Insomnia is highly prevalent in patients with long-term medical conditions. Although fatigue is the most common daytime symptom of insomnia, it is still largely unknown which underlying components...Show moreInsomnia is highly prevalent in patients with long-term medical conditions. Although fatigue is the most common daytime symptom of insomnia, it is still largely unknown which underlying components are associated with fatigue in a broader population of insomnia patients. Previous literature stated that dysfunctional sleep-related beliefs (DSRB) and pre-sleep arousal (PSA) could explain the relationship between insomnia and fatigue. Additionally, subjective sleep characteristics, such as insomnia severity, number of nocturnal awakenings (NoA) and sleep efficiency might also be components of this relationship. This study aimed to investigate how these factors affect fatigue in a broad medical population with insomnia. It was hypothesized that more disturbed sleep-related psychological factors and subjective sleep characteristics were associated with increased fatigue. This cross-sectional study, derived from the ongoing TIMELAPSE study, consisted of 154 participants. Participants completed questionnaires assessing fatigue (Checklist Individual Strength-20), DSRB (Dysfunctional Beliefs and Attitudes about Sleep-16), PSA (Pre-Sleep Arousal Scale), and insomnia severity (Insomnia Severity Index). The Consensus Sleep Diary tracked NoA and sleep efficiency daily for one week. Two multiple regression analyses were performed to assess the relationship between sleep-related psychological factors (DSRB, PSA), subjective sleep characteristics (insomnia severity, NoA, sleep efficiency) and fatigue. Age, gender, and depression were included as controlling variables. Results showed that DSRB (β = .174, p = .027), PSA (β = -.160, p = .036), and insomnia severity (β = .243, p = .002) were factors associated with fatigue in insomnia patients. More severe DSRB and higher insomnia severity predicted elevated levels of fatigue. Contrary to expectations, PSA was negatively associated with fatigue. Lastly, NoA and sleep efficiency were not related to fatigue. This study uncovered connections between more severe DSRB, lower PSA, and higher insomnia severity that led to higher levels of fatigue. The current study suggests that improvements in DSRB and reducing insomnia severity may reduce fatigue of insomnia patients with long-term medical conditions. Sleep interventions should emphasize on challenging these DSRB. Future research is needed to examine the complex relationship between PSA and fatigue, as well as whether changes in DSRB during CBT-I treatment reduce fatigue symptoms in this population.Show less
This paper investigates the effect of nocebo suggestions on food craving levels and explores whether personality traits, specifically neuroticism and impulsivity, moderate this impact. The study...Show moreThis paper investigates the effect of nocebo suggestions on food craving levels and explores whether personality traits, specifically neuroticism and impulsivity, moderate this impact. The study was conducted using a sample of 21 volunteers which were recruited from Leiden University, and used a randomised controlled trial design. The two groups that were used in the analysis were control and nocebo groups (increase hunger). Nocebo group participants received a sham vagus nerve stimulation and were exposed to suggestions that this stimulation will increase their hunger. Food craving was measured using a Visual Analogue Scale at different time points throughout the experiment, and self-report inventories were used to assess neuroticism and impulsivity. A repeated measures Analysis of Variance (ANOVA) and a moderation analysis were performed to analyse the data. The results showed significant changes in craving intensity, F(3, 57) = 11.14, p < .001, with higher craving levels in the control group compared to the nocebo group. Neither neuroticism F(3, 17) = 0.37, p = .77, nor impulsivity, F(3, 17) = 2.11, p = .14, were significant in moderating the relationship between nocebo suggestions and food cravings. However, impulsivity independently showed a significant negative effect on craving ratings, where higher impulsivity was related to lower food cravings, b = -11.07, t(df) = -2.18, p = .04. The study’s limitations included a small sample size and ambiguous definitions of nocebo effects, which could have affected the results. Future research should focus on exploring other personality traits to deepen our understanding of their effect on nocebo suggestions and food cravings.Show less
End-stage kidney disease (ESKD) patients suffer from an extremely lower Health-Related Quality of Life (HRQoL) than the general population. A way of supporting these patients is through internet...Show moreEnd-stage kidney disease (ESKD) patients suffer from an extremely lower Health-Related Quality of Life (HRQoL) than the general population. A way of supporting these patients is through internet-based cognitive-behavioral treatment (iCBT). This study aims to identify psychological variables that might impact the effectiveness of iCBT treatment within an ESKD patient group to provide suggestions for the further optimization of these interventions. This study investigated the association between self-efficacy and treatment outcome after an iCBT intervention together with the potential role of illness cognitions and the therapeutic relationship. The intervention group (N=8) followed a 3- to 4-month iCBT intervention. Secondary data analysis was performed on the prospective data of a two-arm multicenter randomized controlled superiority trial (RCT). To measure treatment outcome from baseline to the 6-month follow-up we examined physical and mental HRQoL and the personalized outcome measure. To measure the other variables, we used the data from the questionnaires on self-efficacy and illness cognitions at baseline and the therapeutic relationship at the 6-month follow-up. To examine the associations between the different variables within this study, hierarchical regression analyses were performed. In addition, we analyzed the possible moderating effects via the Hayes PROCESS extension. This was an underpowered study, so outcomes need to be interpreted with extreme caution. We found indications that a higher level of self-efficacy was associated with better physical HRQoL (ß = .48, p = .26). We also found indications that a higher level of helplessness was related to stronger deteriorations of mental HRQoL (ß = -.43, p = .65) and the personalized outcome measure (ß = -.31, p = .39). Lastly, we found significant moderating effects for acceptance (R²-chng = .59, p = .05) and helplessness (R²-chng = .71, p = .005) between self-efficacy and physical HRQoL. The outcomes of this study suggest that self-efficacy and helplessness are important factors to consider when aiming for the further optimization of iCBT interventions within an ESKD patient group. It seems that self-efficacy creates stronger resilience. Screening on these variables and enrolling patients into pre-treatment to positively impact these variables before iCBT can possibly better treatment outcomes.Show less
Background Suicide is a leading cause of death worldwide. The numbers in The Netherlands confirm this trend, where suicide is the leading cause of death in people aged 10-29. A significant...Show moreBackground Suicide is a leading cause of death worldwide. The numbers in The Netherlands confirm this trend, where suicide is the leading cause of death in people aged 10-29. A significant predictor of suicide is perfectionism: high levels of perfectionism can increase the risk of suicidal ideation. Suicide can be seen as an attack against the self that goes against our innate drive for self-preservation that our ego is involved in. The ego is a component of the self, according to Freud’s Psychoanalytic Theory. It mediates between the super-ego and the id and uses ego functions to do so. Defense mechanisms are examples of these ego functions. They protect the self against internal stress or anxiety. Objective In the last 50 years, our predictive or preventive capabilities regarding SI have not been improved. By adding Psychoanalytic Theory to current theories, we aim to improve their predictive abilities. The question that is central in this project is: “Do mature defense mechanisms moderate the relation between perfectionism and suicidal ideation in university students aged 17-26?” Methods The study followed a cross-sectional design and data was collected through self-report questionnaires. The instruments used were the Multidimensional Perfectionism Scale, the Suicidal Ideation Attributes Scale and the 30-item Defense Mechanism Rating Scale. The sample size was N = 98 and data was analyzed with hierarchical regression. Results The analysis showed that perfectionism can increase the risk of SI (F = 8.20, p = .005) and that mature defense mechanisms can decrease the risk of SI (F = 7.23, p = .017). However, the analysis reported non-significant results for the moderation of mature defense mechanisms in the relation between perfectionism and SI (F = 4.85, p = .673). Conclusion While the RQ cannot be confirmed with this analysis, the study does show positive relations between perfectionism and SI and negative relations between SI and mature defenses. These findings can contribute to the current literature and highlight the importance for further research. This research should be conducted with a bigger and diversified sample.Show less
Expectations can influence the experience of pain and itch, hence expectations may also contribute to symptoms in patients with chronic itch and pain. Currently there is limited research...Show moreExpectations can influence the experience of pain and itch, hence expectations may also contribute to symptoms in patients with chronic itch and pain. Currently there is limited research investigating the role of expectancies in the perception of these patients’ itch and pain compared with healthy people. This study investigates if and how acquired expectations on ambiguous stimuli applied to the skin affect experiences between three groups; healthy people, and patients with chronic pain and itch. This study hypothesises whether patients with chronic pain and chronic itch have a higher expectation and experience a higher intensity of pain and itch, respectively, compared to healthy individuals, and to what extent the expectation of higher intensity of pain and itch contributes to the actually experienced intensity of pain and itch. A mediation analysis is examined to answer this hypothesis. The study used an observational between-subject design to investigate the three groups (Chronic pain group n = 9, chronic itch group n = 4 and healthy participants n = 10, with the target for further study n = 45). Participants were asked about prior expectations and the experience of pain and itch when applying the Von Frey monofilament. Contrary to our hypothesis, this study showed no significant differences in expectations and experiences between the chronic pain and chronic itch group and the healthy participants. In addition, the results of the mediation analyses did not show an indirect significant mediation effect of expectancies in the relationship between the groups and experienced pain/itch. For mild ambiguous stimuli, expectations determine perceptions of pain and itching, while chronic pain and itching do not seem to determine expectations. However, limitations such as the limited sample size need to be taken into account, and additional research is needed to draw further conclusions.Show less
Background: Psoriasis is one of the most common chronic skin disorders and is known for its substantial psychosocial impact. Stigma from the general public plays a significant role. Yet there is...Show moreBackground: Psoriasis is one of the most common chronic skin disorders and is known for its substantial psychosocial impact. Stigma from the general public plays a significant role. Yet there is limited knowledge and research done regarding determinants and mechanisms that explain or predict these stigmatizing attitudes from the general public. Potentially the behavioural immune system (BIS) plays a role. Aims: The aim of the study is to gain insights into factors of the BIS that potentially influence stigmatizing attitudes of the general public, to facilitate the development of an appropriate intervention targeting the reduction of such attitudes. Methods: A sample of 150 participants between the age of 19 and 73 (M= 31.4, SD=13.1) where included. They filled in an online questionnaire after reading a vignette about an encounter with a person with psoriasis. Questionnaires measured perceived vulnerability to disease, knowledge of psoriasis and the personality trait openness to experience. Results: There was no significant association found between higher levels of perceived vulnerability to disease and stigmatizing attitudes towards people with psoriasis (p=.23). Furthermore, neither openness to experience (p=.24) nor knowledge of psoriasis (p=.25) mediated this relationship. Notably, individuals with lower levels of knowledge about psoriasis displayed greater stigmatizing attitudes towards people with psoriasis (p=<.001). Discussion: It is therefore recommended to focus on increasing knowledge about psoriasis in future intervention development. Next to this it is recommended to further investigate if the BIS affects stigma towards people with psoriasis with other determinants and methods and to evoke stigma with visual cues.Show less
Purpose: The aim of our study was (1) to assess the level of openness of communication about illness and death between patients with advanced cancer and their relatives during the last three months...Show morePurpose: The aim of our study was (1) to assess the level of openness of communication about illness and death between patients with advanced cancer and their relatives during the last three months of the patient’s life, (2) to examine its association with relatives’ characteristics (age, gender, level of education, faith, type of relationship with the patient, and emotional functioning before the patient’s death), and (3) to examine its association with relatives’ bereavement distress. Methods: This observational study used data from bereaved relatives of patients with advanced cancer from the prospective, longitudinal, multicenter, observational eQuipe study. Openness of communication about illness and death was measured using the Caregivers’ Communication with Patients about Illness and Death (CCID) scale. Univariate and multivariable linear regression analyses were used to assess the association between the level of openness of communication and (1) the a priori defined characteristics of the relatives, and (2) the level of bereavement distress, as measured by the Impact of Event Scale (IES). Results: A total of 160 bereaved relatives were included in the study and 65% (n=103) reported high levels of open communication about illness and death with their ill loved one during the last three months of the patient’s life. Higher levels of open communication were associated with lower levels of bereavement distress. No associations were found between levels of open communication and relatives’ age, gender, level of education, faith, type of relationship with the patient, or emotional functioning before the patient’s death. Conclusions: The majority of bereaved relatives in our study had few difficulties communicating about illness and death with their loved one with advanced cancer during the last three months of the patient’s life. Higher levels of open communication are associated with lower levels of bereavement distress and future research should investigate the causality of this relationship.Show less
Introduction: Parkinson’s Disease (PD) is a progressive neurological disorder that severely affects patients’ lives. How patients cope with the stress of receiving this diagnosis is influenced by...Show moreIntroduction: Parkinson’s Disease (PD) is a progressive neurological disorder that severely affects patients’ lives. How patients cope with the stress of receiving this diagnosis is influenced by information-seeking coping style, which can be classified on two dimensions: monitoring (seeking information) and blunting (avoiding information). Patients’ level of monitoring and blunting may affect their perception of amount of information. Clinicians may not tailor the amount of information to the individual needs of patients, negatively impacting their recall. This study hypothesized that the amount of provided information by clinicians is equal for patients who score high on monitoring and patients who score high on blunting. Additionally, this study hypothesized that patients with high monitoring scores would report receiving too little information, and that patients with high blunting scores would report receiving too much information. Method: This study employed a prospective observational longitudinal design as part of the DiaMove Project. The sample consisted of newly diagnosed PD patients who completed questionnaires assessing their demographic characteristics, coping styles and perceived amount of information. Diagnostic consultations were video-recorded and subsequently observationally quantitatively coded for duration of information provision per topic. Statistical analyses included equivalence testing, independent t-tests and logistic regression. Results: This study found that the amount of information provided by clinicians is not equivalent for patients (N = 28) with high scores on the monitoring scale and those with high scores on the blunting scale (CI = [-0.26 – 0.37]; CI = [-0.20 – 0.43]). In addition, two independent t-tests were conducted, which showed no significant difference in the amount of information provided for high scores on the different coping styles (p = .288; p = .552). Furthermore, the likelihood of wanting to receive more or less information cannot be predicted by respectively high scores on the monitoring and blunting coping style (p > .05). Discussion: Patients’ level of monitoring or blunting was not a significant predictor for the amount of information provided and did not predict patients’ reported amount of information provided by clinicians. These findings may be influenced by limitations of self-reported questionnaires, such as the length and the small sample size of the study.Show less
Background. Deposit contracts (i.e. financial incentives in which people deposit their own money and can earn it back contingent on proven behavior change) have been shown to be effective to...Show moreBackground. Deposit contracts (i.e. financial incentives in which people deposit their own money and can earn it back contingent on proven behavior change) have been shown to be effective to promote health be- havior change. However, most research up to date has been done in lab settings, included few participants, and did not yet shed light on the characteristics (of challenges or people) that make them more effective. This also includes the nuanced assessment for winners and losers. Objectives. We assessed effectiveness of gamified deposit-based challenges on physical activity (PA) levels provided by the smartphone app StepBet. We also examine effects on PA-levels within early losers of a chal- lenge, i.e. who faced the irreversible loss of their deposit. Secondary, we explored on users’ characteristics possibly linked to PA-increase, or winning a deposit-based challenge. Hence, through our research, we aim to bring forward the personalization of such interventions. Methods. PA was measured as daily average step count. We retrieved data from StepBet users daily step count (N = 323). Once, users step count throughout the challenge period, second, from before challenge start (baseline step level), and third, their step count pre/post challenge failure. We measured changes in daily step count (step increase) by comparing users challenge step count to a personal historic step count. Bet amounts (deposits) of losers of a challenge are split evenly among the winners. Outcomes were, challenge success/ failure (dichotomous) and step increase (continuous). We only included adult first time players in their first challenge, characterized by 41-days duration and $40 deposit. We also surveyed on users psychological char- acteristics (motivation, self-efficacy, self control, risk proneness) and demographics (BMI, age, gender, in- come, education). Results. The daily average step count increased on average 46.0 % (or 3183 steps, SD = 3207) compared to a baseline mean level (M = 6916 steps, SD = 2833) in users. Across the entire challenge duration, winners (n = 256) significantly increased their daily step counts on average by 52.5 % (or 3730 steps, SD = 1489), com- pared to a baseline (M = 7109 steps, SD = 2837). Meanwhile losers (n = 67) significantly increased their dai- ly steps on average by 17.7 % (or 1094 steps, SD = 1610) compared to baseline (M = 6181 steps, SD = 2712) and across the 41-days. Prior to failure, losers showed an increase of 30.7 % (1870 steps, SD =1505), and post-failure a decrease by -28.7 % (-1738 steps, SD = 3265) on average compared to baseline (M = 6052, SD = 2644). Our exploratory results showed older age, male gender, higher scores on income, self control, and self-efficacy were linked to increasing one’s step count, and only older age to winning. Discussion. Results indicate that deposit-based gamified step challenge promote PA in the real world. We presume the key mechanism behind this is based on DCs because they capitalize on our tendency to be loss averse. We advise on scaling DCs up as a more economic, scalable, and more effective alternative to finan- cial rewarding. Though, we urge future studies to consider options of attenuating the found setback effect in losers.Show less
Outcome expectations play a role in the functioning of people with different immune-mediated conditions, like Bechterew’s disease, and could strengthen or convey similar effects of regular long...Show moreOutcome expectations play a role in the functioning of people with different immune-mediated conditions, like Bechterew’s disease, and could strengthen or convey similar effects of regular long-term therapy. The Wim Hof Method has shown promising results with regards to its effect on clinical, autonomic and immune response to experimentally induced inflammation. The current study aims to investigate the relationship between generic (optimism/neuroticism) and specific outcome expectations (related to training effects on health) with the functioning of patients with Bechterew’s disease. In this proof-of-concept randomized controlled trial with a cross-sectional design, 24 patients were included, who followed an adapted version of the Wim Hof Method. During this intervention, a number of areas of functioning variables were included: quality of life, anxiety, depression, and disease activity. These were measured at baseline, week 4, week 8, and a follow-up meeting at week 24. When assessing the relationship between generic and specific treatment outcome expectations, it was found that, higher levels of neuroticism are related more positive specific outcome expectations (r = .414, p = .044). It was seen that better functioning in one area was associated with better functioning in some other areas (r = .434, p < .001, r = .836, p < .001). Regarding the influence of each treatment outcome expectation separately on the different areas of functioning, neuroticism was associated with higher disease activity before and after treatment, as well as more anxiety before treatment (r = .470, p = .018, r = .567, p = .05, r = .253, p = .05). Optimism and specific treatment outcome expectations were not significantly related to functioning. Also, when the influence of baseline functioning was assessed, only the levels of depression before treatment were predictive for depression after treatment (beta = .714, p = .027). When treatment outcome expectations were taken together, they were not significant predictors for functioning after treatment. This study provides limited indications for the importance of treatment outcome expectations for alternative treatment methods. However, neuroticism plays a role in worse functioning and could be used to predict treatment response, and its influence could be addressed through neuroticism management.Show less
Chronic Low Back Pain (CLBP) is associated with one of the highest disease burdens in the Netherlands. Research using the biopsychosocial model could find areas of improvement in the treatment of...Show moreChronic Low Back Pain (CLBP) is associated with one of the highest disease burdens in the Netherlands. Research using the biopsychosocial model could find areas of improvement in the treatment of CLBP. This study attempts to find a relationship between Pain Catastrophizing (PC) and trunk movement patterns in CLBP Patients (N = 67) by performing retrospective data analysis on data collected by the Spine and Joint Centre in Rotterdam. Data was gathered from the Pain Catastrophizing Scale (PCS) and the Objective Back Coordination Analysis (ORCA), a trunk movement measurement method. The analysis was performed through linear regression between the variables, which resulted in small, significant negative correlations between total PCS scores and trunk range of motion (ROM) (r = -.204, p < .05) and total PCS scores and movement pattern abnormality when compared to asymptomatic controls (r = -.244, p < .05). These results indicate that a high PC tends to coincide with lower ROM and a lower level of movement pattern abnormality. No correlations were found between the Magnification subscale of the PCS and ROM or movement pattern abnormality. A possible explanation for these results is that heightened PC could lead to higher levels of compensatory muscle use in the lower back, making patients’ movement patterns approximate that of asymptomatic controls. Further research would be needed to confirm this.Show less
Itch is an unpleasant somatic sensation which acts as a danger signal for threatening stimuli on the skin. Attentional bias is the tendency to prioritize the processing of specific types of stimuli...Show moreItch is an unpleasant somatic sensation which acts as a danger signal for threatening stimuli on the skin. Attentional bias is the tendency to prioritize the processing of specific types of stimuli over others. The mind prioritizes threat-related stimuli over neutral stimuli, therefore an attentional bias towards itch is expected. Neuroticism is an individual characteristic that might influence attentional bias towards itch and could be defined as emotional instability, resulting in the tendency to ruminate, experience negative emotions and fear. Previous studies found mixed results regarding both the presence of attentional bias towards itch, and the relation between neuroticism and attentional bias towards itch in healthy participants. Therefore, the first aim was to examine the presence of attentional bias towards itch in healthy individuals. The second aim was to identify the relationship between neuroticism and attentional bias towards itch in healthy individuals. The design of this study is a secondary analysis and used the data from seven earlier studies. The 577 included participants were all healthy individuals between 18 and 35 years old. In order to examine the presence of attentional bias towards itch, the dot-probe task with neutral vs. itch-related words and/or pictures was used. Furthermore, the neuroticism subscale of the Eysenck Personality Questionnaire revised short scale (EPQ-RSS) was used to measure neuroticism. A multilevel analysis showed no attentional bias towards itch-related stimuli in healthy participants, t(4.941)=-1.252, p=0.266. Furthermore, the effect of neuroticism scores was not significant, indicating that higher neuroticism scores were not associated with more attentional bias towards itch, t(382.636)=-0.825, p=0.410. The inclusion of healthy participants only, the low neuroticism scores and the absence of itch-related goals in the current study could be a reason for not finding an attentional bias towards itch and the relation with neuroticism. However, given the fact that this study is a secondary analysis with a large sample size, it also has to be considered that there simply is no attentional bias towards itch in healthy participants. This study could be used as a guideline for future research, in order to further investigate the relationship between neuroticism and attentional bias towards itch.Show less
Itch is an unpleasant sensation serving as a protection against bodily harm. Attentional bias is the tendency to prioritize the processing of certain information over other information. Attentional...Show moreItch is an unpleasant sensation serving as a protection against bodily harm. Attentional bias is the tendency to prioritize the processing of certain information over other information. Attentional bias towards itch is shown, when there is a preference to allocate attention towards itch-related information. Earlier studies which investigated attentional bias towards itch in healthy participants have shown mixed results. This could possibly be explained by individual characteristics, especially catastrophizing about itch is promising, because in the closely related field of pain this seems to be the case. Catastrophizing is an overstated negative interpretation of an experience. Research investigating the relationship between attentional bias towards itch and catastrophizing about itch in healthy participants is limited. Firstly, this study aimed to identify if there was an attentional bias towards itch in healthy participants. Furthermore, this study aimed to identify if there was a positive relationship between catastrophizing about itch and attentional bias towards itch in healthy participants. This study was a secondary analysis, which included seven studies and 577 healthy participants between 18 and 35 years. The studies used the dot-probe task with itch-related words and images to measure attentional bias. Five of the studies used the Pain Catastrophizing Scale adjusted for itch (PCS-I) to measure catastrophizing about itch. The statistical method which was used was a multilevel analysis. The results demonstrated that healthy participants did not show an attentional bias towards itch, t(4.942) = -1.252, p = .266. Furthermore, the results did not provide evidence for a positive relationship between catastrophizing about itch and attentional bias towards itch in healthy participants, t(471.705) = -.540, p = .589. That there was no relation found between attentional bias and itch could be because of the healthy sample. This study probably did not find a positive association between catastrophizing about itch and attentional bias towards itch, because there were only low scores on catastrophizing about itch. Possible implications for future studies are that both participants with high and low scores on catastrophizing about itch should be included and that other methods to measure attentional bias towards itch should be used, like the eye-tracking method.Show less
Abstract Introduction: Parkinson’s Disease (PD) is a progressive neurodegenerative disorder which has a big impact on patients’ lives. During diagnostic consultations clinicians inform patients...Show moreAbstract Introduction: Parkinson’s Disease (PD) is a progressive neurodegenerative disorder which has a big impact on patients’ lives. During diagnostic consultations clinicians inform patients regarding the PD diagnosis and the treatment patients will receive. PD patients report dissatisfaction with the diagnostic consultations, which could be due to a lack of involvement in medical decision-making (MDM). More information about the topics of MDM, about the level of trust in the patients’ clinician and more patient involvement in MDM could therefore improve patient satisfaction. Research on patient involvement in MDM and trust in their clinician was still scarce. However, we think that patient satisfaction could be higher if patient involvement in MDM and trust in their clinician were improved. The first step in researching this was to investigate the MDM topics during diagnostic consultations for PD patients. Specifically, this study aimed to assess the level of patient involvement in MDM during diagnostic consultations and the factors affecting patient involvement. Finally, this study aimed to examine if patients who were more involved in MDM, had higher trust in their clinician. Gaining insight on these topics could empower them to implement more patient involvement and might thus lead to higher satisfaction and patients’ trust in their clinician. Methods: This study was a part of the DiaMove-project which had a prospective observational mixed-methods longitudinal design. Participants (N=26) completed questionnaires regarding characteristics before diagnostic consultations and reported trust in their clinicians (TiOS-sf) afterwards. The first and second diagnostic consultations were video-recorded. Researchers observationally coded topics of medical decisions and measured patient involvement regarding PD medication using the OPTION-12. Statistical analyses consisted of (multiple) regression analyses. Results: Most commonly observed MDM during diagnostic consultations regarding PD concerned whether or not to start PD medication and follow-up appointments. Patients mean involvement in MDM was low (M=14.11; 2.08 – 50.00). The level of patient involvement was higher for women (Cohen’sf 2=.24; p=.02). Age (p=.30) and educational level (p=.66) did not predict patient involvement. Moreover, the mean patient involvement was 4.18 on a scale from 1 to 5, and did not predict patients’ trust in clinicians (p=.90). Conclusion: Clinicians discuss decisions regarding PD medication and follow-up appointments were most frequently discussed during diagnostic consultations. The results suggested that patients’ mean involvement is low in medical decisions regarding PD medication. However, women are more involved. The results of this study should be interpreted cautiously because of a small sample size. It is recommended to repeat this study with a larger sample size. For clinical practice clinicians are advised to involve their patients more in the medical decision-making process.Show less
Abstract Introduction: Parkinson’s Disease (PD) is a progressive neurodegenerative disorder which has a big impact on patients’ lives. During diagnostic consultations clinicians inform patients...Show moreAbstract Introduction: Parkinson’s Disease (PD) is a progressive neurodegenerative disorder which has a big impact on patients’ lives. During diagnostic consultations clinicians inform patients regarding the PD diagnosis and the treatment patients will receive. PD patients report dissatisfaction with the diagnostic consultations, which could be due to a lack of involvement in medical decision-making (MDM). More information about the topics of MDM, about the level of trust in the patients’ clinician and more patient involvement in MDM could therefore improve patient satisfaction. Research on patient involvement in MDM and trust in their clinician was still scarce. However, we think that patient satisfaction could be higher if patient involvement in MDM and trust in their clinician were improved. The first step in researching this was to investigate the MDM topics during diagnostic consultations for PD patients. Specifically, this study aimed to assess the level of patient involvement in MDM during diagnostic consultations and the factors affecting patient involvement. Finally, this study aimed to examine if patients who were more involved in MDM, had higher trust in their clinician. Gaining insight on these topics could empower them to implement more patient involvement and might thus lead to higher satisfaction and patients’ trust in their clinician. Methods: This study was a part of the DiaMove-project which had a prospective observational mixed-methods longitudinal design. Participants (N=26) completed questionnaires regarding characteristics before diagnostic consultations and reported trust in their clinicians (TiOS-sf) afterwards. The first and second diagnostic consultations were video-recorded. Researchers observationally coded topics of medical decisions and measured patient involvement regarding PD medication using the OPTION-12. Statistical analyses consisted of (multiple) regression analyses. Results: Most commonly observed MDM during diagnostic consultations regarding PD concerned whether or not to start PD medication and follow-up appointments. Patients mean involvement in MDM was low (M=14.11; 2.08 – 50.00). The level of patient involvement was higher for women (Cohen’sf 2=.24; p=.02). Age (p=.30) and educational level (p=.66) did not predict patient involvement. Moreover, the mean patient involvement was 4.18 on a scale from 1 to 5, and did not predict patients’ trust in clinicians (p=.90). Conclusion: Clinicians discuss decisions regarding PD medication and follow-up appointments were most frequently discussed during diagnostic consultations. The results suggested that patients’ mean involvement is low in medical decisions regarding PD medication. However, women are more involved. The results of this study should be interpreted cautiously because of a small sample size. It is recommended to repeat this study with a larger sample size. For clinical practice clinicians are advised to involve their patients more in the medical decision-making process.Show less
Background: Pain and anxiety after surgery are common and can lead to negative outcomes, including impaired immune function, slow wound healing, higher morbidity rates and chronic pain. Empathic...Show moreBackground: Pain and anxiety after surgery are common and can lead to negative outcomes, including impaired immune function, slow wound healing, higher morbidity rates and chronic pain. Empathic communication can generate a placebo effect in clinical settings. Studies show a relationship between warm and empathic communication and reduced anxiety, specifically in highly anxious patients. Empathic communication may be beneficial for those with high anxiety, in reducing pain as well as anxiety. Aim: This study aimed to understand the moderating effect of pre-operative anxiety of patients on the effect of empathic communication on post-operative pain and anxiety. Methods: The study used a 2x2, single-blind, randomised controlled trial. Nurses used an empathy manipulation in communication with participants, standard and enhanced conditions of empathy. Participants’ post-operative pain and anxiety were assessed using NRS and STAI-state. Preoperative anxiety was measured before the surgery in two questions. A regression analysis was used to see what effect the moderator pre- operative anxiety had on the relationship between empathy and pain. We used a Bonferroni correction on the outcome of pain ( p <.025). Results: Empathic clinical communication did not significantly predict post-operative pain scores in highly anxious participants (p = .64, p = .46, p = .25, p = .50, p = .52, p = .42). There was a curious result of an increase in pain on day 3 in the subgroup of highly anxious participants (p = 0.01), but none of the variables in the model were significant so we could not attribute this higher pain score to the empathic communication or subgroup of highly anxious patients. Pre-operative anxiety did moderate the effect of empathy on post-operative anxiety (p = .05, p = .02). Discussion: The results suggest that empathy may be a useful tool for reducing anxiety in highly anxious patients undergoing surgery. Further research is needed to understand the mechanisms by which empathy affects pain and anxiety in this context and identify potential strategies for optimising its impact on patient outcomes.Show less
Background Lower neuroticism and higher optimism have been shown to predict more positive treatment-specific expectancies and more favourable treatment outcomes. A recent proof-of-concept study...Show moreBackground Lower neuroticism and higher optimism have been shown to predict more positive treatment-specific expectancies and more favourable treatment outcomes. A recent proof-of-concept study demonstrated the favourable effect of Wim Hof Method training (breathing exercises, meditation, and cold exposure) on inflammation in patients with Axial Spondyloarthritis (AxSpa). Objective This proof-of-principle study examined the relationship between general outcome expectancies (neuroticism and optimism) and change in disease activity after Wim Hof Method training among AxSpa patients, and the mediating role of treatment-specific expectancies. Methods A within-subject design with correlational, regression, and mediation analyses was employed. Nineteen Dutch AxSpa patients (57.9% male) between 24 and 49 years old completed the 8-week Wim Hof Method training. Neuroticism, optimism, and expectancies regarding training were assessed at baseline, and a combination of subjective and objective disease activity was assessed immediately before and after the intervention period. Results No significant correlations between general outcome expectancies and change in disease activity were observed (r-values ≤ .187). Moderate sized but non-significant associations were observed between higher neuroticism and more positive specific outcome expectancies (r = .37), and between more positive specific outcome expectancies and larger declines in disease activity (r = -.36). Specific outcome expectancies did not significantly mediate the relationship between neuroticism and change in disease activity, 95% CIbootstrap [-0.45, 0.09] nor the relationship between optimism and change in disease activity 95% CIbootstrap [-0.19, 0.30]. Conclusion Findings cautiously suggest that AxSpa patients who expect the Wim Hof Method training to be relatively effective experience better treatment outcome. Contrary to previous findings, results suggest that patients with higher neuroticism expected greater treatment effectiveness. It could be hypothesized that patients who experience negative emotions more intensely are desperate for treatments to work, therefore attaching more hope onto interventions. Future research is warranted to consolidate findings. It may be worth including possibly confounding biopsychosocial variables and measures of specific negative emotions, thereby assessing whether they provide a better conceptualization of the real-life interplay between emotional predispositions, expectancies, and treatment effects among inflammatory diseases.Show less
