Globally, over 537 million adults are living with diabetes mellitus. Treatment of diabetes poses a large burden on patients, since it relies predominantly on the patient’s daily self-management.... Show moreGlobally, over 537 million adults are living with diabetes mellitus. Treatment of diabetes poses a large burden on patients, since it relies predominantly on the patient’s daily self-management. Therefore, providing the patient with a care plan that fits seamlessly in one’s daily routines, is in line with their values and preferences and does not overburden their capacities, is of major importance. In order to make diabetes care fit, clinicians and patients need to collaborate and share their knowledge and experience. One possible approach to this collaboration is shared decision making (SDM). In SDM, patients and clinicians partner up and work together to decide on the best available healthcare strategy for the individual patient, taking into account both the best available evidence, and the patient’s preferences, needs and context. This thesis aimed to explore patient and clinician efforts towards making diabetes care fit. In this exploration we aimed to provide insight in the factors driving the decision making process, discuss various strategies to tailor SDM to the patient’s situation, needs and preferences, and explore ways to support the patient and the patient-clinician partnership in diabetes care. Show less
Akkermans, A.; Prins, S.; Spijkers, A.S.; Wagemans, J.; Labrie, N.H.M.; Willems, D.L.; ... ; Vos, M.A. de 2023
PurposeIn intensive care units (ICUs), decisions about the continuation or discontinuation of life-sustaining treatment (LST) are made on a daily basis. Professional guidelines recommend an open... Show morePurposeIn intensive care units (ICUs), decisions about the continuation or discontinuation of life-sustaining treatment (LST) are made on a daily basis. Professional guidelines recommend an open exchange of standpoints and underlying arguments between doctors and families to arrive at the most appropriate decision. Yet, it is still largely unknown how doctors and families argue in real-life conversations. This study aimed to (1) identify which arguments doctors and families use in support of standpoints to continue or discontinue LST, (2) investigate how doctors and families structure their arguments, and (3) explore how their argumentative practices unfold during conversations.MethodA qualitative inductive thematic analysis of 101 audio-recorded conversations between doctors and families.ResultsSeventy-one doctors and the families of 36 patients from the neonatal, pediatric, and adult ICU (respectively, N-ICU, P-ICU, and A-ICU) of a large university-based hospital participated. In almost all conversations, doctors were the first to argue and families followed, thereby either countering the doctor's line of argumentation or substantiating it. Arguments put forward by doctors and families fell under one of ten main types. The types of arguments presented by families largely overlapped with those presented by doctors. A real exchange of arguments occurred in a minority of conversations and was generally quite brief in the sense that not all possible arguments were presented and then discussed together.ConclusionThis study offers a detailed insight in the argumentation practices of doctors and families, which can help doctors to have a sharper eye for the arguments put forward by doctors and families and to offer room for true deliberation. Show less
During the COVID-19 lockdown courts tried urgent criminal cases by using videoconferencing technology. Communicating via a screen affects what one can see, hear or feel. This article presents the... Show moreDuring the COVID-19 lockdown courts tried urgent criminal cases by using videoconferencing technology. Communicating via a screen affects what one can see, hear or feel. This article presents the findings of three different studies on the experiences with videoconferencing during the lockdown. A survey among lawyers, a survey among detainees and a Twitter search all indicate that the defendant’s right to effective participation was undermined: connectivity problems harmed the right to attend court and confidential communication between the defendant and his lawyer was impossible.Tijdens de COVID-19-lockdown behandelden rechtbanken urgente strafzaken met behulp van videoverbindingen. Communiceren via een beeldscherm heeft invloed op wat men kan zien, horen of voelen. Dit artikel presenteert de bevindingen van drie verschillende onderzoeken naar de ervaringen met videorechtspraak tijdens de lockdown. Een survey onder advocaten, een survey onder gedetineerden en een zoekactie op Twitter wijzen er allemaal op dat het recht van de verdachte op effectieve participatie werd ondermijnd: verbindingsproblemen hebben het aanwezigheidsrecht onder druk gezet en vertrouwelijke communicatie tussen de verdachte en zijn advocaat was onmogelijk.Show less
Nakane, Ikuko; Maree, Claire; Ewing, Michael C. 2023
Background: The prevalence of coronary artery disease is increasing due to the aging population and increasing prevalence of cardiovascular risk factors. Non-acute chest pain often is the first... Show moreBackground: The prevalence of coronary artery disease is increasing due to the aging population and increasing prevalence of cardiovascular risk factors. Non-acute chest pain often is the first symptom of stable coronary artery disease. To optimise care for patients with non-acute chest pain and make efficient use of available resources, we need to know more about the current incidence, referral rate and management of these patients. Methods: We used routinely collected health data from the STIZON data warehouse in the Netherlands between 2010 and 2016. Patients > 18 years, with no history of cardiovascular disease, seen by the general practitioner (GP) for non-acute chest pain with a suspected cardiac origin were included. Outcomes were (i) incidence of new non-acute chest pain in primary care, (ii) referral rates to the cardiologist, (iii) correspondence from the cardiologist to the GP, (iv) registration by GPs of received correspondence and; (v) pharmacological guideline adherence after newly diagnosed stable angina pectoris. Results: In total 9029 patients were included during the study period, resulting in an incidence of new non-acute chest pain of 1.01/1000 patient-years. 2166 (24%) patients were referred to the cardiologist. In 857/2114 (41%) referred patients, correspondence from the cardiologist was not available in the GP's electronic medical record. In 753/1257 (60%) patients with available correspondence, the GP did not code the conclusion in the electronic medical record. Despite guideline recommendations, 37/255 (15%) patients with angina pectoris were not prescribed antiplatelet therapy nor anticoagulation, 69/255 (27%) no statin and 67/255 (26%) no beta-blocker. Conclusion: After referral, both communication from cardiologists and registration of the final diagnosis by GPs were suboptimal. Both cardiologists and GPs should make adequate communication and registration a priority, as it improves health outcomes. Secondary pharmacological prevention in patients with angina pectoris was below guideline standards. So, proactive attention needs to be given to optimise secondary prevention in this high-risk group in primary care. Show less
Struiksma, M.E.; De Mulder, H.N.M.; Van Berkum, J.J.A. 2022
Verbal insults go against a universal moral imperative not to inflict harm on others, and they also pose a threat to one’s face or reputation. As such, these “verbal slaps in the face” provide a... Show moreVerbal insults go against a universal moral imperative not to inflict harm on others, and they also pose a threat to one’s face or reputation. As such, these “verbal slaps in the face” provide a unique opportunity to explore the interface between language and emotion. We used electroencephalography (EEG) and skin conductance (SC) recordings to compare the short-term impact of verbal insults such as “Linda is an idiot” or “Paula is horrible” to that of more positive evaluations (e.g., “Linda is an angel”, “Paula is impressive”) and neutral factual descriptions (e.g., “Linda is a student”), examining how responses to these various speech acts adapt as a function of massive repetition. By using either the participant’s or somebody else’s name, we also explored how statement impact depended on who was being evaluated. Multilevel ERP analysis with three predesignated latency ranges revealed an early insult effect in P2 amplitude that was highly robust over repetition and also did not depend on who the insult was about. This P2 effect points to a very rapid and stable capture of emotional attention, plausibly triggered by the retrieval of evaluative word meaning from long-term memory. Insults also elicited a larger late positive potential (LPP), again regardless of who the insult was about, but this later effect did not withstand repetition. Skin conductance responses showed that insults did not lead to more arousal than compliments did. In all, our findings suggest that in a standard psycholinguistic comprehension experiment without real interaction between speakers, insults deliver lexical “mini-slaps in the face,” such that the strongly negative evaluative words involved (e.g., “idiot”) automatically grab attention during lexical retrieval, regardless of how often that retrieval occurs. Show less
Kunneman, M.; Hargraves, I.G.; Sivly, A.L.; Branda, M.E.; LaVecchia, C.M.; Labrie, N.H.M.; ... ; Montori, V. 2022
Objective: To evaluate how the use of a within-encounter SDM tool (compared to usual care in a randomized trial) contributes to care plans that make sense to patients with atrial fibrillation... Show moreObjective: To evaluate how the use of a within-encounter SDM tool (compared to usual care in a randomized trial) contributes to care plans that make sense to patients with atrial fibrillation considering anticoagulation. Methods: In a planned subgroup of the trial, 123 patients rated post-encounter how much sense their decided-upon care plan made to them and explained why. We explored how sense ratings related to observed patient involvement (OPTION12), patient's decisional conflict, and adherence to their plan based on pharmacy records. We analyzed patient motives using Burke's pentad. Results: Plan sensibility was similarly high in both arms (Usual care n = 62: mean 9.4/10 (SD 1.0) vs SDM tool n = 61: 9.2/10 (SD 1.5); p = .8), significantly and weakly correlated to decisional conflict (rho = -0.28, p = .002), but not to OPTION12 or adherence. Plans made sense to most patients given their known efficacy, safety and what is involved in implementing them. Conclusion: Adding an effective intervention to promote SDM did not affect how much, or why, care plans made sense to patients receiving usual care, nor patient adherence to them. Practice Implications: Evaluating the extent to which care plans make sense can improve SDM assessments, particularly when SDM extends beyond selecting from a menu of options. Show less
Bredart, A.; Pauw, A. de; Anota, A.; Tuchler, A.; Dick, J.; Muller, A.; ... ; Dolbeault, S. 2021
Objectives: Comprehensive breast cancer (BC) risk models integrating effects of genetic (GRF) and non-genetic risk factors (NGRF) may refine BC prevention recommendations. We explored the perceived... Show moreObjectives: Comprehensive breast cancer (BC) risk models integrating effects of genetic (GRF) and non-genetic risk factors (NGRF) may refine BC prevention recommendations. We explored the perceived information received on BC risk factors, and related characteristics, in female relatives of women with a BRCA1/2 or PALB2 pathogenic variant, undergoing BC risk assessment using the CanRisk(C) prediction tool.Methods: Of 200 consecutive cancer-free women approached after the initial genetic consultation, 161 (80.5%) filled in questionnaires on their perception of information received and wished further information on BC risk factors (e.g., being a carrier of a moderate risk altered gene, personal genetic profile, lifestyles). Multilevel multivariate linear models were performed accounting for the clinician who met the counselee and exploring the effect of counselees' socio-demographic, familial and psychological characteristics on the perceived extent of information received.Results: Perceived no/little information received and wish for further information were more frequent for NGRF (>50%) than for GRF, especially high-risk genes (<20%). Perceived amount of information received and desire for further information were inversely correlated (p=<0.0001). Higher education level related to lower perceived levels of information received on GRF. Younger counselees' age (beta = 0.13, p = 0.02) and less frequent engagement coping (e.g., inclination to solicit information) (beta = 0.24, p = 0.02) related to lower perceived information received about NGRF. Other assessed counselees' features were not found to be associated to GRF and NGRF information perception.Conclusions: Awareness of counselees' perceived lack of information on BC risk factors indicates a need to enhance evidence-based information on BC NGRF especially. (C) 2021 The Authors. Published by Elsevier Ltd. Show less
Westendorp, J.; Evers, A.W. M.; Stouthard, J.M.L.; Budding, J.; Wall, E.; Plum, N.M.F.; ... ; Vliet, L.M. van 2021
BackgroundMany complaints in medicine and in advanced illnesses are about communication. Little is known about which specific communications harm. This study explored the perspectives of patients... Show moreBackgroundMany complaints in medicine and in advanced illnesses are about communication. Little is known about which specific communications harm. This study explored the perspectives of patients with advanced cancer about potentially harmful communication behaviors by oncologists and helpful alternatives.MethodsAn online survey design was used that was based on literature scoping and patient/clinician/researcher input. Patients with advanced cancer (n = 74) reflected on the potential harmfulness of 19 communication situations. They were asked whether they perceived the situation as one in which communication could be harmful (yes/no). If they answered “yes,” they were asked whether they perceived the examples as harmful (yes/no) or helpful (yes/no) and to provide open comments. Results were analyzed quantitatively and qualitatively (content analysis).ResultsCommunication regarding information provision, prognosis discussion, decision-making, and empathy could be unnecessarily potentially harmful, and this occurred in various ways, such as making vague promises instead of concrete ones (92%), being too directive in decision-making (qualitative), and not listening to the patient (88%). Not all patients considered other situations potentially harmful (eg, introducing the option of refraining from anticancer therapy [49%] and giving too much [prognostic] information [60%]). Exploring each individual patients' needs/preferences seemed to be a precondition for helpful communication.ConclusionsThis article provides patient perspectives on oncologists' unnecessarily potentially harmful communication behaviors and offers practical tools to improve communication in advanced cancer care. Both preventable pitfalls and delicate challenges requiring an individualized approach, where exploration might help, are described. Although providing difficult and unwelcome news is a core task for clinicians, this study might help them to do so while preventing potentially unnecessary harm. Show less
Miranda, R.; Smets, T.; Noortgate, N. van den; Steen, J.T. van der; Deliens, L.; Payne, S.; ... ; PACE Collaborators 2021
Background: 'PACE Steps to Success' is a multicomponent training program aiming to integrate generalist and non-disease-specific palliative care in nursing homes. This program did not improve... Show moreBackground: 'PACE Steps to Success' is a multicomponent training program aiming to integrate generalist and non-disease-specific palliative care in nursing homes. This program did not improve residents' comfort in the last week of life, but it appeared to improve quality of care and dying in their last month of life. Because this program included only three dementia-specific elements, its effects might differ depending on the presence or stage of dementia. We aimed to investigate whether the program effects differ between residents with advanced, non-advanced, and no dementia.Methods: Pre-planned subgroup analysis of the PACE cluster-randomized controlled trial in 78 nursing homes in seven European countries. Participants included residents who died in the previous 4 months. The nursing home staff or general practitioner assessed the presence of dementia; severity was determined using two highly-discriminatory staff-reported instruments. Using after-death questionnaires, staff assessed comfort in the last week of life (Comfort Assessment in Dying-End-of-Life in Dementia-scale; primary outcome) and quality of care and dying in the last month of life (Quality of Dying in Long-Term Care scale; secondary outcome).Results: At baseline, we included 177 residents with advanced dementia, 126 with non-advanced dementia and 156 without dementia. Post-intervention, respectively in the control and the intervention group, we included 136 and 104 residents with advanced dementia, 167 and 110 with non-advanced dementia and 157 and 137 without dementia. We found no subgroup differences on comfort in the last week of life, comparing advanced versus without dementia (baseline-adjusted mean sub-group difference 2.1; p-value = 0.177), non-advanced versus without dementia (2.7; p = 0.092), and advanced versus non-advanced dementia (- 0.6; p = 0.698); or on quality of care and dying in the last month of life, comparing advanced and without dementia (- 0.6; p = 0.741), non-advanced and without dementia (- 1.5; p = 0.428), and advanced and non-advanced dementia (0.9; p = 0.632).Conclusions: The lack of subgroup difference suggests that while the program did not improve comfort in dying residents with or without dementia, it appeared to equally improve quality of care and dying in the last month of life for residents with dementia (regardless of the stage) and those without dementia. A generalist and non-disease-specific palliative care program, such as PACE Steps to Success, is a useful starting point for future palliative care improvement in nursing homes, but to effectively improve residents' comfort, this program needs further development. Show less
Shackley, S.; Jack, C.; Broecks, K.; Mors, E. ter 2020
Objective: Patient-directed knowledge tools are designed to engage patients in dialogue or deliberation, to support patient decision-making or self-care of chronic conditions. However, an abundance... Show moreObjective: Patient-directed knowledge tools are designed to engage patients in dialogue or deliberation, to support patient decision-making or self-care of chronic conditions. However, an abundance of these exists. The tools themselves and their purposes are not always clearly defined; creating challenges for developers and users (professionals, patients). The study's aim was to develop a conceptual framework of patient-directed knowledge tool types.Methods: A face-to-face evidence-informed consensus meeting with 15 international experts. After the meeting, the framework went through two rounds of feedback before informal consensus was reached.Results: A conceptual framework containing five patient-directed knowledge tool types was developed. The first part of the framework describes the tools' purposes and the second focuses on the tools' core elements.Conclusion: The framework provides clarity on which types of patient-directed tools exist, the purposes they serve, and which core elements they prototypically include. It is a working framework and will require further refinement as the area develops, alongside validation with a broader group of stakeholders.Practice implications: The framework assists developers and users to know which type a tool belongs, its purpose and core elements, helping them to develop and use the right tool for the right job. (C) 2019 Elsevier B.V. All rights reserved. Show less
Objective: To learn how to configure a patient communication aid (PCA) to facilitate shared decision-making (SDM) about treatment for advanced cancer.Methods: The PCA consists of education about... Show moreObjective: To learn how to configure a patient communication aid (PCA) to facilitate shared decision-making (SDM) about treatment for advanced cancer.Methods: The PCA consists of education about SDM, a question prompt list, and values clarification methods. Study 1. A first veersion was presented to 13 patients, 8 relatives and 14 bereaved relatives in interviews. Study 2. A second version was used by 18 patients in a pilot study. Patients and oncologists were interviewed, patients were surveyed, and consultations were audio-recorded.Results: Respondents reported that the aid facilitated patient control over information, raised choice awareness and promoted elaboration. Risks were identified, most importantly that the aid might upset patients. Also, some respondents reported that the PCA did not, or would not support decision making because they felt sufficiently competent, did not perceive a role for themselves, or did not perceive that the decision required elaboration.Conclusions: Opinions on the usefulness of the PCA varied. It was challenging to raise awareness about the presence of a choice, and to find a balance between comprehensive information and sensitivity.Practice implications: A future study should demonstrate whether the PCA can improve SDM, and whether this effect is stronger when oncologists receive training. (C) 2018 Elsevier B.V. All rights reserved. Show less
Objective: To assess the extent to which evaluations of shared decision making (SDM) assess the extent and quality of humanistic communication (i.e., respect, compassion, empathy).Methods: We... Show moreObjective: To assess the extent to which evaluations of shared decision making (SDM) assess the extent and quality of humanistic communication (i.e., respect, compassion, empathy).Methods: We systematically searched Web of Science and Scopus for prospective studies published between 2012 and February 2018 that evaluated SDM in actual clinical decisions using validated SDM measures. Two reviewers working independently and in duplicate extracted all statements from eligible studies and all items from SDM measurement instruments that referred to humanistic patient-clinician communication.Results: Of the 154 eligible studies, 14 (9%) included >= 1 statements regarding humanistic communication, either in framing the study (N = 2), measuring impact (e.g., empathy, respect, interpersonal skills; N = 9), as patients'/clinicians' accounts of SDM (N = 2), in interpreting study results (N = 3), and in discussing implications of study findings (N = 3). Of the 192 items within the 11 SDM measurement instruments deployed in the included studies, 7 (3.6%) items assessed humanistic communication.Conclusion: Assessments of the quality of SDM focus narrowly on SDM technique and rarely assess humanistic aspects of patient-clinician communication. Practice implications: Considering SDM as merely a technique may reduce SDM's patient-centeredness and undermine its' contribution to patient care. (c) 2018 Elsevier B.V. All rights reserved. Show less
The People’s Republic of China began the 21st century with a new-and-improved public relations approach that was meant to counter anxieties about China’s role in the world while simultaneously... Show moreThe People’s Republic of China began the 21st century with a new-and-improved public relations approach that was meant to counter anxieties about China’s role in the world while simultaneously showcasing the leadership’s policies to a domestic audience. Crucial to this communication strategy have been networked spectacles: elaborate mass event, designed to reconfigure organisations, ideas, and the relations between people. In Staging China, Florian Schneider analyses large-scale projects like the Beijing Olympics and Shanghai Expo to show how such spectacles became part of the ruling party’s governance toolkit under Hu Jintao’s leadership, and how their legacy informs politics and political communication in China to this day. Show less
Many mating signals consist of multimodal components that need decoding by several sensory modalities on the receiver’s side. For methodological and conceptual reasons, the communicative functions... Show moreMany mating signals consist of multimodal components that need decoding by several sensory modalities on the receiver’s side. For methodological and conceptual reasons, the communicative functions of these signals are often investigated only one at a time. Likewise, variation of single signal traits are frequently correlated by researchers with senders’ quality or receivers’ behavioural responses. Consequently, the two classic and still dominating hypotheses regarding the communicative meaning of multimodal mating signals postulate that different components either serve as back-up messages or provide multiple meanings. Here we discuss how this conceptual dichotomy might have hampered a more integrative, perception encompassing understanding of multimodal communication: neither the multiple message nor the back-up signal hypotheses address the possibility that multimodal signals are integrated neurally into one percept. Therefore when studying multimodal mating signals, we should be aware that multimodal signals can give rise to multimodal percepts, meaning that receivers can gain access to additional information inherent to only combined signal components (‘the whole is something different than the sum of its parts’). We review the evidence for the importance of multimodal percepts and outline potential avenues for discovery of multimodal percepts in animal communication. Show less
