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Biomedical subjects

J Bensing

Publications and source records attributed to J Bensing.

11 recordsLinked to original sources
PubMed2004

Psychosocial interventions for patients with advanced cancer - a systematic review of the literature.

Advanced cancer is associated with emotional distress, especially depression and feelings of sadness. To date, it is unclear which is the most effective way to address these problems. This review focuses on the effects of psychosocial interventions on the quality of life (QoL) of patients with advanced cancer. It was hypothesised that patients will benefit from psychosocial interventions by improving QoL, especially in the domain of emotional functioning. The review was conducted using systematic review methodology involving a systematic search of the literature published between 1990 and 2002, quality assessment of included studies, systematic data extraction and narrative data synthesis. In all, 10 randomised controlled studies involving 13 trials were included. Overall interventions and outcome measures across studies were heterogeneous. Outcome measures, pertaining to the QoL dimension of emotional functioning, were most frequently measured. A total of 12 trials evaluating behaviour therapy found positive effects on one or more indicators of QoL, for example, depression. The results of the review support recommendation of behaviour therapy in the care of patients with advanced cancer.

Clinical Trials as Topic↗
PubMed2002

I've come for his throat': roles and identities in doctor-parent-child communication.

Previous studies on doctor-parent-child communication at the general practitioner's surgery showed that the GP and the parent differ fundamentally in the way they enable or constrain child participation. The question how to explain these differences is at the core of the present study. The aim is to describe how the three participants display their orientation to their institutional roles and identities; how they collaboratively co-construct the course of action; and how these discursive constructions structure the ongoing interaction. A qualitative analysis of 106 videos shows that although GP and parent initially show incongruent orientations toward child participation, in the further course of the encounter all three participants jointly establish a situation in which child participation appears to be rather an exception. It is concluded that parental speaking for the child is, in a way, institutionally co-constructed; parents take their responsibility, which is hardly ever questioned by children, and GPs ratify this behaviour by refraining from meta-communicative comments and by aligning with the parent in the course of the interaction. The results are discussed in terms of enabling child participation and implications for medical practice.

Child↗
PubMed2001

Cure-oriented versus care-oriented attitudes in medicine.

This article focuses on the attitudinal component of patient-centredness. The literature reveals that the relationship between cure- and care-oriented attitudes remains to be clarified. The aim of this study is to gain further insight in the relationship between cure and care attitudes by questioning the bipolar unidimensional structure of the concept. By means of an empirical analysis among Belgian medical students, the cure versus care attitudes regarding the 'ideal physician' are investigated. Traits of the ideal physician are described in a bipolar rating scale reflecting cure-oriented versus care-oriented views of the medical profession. Subjects included 88 medical students of the Limburgs University Centre in Diepenbeek, Belgium. Results indicate that the Belgian sample is less care-oriented than the Dutch sample.Further, a factor-analysis reveals two components which correspond with the instrumental (cure) and the affective dimension (care) of the medical profession. The advantages of a two-dimensional framework as a basis for the development of courses aimed at attitude development in the curriculum of a medical school are discussed.

Affect↗
PubMed2001

Patient education in Europe: united differences.

This issue of Patient Education and Counseling presents the state of the art of patient education in several European countries. It is based on papers presented at a meeting in Paris on the evolution and development of patient education in western, central and eastern Europe (May 1999). Also patient education in the US is presented in this issue. Patient education is defined as all the educational activities directed to patients, including aspects of therapeutic education, health education and clinical health promotion. Five important factors are identified in the development of patient education: (1) research and evidence based standards; (2) the organization of care; (3) training and methodological support; (4) professional values; and (5) acknowledgment, funding and place of patient education in health policy. Several of the discussed common orientations and priorities in the patient education in the reviewed countries are highlighted in this issue. And finally, an example of the possible integrated international practice in patient education in the field of diabetes is described in this issue. Several conclusions are drawn concerning future development of communication in health care within the framework of patient education in Europe.

Communication↗
PubMed2001

Stress in chronic disease: do the perceptions of patients and their general practitioners match?

OBJECTIVE: To compare the stressors accompanying chronic disease as perceived by patients and their GPs and to explore how incongruence in patients' and GPs' ideas influences patients' health status and use of health care. METHOD: A total of 580 patients with a diagnosis of diabetes or osteoarthritis and their GPs were interviewed by questionnaire about the stressors accompanying a patient's illness. In addition, information was obtained from each patient on health status and use of health care. RESULTS: The results show that patient and GP diverge in the way they think about chronic illness. Incongruence was larger in the case of osteoarthritis. In both diabetes and osteoarthritis, incongruence between patient and GP was associated with a worse health status of the patient and an increase in health-care use, although the pattern of correlation differed by type of disease. CONCLUSIONS: A chronic disease requires an ongoing relationship between patient and GP over years. Therefore, it is especially important that providers recognize the problems with which chronic disease patients are faced. Too often, providers are one-sided focused on the medical aspects of disease, neglecting the personal impact that a chronic disease has on the patient's life. In this way, successful treatment is complicated.

Journal Article↗
PubMed2000

Bridging the gap. The separate worlds of evidence-based medicine and patient-centered medicine.

Modern medical care is influenced by two paradigms: 'evidence-based medicine' and 'patient-centered medicine'. In the last decade, both paradigms rapidly gained in popularity and are now both supposed to affect the process of clinical decision making during the daily practice of physicians. However, careful analysis shows that they focus on different aspects of medical care and have, in fact, little in common. Evidence-based medicine is a rather young concept that entered the scientific literature in the early 1990s. It has basically a positivistic, biomedical perspective. Its focus is on offering clinicians the best available evidence about the most adequate treatment for their patients, considering medicine merely as a cognitive-rational enterprise. In this approach the uniqueness of patients, their individual needs and preferences, and their emotional status are easily neglected as relevant factors in decision-making. Patient-centered medicine, although not a new phenomenon, has recently attracted renewed attention. It has basically a humanistic, biopsychosocial perspective, combining ethical values on 'the ideal physician', with psychotherapeutic theories on facilitating patients' disclosure of real worries, and negotiation theories on decision making. It puts a strong focus on patient participation in clinical decision making by taking into account the patients' perspective, and tuning medical care to the patients' needs and preferences. However, in this approach the ideological base is better developed than its evidence base. In modern medicine both paradigms are highly relevant, but yet seem to belong to different worlds. The challenge for the near future is to bring these separate worlds together. The aim of this paper is to give an impulse to this integration. Developments within both paradigms can benefit from interchanging ideas and principles from which eventually medical care will benefit. In this process a key role is foreseen for communication and communication research.

Communication↗
PubMed1999

Optimism and adaptation to multiple sclerosis: what does optimism mean?

The aim of the present study was to determine the meaning of optimism by explicating the dimensions underlying the notion and their links to adjusting to MS. Seventy-three patients responded to optimism questionnaires (i.e., the LOT, Generalized Self-Efficacy Scale) and outcome questionnaires. In confirmatory factor analyses, the underlying dimensions of optimism were specified. Explanatory structural equation modeling was used to examine the relation of the dimensions of optimism to coping (CISS), depression (BDI), and impaired mobility range (SIP). Optimism was found to consist of three dimensions, namely, outcome expectancies, efficacy expectancies, and unrealistic thinking. Outcome and efficacy expectancies explained depression via emotion-oriented coping but did not explain impaired mobility range either directly or indirectly. Unrealistic thinking directly explained impaired mobility range. The present study can be seen as a first step in explicating the role of optimism in the management of chronic disease.

Adaptation, Psychological↗
PubMed1998

Distinguishing between chronic and nonchronic fatigue, the role of gender and age.

In this study the authors try to clarify the ambiguities in previous studies on demographic and social factors and fatigue. We have divided people with fatigue complaints and associated symptoms into those who have chronic and non-chronic complaints, and into men and women. The research is based on diaries kept by Dutch citizens over a 21-day period, and uses univariate and discriminant analyses. The results show the utility of stratification for chronicity, gender and age. Compared to non-chronically fatigued subjects (NCFd) the chronically fatigued subjects (CFd) reveal multiple sources of vulnerability: physical, psychological, psycho-social and socio-economic. They report more days of fatigue, they tend to be older, and their physical health is characterized by significantly more acute complaints and chronic disease. Their sum scores on psychological and psycho-social problems are above average. Their health histories are worse, they express greater feelings of frustration and irritation due to their ailments and report more health-related initiatives. The socio-economic profile of the CFd is disadvantaged: their educational level, occupational classification and income are lower than that of the NCFd, and they are more frequently unemployed. CFd women are more frequently divorced or widowed than NCFd women. The factors predicting chronic vs non-chronic fatigue vary with the age and gender of the population. It is easier to predict non-chronic than chronic fatigue. Additional stratification within the group of CFd is recommended.

Adult↗
PubMed1991

Doctor-patient communication and the quality of care.

In this article a comparison is made between three independent sources of assessment of medical consultations. A panel of 12 experienced general practitioners rated 103 consultations with hypertensive patients on the quality of psychosocial care. There was a wide consensus between the judges, resulting in a high reliability score. Two contrasting groups were formed: consultations that were rated high and those rated low in quality of psychosocial care. A comparison was made between this general assessment of the quality of psychosocial care and a more detailed assessment of the same consultations on nine much used communication variables made by trained psychologists. Knowledge about doctor-patient communication proved to predict very well as to which quality group the consultations belonged. A very high percentage (95%) was predicted accurately, solely on the basis of these nine communication variables. Affective behaviour, and especially nonverbal affective behaviour had the strongest predictive power. In the last part of the study a third source of assessment, i.e. patients' satisfaction was compared with both other sources. Much lower relationships were found, although most were in the predicted direction. Affective behavior seems to be the most important in determining patient's satisfaction. The implications of these findings are discussed.

Adult↗
PubMedDate not supplied

Medical students' attitudes towards breaking bad news: an empirical test of the World Health Organization model.

The literature regarding breaking bad news distinguishes three disclosure models: non-disclosure, full-disclosure and individualized disclosure. In this study, we investigated the relations between attitudes regarding disclosure of bad news and global professional attitudes regarding medical care in a sample of medical students (n=88). The Attitudes towards Breaking Bad News Questionnaire was developed and factor analysed to provide a valid and reliable instrument to measure attitudes regarding disclosure of bad news. The results indicate a preference for an individualized, patient-centred disclosure model in male and female students. Regarding the global professional attitudes, female students appear more humane-oriented than male students. Second, the relationship between global professional attitudes and attitudes regarding breaking bad news was examined by means of correlational and cluster analysis. The inter-relationship between global professional attitudes and attitudes regarding bad news is poor. Results of the cluster analysis, however, suggest that the sample can be divided into subsamples representing different disclosure clusters on the basis of specific combinations of global professional attitudes regarding medical care and attitudes regarding breaking bad news. The results are discussed in view of the theoretical framework proposed by the World Health Organization (WHO) in their training module on communication of bad news.

Attitude of Health Personnel↗