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Biomedical subjects

Marja Verhoef

Publications and source records attributed to Marja Verhoef.

At least 19 recordsLinked to original sources
PubMed2006

Parents' global rating of mental health correlates with SF-36 scores and health services satisfaction.

BACKGROUND: Patient satisfaction surveys are often used to measure quality of care. However, patient satisfaction may not be a reliable indicator of service quality because satisfaction can be influenced by clients' characteristics such as their health status. METHODS: Parents of children attending a pediatric neurology clinic completed the Short Form Health Survey (SF-36) and global ratings of their physical and mental health. They also completed the Client Satisfaction Questionnaire (CSQ), the Measure of Processes of Care (MPOC), and the Family-Centered Care Survey (FCCS). RESULTS: 104 parents completed the survey. The correlation between the global rating of physical or mental health and their corresponding SF-36 scores was high. The majority (88%) of parents were satisfied, with a median CSQ score of 28 (IQR, 24 to 31) and a FCCS score of 4.7 (IQR, 4.2 to 4.9). Logistic regression identified parents' mental health as a significant predictor of client satisfaction (OR, 1.07; 95% CI, 1.01 to 1.14). CONCLUSIONS: Given the positive association between parents' mental health and satisfaction with care, it is important to consider mental status as a covariate in interpreting satisfaction surveys. Parents' global rating of mental health appears to be a reasonable indicator of their SF-36 mental scores.

Adolescent↗
PubMed2006

Developing CAM Research Capacity for Complementary Medicine.

This article describes initiatives that have been central to the development of complementary and alternative medicine (CAM) research capacity in the United Kingdom, Canada and the United States over the last decade. While education and service delivery are essential parts of the development of CAM, this article will focus solely on the development of research strategy. The development of CAM research has been championed by both patients and politicians, primarily so that we may better understand the popularity and apparent effectiveness of these therapies and support integration of safe and effective CAM in health care. We hope that the perspective provided by this article will inform future research policy.

Journal Article↗
PubMed2006

Adolescent quality of life and satisfaction with care.

PURPOSE: 1) To describe adolescents' responses to a client satisfaction and family-centered care survey; 2) to examine the relationship between satisfaction with health care and health-related quality of life (HRQL) among these adolescents; and 3) to determine if adolescents and their parents differ in their satisfaction with services. METHODS: We recruited 104 adolescents who attended the Alberta Children's Hospital pediatric neurology clinic. Each family completed the Client Satisfaction Questionnaire (CSQ), the Family Centered Care Survey (FCCS), the Measure of Processes of Care (MPOC) survey, the Give Youth a Voice (GYV) survey, and the Pediatric Quality of Life Inventory (PedsQL). RESULTS: Of 116 eligible families, 104 (90%) completed the study. The majority (83%) of adolescents were satisfied with services provided. Adolescents who were very satisfied on the CSQ and the FCCS had higher PedsQL psychosocial scores (p = .009 and .013, respectively). Multivariate analysis revealed that adolescents' psychosocial HRQL was the most significant predictor of their satisfaction with care (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01 to 1.06). There was a difference between parents' and adolescents' responses to the FCCS (p = .02), with adolescents being less satisfied overall. CONCLUSIONS: Given that adolescents and parents differ in their satisfaction with health care, it is helpful to have direct input from adolescents on health services surveys. The positive relationship between adolescents' psychosocial HRQL and satisfaction with care highlights the potential impact of emotional health on subjective rating of services. Further studies should determine if improvement in adolescents' mental health is associated with greater satisfaction with health care and/or increased adherence with medical treatments.

Adolescent↗
PubMed2006

Cancer as part of the journey: the role of spirituality in the decision to decline conventional prostate cancer treatment and to use complementary and alternative medicine.

BACKGROUND: The role of spirituality in patients' use of complementary and alternative medicine (CAM) approaches to cancer management has hardly been explored. OBJECTIVE: To explore the role of spirituality in cancer management by men with prostate cancer who have declined conventional treatment and are using CAM. METHODS: This qualitative analysis is part of a longitudinal study to assess decision making by men with prostate cancer who decline conventional treatment and use CAM. In-depth interviews were conducted at study entry (n = 29). Themes were presented to participants in focus groups to further explore and validate the interview results. For a subset of participants (n = 10), spirituality emerged as an important theme; therefore, we conducted a secondary analysis of the interview data of these men to explore the role of spirituality in cancer management and decision making. RESULTS: Spirituality appeared to influence all aspects of the cancer experience. Most participants intensified their use of spiritual practice after a diagnosis of prostate cancer. These practices included spiritual ceremonies, indigenous healing, prayer, meditation, and use of spiritual imagery. Themes related to the role of spirituality in cancer management include beliefs about Western medicine, the role of spiritual beliefs in treatment decision making, the use of spiritual imager y and metaphor in healing, and the impact of cancer on spirituality. The discussion of these themes draws on quotes and case examples, illustrating how spirituality influenced study participants' response to diagnosis, treatment decision making, and cancer care. Two case examples provide a more in-depth understanding of how some participants incorporated spiritual imagery and metaphor into treatment decision making and cancer care. Ways in which cancer influenced spirituality are also discussed. Having prostate cancer appeared to influence their spirituality by strengthening their links with a spiritual community, increasing feelings of gratitude toward life, and improving personal relationships. RELEVANCE: These findings indicate that spiritual beliefs and practices may play an important role in the formation of treatment choices for some patients. Health care providers need to be aware of and address patient concerns about how conventional treatment may conflict with their spiritual beliefs and practices. Further research and medical education is needed on spirituality and prostate cancer.

Complementary Therapies↗
PubMed2005

Percutaneous endoscopic gastrostomy (PEG): the role and perspective of nurses.

AIMS AND OBJECTIVES: To study the perspectives of nurses on (i) the process of decision-making regarding the placement of feeding gastrostomies, (ii) their role in the process, (iii) the impact this participation has on them personally and (iv) gastrostomy placement in general. BACKGROUND: The decision to commit patients to long-term feeding using a gastrostomy tube can be very difficult, particularly when the anticipated benefits are uncertain. Strategies to improve such decision-making are required. Nurses are in an excellent position to provide valuable insights regarding this decision-making and their increased participation in this process might substantially improve it. DESIGN: A cross-sectional, exploratory design using in-depth semi-structured interviews and a self-administered questionnaire. METHODS: In-depth semi-structured interviews with 17 nurses experienced in percutaneous endoscopic gastrostomy decision-making were undertaken and analysed. RESULTS: Individuals making decisions regarding feeding gastrostomy placement were observed to be insufficiently informed regarding the device and the ramifications of its placement. Nurses were perceived to play an important, although underused, role in decisions to commit patients to long-term feeding. Participation in the making of these decisions may be stressful to nurses, particularly when the only result anticipated is the sustaining of a life of poor quality. Sixteen nurses reported that they would not want to have a gastrostomy for themselves if they were unable to maintain some quality of life. Strategies that could improve decision-making were suggested. CONCLUSIONS: Decision-making could be improved by providing better information to decision makers. A team-orientated approach and more active dialogue with regard to care planning among health professionals, especially between doctors and nurses is needed. Effective decisions regarding feeding gastrostomy placement require adequate resources, especially sufficient time for caregivers to communicate effectively with those who must make these decisions. RELEVANCE TO CLINICAL PRACTICE: The role of nurses in decision-making regarding commitments to long-term feeding using gastrostomy tubes could be effectively augmented.

Adult↗
PubMed2005

Understanding participation in a trial comparing cryotherapy and radiation treatment.

BACKGROUND: To date, few two-arm active treatment randomized control trials (RCTs) have compared prostate cancer therapies. OBJECTIVE: To examine the difference and similarities between the reasons for accepting and declining participation in a two-arm active treatment RCT comparing external beam radiation therapy (EBRT) versus cryotherapy. METHODS: Eleven men with prostate cancer, selected purposively, participated in a 30-minute post-treatment semi-structured interview. Interviews were transcribed verbatim, coded and analyzed for patterns with the assistance of the text management (TM) software (NVivo). RESULTS: RCT accepters participated principally with the hope of being randomized into the cryotherapy treatment arm. Consequently, randomization into the EBRT arm was often perceived as receiving the consolation prize. RCT decliners were either pushed away from cryotherapy and/or pulled towards another treatment (surgery, EBRT, brachytherapy). Factors influencing accepters'/decliners' treatment decisions include (1) personal factors such as patient research and treatment preference, cancer survivors, family/friends, and altruism, and (2) physician, trial, and treatment factors such as patient-physician rapport, RCT awareness and understanding, therapy convenience, expected outcome and perceived side effects. CONCLUSIONS: By better understanding patients' views about RCT participation, recruitment rates for prostate cancer RCTs can be improved.

Cryotherapy↗
PubMed2004

From parallel practice to integrative health care: a conceptual framework.

BACKGROUND: "Integrative health care" has become a common term to describe teams of health care providers working together to provide patient care. However this term has not been well-defined and likely means many different things to different people. The purpose of this paper is to develop a conceptual framework for describing, comparing and evaluating different forms of team-oriented health care practices that have evolved in Western health care systems. DISCUSSION: Seven different models of team-oriented health care practice are illustrated in this paper: parallel, consultative, collaborative, coordinated, multidisciplinary, interdisciplinary and integrative. Each of these models occupies a position along the proposed continuum from the non-integrative to fully integrative approach they take to patient care. The framework is developed around four key components of integrative health care practice: philosophy/values; structure, process and outcomes. SUMMARY: This framework can be used by patients and health care practitioners to determine what styles of practice meet their needs and by policy makers, healthcare managers and researchers to document the evolution of team practices over time. This framework may also facilitate exploration of the relationship between different practice models and health outcomes.

Complementary Therapies↗
PubMed2004

Operationalizing the concept of the optimal healing environment in clinical settings: the importance of "readiness".

Creation of an optimal healing environment (OHE) in a clinical setting is a multifaceted undertaking and subject to a wide variety of developmental influences. While comprehensive definitions for OHE might provide sufficient guidance for communicating philosophy and values and developing patient-practitioner processes, direction for creating a supportive administrative structure or establishing an evaluation/research strategy is less defined. Operationalizing the concept of OHE by breaking it down into components such as values, structure, process, and measurement of outcomes, proved to be a useful framework for analyzing the evolution of our integrated care program. Future OHE initiatives may benefit from using this type of framework to assess readiness among cocreators prior to development and implementation, as a guide for ongoing evaluation of an OHE postimplementation and as a basis for comparing OHEs across a variety of clinical settings.

Attitude of Health Personnel↗
PubMed2004

Complementary therapy use by cancer patients. Physicians' perceptions, attitudes, and ideas.

OBJECTIVE: To explore family physicians' perceptions of their cancer patients' use of complementary therapy. DESIGN: Qualitative pilot study. SETTING: British Columbia and Alberta. PARTICIPANTS: Rural and urban family physicians. METHOD: Five focus groups were conducted with a total of 28 participants. Content analysis of focus group transcripts. MAIN FINDINGS: Eight themes were identified: definition of complementary therapies, importance of holistic health, role of evidence, attitudes toward complementary therapies, perceptions of cancer patients' use of complementary therapies, patient-physician communication, perceptions of family physicians' role with respect to complementary therapies, and concerns about complementary therapies. Family physicians believed that many of their patients were using complementary therapies and that patients and physicians needed to communicate about this practice. CONCLUSION: The study increased understanding of physicians'perspectives on communication about complementary therapies and exposed issues that need to be addressed through education and research.

Adult↗
PubMed2004

Assessment of the information needs and use of information resources on complementary and alternative medicine by Alberta family physicians.

BACKGROUND: The public's increasing use of complementary and alternative medicine (CAM) poses unique challenges for primary care physicians in knowledge and patient communication. The objective of our study was to assess Alberta family physicians' interest in CAM information and the type of information sources they currently use. METHODS: A cross-sectional survey was designed and mailed to a random sample of family physicians registered with the College of Physicians and Surgeons of Alberta. Main outcomes were physicians' self-reported knowledge of CAM, interest in CAM information and frequency of use of various medical information sources. RESULTS: Response rate was 34% (n = 346). Physicians indicated having limited knowledge of CAM, but were interested in evidence-based CAM information such as randomized controlled trials and systematic reviews on acupuncture, herbal medicine, massage, chiropractic treatment and meditation. Most respondents did not make use of reliable information sources that are available on the Internet. CONCLUSION: Education strategies are needed to help physicians access and use Internet sources of evidence-based CAM information more effectively.

Alberta↗
PubMed2003

Evaluation of the Tzu Chi Institute for Complementary and Alternative Medicine's Integrative Care Program.

OBJECTIVE: There are an increasing number of clinics providing integrative health care using new and innovative delivery models. The purpose of this study was to quantitatively and qualitatively evaluate the Integrative Care Program offered at the Tzu Chi Institute for Complementary and Alternative Medicine, Vancouver, British Columbia, Canada. DESIGN: At enrollment, data are collected on demographics, health history, current health concerns and diagnoses, quality of life/health status (SF-36) and patient satisfaction. The measures are repeated 6 months into the program. Descriptive analysis was used to summarize the data. Focus groups were also included as part of the study design. RESULTS: Patients seeking integrative care are a highly complex population living with numerous comorbid chronic conditions. Although their baseline scores on the SF-36 are lower than Canadian population norms across all subscales, significant improvement occurred from baseline to 6 months. Qualitative data support that patients were pleased with the clinical care they received and aligned with the philosophical underpinnings of the program. DISCUSSION: This is one of the first studies to evaluate integrative health care. Studies like this are needed to develop appropriate methods to assess models of integrative health care delivery.

Adult↗
PubMed2003

Understandings of health and its determinants among clients and providers at an urban community health center.

The authors' aim was to explore clients' and health care providers' perceptions of health and its determinants in preparation for the development of a screening tool to assess client health determinants at a community health center through template and editing analyses of interviews with 6 health care providers and 7 clients. Participants defined health as a multidimensional state, with common themes including the ability to cope and to function according to expectations. They identified multiple interrelated factors that affect health. The findings support existing health determinant frameworks but provide greater detail about specific determinants within broad categories presented in these frameworks. The results create a foundation for the development of a screening tool to assess client health determinants.

Adult↗
PubMed2003

A population-based survey of complementary and alternative medicine use in men recently diagnosed with prostate cancer.

PURPOSE: To determine prevalence and patterns of use of complementary and alternative medicine (CAM) among men recently diagnosed with prostate cancer. STUDY DESIGN: Men, diagnosed with prostate cancer over a 10-month period in British Columbia, Canada, were randomly selected to obtain a population-based sample. METHODS: Surveys, addressing patient demographics, types of CAM therapies, and CAM information resources utilized, reasons for use, and disclosure to physician(s), were mailed to 1108 men newly diagnosed with prostate cancer. A 42% response rate was obtained. RESULTS: Thirty-nine percent of patients used CAM therapies with the most common being herbal supplements (saw palmetto), vitamins (vitamin E), and minerals (selenium). The most common reasons given for choosing to use CAM therapies were to (1) boost the immune system and (2) prevent recurrence. The majority of men (58%) had told their physician(s) about their CAM use, but few utilized either their family physician (15%) or their oncologist (7%) as sources of CAM information. CAM users most commonly consulted friends or family (39%) or the Internet (19%) for information about CAM. CAM users were more likely than nonusers to delay (9%) or decline (4%) conventional treatment. Respondents who had never used CAM had typically never thought about it or did not have enough information about the treatments. CONCLUSIONS: More than one third of recently diagnosed prostate cancer patients utilize some form of CAM therapy, and the majority disclose their use to their physician(s). However, they tend to rely on anecdotal information for their CAM decision making. Dissemination of reliable CAM information is one key to helping men navigate this difficult arena.

Adult↗
PubMed2003

Maturation of complementary and alternative healthcare in Canada.

Complementary and alternative medicine (CAM) use is increasing rapidly in Canada. This use is mostly driven by consumer demand. While this field of research is relatively new, it is maturing rapidly. This commentary highlights three areas of increasing maturation: the emergence of integrative healthcare; the development and application of new approaches to investigating CAM and integrative healthcare; and the development of a research infrastructure to support these developments. It is encouraging, the authors note, that organizations, networks and federal agencies such as the Canadian Institutes of Health Research and Health Canada are collectively and collaboratively identifying barriers to these developments and are developing strategies to overcome them.

Canada↗
PubMed2002

Understanding coordination of care from the consumer's perspective in a regional health system.

OBJECTIVE: To understand and develop a model about the meaning of coordination to consumers who experienced a transition from acute care to home care. STUDY DESIGN: A qualitative, exploratory study using Grounded Theory. DATA SOURCES/ANALYSIS: Thirty-three consumers in the Calgary Regional Health Authority who had experienced the transition from an acute care hospital back into the community with home care support were interviewed. They were asked to describe their transition experience and what aspects of coordination were important to them. Interviews were recorded, transcribed, and analyzed using constant comparison. The coding and retrieval of information was facilitated by the computer software program Nud*ist. PRINCIPAL FINDINGS: The resulting model has four components: (1) the meaning of coordination to consumers; (2) aspects of health care system support that are important for coordination; (3) elements that prepared consumers to return home; and (4) the components of a successful transition experience. Consumers appeared to play a crucial role in spanning organizational boundaries by participating in the coordination of their own care. CONCLUSIONS: Consumers must be included in health care decisions as recipients of services and major players in the transition processes related to their care. Health care providers need to ensure that consumers are prepared to carry out their coordination role and managers need to foster a culture that values the consumer "voice" in organizational processes.

Adult↗