Biomedical subjects

Tony Hak

Publications and source records attributed to Tony Hak.

6 recordsLinked to original sources

PubMed2006

Problems eliciting cues in SEIQoL-DW: quality of life areas in small-cell lung cancer patients.

The Schedule of Individual Quality of Life - Direct Weighting (SEIQoL-DW) is an individualized approach in the measurement of quality of life in which patients can choose, value and weight five areas that they consider important for their quality of life. Although a number of studies have reported on the feasibility of the administration of the instrument, little is known about how patients choose and define these five areas, the so-called 'cues'. This article describes problems in the elicitation of cues experienced in a qualitative, exploratory study among small-cell lung cancer patients (n = 31) in the Netherlands. Cues originate from patient-interviewer interaction which is best described as an area of tension between the patient's answers and the instrument instructions. As a result, the interviewer may inadvertently introduce bias while attempting to elicit cues, ultimately affecting patients' SEIQoL-DW measures. In order to prevent possible unnoticed interviewer bias special attention should be paid to the interviewer behaviour. Methods to record the meaning of cues should be considered. More research is needed in order to investigate differences in nominating cues with and without the use of the prompt list.

Adult↗

PubMed2006

Patients' perceptions of the side-effects of prostate cancer treatment--a qualitative interview study.

Primary prostate cancer treatment often results in suboptimal urinary, bowel and/or sexual function. These effects are not inevitable. After treatment patients typically report high health related quality of life (QoL) scores. This discrepancy between disease-specific and generic results raises the question which meaning side effects actually have to patients. In a qualitative study we explored two mechanisms which could possibly explain the discrepancy: insensitivity of generic QoL measures to these specific symptoms and adaptation to changed health (response shift). In semi-structured interviews with 33 prostate cancer patients in the Netherlands we collected data on their opinions regarding health and QoL, we observed how respondents behaved when completing health status and QoL questionnaires, and solicited comments on a QoL questionnaire, its items, and its content validity. We observed that patients trivialized sexual (dys) function referring to old age. We found that while they might consider sexual, urinary, and bowel dysfunctions as problems, they did not take such dysfunctions into account when completing QoL measures because they did not view these dysfunctions as aspects of health. This finding reveals a so far unidentified cause of the insensitivity of generic measures of health status. Furthermore, response shift appeared to be present: many patients accepted the side effects as inevitable consequences of having been treated for prostate cancer, a condition they perceived as life threatening. We conclude that generic QoL measures cannot reveal the impact of sexual, urinary and bowel dysfunctions on patients because such dysfunctions are not perceived as health problems. By presenting these findings we want to draw attention to issues that complicate QoL assessments in general and in prostate cancer patients in particular.

Aged↗

PubMed2004

Self-directed learning and student pragmatism.

OBJECTIVE: To explore the experience and practice of students entering a problem-based (PBL) medical undergraduate course and to identify contributory social, curricular and contextual factors. DESIGN: A multiple case study exploiting the natural experimental features of the setting. Qualitative data collection methods, including participant observation, interviews and focus groups were supplemented by a survey. SETTING: The medical school at the University of Liverpool between 1996 and 1998, which launched an integrated PBL curriculum in line with recommendations of the General Medical Council of the UK. PARTICIPANTS: Two successive cohorts of first year medical students entering the PBL course. RESULTS: The first case study findings demonstrated student insecurity and dependence on the faculty resources rather than conforming to PBL principles. Uncertainty gradually diminished but resource dependence persisted, endorsed by peer interaction. Survey results confirmed the qualitative findings. The hypotheses raised for the second case study predicted replications of resource dependent learning, social influences and initial insecurity. Only the first two were upheld. Second year students' advice on textbooks undercut initial uncertainty but insecurity and social comparison reappeared following the changeover of PBL groups and tutors in the second semester. Survey results were replicated. CONCLUSION: Student learning was socially agreed amongst the peer group and directed by faculty given resources. It was not self-directed. Claims made for PBL type curricula may not be justified and GMC recommendations may remain unfulfilled without rigorous attention to educational principles.

Cohort Studies↗

PubMed2004

A qualitative validation of the Minnesota Living with Heart Failure Questionnaire.

BACKGROUND: In an overview of quality-of-life questionnaires that have been used to measure treatment effects in clinical trials in congestive heart failure (CHF), it was concluded that 'no QoL instrument has measured quality of life in CHF trials in a reliable or reproducible fashion' and that the usefulness of these instruments in clinical trials was hampered by a lack of sensitivity to changes in health status. AIM: The aim of our study was to qualitatively explore issues of validity, specificity, and sensitivity with regard to the Minnesota Living with Heart Failure (MLHF) questionnaire in patients with severe heart failure. METHODS: We included 31 patients with severe heart failure in a 2-year prospective longitudinal case study. Each patient was interviewed two or three times in a semi-structured way, resulting in a total of 76 interviews. We used simple qualitative techniques such as respondent observation and respondent debriefing to collect data on practical and interpretative problems that patients experience in conducting the task of completing the questionnaire. RESULTS: The introduction to the questionnaire, which contains essential instructions, was almost never read. Patients did not interpret items as intended. Some items posed problems to respondents because of their wording or because they were considered not applicable to the respondents' circumstances. CONCLUSIONS: Our findings suggest that the MLHF does not measure the concept that it is intended to measure, but our study does not provide a remedy. However, problems regarding individual items and response categories can be remedied.

Heart Failure↗

PubMed2003

Radiographic images and the emergence of optimism about recovery in patients with small cell lung cancer: an ethnographic study.

BACKGROUND: In a previous study, patients with small cell lung cancer showed "false optimism" about their recovery. Because patients' ideas about prognosis affect the choices they make regarding their treatment and end of life care, we explored the reasons why patients showed this optimism. METHODS: An ethnographic study was conducted involving 35 patients with small cell lung cancer in a lung diseases ward and outpatient clinic in a university hospital in the Netherlands. Patients were observed during their entire illness trajectory from diagnosis until death. FINDINGS: At the point of diagnosis, the patient felt ill but not to such a degree that a diagnosis of an incurable cancer was expected. The patient was convinced of really having a cancer when he could see "with his own eyes" a tumour on the radiographic images. During and just after chemotherapy treatment, the patient felt very ill, much more than at the time of diagnosis. It felt as if treatment had made things worse. The patient was convinced that he had been successful in his fight against the tumour when he could see "with his own eyes" a much smaller tumour on the radiographic images. INTERPRETATION: When there was a discrepancy between what patients felt and what the doctor said, radiographic images were used to convince the patient that the doctor was right. An effect of this practice is that patients "learn" to not trust their own bodily sensations and to consider clinical evidence as a more reliable source of information about their condition.

Aged↗

PubMed2002

Attitudes toward illegal immigration: a cross-national methodological comparison.

This research is an examination of the generalizability of a Likert-type scale originally devised to measure attitudes toward illegal immigrants (IA) in the United States. The current authors administered this scale across 4 national samples using several methodological procedures. Undergraduate students (631) responded to the IA scale (R. Ommundsen & K. S. Larsen, 1997) at the University of Oslo, Oregon State University, the University of Copenhagen, and Vrije University of Amsterdam. The authors' main purpose was to evaluate the adequacy of the 20-item IA scale by examining possible problems with method and translation. A translation study carried out with the Danish, Norwegian, and Dutch samples (N = 299) showed that the various national versions were fairly accurate and contained largely the same meanings. The use of procrustes analysis of the IA scale yielded 3 factors in all 4 national samples. The coefficient of congruence of these 3 orthogonally rotated factor matrices, with the U.S. factor matrix as target, varied from .80 to .95, supporting the cross-national robustness of the scale. In the search for a more economical cumulative scale, a Mokken analysis yielded a 5-item scale that represented the aforementioned 3 factors and was stable across national samples.

Adult↗