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Noordman J, Roodbeen R, Gach L, Schulze L, Rademakers J, van den Muijsenbergh M, Boland G, van Dulmen S. 'A basic understanding'; evaluation of a blended training programme for healthcare providers in hospital-based palliative care to improve communication with patients with limited health literacy. BMC Med Educ 2022; 22:613. [PMID: 35953800 PMCID: PMC9371628 DOI: 10.1186/s12909-022-03685-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The non-curative setting makes communication and shared decision-making in palliative care extremely demanding. This is even more so for patients with limited health literacy. So far, research in palliative care focusing on shared decision-making with patients with limited health literacy is lacking. Recent research from our team indicates that the assessment of these patients' understanding of their situation and the implementation of shared decision-making in palliative care, needs improvement. METHODS To improve communication and decision-making, especially with patients with limited health literacy, we developed and evaluated a blended training programme for healthcare providers. The training programme comprised of an e-learning and a team training. The evaluation was performed by 1. conducting interviews (n = 15) focused on evaluating the whole programme and, 2. coding video-recorded outpatient consultations on the extent to which providers involved patients in decision-making before (n = 19) and after (n = 20) the intervention, using the 5-item OPTION coding instrument. RESULTS The interviews showed that healthcare providers valued the skills they had learned during the e-learning and team training. Providers specifically valued the teach-back technique, learned to use simpler wording and felt better able to recognize patients with limited health literacy. Many providers reported a change in communication behaviour as a consequence of the training programme. Suggestions for improvement for both e-learning and training were, amongst others, a follow-up team training course and a new scenarios for the e-learning about discussing palliative care. For both the pre- and the post-measurement, involving patients in decision-making lies between a minimal and a moderate effort; differences were not significant. CONCLUSIONS The e-learning and team training were valued positively by the healthcare providers. Adaptations to the e-learning have been made after evaluation. The e-learning has been implemented in several hospitals and medical education. To improve shared decision-making in practice a more sustained effort is needed.
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Affiliation(s)
- Janneke Noordman
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands.
| | - Ruud Roodbeen
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands
- Research Department, Breuer & Intraval, Research and Consultancy, Groningen, The Netherlands
| | - Leonie Gach
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands
| | - Lotte Schulze
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands
| | - Jany Rademakers
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Maria van den Muijsenbergh
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Gudule Boland
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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van Dulmen S, Roodbeen R, Schulze L, Prantl K, Rookmaaker M, van Jaarsveld B, Noordman J, Abrahams A. Practices and perspectives of patients and healthcare professionals on shared decision-making in nephrology. BMC Nephrol 2022; 23:258. [PMID: 35864466 PMCID: PMC9306155 DOI: 10.1186/s12882-022-02887-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/12/2022] [Indexed: 12/12/2022] Open
Abstract
Background Given the complexity and variety in treatment options for advanced chronic kidney disease (CKD), shared decision-making (SDM) can be a challenge. SDM is needed for making decisions that best suit patients’ needs and their medical and living situations. SDM might be experienced differently by different stakeholders. This study aimed to explore clinical practice and perspectives on SDM in nephrology from three angles: observers, patients and healthcare professionals (HCPs). Methods An explanatory sequential mixed methods design was used. First, in the quantitative part of the study, outpatient consultations with patients with advanced chronic kidney disease (eGFR < 20 ml/min) were video recorded and SDM was assessed using the OPTION5 instrument. Subsequently, in the qualitative part, patients and HCPs reflected on their own SDM behaviour during individual stimulated recall interviews which were analysed using deductive thematic content analysis. Results Twenty nine consultations were recorded and observed in seven hospitals. The mean SDM score was 51 (range 25–80), indicating that SDM was applied to a moderate extent. The stimulated recall interviews with patients showed that they rely on the information provision and opinion of HCPs, expect consistency and support, and desire a proactive role. They also expect to be questioned by the HCP about their SDM preferences. HCPs said they were willing to incorporate patients’ preferences in SDM, as long as there are no medical contraindications. They also prefer patients to take a prominent role in SDM. HCPs ascribe various roles to themselves in supporting patients’ decision-making. Conclusions Although SDM was applied by HCPs to a moderate extent, improvement is needed, especially in helping patients get the information they need and in making sure that every patient is involved in SDM. This is even more important given the complex nature of the disease and the relatively high prevalence of limited health literacy among patients with chronic kidney disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02887-4.
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Affiliation(s)
- Sandra van Dulmen
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500, Utrecht, BN, Netherlands. .,Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, Netherlands. .,Faculty of Caring Science, Working Life and Social Welfare, University of Borås, Borås, Sweden.
| | - Ruud Roodbeen
- Breuer&Intraval, Research and Consultancy, Groningen, Netherlands
| | - Lotte Schulze
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500, Utrecht, BN, Netherlands
| | - Karen Prantl
- Dutch Kidney Patients Association, Bussum, Netherlands
| | - Maarten Rookmaaker
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
| | - Brigit van Jaarsveld
- Department of NephrologyAmsterdam UMC, Vrije Universiteit Amsterdam location, Amsterdam, Netherlands.,Diapriva Dialysis Center, Amsterdam, Netherlands
| | - Janneke Noordman
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500, Utrecht, BN, Netherlands
| | - Alferso Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
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Scheffer M, Menting J, Roodbeen R, van Dulmen S, van Hecke M, Schlingemann R, van Nispen R, Boeije H. Patients' and health professionals' views on shared decision‐making in age‐related macular degeneration care: A qualitative study. Ophthalmic Physiol Opt 2022; 42:1015-1022. [DOI: 10.1111/opo.13016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Mariska Scheffer
- Department of Care and Participation of People with Chronic Conditions Netherlands Institute for Health Services Research (Nivel) Utrecht The Netherlands
| | - Juliane Menting
- Department of Care and Participation of People with Chronic Conditions Netherlands Institute for Health Services Research (Nivel) Utrecht The Netherlands
| | - Ruud Roodbeen
- Department of Research Breuer&Intraval Research and Consultancy Groningen The Netherlands
| | - Sandra van Dulmen
- Department of Communication in Healthcare Netherlands Institute for Health Services Research (Nivel) Utrecht The Netherlands
- Department of Primary and Community Care Radboud University Medical Center Radboud Institute for Health Sciences Nijmegen The Netherlands
- Faculty of Caring Science University of Borås Borås Sweden
| | - Manon van Hecke
- Department of Ophthalmology Elisabeth‐TweeSteden Ziekenhuis Tilburg The Netherlands
| | - Reinier Schlingemann
- Department of Ophthalmology, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
- Bergman Clinics Ogen Amsterdam The Netherlands
- Department of Ophthalmology, University of Lausanne Jules‐Gonin Eye Hospital, Fondation Asile des Aveugles Lausanne Switzerland
| | - Ruth van Nispen
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam Public Health Research Institute Amsterdam The Netherlands
| | - Hennie Boeije
- Department of Care and Participation of People with Chronic Conditions Netherlands Institute for Health Services Research (Nivel) Utrecht The Netherlands
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Otte R, Roodbeen R, Boland G, Noordman J, van Dulmen S. Affective communication with patients with limited health literacy in the palliative phase of COPD or lung cancer: Analysis of video-recorded consultations in outpatient care. PLoS One 2022; 17:e0263433. [PMID: 35143534 PMCID: PMC8830703 DOI: 10.1371/journal.pone.0263433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/19/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Affective communication in outpatient care is important, especially in the palliative phase. Appropriate responses by healthcare providers to emotional cues or concerns let patients express their feelings and enhance information recall and patient satisfaction. Patients with limited health literacy experience more barriers in health-related communication and information, which makes recognizing their cues and concerns even more relevant. This study explores emotional cues/concerns expressed by patients with limited health literacy and evaluates healthcare providers’ responses to these utterances. Methods Verona Coding Definitions of Emotional Sequences (VR-CoDES), a consensus-based system for coding patients’ expression of emotional distress in medical consultations, was used in this exploratory observational study to analyse affective communication in video-recorded outpatient consultations. Consultations of 18 (10 female, 8 male) COPD or lung cancer patients (aged 70.3±6.8) with limited health literacy were recorded and analysed. Eight healthcare providers in four hospitals participated in the study. Results 101 cues and 11 concerns were observed, making 6.2 (SD = 4.2) cues or concerns per consultation. Healthcare provider responses were explicit in 56% and left scope for further disclosures in 58% of the cases. Patients with limited health literacy seem to express more cues or concerns than other patient populations. Healthcare providers responded roughly equally often in five different ways, but they shied away from further exploring the emotion disclosed in the cue/concern. Future research should elaborate on these exploratory observations, especially regarding why HCPs often only leave limited space for further disclosure of emotions in palliative care.
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Affiliation(s)
- Rebecca Otte
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Strategic Communication Group, Wageningen University and Research, Wageningen, the Netherlands
- * E-mail:
| | - Ruud Roodbeen
- Breuer&Intraval, Research and Consultancy, Research Department, Groningen, the Netherlands
| | - Gudule Boland
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, the Netherlands
| | - Janneke Noordman
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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van Dulmen S, Peereboom E, Schulze L, Prantl K, Rookmaaker M, van Jaarsveld BC, Abrahams AC, Roodbeen R. The use of implicit persuasion in decision-making about treatment for end-stage kidney disease. Perit Dial Int 2021; 42:377-386. [PMID: 34212786 DOI: 10.1177/08968608211027019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There are various options for managing end-stage kidney disease. Each option impacts the lives of patients differently. When weighing the pros and cons of the different options, patients' values, needs and preferences should, therefore, be taken into account. However, despite the best intentions, nephrologists may, more or less deliberately, convey a treatment preference and thereby steer the decision-making process. Being aware of such implicit persuasion could help to further optimise shared decision-making (SDM). This study explores verbal acts of implicit persuasion during outpatient consultations scheduled to make a final treatment decision. These consultations mark the end of a multi-consultation, educational process and summarise treatment aspects discussed previously. METHODS Observations of video-recorded outpatient consultations in nephrology (n = 20) were used to capture different forms of implicit persuasion. To this purpose, a coding scheme was developed. RESULTS In nearly every consultation nephrologists used some form of implicit persuasion. Frequently observed behaviours included selectively presenting treatment options, benefits and harms, and giving the impression that undergoing or foregoing treatment is unusual. The extent to which nephrologists used these behaviours differed. CONCLUSION The use of implicit persuasion while discussing different kidney replacement modalities appears diverse and quite common. Nephrologists should be made aware of these behaviours as implicit persuasion might prevent patients to become knowledgeable in each treatment option, thereby affecting SDM and causing decisional regret. The developed coding scheme for observing implicit persuasion elicits useful and clinically relevant examples which could be used when providing feedback to nephrologists.
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Affiliation(s)
- Sandra van Dulmen
- Department of Communication in healthcare, Nivel (Netherlands institute for health services research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud institute for health sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Emma Peereboom
- Department of Communication in healthcare, Nivel (Netherlands institute for health services research), Utrecht, The Netherlands
| | - Lotte Schulze
- Department of Communication in healthcare, Nivel (Netherlands institute for health services research), Utrecht, The Netherlands
| | - Karen Prantl
- Dutch Kidney Patients Association, Bussum, The Netherlands
| | - Maarten Rookmaaker
- Department of Nephrology and Hypertension, University Medical Center Utrecht, The Netherlands
| | - Brigit C van Jaarsveld
- Department of Nephrology, Amsterdam University Medical Centers, VU Amsterdam, The Netherlands.,Diapriva Dialysis Center, Amsterdam, The Netherlands
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, The Netherlands
| | - Ruud Roodbeen
- Department of Communication in healthcare, Nivel (Netherlands institute for health services research), Utrecht, The Netherlands.,Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, The Netherlands
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6
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van Vliet LM, Noordman J, Mijnlieff M, Roodbeen R, Boland G, van Dulmen S. Health literacy, information provision and satisfaction in advanced cancer consultations: two observational studies using level of education as a proxy. BMJ Support Palliat Care 2021:bmjspcare-2020-002859. [PMID: 34006513 DOI: 10.1136/bmjspcare-2020-002859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/09/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Patients with low health literacy (LHL) might feel less informed and satisfied with provided information than patients with high health literacy (HHL). In the setting of advanced cancer, we explored whether LHL patients, compared with HHL patients are: (1) often less informed, and (2) less satisfied with clinicians' communication (a) in general and (b) following information provision specifically. METHODS Data from two observational studies using recorded consultations were combined. Clinicians' provided information and patients' health literacy level-defined by educational levels-and satisfaction were measured. Χ2 tests and regression (moderation) analyses assessed the relation between health literacy and information provision, and between information provision and satisfaction, meanwhile exploring moderating influences of health literacy. RESULTS Of 61 included patients, 25 (41%) had LHL. LHL and HHL patients were equally seldom informed about the disease's incurability (36% vs 42%, p=0.66). LHL patients were more often informed about the option of not pursuing anticancer therapy than HHL patients (28% vs 8%, p=0.04). LHL patients were more satisfied with clinicians' communication than HHL patients (M=9.3 vs M=8.5, p=0.03), especially when the option of no anticancer treatment was discussed (p=0.04). Discussing the disease's incurability did not influence satisfaction levels (p=0.58) for LHL and HHL patients. CONCLUSIONS LHL patients were not less informed, yet more satisfied than HHL patients. Both groups were equally seldom informed about the disease's incurability. No anticancer therapy was mostly discussed with LHL patients who were more satisfied following this information. Clinicians should be encouraged to inform all patients about the disease status and (non)treatment options, while not overlooking empathic support.
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Affiliation(s)
- Liesbeth M van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
| | | | - Marit Mijnlieff
- Department of Communication, NIVEL, Utrecht, The Netherlands
| | - Ruud Roodbeen
- Department of Communication, NIVEL, Utrecht, The Netherlands
- Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
| | - Gudule Boland
- Pharos, Dutch Center of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Sandra van Dulmen
- Department of Communication, NIVEL, Utrecht, The Netherlands
- Institute for Healh Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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7
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Noordman J, Schulze L, Roodbeen R, Boland G, van Vliet LM, van den Muijsenbergh M, van Dulmen S. Instrumental and affective communication with patients with limited health literacy in the palliative phase of cancer or COPD. BMC Palliat Care 2020; 19:152. [PMID: 33028308 PMCID: PMC7542099 DOI: 10.1186/s12904-020-00658-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/24/2020] [Indexed: 11/13/2022] Open
Abstract
Background Patients have a ‘need to know’ (instrumental need) and a ‘need to feel known’ (affective need). During consultations with patients with limited health literacy (LHL) in the palliative phase of their disease, both the instrumental and the affective communication skills of healthcare providers are important. The study aims to explore instrumental and affective communication between care providers and LHL patients in the palliative phase of COPD or cancer. Methods In 2018, consultations between LHL patients in the palliative phase of cancer or COPD and their healthcare providers were video-recorded in four hospitals in the Netherlands. As there was no observation algorithm available for this setting, several items were created to parameterize healthcare providers’ instrumental communication (seven items: understanding, patient priorities, medical status, treatment options, treatment consequences, prognosis, and information about emotional distress) and affective communication (six items: hope, support, reassurance, empathy, appreciation, and emotional coping). The degree of each item was recorded for each consultation, with relevant segments of the observation selected and transcribed to support the items. Results Consultations between 17 care providers and 39 patients were video-recorded and analyzed. Care providers primarily used instrumental communication, most often by giving information about treatment options and assessing patients’ care priorities. Care providers assessed patients’ understanding of their disease less often. The patients’ prognosis was not mentioned in half the consultations. Within the affective domain, the care providers did provide support for their patients; providing hope, reassurance, empathy, and appreciation and discussing emotional coping were observed less often. Conclusions Care providers used mostly instrumental communication, especially treatment information, in consultations with LHL patients in the palliative phase of cancer or COPD. Most care providers did not check if the patient understood the information, which is rather crucial, especially given patients’ limited level of health literacy. Healthcare providers did provide support for patients, but other expressions of affective communication by care providers were less common. To adapt the communication to LHL patients in palliative care, care providers could be less wordy and reduce the amount of information, use ‘teach-back’ techniques and pay more attention to affective communication.
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Affiliation(s)
- Janneke Noordman
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500 BN, Utrecht, Netherlands.
| | - Lotte Schulze
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500 BN, Utrecht, Netherlands
| | - Ruud Roodbeen
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500 BN, Utrecht, Netherlands.,Department of Tranzo Scientific Centre for Care and Well-being, Tilburg University, Tilburg, Netherlands
| | - Gudule Boland
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, Netherlands
| | - Liesbeth M van Vliet
- Department of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Maria van den Muijsenbergh
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, Netherlands.,Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500 BN, Utrecht, Netherlands.,Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Van De Mheen D, Bovens R, Friele R, Van De Goor I, Kools N, Roodbeen R, Schelleman-Offermans K, Rozema A. Alcohol policy in the Netherlands in a National Prevention Agreement: results of three studies. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
On 23 November 2018 in the Netherlands more than 70 organizations signed the National Prevention Agreement. This document had been set up by the Dutch government aiming to create a healthy generation in 2040. It focuses on alcohol, next to overweight and tobacco control. Participants are a.o. NGO's, the sports sector, insurance companies, municipalities but also the alcohol industry and retailers.
Methods
Three studies were performed aiming to map how alcohol use might be reduced. 30 days without alcohol: the IkPas (No Thanks) campaignAlcohol screening and interventions for patients in General HospitalsPrioritizing alcohol enforcement and prevention efforts by combining prevalence and success-rate for minors purchasing alcohol.
Respectively a quantitative survey among adult alcohol users (n = 15.947), qualitative interviews among health professionals (n = 21), a quantitative survey among youngsters (n = 510) and purchase attempts (n = 1.373) of alcohol by mystery shoppers were performed.
Results
Beside on youth, in the Prevention Agreement priority has been laid on elderly, pregnant women, members and visitors of sports clubs and students. Also important are measures in primary and secondary health care and health policy in industrial companies. Measures are proposed in the field of the 'three best buys' (higher prices, lesser advertisement and restrictions in availability). The three studies showed that participants of the IkPas campaign feel fitter, sleep better, lose weight and drink less after 6 months follow-up. Furthermore, implementation of alcohol screening and interventions for patients in Dutch hospitals is still in its infancy. Lastly, bars/cafes/discos should be given priority for enforcement and prevention.
Conclusions
The question that will be discussed is whether the Netherlands by this agreement really do make a step forward in developing a healthy alcohol policy. Will the ambitious goals formulated in the agreement be reached in 2040?
Key messages
Alcohol policy measures are needed to reach a healthy population in 2040. Campaigns, screening and brief interventions, and alcohol enforcement are promising.
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Affiliation(s)
- D Van De Mheen
- Tranzo, Scientic Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | - R Bovens
- Tranzo, Scientic Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | - R Friele
- Tranzo, Scientic Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- NIVEL, Utrecht, Netherlands
| | - I Van De Goor
- Tranzo, Scientic Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | - N Kools
- Tranzo, Scientic Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- NIVEL, Utrecht, Netherlands
| | - R Roodbeen
- Tranzo, Scientic Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | | | - A Rozema
- Tranzo, Scientic Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
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Roodbeen R, Vreke A, Boland G, Rademakers J, van den Muijsenbergh M, Noordman J, van Dulmen S. Communication and shared decision-making with patients with limited health literacy; helpful strategies, barriers and suggestions for improvement reported by hospital-based palliative care providers. PLoS One 2020; 15:e0234926. [PMID: 32559237 PMCID: PMC7304585 DOI: 10.1371/journal.pone.0234926] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/04/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Communication and shared decision-making (SDM) are essential to patient-centered care. Hospital-based palliative care with patients with limited health literacy (LHL) poses particular demands on communication. In this context, patients' emotions and vulnerable condition impact their skills to obtain, understand, process and apply information about health and healthcare even more. If healthcare providers (HCPs) meet these demands, it could enhance communication. In this study, HCPs were interviewed and asked for their strategies, barriers and suggestions for improvement regarding communication and SDM with LHL patients in hospital-based palliative care. METHODS A qualitative interview study was conducted in 2018 in four Dutch hospitals with 17 HCPs-11 physicians and 6 nurses. Transcripts were analyzed using thematic analysis. RESULTS In general HCPs recognized limited literacy as a concept, however, they did not recognize limited health literacy. Regarding SDM some HCPs were strong advocates, others did not believe in SDM as a concept and perceived it as unfeasible. Furthermore, five themes, acting as either strategies, barriers or suggestions for improvement emerged from the interviews: 1) time management; 2) HCPs' communication skills; 3) information tailoring; 4) characteristics of patients and significant others; 5) the content of the medical information. CONCLUSIONS According to HCPs, more time to communicate with their patients could resolve the most prominent barriers emerged from this study. Further research should investigate the organizational possibilities for this and the actual effectiveness of additional time on effective communication and SDM. Additionally, more awareness for the concept of LHL is needed as a precondition for recognizing LHL. Furthermore, future research should be directed towards opportunities for tailoring communication, and the extent to which limited knowledge and complex information affect communication and SDM. This study provides first insights into perspectives of HCPs, indicating directions for research on communication, SDM and LHL in hospital-based palliative care.
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Affiliation(s)
- Ruud Roodbeen
- Nivel (Netherlands institute for health services research), Utrecht, the Netherlands
- Department of Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, the Netherlands
- * E-mail:
| | - Astrid Vreke
- Nivel (Netherlands institute for health services research), Utrecht, the Netherlands
| | - Gudule Boland
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Jany Rademakers
- Nivel (Netherlands institute for health services research), Utrecht, the Netherlands
- Department of Family Medicine, CAPHRI (Care and Public Health Research Institute), Maastricht University, Maastricht, the Netherlands
| | - Maria van den Muijsenbergh
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Janneke Noordman
- Nivel (Netherlands institute for health services research), Utrecht, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands institute for health services research), Utrecht, the Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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