Research master thesis | Psychology (research) (MSc)
under embargo until 2025-08-31
2025-08-31T00:00:00Z
Background: An innovative approach to improving poor psychological outcomes in breast cancer patients undergoing chemotherapy is via clinician-patient communication strategies such as educating...Show moreBackground: An innovative approach to improving poor psychological outcomes in breast cancer patients undergoing chemotherapy is via clinician-patient communication strategies such as educating patients about the nocebo effect (i.e., nocebo information) and using reassurance of non-abandonment (i.e., clinician-expressed empathy). Research suggests that nocebo information may improve some outcomes in non-cancer settings, but its effectiveness on psychological outcomes in cancer settings remains uncertain. Clinician-expressed empathy has repeatedly been shown to improve short-term psychological outcomes in cancer patients, although the long-term effects require further investigation. Moreover, potential interaction effects between nocebo information and clinician-expressed empathy observed in non-cancer settings warrant exploration in cancer care. Objective: To investigate the distinct and combined effects of nocebo information and clinician-expressed empathy on breast cancer patients’ psychological outcomes (main outcome: state anxiety) over time and at short term when undergoing chemotherapy. Methods: In this 2x2 clinical proof-of-principle randomized controlled trial, female breast cancer patients undergoing chemotherapy for the first time viewed 1 out of 4 role-played information videos, wherein the levels of nocebo information (present vs. absent) and empathy (present vs. absent) were varied. Using stepwise multilevel analyses and two-way analyses of variance, we investigated the videos’ effects on participants’ psychological outcomes over time and at short term. Results: Among the 19 participants, over time, nocebo information showed trends (p > .05) to improve state anxiety but worsen self-efficacy and distress, and empathy showed trends to worsen state anxiety, self-efficacy, as well as distress. When combined, nocebo information and empathy significantly and largely worsened self-efficacy (β = -3.21; p = .009). At short term, both nocebo information and empathy showed trends (p > .05) to worsen feelings of satisfaction and trust. Conclusion: Although these unexpected and mixed findings are preliminary, they highlight the need to fully understand the potential benefits and risks associated with clinician-patient communication strategies in cancer care.Show less
Abstract Background: As day surgery becomes more common and patients are discharged only a few hours after surgery, recovery happens more at home, which can elicit feelings of anxiety and...Show moreAbstract Background: As day surgery becomes more common and patients are discharged only a few hours after surgery, recovery happens more at home, which can elicit feelings of anxiety and insecurity. This presents a need for patient tailored support during the postoperative phase. Aim: The aim of this study was to examine the effect of an application that combines self- assessment with emphatic remote monitoring on the psychological aspects of recovery. Methods: The study was part of a multicentre study. For this two-arm non-blinded randomized controlled trial we aimed to recruit 100 patients at the day care of OLVG hospital. Patients in the intervention group received a smartphone application to record pain and nausea, and send messages to the hospital. Data was monitored by a medical assistant and patients were contacted in case of i) an increase in pain or nausea, ii) if answered yes to ‘Do you want something to be done about your pain or nausea?’ or iii) when a message was sent. Patients in the control group received standard discharge instructions. The main outcome was the difference in psychological aspects of recovery between the intervention group and the control group at day seven after surgery, measured with selected items from the QoR15. Secondary outcomes were i) an evaluation of comments after the questionnaires about general experiences after surgery and ii) semi-structured interviews (N=8) with patients in the intervention group. Results: A Mann-Whitney U test showed no differences between the groups at day seven after surgery in feelings of support (U=596.50, p=0.43), feeling comfortable and in control (U=558.50, p=0.23), general well-being (U=562.50, p=0.25), feelings of anxiety (U=623.50, p=0.62) and depressed feelings (U=525.50, p=0.10) and satisfaction (U=613.00, p=0.55) and trust towards the provided care (U=633.50, p=0.71). Comments after the questionnaires showed mostly physical problems experienced after surgery. Data from the interviews showed patients reporting some positive effects from the intervention, such as reassurance and awareness. Conclusion: Despite not finding significant results, some patients experienced positive effects from our intervention. Overall, we think an application that combines self-assessment with remote monitoring has potential to improve some patient outcomes, but more research is needed.Show less
Background: Cancer demands proper patient-doctor communication. Helpful communication, such as empathy, improves patients' well-being. However, many complaints revolve around communication deficits...Show moreBackground: Cancer demands proper patient-doctor communication. Helpful communication, such as empathy, improves patients' well-being. However, many complaints revolve around communication deficits, yet little is known about the specific communication behaviours that cause harm. This study aimed to determine cancer patients’ and caregivers’ perspectives on harmful communication behaviours of healthcare professionals, and determined the relationship between age, gender, education, marital status and ethnicity and the type of harmful communication that is perceived as most harmful. Methods: A systematic literature search of several databases, supplemented by expert consultations was conducted. Studies were included if they focused on English peer-reviewed articles addressing adult (≥18) cancer patients’ and/or caregivers’ perspectives on harmful communication behaviours of healthcare professionals. ASReview tool was used for screening records based on Title and Abstract. Two researchers (JW/TW) independently screened the full text of the eligible records. Thematic analysis was used to analyse the extracted data. Due to insufficient quantitative studies, a subsequent dataset was used for quantitative analyses. An online questionnaire was used to assess patients’ views on potential harmful situations (yes/no). Quantitative analyses involved binary logistic regressions. Results: Qualitative results revealed 47 studies. Fifteen subthemes were developed under 4 categories including information provision, shared-decision making, healthcare providers’ personal factors and the healthcare process. Quantitative findings revealed that making vague promises by HCPs is perceived as the most potentially harmful situation according to patients (92.2%). No significant relation was found between age (p=.99), gender (p=.99), education(p=.916), marital status(p=.99), ethnicity(p=.99) and perceiving vague promises as harmful. Conclusions: Healthcare professionals should adapt their communication strategies to the unique preferences of patients and caregivers, considering their ambivalent preferences towards information provision. By adopting a personalized approach that considers the individual needs, cultural background and stage of disease, healthcare professionals might prevent harm. Future research should focus on recruiting diverse and larger sample sizes and focus on the caregivers’ perspectives solely.Show less
Objective Breast cancer patients who are undergoing treatment often experience side effects as a consequence. Because patients speak a lot with their doctor during their disease process,...Show moreObjective Breast cancer patients who are undergoing treatment often experience side effects as a consequence. Because patients speak a lot with their doctor during their disease process, psychological interventions via doctor-patient communication can be used to positively influence patient outcomes, like side effect expectations. This experimental video-vignette study aimed to i) Investigate if clinician-expressed empathy and giving information about the nocebo-effect (e.g. when negative outcome expectations lead to worsening of a symptom) decreases the probability of patients’ expected side effects and ii) Determine whether a decrease in patients’ anxiety levels plays a mediating role between the effects of empathy and nocebo-effect information and side effect expectations. Methods Using a scripted video-vignette study, analogue patients (AP’s: healthy women, women with cancer and cancer survivors, N= 160) randomly watched one out of four videos. The video-vignettes differed in clinician’s communication: Absence or presence of clinician-expressed empathy and information on the nocebo-effect. Pre-video and post-video, APs’ state-anxiety levels were captured and post-video a manipulation check and side effect expectations (specific, partial and non-specific) were assessed. Data was analysed using anova, multiple regression- and mediation analysis. Results Between-group effects demonstrated that AP’s who received both clinician-expressed empathy and nocebo-information compared to no intervention at all showed the best results for expectations of specific side effects (p = .017). However this can be explained by a main effect of empathy on specific side effect expectations (β = -.254, 95% CI = -1.299 to -.324, p = .001). Exploratory analysis showed that this was specifically due to decreased expectations of hair loss (p=.003) and diarrhea (p=.009). The effects of both interventions on side-effects were in no case mediated by APs’ state anxiety levels. Conclusion The current experimental study demonstrated that clinician-expressed empathy might help to decrease APs’ specific side effects, yet this effect cannot be explained by a decrease in anxiety levels. When empathy by the doctor is combined with informing patients about the nocebo effect this might be a promising intervention to further decrease the degree of side effects for cancer patients. More research in a clinical care setting is needed to generalize the effects of the interventions to a clinical population and to gain insight into the underlying mechanism that remains unclear.Show less
