Introduction: Parkinson’s Disease (PD) is a neurodegenerative, progressive motor disorder. Receiving this diagnosis can be impactful for patients. PD patients have reported dissatisfaction with the...Show moreIntroduction: Parkinson’s Disease (PD) is a neurodegenerative, progressive motor disorder. Receiving this diagnosis can be impactful for patients. PD patients have reported dissatisfaction with the diagnostic process, which may partly result from a perceived lack of active involvement during medical decision-making. Neurologists are expected to inform and involve patients based on the ethical imperative of patient autonomy. Yet, insight into how medical decisions are actually made is scarce, particularly which types of medical decisions, the extent of patient involvement, and how this affects their satisfaction. This study aimed to get more insight into medical decision-making by observing PD diagnostic consultations in current clinical practice. Hypotheses: Firstly, it was expected that medical decisions were related to topics such as follow-up appointments and PD medication (H1). Secondly, it was expected that the level of patient involvement was low during PD diagnostic consultations (H2). Thirdly, it was hypothesized that patient involvement and overall satisfaction were positively associated (H3). Fourthly, it was hypothesized that female, younger, and more highly educated patients were more substantially involved compared to male, older, and more lowly educated patients (H4, H5 & H6). Methods: This prospective longitudinal study used both quantitative (i.e., questionnaires, structured observational coding) and qualitative (i.e., explorative observational coding) data. PD patients (N=12) visiting neurology outpatient departments in the Netherlands were included upon referral. Diagnostic consultations were video-recorded and patients filled in questionnaires. Types of medical decisions were identified using an adapted existing coding scheme. The observed level of involvement was scored using the OPTION-12 for the most frequently and crucial occurring medical decision. Patients’ overall satisfaction with their consultations was measured six weeks after their last consultation. Statistical analyses included non-parametric tests and multiple regressions. Results: Topics of medical decisions most frequently concerned: follow-up appointments, PD medication and diagnostic testing. Patient involvement was low (M = 9.8; 0-100), indicating that neurologists exhibited few attempts to involve patients during medical decisions about PD medication. Patient involvement was not predictive for patients’ overall satisfaction (p = .23), nor did patients’ demographic characteristics predict the level of patient involvement (p = .29). Conclusion: Medical decisions during PD diagnostic consultations mainly pertained to follow-up appointments, diagnostic testing, and PD medication. PD patients are rarely involved in decisions about PD medication. These results should be interpreted with caution due to a small sample. We recommend repeating this study with a larger sample and investigating what neurologists think is necessary and feasible in terms of patient involvement for the various identified types of medical decisions.Show less
CenteringPregnancy® (CP) is a prenatal care model that provides all aspects of prenatal care in a group setting. This retrospective cohort study investigated how the CP group facilitators’ fidelity...Show moreCenteringPregnancy® (CP) is a prenatal care model that provides all aspects of prenatal care in a group setting. This retrospective cohort study investigated how the CP group facilitators’ fidelity to the CP model, social support (as perceived by the CP participants), group cohesion (as perceived by the CP group facilitators), and the CP participants’ satisfaction with care were related. Additionally, it was assessed how the perceived social support and the observed group cohesion developed over time, and to what extent these were related to each other. 637 women (mean age 30.44) and 69 groups were included. Questionnaires were used to measure perceived social support at the 28th week and 36th week of pregnancy, and satisfaction with care (PPSQ) at the 36th week. Model fidelity and group cohesion were measured by a questionnaire filled in by the group facilitators after each session. A parallel mediation analysis, a dependent samples t-test, and a one way repeated measures ANOVA were conducted. The results showed that women that felt more supported by their peers were generally more satisfied with CP care (95% CI [.15, .22]). In contrast, group facilitators’ perceptions of the groups’ cohesiveness did not predict how satisfied the women were with CP care (95% CI [-.17, .12]). It was also found that the group facilitators’ fidelity to the CP model did not predict the participants’ satisfaction with care (95% CI [-0.01, 0.00]). Further, the results showed that the participants felt increasingly supported by their peers over the course of the program (p < .001, d = .82). Similarly, the group facilitators’ perceived the CP groups to be increasingly cohesive over time (p = .001, η 2 = .02). Finally, the participants’ and group facilitators’ perceptions of social support and group cohesion were found to be weakly related (p < .001). These findings highlight that the implementation of CP in the Netherlands shows promise in enhancing maternal social support, and consequently, satisfaction with care. This study also adds unique knowledge to the evidence base of CP by assessing the cohesiveness of the groups. Future research is called upon to examine the presented relationships by applying different instruments regarding the group facilitators’ (in)fidelity to the CP model.Show less
