The studies described in this thesis provide additional evidence that the current Dutch population-based screening programmes (CSPs) can be further optimized, particularly concerning the... Show moreThe studies described in this thesis provide additional evidence that the current Dutch population-based screening programmes (CSPs) can be further optimized, particularly concerning the participation of potential participants from highly urbanized and low socioeconomic status (SES) neighbourhoods. Our findings suggest that non-participation in the CSPs in these low SES-neighbourhoods is associated with more unfavourable, relatively advanced, tumour outcomes. Given that the decision to participate in a CSP is not solely based on rational decision-making processes, primary care providers could play an important role here. This would primarily involve informing and advising potential participants who are hesitant about participating in CSPs. In this thesis, we describe that both potential participants and general practitioners support the idea that primary care should be more involved in the invitation process of the CSPs. Based on our findings, we therefore recommend implementing a proactive, risk-based invitation strategy from primary care regarding the invitation process of the current CSPs. Show less
Background: Chronic diseases are often associated with sexual dysfunction (SD). Little is known about the practice patterns of general practitioners (GPs) regarding sexual care for chronically ill... Show moreBackground: Chronic diseases are often associated with sexual dysfunction (SD). Little is known about the practice patterns of general practitioners (GPs) regarding sexual care for chronically ill patients. Therefore, the aim of this study was to examine; to what extent GPs discuss SD with chronically ill patients; the barriers that may stop them; and the factors associated with discussing SD. Methods: A cross-sectional survey using a 58-item questionnaire was sent to 604 Dutch GPs. Descriptive statistics and associations were used for analysis of the data. Results: Nearly 58% (n = 350) of all GPs approached gave a response and 204 questionnaires were analysable (33.8%). Almost 60% of respondents considered discussing SD with patients important (58.3%, n = 119). During the first consultation, 67.5% (n = 137) of the GPs reported that they never discussed SD. The most important barrier stopping them was lack of time (51.7%, n = 104). The majority (90.2%, n = 184) stated that the GP was responsible for addressing SD; 70.1% (n = 143) indicated that the GP practice somatic care nurse (GPN) was also responsible. Nearly 80% (n = 161) of respondents were unaware of agreements within the practice on accountability for discussing SD. This group discussed SD less often during first and follow-up consults (p = 0.002 and p < 0.001, respectively). Of the respondents, 61.5% (n = 116) felt that they had received insufficient education in SD and 74.6% (n = 150) stated that the subject is seldom discussed during training. Approximately 62% of the GPs (n = 123) wanted to increase their knowledge, preferably through extra training. According to 53.2% of the GPs (n = 107) it was important to improve the knowledge of the GPN. The most frequently mentioned tool that could help improve the conversation about SD was the availability of information brochures for patients (n = 123, 60.3%). Conclusions: This study indicates that Dutch GPs do not discuss SD with chronically ill patients routinely, mainly due to lack of time. An efficient tool is needed to enable GPs to address SD in a time-saving manner. Increased availability of informational materials, agreements on accountability within GP practices, and extra training for the GPs and GPNs could improve the discussion of SD. Show less
