonadotrophic eugonadism, but Leydig cell function had recovered. Changes in cavernosal artery peak flow velocities induced by local injection with papaverine/phentolamine showed no difference between the groups before and 6 months after orchidectomy. Loss of libido and erectile dysfunction were reported more frequently by BEP-treated patients. However, 1 year after treatment, most reported a satisfying sex life and VES resulted in a rigid erection in nearly all patients. The reported erectile dysfunction could not be explained by changes in plasma testosterone levels or diminished blood flow velocities. CONCLUSIONS: After being diagnosed with testicular cancer, sexual morbidity is considerable, but within 1 year some improvement may be expected. BEP induces transient testicular dysfunction but this recovers. Although BEP is related to symptoms of angiopathy, cavernosal blood flow seems to be unaffected. These findings and the normal VES-evoked penile rigidity suggest that sexual dysfunction is more psychological than organically induced by BEP.

Adult↗
PubMed1999

Decision-making process in patients before entering phase III cancer clinical trials: a pilot study.

The present study was performed to gain insight into the decision-making process that patients go through when asked to participate in a cancer clinical trial. Fourteen cancer patients entered a pilot study concerning decision making. They were interviewed in a semistructured manner after consenting or refusing to participate in a randomized phase III clinical trial concerning chemotherapy or immunotherapy. Results from this study showed that patients, after receiving information from the medical oncologist, oncology nurse, or both, decide about participation instantaneously. This means that time for procedural soundness has not been used, which raises questions about the normative quality of the decision.

Adult↗
PubMed1999

Supportive nursing care around breast cancer surgery: an evaluation of the 1997 status in The Netherlands.

This study aimed to assess nurses' involvement in the supportive care of patients with recently diagnosed breast cancer in Dutch hospitals. A questionnaire used to evaluate various aspects of nursing care for breast cancer patients was sent to the surgical nursing teams in all 120 Dutch hospitals that provide surgical treatment for these patients. Nursing care was defined to be optimal if it met the following criteria: (a) Specialized nursing support is provided to all patients during admission and in the outpatient departments both before and after surgery. (b) A protocol is in place outlining standard nursing procedures for breast cancer patients. (c) Formal communication about each breast cancer patient exists between the nurses involved. On the basis of this definition, it was found that optimal nursing care was provided in only 6% of the hospitals. Nursing care fell short mainly in the outpatient setting. This shortcoming also was recognized by most respondents, and many were already planning improvements. Nurses had varying opinions about their responsibility to provide the patient with information about the disease and its treatment, and consensus was lacking. In summary, nursing care for newly diagnosed breast cancer patients in Dutch hospitals needs improvement, especially in the outpatient setting.

Breast Neoplasms↗
PubMed1998

Stressful life events and psychological dysfunction in Complex Regional Pain Syndrome type I.

OBJECTIVE: To determine to what extent stressful life events and psychological dysfunction play a role in the pathogenesis of Complex Regional Pain Syndrome type I (CRPS). DESIGN: A comparative study between a CRPS group and a control group. Stressful life events and psychological dysfunction evaluation was performed with a life event rating list and the Symptom Checklist-90 (SCL-90). SETTING: A university hospital. SUBJECTS: The CRPS group consisted of 24 patients with a history of upper extremity CRPS of less than 3 months. The control group consisted of 42 hand pathology patients waiting for elective hand surgery within the next 24 hours. MAIN OUTCOME MEASURES: Stressful life event rating was measured using the Social Readjustment Rating Scale. Psychological dysfunction was measured using the SCL-90. RESULTS: Stressful life events were experienced by 19 patients (79.2%) in the CRPS group and by 9 patients (21.4%) in the control group. This difference was significant. Testing of psychological dysfunction (SCL-90) in CRPS patients and the control group demonstrated some significant differences: male patients were more anxious than male controls; female patients were statistically more depressed, had feelings of inadequacy, and were emotionally less stable than female controls. In multivariate analysis, no significant differences were found across gender, age, or gender x group interactions. Of the SCL-90 dimensions, only insomnia correlated with the experienced stressful life events. CONCLUSION: Stressful life events are more common in the CRPS group, which indicates that there may be a multiconditional model of CRPS. The experience of stressful life events besides trauma or surgery are risk factors, not causes, in such a model.

Adult↗
PubMed1997

Sexual functioning after treatment for testicular cancer: comparison of treatment modalities.

BACKGROUND: This retrospective study evaluates changes in sexual functioning after treatment for testicular cancer and investigates whether there is a relationship with different treatment modalities. METHODS: A self-reported questionnaire was sent to 337 men who had been treated for testicular cancer at the University Hospital Groningen between 1977 and 1994. Medical information was obtained from the patient records. RESULTS: A response was received from 287 men (85%); 264 patients were included in this study (78%). The mean patient age at follow-up was 37.7 years (range, 17-71 years). The mean follow-up period was 6.7 years (range, 0.25-18 years). Decrease in sexual functions was reported by 40% of patients (decrease in libido: 19%; arousal: 12% erection: 12.5%; orgasm: 19%; and ejaculation: 26%). Moreover, 23.5% of patients responding reported decreased sexual activity and 12.5% were dissatisfied with their sexual functioning. Patients with Stage II-IV nonseminoma who had been treated with polychemotherapy (PCT) with or without resection of residual retroperitoneal tumor mass (RRRTM) (PCT +/- RRRTM) reported a significantly sharper decrease in sexual functioning than patients who had been followed with a wait-and-see policy (W & S) (Stage I nonseminoma patients). It was noteworthy that patients treated by PCT alone reported more sharply decreased sexual functioning than patients treated by PCT + RRRTM. Patients treated by radiotherapy (Stage I-IIA seminoma) did not report findings significantly different from the W & S group. CONCLUSIONS: Testicular cancer patients are at risk for reduced sexual functioning, especially when treated by chemotherapy, with or without resection of residual tumor. Although chemotherapy may influence somatic aspects of sexual functioning, it appears that psychologic factors arising from the confrontation with testicular cancer play a strongly mediating (if not determining) role.

Adult↗
PubMed1997

Sexual functioning in testosterone-supplemented patients treated for bilateral testicular cancer.

OBJECTIVE: To determine the effects of intramuscular injections with testosterone (Sustanon) on sex-hormone levels, sexual functioning and general well-being in patients treated with orchidectomy for bilateral testicular cancer. PATIENTS AND METHODS: The study comprised seven men (median age 38 years, range 25-46) who had undergone orchidectomy for bilateral testicular cancer. Patients received intramuscular injections with testosterone every 3 weeks and blood samples for hormone analysis were collected from each patient at three times: one day after testosterone injection (t1), halfway between subsequent injections (t2) and just before injection (t3). Plasma hormone levels were then related to sexual function, as assessed by self-reported data on sexuality and general well-being, measurements of nocturnal penile tumescence and rigidity (NPTR) and erectile function elicited by visual erotic stimulation (VES), determined at t1, t2 and t3. RESULTS: During the 3-week interval between injections, there was a sixfold decrease in plasma testosterone level (mean testosterone 35.8, SD 7.8, and 6.0, SD 2.5 nmol/L, at t1 and t3, respectively). At t1, five of the men had a plasma testosterone level above the upper normal limit (> 35 nmol/L) and at t2 and t3, testosterone levels were below the reference range (< 10 nmol/L) in three and six men, respectively. Oestradiol (E2) levels showed the same pattern: at t1 the mean (SD) E2 level was 0.17 (0.07) nmol/L and at t3 0.07 (0.01) nmol/L. In contrast to follicle-stimulating hormone, luteinizing hormone (LH) mirrored the decline in plasma testosterone after injection, with the lowest levels at t1 and the highest at t3. Other hormone levels remained unchanged. Three patients reported loss of libido, decreased arousal, erectile dysfunction, fatigue and mood depression. However, neither the arousal nor the erectile problems could be verified by VES. There was no relationship between plasma testosterone levels, the reported sexual dysfunctions and the results of NPTR and VES measurements. Although unrelated to a specific testosterone level, three patients reported increased irritability, excessive sweating, hot flushes and heat intolerance at the end of the injection interval. These adverse effects of declining plasma testosterone were related to loss of libido and other sexual problems. CONCLUSION: In most patients castrated for bilateral testicular cancer and receiving intramuscular injections with testosterone, plasma testosterone levels were outside the normal range. After injection, there was a rapid decline of plasma testosterone to levels below the lower normal limit. With the exception of oestradiol, sex-hormone levels were not correlated to testosterone levels. Sexual functioning was not affected by the fluctuations of plasma testosterone level. However, at the end of the injection interval, adverse psychological and physical effects had a significant impact on libido and arousal.

Adult↗
PubMed1997

Sexual functioning after multimodality treatment for disseminated nonseminomatous testicular germ cell tumor.

PURPOSE: We determined sexual functioning after chemotherapy for disseminated nonseminomatous testicular germ cell tumor, and evaluated the impact of resection of post-chemotherapy residual retroperitoneal tumor. MATERIALS AND METHODS: A total of 155 consecutive patients treated with chemotherapy for disseminated nonseminomatous testicular germ cell tumor (between 1980 and 1994) was questioned about their sexual functioning. The patients were divided in 2 subgroups: patients treated with or without resection of post-chemotherapy residual retroperitoneal tumor. Volume and location (divided into left para-aortal or right paracaval/interaortacaval) of the resected tumor were related to absence of ejaculation as well as decreased semen amount. In addition, libido, arousal, erection and orgasm were related to ejaculatory dysfunction. RESULTS: A total of 43 patients (27.7%) was treated with chemotherapy only and 112 (72.3%) had additional resection of post-chemotherapy residual retroperitoneal tumor mass. Overall, 22.4% reported loss of libido, 14.1% decreased arousal, 16% erectile dysfunction, 23.1% decreased orgasmic intensity, 17.4% decreased semen amount and 18.7% complete absence of antegrade ejaculation. With exception of absence of ejaculation, sexual dysfunctions were reported in similar frequencies in both treatment subgroups. In the resection of post-chemotherapy residual retroperitoneal tumor subgroup, 25.9% of the patients had complete absence of ejaculation. The other sexual dysfunctions were related neither to decreased semen amount nor to complete absence of ejaculation. The mean volume of resected tumor was higher (95 cm.3) in patients with absence of ejaculation than in those without (40 cm.3), and patients with right paracaval/interaortacaval tumor (20 of 58, 34.5%) reported more often absence of ejaculation than those with left para-aortal tumor (9 of 54, 16.7%). CONCLUSIONS: In patients treated for disseminated nonseminomatous testicular germ cell tumor, post-chemotherapy sexual morbidity cannot be neglected. Except for loss of antegrade ejaculation, sexual dysfunctions are not related to resection of post-chemotherapy residual retroperitoneal mass. A high volume of tumor and a right paracaval/interaortacaval location predispose to loss of antegrade ejaculation.

Adult↗
PubMed1997

Distressed or relieved? Psychological side effects of breast cancer screening in The Netherlands.

STUDY OBJECTIVES: To assess the psychological impact of mammographic screening on women with non-malignant outcomes after attending the Netherlands' National Breast Cancer Screening Programme. DESIGN: During one year all women with false positive test results (95) in a screening area were invited for the study. Each false positive was matched with two women with normal mammograms with respect to age and municipality. A random reference group of 400 was drawn from the female population in an area not yet included in the screening programme. Experiences with screening and psychological status of subjects were assessed 8-10 weeks after screening (T1) and again after six months (T2), by interviews as well as questionnaires. References completed two questionnaires with a six months' interval. PARTICIPANTS: 74 (78%) women with false positive outcomes and 113 (59%) women with negative outcomes participated at T1, of these 65 (88%) and 105 (93%) at T2, respectively; 238 references returned questionnaires at T1 (59%), of these 143 (60%) at T2. MAIN RESULTS: At 8-10 weeks after the screening, the women who received false positive test results scored higher on most of the variables indicating psychological disfunctioning than women with normal mammograms, but did not notably differ on the same variables from the non-screened reference group. Women with normal mammograms had the lowest scores on all the variables in the study at both assessments. The same situation was observed six months later. Although 61% of the women who received false positive mammograms reported that they had experienced the "false alarm" as a stressful event, this experience had apparently no adverse effects on their psychological functioning, as assessed 8-10 weeks after screening. CONCLUSIONS: Overall, breast screening is not likely to generate adverse psychological effects in "healthy" women, even if the outcome is false positive. Differences in psychological functioning between false positives and negatives are more likely ascribable to feelings of relief in the negative group than to raised anxiety and distress in the false positive group.

Aged↗
PubMed1997

Sexual dysfunction in nonseminoma testicular cancer patients is related to chemotherapy-induced angiopathy.

PURPOSE: To establish the prevalence of sexual dysfunctions after different treatment modalities for nonseminomatous testicular germ cell tumor (NSTGCT) and to investigate whether treatment-induced angiopathy and neuropathy is related to sexual dysfunction. PATIENTS AND METHODS: A questionnaire assessing sexual dysfunction was sent to 255 NSTGCT survivors. Polychemotherapy (PCT) regimens (cisplatin, vinblastine, and bleomycin [PVB], vinblastine substituted by etoposide [BEP], or cisplatin substituted by carboplatin [CEB], etoposide combined with cisplatin [EP], or with ifosfamide and cisplatin [VIP] were compared regarding treatment-induced angiopathy and neuropathy. Sexual dysfunctions were related to Raynaud's phenomenon and acral paresthesia. RESULTS: Among the 215 responders, 56 (26%) had been treated by orchidectomy and surveillance, 42 (19.6%) by PCT, and 117 (54.4%) by PCT and resection of residual retroperitoneal tumor mass (RRRTM). Overall, loss of libido was reported by 19.1%, decreased arousal by 11.2%, erectile dysfunction by 12.1%, decreased intensity of orgasm by 20%, and ejaculatory problems by 28%. Patients treated with PVB suffered more often from Raynaud's phenomenon compared with those treated with other regimens (40.4% v 29%; P < .05) and from paresthesia (31.6% v 14.7%; P < .05). Patients with Raynaud's phenomenon had more often erectile dysfunction (28.8%) compared with those without (8.4%) (P < .05). CONCLUSION: Compared with orchidectomy alone, PCT, with or without RRRTM, induced more often posttreatment sexual dysfunction. Compared with other chemotherapeutic regimens, signs of angiopathy and neuropathy were most prevalent in those treated with PVB. Erectile dysfunction was related to the chemotherapy-induced Raynaud's phenomenon but not to acral paresthesia.

Adult↗