Objective: Informal caregivers of palliative care patients face many challenges and are in need of support by healthcare providers. We aim to assess the care provided to informal caregivers, the...Show moreObjective: Informal caregivers of palliative care patients face many challenges and are in need of support by healthcare providers. We aim to assess the care provided to informal caregivers, the effects of healthcare providers’ background characteristics and actions undertaken to improve the care provided in healthcare organizations. Method: A cross-sectional mixed-method approach was applied. Questionnaires were used for statistical analysis. First, the care provided to informal caregivers (i.e. basic emotional care and specific care tasks) was examined using descriptive statistics. Second, the effects of healthcare providers’ background characteristics (i.e. healthcare setting, profession, age and work experience) on the care provided were examined using bivariable analyses and general linear model (GLM). Third, actions to improve the care provided in healthcare organizations were examined using qualitative conventional content analysis. Journey mapping workshops provided input for the 19 analyzed action plan reports. Results: 586 healthcare providers and volunteers of 19 Dutch healthcare organizations completed the questionnaire (response rate: 49%). First, participants had an average basic emotional care of 6.70 (SD = 3.33, 0-10 range) and an average of specific care tasks of 8.51 (SD = 2.89, 0-13 range). Second, volunteers and paramedics scored lower than other healthcare providers on basic emotional care (p = .003, p = .012) and volunteers scored lower on specific care tasks (p = .012). The age of healthcare providers and volunteers seemed to have a quadratic effect on the basic emotional care (p = .017) with an increase until 45-55 years. The same effect was found on specific care tasks (p = 0.042) after excluding the volunteers. Third, improvement categories were derived from the action plan reports. For individual healthcare providers: care and support for informal caregivers during the illness-trajectory, bereavement care for informal caregivers, cooperation with informal caregivers, interprofessional cooperation. For healthcare organizations: organizational support. Discussion: The care provided to informal caregivers is still in need of improvement. The age and profession of healthcare providers were found to affect the care provided. The actions found to improve the care provided to informal caregivers are promising and can be a source of inspiration for healthcare organizations.Show less
Limited literature exists on the mental health of older (55+) transgender individuals who have been using long term gender-affirming hormone therapy (GHT). Based on studies that found heightened...Show moreLimited literature exists on the mental health of older (55+) transgender individuals who have been using long term gender-affirming hormone therapy (GHT). Based on studies that found heightened levels of mental health challenges in the transgender population of all ages and the general older population, this study aimed to compare levels of depression, anxiety and loneliness of older transgender women and men who have been using GHT for at least 10 years, to their cisgender peers. Secondly, this study aimed to investigate the potential impact of various social, self-belief and health (risk) factors on the difference in mental health between the groups. This was a cross-sectional study. Mental health outcomes of 73 transgender women and 39 transgender men (age 56-84) receiving long-term GHT (10-47 years) were compared to 219 cisgender men and 219 cisgender women from the Longitudinal Aging Study Amsterdam (LASA) matched on age and level of education. Linear regression analyses per group on the different mental health outcome measures were performed. Clusters of (risk)factors (i.e. social, self-belief and physical health) were (independently) added to the model. Consistent with expectations, transgender women exhibited significantly higher levels of depression, anxiety and loneliness compared to both cisgender women and men. Similarly, transgender men displayed significantly higher levels of these mental health challenges compared to cisgender men. Compared to cisgender women, transgender men only showed significantly higher levels of loneliness. For transgender women, clusters of social, self-belief and health factors separately were identified as risk factors compared to cisgender men and all factors together as risk factors compared to both cisgender groups. For transgender men, self-belief factors and all factors together were identified as protective factors when compared to cisgender women and health factors and all factors together as risk factors compared to cisgender men. More (clinical) awareness of the mental health challenges of older transgender people is warranted in order to provide more effective (mental health) care. Further in-depth research on the risk and protective factors of influence on mental health challenges, including the influence of discrimination, minority stressors and social support, is recommended.Show less
This research paper aims to investigate the safety and efficacy of the newly emerging online approach to psychedelic ceremonies as well as explore the impact set and setting have on the experience....Show moreThis research paper aims to investigate the safety and efficacy of the newly emerging online approach to psychedelic ceremonies as well as explore the impact set and setting have on the experience. Previous research has demonstrated and explored the benefits of psychedelics and their impact on mental health. Nonetheless, no study has yet investigated the potential benefits of psychedelics in an online setting. Therefore, this study recorded the experiences of average people who participated in Spinoza’s online psychedelic ceremonies by means of a voluntary questionnaire. Results showed a significant increase in mental health, compared to baseline, for almost all participants. Additionally, individual differences and setting seemingly had no significant impact on the trip experience. This study provides an insight into the potential experiences of virtual psychedelic ceremonies, contributing to the growing research within the field of psychedelics.Show less
Presenteeism can cause economic losses, physical impairments and individual maladies. This paper explores which demographic variables (age, gender) correlate with presenteeism in research which...Show morePresenteeism can cause economic losses, physical impairments and individual maladies. This paper explores which demographic variables (age, gender) correlate with presenteeism in research which aims to reproduce previous studies’ results. We aim to identify factors which may increase an individual’s susceptibility to presenteeism. This paper also introduces collectivism, a measure of one's self conception in relation to one’s ingroups, as a possible moderator of the relationship of age and gender on presenteeism. The thesis is that collectivism moderates certain demographic variables, strengthening their relationship to presenteeism. Participants worked more than 20 hours a week and responded to a 15 minute survey offered in Dutch and English. Data was analyzed with Pearson correlations, ANOVA and linear regression models in R Studio. Conclusions were that gender had a significant relationship with presenteeism and when collectivism is added to the regression equation this remains significant. The interaction effect of gender and collectivism had more of an impact on a woman’s presenteeism score, especially at lower collectivism scores. A high collectivism score for men resulted in increased presenteeism, and the opposite for women. Between age*collectivism and presenteeism no significant interaction was found.Show less
Abstract This study investigated the effects of exercise on positive emotions. It also inquired into whether sensory processing sensitivity moderates the strength of this effect, and whether...Show moreAbstract This study investigated the effects of exercise on positive emotions. It also inquired into whether sensory processing sensitivity moderates the strength of this effect, and whether emotional regulation mediates it. 134 participants were randomly assigned across three conditions: exercising, puzzling (our active control), and rear (our passive control). Before randomization, all participants underwent a negative-emotion induction task (an autobiographical recall task), which homogeneously reduced their level of positive emotions. Afterwards, they got to engage in their respective task for 30 minutes, while reflecting on the negative episode they had just brought back to mind. Participants in the exercise condition cycled on a at a self-chosen moderate intensity; those in the puzzling condition tried to assemble as far as possible a 1000-pieces puzzle; those in the rest condition sat on a chair. Both before and after their task, all participants filled up a questionnaire in which we measured their levels of positive emotion, sensory processing sensitivity, and emotional regulation strategies. The results were that exercise significantly increased positive emotions compared to rest (p = .002, 95% CI = .31, 1.68) but not when compared to puzzling (p = .98, 95% CI = -.63, .74). Contrary to expectations, emotional regulation did not mediate such effect (95% CI = -.42, .003 and 95% CI = -.26, .09), nor did sensory processing sensitivity moderate its strength (b = .02, SE = .61, p = .97 and b = .56, SE = .61, p = .37). Hence, exercise (and puzzling) can serve as a useful intervention to increase positive emotions subsequent to exposure to a stressor, and this effect is valid for all individuals independently of their degree of sensory processing sensitivity.Show less
In the Netherlands, the onset of the pandemic was associated with increased symptoms of anxiety, depression, and general distress, and may have negatively impacted subjective well-being. The first...Show moreIn the Netherlands, the onset of the pandemic was associated with increased symptoms of anxiety, depression, and general distress, and may have negatively impacted subjective well-being. The first objective of this study was to investigate how subjective well-being was affected, by comparing before- and during- scores of its components positive affect, negative affect, and life satisfaction. It was predicted that all components had shown a decrease over time. Additionally, leisure engagement may have been a stimulating factor of subjective well-being during the pandemic. The second objective was therefore to investigate how an increase of the components of leisure engagement: duration, frequency, and diversity was related to the components of subjective well-being. It was proposed that an increase in leisure engagement from before- to during the pandemic was related to higher subjective well-being. Last, it was investigated whether different types of leisure activities were more potent than others in contributing to subjective well-being. It was hypothesized that the association between leisure engagement and subjective well-being was stronger for participants who spent a higher proportion of their leisure on creative leisure activities. To test these hypotheses, this study incorporated a true probability sample of Dutch participants (N = 3439) and used data of an ongoing longitudinal study in which participants participated in different waves of questionnaires. Subjective well-being did not significantly decrease after the onset of the pandemic. Furthermore, an increase in duration was only related to positive affect, and was so negatively. The same result was found for frequency. An increase in diversity was negatively related to positive affect as well, in addition to life satisfaction. None of the components were related to negative affect. These results indicate that among those who increased their leisure engagement from prior to during the pandemic, subjective well-being was actually lower. The found effect sizes for these negative associations were small however. At last, no difference was found between creative and non-creative leisure activities in their ability to contribute to subjective well-being. These findings were unexpected and suggest that the factors that help leisure engagement contribute to subjective wellbeing could operate differently during a pandemic.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
For women with a diminished oocyte reserve, for example due to premature ovarian insufficiency, oocyte donation (OD) is their only possibility to conceive. However, OD is related to a higher...Show moreFor women with a diminished oocyte reserve, for example due to premature ovarian insufficiency, oocyte donation (OD) is their only possibility to conceive. However, OD is related to a higher incidence of pregnancy complications and psychosocial challenges. Preconception counselling (PC) helps women who might opt for OD by explaining the risks of a pregnancy, guiding them in their decision making and focussing on the psychosocial wellbeing. This thesis aims to explore the perspectives on PC of women who conceived through OD. Furthermore, using a quantitative questionnaire design, this thesis aims to investigate the differences on psychosocial constructs (quality of life (QoL), contentment, anxiety, and distress) between women who did and did not receive PC. The perspectives of these women were investigated by conducting qualitative focus-group research. To summarize the perspectives of these women, analyses of the focus groups were done by both deductive and inductive coding. The questionnaire was based upon the validated FertiQoL questionnaire (measures QoL in people with fertility problems) and the GAD-7 questionnaire (measures anxiety and distress). Analyses of the quantitative outcomes were done with an independent samples t-test or a Mann-Whitney U test. The sample included 87 women who did receive PC, and 24 women who did not receive PC before their OD treatment. Analyses of the focus groups indicated the need for more clarity on the process of OD (e.g., finding a donor, possible risks), possibly by the development of a guideline. Also, the participating women would have liked to receive more psychosocial support. Analyses of the questionnaire showed no significant differences between both groups on the psychosocial variables, except for one scale on contentment, U(NPC=no=21, NPC=yes= 80) = 599.50, z = -2.02, p = .043. Women who did receive PC were more content with the quality and availability of treatment. In conclusion, this research could be implemented into a national guideline, offering a helpful document on OD care for health care providers, and thereby improving OD care for these women and their partners.Show less
Objective: To assess clinicians’ expressions of prognostic uncertainty, how these expressions are related to participants’ characteristics, and patient involvement in medical drama series. Methods:...Show moreObjective: To assess clinicians’ expressions of prognostic uncertainty, how these expressions are related to participants’ characteristics, and patient involvement in medical drama series. Methods: In this empirical, non-interventional study, we observed consecutive simulated encounters between patients and clinicians in modern medical drama series (Grey’s Anatomy, The Good Doctor, New Amsterdam & The Resident). We coded encounters in duplicate using a self-developed coding scheme to code prognostic uncertainty and the validated OPTION-12 scale to code observed clinicians’ behavior of involving patients in medical decision making. We performed Chi-square tests of independence to measure the hypothesized links between participant characteristics and prognostic uncertainty. We explored the occurrence of MCF dimensions within expressions of prognostic uncertainty using frequencies. Results: We included 80 simulated encounters. Prognostic uncertainty was expressed in the minority of patient-clinician encounters (N=28, 35%). We found no relation between the discussion of prognostic uncertainty and patients’ gender, age and ICD classification. In addition, no relation between discussing of prognostic uncertainty and clinicians’ gender, age and function was found. Within expression of prognostic uncertainty, the presence of MCF dimensions related to the patient future and preference was higher than MCF dimensions associated with the process, such as manner of collaboration. OPTION-12 scores indicated a low degree of patient involvement in the decision making process (M = 19.69, SD = 9.94). Conclusions and implications: Modern medical drama series portrayal both accuracies and inaccuracies related to prognostic uncertainties and patient involvement. These portrayals can contribute to unrealistic expectations about roles of patient and clinicians and general views on care and treatments. For example, prognostic uncertainties were expressed in a minority of encounters, possibly contributing to the impression that medicine entails low levels of uncertainty in prognosis. In addition, the paternalistic communication approaches and over-presentation of certainty in these medical drama series may reduce patient involvement in real-life care and limit possible effects of interventions. Future research should focus on patients wishes in the communication of uncertainties in medicine. Educational and in practice implications consist of awareness on the effects of portrayals in medical drama series and certain conversational techniques, to ultimately increase shared decision making and make care fit.Show less
Abstract Yearly, many patients get admitted to the Intensive Care Unit (ICU) worldwide, with even more admissions since the Coronavirus Disease 2019 (COVID-19) pandemic. With the rising survival...Show moreAbstract Yearly, many patients get admitted to the Intensive Care Unit (ICU) worldwide, with even more admissions since the Coronavirus Disease 2019 (COVID-19) pandemic. With the rising survival number, investigating the long-term Health-Related Quality of Life (HRQoL) outcomes, which can be negatively influenced by depressive symptoms, became important. This study investigates whether there is a difference in depressive symptoms between COVID-19 and non-COVID patients that got admitted to the ICU; how depressive symptoms influence the HRQoL, and if there is a difference in HRQoL between COVID-19 patients and non-COVID patients; and if there is a relationship between the self-reported health, happiness, and satisfaction about the ICU stay and depressive symptoms. It was expected that COVID-19 patients would have a higher mean score on depressive symptoms than non-COVID patients, COVID-19 patients with depressive symptoms have lower HRQoL scores than non-COVID patients, and lastly, that there would be a negative relation between the self-reported health, happiness and satisfaction about the ICU stay and depressive symptoms. In this study, 278 patients participated. Approximately one year after ICU discharge, patients filled out a survey. For this study, the Patient Health Questionnaire (PHQ-9), the Euroqol Quality of Life (EQ6D), and general questions about the health, happiness, and satisfaction of the ICU stay were taken into account. An independent t-test demonstrated significant higher mean scores on depressive symptoms in COVID-19 patients than in non-COVID patients (p < .05). Regression analysis showed that depressive symptoms predicted HRQoL (p < .05), but HRQoL was not different between COVID versus non-COVID (p = .225). Regression analysis showed both health and happiness predicted depressive symptoms(p < .05), but not between satisfaction and depressive symptoms (p = .318). The results confirmed our hypothesis that there would be higher mean scores on depressive symptoms in COVID-19 patients than in non-COVID patients. Our findings are clinically relevant and can be used to provide better mental health care after ICU discharge. Follow-up studies should among other things focus on the length of ICU stay, the time during the pandemic that someone got admitted to the ICU, and the depressive symptoms two years after ICU discharge.Show less
Chronic pain occurs in 23% of the Dutch adult population. Psychological factors like expectancies of pain play a big role in pain and methods that can make these expectancies more positive could...Show moreChronic pain occurs in 23% of the Dutch adult population. Psychological factors like expectancies of pain play a big role in pain and methods that can make these expectancies more positive could greatly improve a patient his quality of life. The aim of this study was to examine the relationship between manipulated outcome expectancies and pain. It was hypothesised that a positive outcome expectancy would result in a higher tolerance of pain. 61 healthy students were randomly divided into two groups, where one group received the positive outcome expectancy manipulation and the other group the control manipulation. This was done by presenting information via a computer screen of which the participants believed was about their psychological factors based on a pain test and a questionnaire, but was only based on the group to which the participant was allocated. Pain tolerance was measured using the Cold Pressor Test, where the participant had to hold his/her hand in the water bath for as long as possible and the duration was the measurement for pain tolerance. Both groups showed equal outcome expectancies, p = .193, which means the manipulation was unsuccessful and both groups had the same belief on how well they could tolerate pain. Unsurprisingly, the total amount of time spent in the CPT between the conditions was also the same, p = .988. The research question remains unanswered as the outcome expectancy manipulation was ineffective. A successful manipulation is needed which could be achieved by telling participants face-to-face by a researcher that they are expected to handle pain well, as this might be more convincing and more effective to increase outcome expectancy. Future research could focus on this aspect. This study has gained insight into the possibility that a manipulation via a computer presentation might not be effective enough to induce a positive outcome expectancy.Show less
Health care professionals are crucial in providing palliative care for patients with Chronic Obstructive Pulmonary Disease. These patients are referred less often to palliative care services than...Show moreHealth care professionals are crucial in providing palliative care for patients with Chronic Obstructive Pulmonary Disease. These patients are referred less often to palliative care services than patients with other terminal diseases. Health care professionals are often reluctant to initiate palliative care as they are unsure whether they can implement it adequately. Few studies have looked at the effect of a palliative care training on the level of self-efficacy of the health care professionals. This study investigated whether an intervention with the use of simulations can increase the level of self-efficacy regarding the palliative care they provide. Additionally, the effect of self-efficacy on palliative care measures, such as the amount and duration of advanced care planning conversations with patients, and the amount of collaboration and consultation with other health care professionals was investigated. This study was a randomised cluster-controlled trial that applied a hybrid design type 2 which took part in eight hospital regions around The Netherlands. Four of the hospital regions were in the control group and four were in the intervention group. In total, 93 doctors, nurses, and palliative care consultants participated. The intervention consisted of two evening courses with information about palliative care and simulations with actors so that conversations with patients could be practiced. Additionally, a tool for recognising when palliative care needs to be initiated was offered, and extra meetings with their project managers to see if palliative care was implemented as intended. Self-efficacy was measured with the End-of-Life Professional Caregiver Survey at three time points, before intervention, five months after the interventions, and fifteen months after the intervention. An unstructured multilevel mixed model showed an increase of self-efficacy over Time for both the intervention and control group (p < .001) and an interaction between Group and Time (p < .001) indicating that the intervention group had a greater increase of self-efficacy over time compared to the control group. A Spearman Rho test showed that self-efficacy is correlated with the amount of advanced care planning conversations that are held with the patient (ρ(80) = .31, p = .004). Additionally, a Pearson correlation showed that self-efficacy is correlated with the amount of collaboration with other health care professionals (r(81) = .32, p = .003). No significant correlation was found between the level of self-efficacy and the duration of the advanced care planning conversations and the number of consultations with other health care professionals. Thus, this intervention was successful in increasing self-efficacy of health care professionals over time and that self-efficacy is correlated with some of the identified palliative care measures. A palliative care intervention can help health care professionals to feel more confident about their skills and offer better care to patients with COPD.Show less
Background: The nocebo effect has been shown to play an important role in fibromyalgia, with some research naming counterconditioning as a possible treatment for this effect. Research suggests pain...Show moreBackground: The nocebo effect has been shown to play an important role in fibromyalgia, with some research naming counterconditioning as a possible treatment for this effect. Research suggests pain catastrophizing and optimism appear to influence the strength of the nocebo effect and possibly its reduction. We examined if it is possible to induce and later reduce the nocebo effect through counterconditioning with pressure stimuli and whether optimism and pain catastrophizing are related to this process. Methods: 7 women diagnosed with fibromyalgia underwent nocebo conditioning, to induce a nocebo effect on pressure pain, followed by counterconditioning, intended to reduce this nocebo effect again. A sham TENS device was used as conditioning stimulus and paired with moderate (nocebo conditioning), non-painful (counterconditioning), and slightly painful (serving as control during all procedures pressure) pressure stimuli. Through self-report questionnaires, the personality traits optimism and pain catastrophizing were measured. Results A significant nocebo effect was induced after nocebo conditioning (t(6) = 3.152, p = .020), and a placebo effect was induced during the nocebo reduction (t(6) = -4.235, p = .005). Furthermore, the nocebo effect was reduced significantly from conditioning to after counterconditioning (t(6) = 4.157, p = 0.006). The results of a multiple regression analysis showed no significant relationship between optimism, pain catastrophizing and the strength of the nocebo effect (F(2, 4) = .018, p = .982), the strength of the placebo effect (F(2, 4) = 1.115, p = .412) or the reduction of the nocebo effect (F(2, 4) = .251, p = .789). Conclusion: Our results demonstrate that it is possible to induce a nocebo effect on pressure pain in participants with fibromyalgia. Additionally, it is also possible to reduce a nocebo effect through counterconditioning and even change it into a placebo effect. This study further indicates that optimism and pain catastrophizing do not significantly predict the induction of the nocebo effect or its reduction through counterconditioning in females with fibromyalgia. These results on the effectiveness of counterconditioning could help in developing future treatments for fibromyalgia by removing the nocebo effect and possibly creating a placebo effect.Show less
