Estudio transversal comparativo sobre alimentación emocional en tres poblaciones universitarias de la Península Ibérica / Emotional eating in university students: a cross-sectional and comparative study in the Iberian Peninsula

Fundamentos: aunque la falta de avances en la reducción de la obesidad supone un problema mundial, cada lugar presenta diferentes factores contribuyentes. Uno de los que contribuyen actualmente al aumento de la prevalencia de la obesidad es la ali-mentación emocional. El objetivo de este trabajo fue describir y comparar el nivel de alimentación emocional y analizar qué variables y en qué medida afectaban al resto de las variables.métodos: se realizó un estudio descriptivo transversal en alumnado de tres universidades de la península ibérica (n=1.654) entre octubre de 2019 y junio de 2020. Los datos se recogieron a través de un cuestionario online de autoinforme en el cual se incluyeron datos sociodemográficos y antropométricos, así como cuestionarios validados como el cuestionario de comedores emocionales, el shortform-36 y el cuestionario hospitalario de ansiedad y depresión. Se realizó un muestreo aleatorio estratificado por grupos de facultad, titulación y clase. Para los resultados descriptivos, se calcularon las medias, la desviación estándar y las frecuencias relativas de las variables. Para comparar las medias se utilizaron la prueba t de student, chi-cuadrado y anova. Se realizaron regresiones lineales simples y múltiples para ambas muestras.resultados: la puntuación media en alimentación emocional fue de 8,77±5,66 para el alumnado de españa y de 10,02±6,19 para el de portugal, con una diferencia de 3,62 (<0,001). En españa, la variable dependiente que más afectó a la alimentación emocional fue la calidad de vida (13,8% de varianza [<0,001]), mientras que en portugal fue la ansiedad (10,1% de varianza [<0,001]).conclusiones: se encuentran diferencias estadísticamente significativas en el nivel de alimentación emocional entre poblacio-nes. Además, existe disimilitud en las variables que influyen en el principal en ambos países. Estos hallazgos implican que deben ser considerados en el diseño de futuras investigaciones o intervenciones sanitarias.(AU)

Background: although the lack of progress in reducing obesity is a global problem, different places have different contributing factors. One of the factors currently contributing to the increasing prevalence of obesity is emotional eating. The aim of this paper was to describe and compare the level of emotional eating and to analyse which variables and to what extent they affected the other variables.methods: a descriptive cross-sectional study was conducted in students from 3 universities of the iberian peninsula (n=1,654) between october 2019 and june 2020. Data were collected through an online self-report questionnaire which included sociodemographic and anthropometric data and validated questionnaires such as: the emotional eaters questionnaire, the shortform-36 and the hospital anxiety and depression questionnaire. Stratified random sampling was performed by faculty, degree, and class groups. For descriptive results, means, standard deviation and relative frequencies of variables were calculated. Student’s t-test, chi-square and anova were used to compare means. Simple and multiple linear regressions were performed for both samples.results: the mean emotional eating score was 8.77±5.66 for spanish students and 10.02±6.19 for portuguese students, with a difference of 3.62 (<0.001). In spain, the dependent variable that most affected emotional eating was quality of life (13.8% variance [<0.001]), while in portugal it was anxiety (10.1% variance [<0.001]).conclusions: statistically significant differences are found in the level of emotional eating between populations. In addition, there is dissimilarity in the variables influencing the principal in both countries. These findings imply that they should be considered in the design of future research or health interventions.(AU)

[Emotional eating in university students: a cross-sectional and comparative study in the Iberian Peninsula]. / Estudio transversal comparativo sobre alimentación emocional en tres poblaciones universitarias de la Península Ibérica.

OBJECTIVE: Although the lack of progress in reducing obesity is a global problem, different places have different contributing factors. One of the factors currently contributing to the increasing prevalence of obesity is emotional eating. The aim of this paper was to describe and compare the level of emotional eating and to analyse which variables and to what extent they affected the other variables. METHODS: A descriptive cross-sectional study was conducted in students from 3 universities of the Iberian Peninsula (n=1,654) between October 2019 and June 2020. Data were collected through an online self-report questionnaire which included sociodemographic and anthropometric data and validated questionnaires such as: the Emotional Eaters Questionnaire, the ShortForm-36 and the Hospital Anxiety and Depression Questionnaire. Stratified random sampling was performed by faculty, degree, and class groups. For descriptive results, means, standard deviation and relative frequencies of variables were calculated. Student's t-test, chi-square and ANOVA were used to compare means. Simple and multiple linear regressions were performed for both samples. RESULTS: The mean emotional eating score was 8.77±5.66 for spanish students and 10.02±6.19 for portuguese students, with a difference of 3.62 (<0.001). In Spain, the dependent variable that most affected emotional eating was quality of life (13.8% variance [<0.001]), while in Portugal it was anxiety (10.1% variance [<0.001]). CONCLUSIONS: Statistically significant differences are found in the level of emotional eating between populations. In addition, there is dissimilarity in the variables influencing the principal in both countries. These findings imply that they should be considered in the design of future research or health interventions.

OBJECTIVE: Aunque la falta de avances en la reducción de la obesidad supone un problema mundial, cada lugar presenta diferentes factores contribuyentes. Uno de los que contribuyen actualmente al aumento de la prevalencia de la obesidad es la alimentación emocional. El objetivo de este trabajo fue describir y comparar el nivel de alimentación emocional y analizar qué variables y en qué medida afectaban al resto de las variables. METHODS: Se realizó un estudio descriptivo transversal en alumnado de tres universidades de la Península Ibérica (n=1.654) entre octubre de 2019 y junio de 2020. Los datos se recogieron a través de un cuestionario online de autoinforme en el cual se incluyeron datos sociodemográficos y antropométricos, así como cuestionarios validados como el Cuestionario de Comedores Emocionales, el ShortForm-36 y el Cuestionario Hospitalario de Ansiedad y Depresión. Se realizó un muestreo aleatorio estratificado por grupos de facultad, titulación y clase. Para los resultados descriptivos, se calcularon las medias, la desviación estándar y las frecuencias relativas de las variables. Para comparar las medias se utilizaron la prueba t de Student, chi-cuadrado y ANOVA. Se realizaron regresiones lineales simples y múltiples para ambas muestras. RESULTS: La puntuación media en alimentación emocional fue de 8,77±5,66 para el alumnado de España y de 10,02±6,19 para el de Portugal, con una diferencia de 3,62 (<0,001). En España, la variable dependiente que más afectó a la alimentación emocional fue la calidad de vida (13,8% de varianza [<0,001]), mientras que en Portugal fue la ansiedad (10,1% de varianza [<0,001]). CONCLUSIONS: Se encuentran diferencias estadísticamente significativas en el nivel de alimentación emocional entre poblaciones. Además, existe disimilitud en las variables que influyen en el principal en ambos países. Estos hallazgos implican que deben ser considerados en el diseño de futuras investigaciones o intervenciones sanitarias.

Patient reported outcomes in oncology: changing perspectives-a systematic review.

In public health context, oncology is associated with severe negative impact on patients and on their relatives' quality of life. Over the last decades, survival has remained at 50% worldwide for some tumor locations. Patient reported outcomes (PROs) assessment and, the corresponding use in clinical practice, help establishing patient individualized profiling involving caregivers. The purpose of this systematic review was to examine critical success factors for PROs assessment in daily clinical oncology practice. Additionally, we investigated how PROs collection can change oncology perspectives for patients and caregivers. According to PRISMA guidelines, 83 studies were included in this systematic review, whether related with implementation in daily clinical practice or associated with its use in oncology. PROs assessment gathers multi-professional teams, biomedical and clinical expertise, patients, families and caregivers. Institutional involvement, first line for caregiver's adherence, team continuous formation, encompassing training and support, design of clear workflows, continuous monitoring, and data analysis are crucial for implementation. PROs measures are decisive in oncology. Several items were improved, including caregiver-patient-physician communication, patient risk groups identification, unmet problems and needs detection, disease course and treatment tracking, prognostic markers, cost-effectiveness measurement and comfort/support provision for both patients and caregivers. Routine assessment and implementation of PROs in clinical practice are a major challenge and a paradigm transformation for future.

Cross-cultural Adaptation and Validation of the European Portuguese Version of the Western Ontario Shoulder Instability Index (WOSI).

INTRODUCTION: The Western Ontario Shoulder Instability Index (WOSI) is a self-administered questionnaire specifically used to determine the impact of shoulder instability on quality of life. The aim of this study was to translate the WOSI into European Portuguese and analyze its validity and reliability in a population with shoulder instability. MATERIAL AND METHODS: The WOSI was translated and culturally adapted from its original version into European Portuguese (WOSIPT). Internal consistency and test-retest analyses were conducted to determine the level of reliability of the scale. WOSI-PT, Quick-DASH, and SF-12 questionnaires were applied to 81 patients with symptomatic shoulder instability to assess validity, and reliability was tested by randomly selecting 50 patients within 72 hours using a test-retest design. RESULTS: The reliability of the WOSI-PT was very high, with Cronbach´s alpha equal to 0.97 and an intraclass correlation coefficient of 0.98. Regarding the construct validity, the correlation between the WOSI-PT and QuickDASH was high and negative (-0.79). The correlations between WOSI-PT and SF-12 were positive, respectively, moderate with physical (0.66) and low with mental (0.34) health. CONCLUSION: WOSI-PT is a reliable and valid instrument for assessing the functional impact of shoulder joint instability on quality of life.

Introdução: O Western Ontario Shoulder Instability Index (WOSI) é um questionário de autopreenchimento utilizado especificamente para determinar o impacto da instabilidade do ombro na qualidade de vida. O objetivo deste estudo foi traduzir o WOSI para português e analisar a sua validade e fiabilidade para a população portuguesa com instabilidade do ombro. Material e Métodos: O WOSI foi traduzido e adaptado culturalmente da sua versão original para Português (WOSI-PT). Foram efetuadas as análises de consistência interna e teste-reteste para determinar o seu nível de fiabilidade. Os questionários WOSI-PT, QuickDASH, and SF-12 foram aplicados a 81 pacientes com sintomas de instabilidade para avaliar a validade, enquanto a fiabilidade foi testada usando 50 desses pacientes selecionados de modo aleatório, num estudo do tipo teste-reteste com 72 horas de intervalo. Resultados: A fiabilidade do WOSI-PT foi excelente com alfa de Cronbach de 0,97 e um ICC (intraclass correlation coeficiente) de 0.98. Relativamente à validade de constructo, a correlação entre o WOSI-PT e a QuickDASH foi alta e negativa (-0,79). A correlação entre o WOSI-PT e o SF-12 foi positiva e moderada para a componente física (0,66) e positiva e baixa para a componente de saúde mental (0,34). Conclusão: O WOSI-PT é um instrumento fiável e valido para avaliar o impacto da instabilidade do ombro na qualidade de vida.

Process Evaluation of a Mixed Methods Feasibility Study to Identify Hospital Patients with Palliative Care Needs in Portugal.

INTRODUCTION: Evidence shows most patients are not recognised by their attending healthcare professionals as having palliative needs. This feasibility study aimed to aid healthcare professionals identify hospital patients with palliative needs. MATERIAL AND METHODS: Mixed-methods, cross-sectional, observational study. The patient inclusion criteria comprised: age over 18 years old, being mentally capable to give consent judged as such by participating healthcare professionals, and if unable, having a legal substitute to consent, having a diagnosis of an incurable, potentially life-threatening illness. Field notes were taken for reflexive purposes. Outcome measures included: Integrated Palliative Care Outcome scale, surprise question, phase of illness, referral request status, The Eastern Cooperative Oncology Group Performance Status and social needs assessment. An interim data collection period meeting assessed implementation outcomes in each context. A web-based survey was sent to all participating healthcare professionals at the end of data collection period to explore overall experiences of participation and implementation outcomes. RESULTS: Forty-two departments in four hospitals were contacted. The study was presented in nine departments. The field notes were vital to understand the recruitment process and difficulties experienced: time constraints, fear of additional work, department dynamics and organisation, relationships between departments and need of training in palliative care and research. One department agreed to participate. There were six participating healthcare professionals and only 45 patients included. Three participating healthcare professionals responded to the web-based survey. DISCUSSION: The response rate was very low. Legislating palliative care is not enough, and an integrated palliative care plan needs to be implemented at country and institution level. CONCLUSION: There is an urgent need to provide generalist palliative care training to clinicians.

Introdução: A maioria dos pacientes não são reconhecidos pelos seus profissionais de saúde como tendo necessidades paliativas.Este estudo de viabilidade visou ajudar os profissionais de saúde a identificar doentes hospitalares com necessidades paliativas. Material e Métodos: Método misto, transversal e observacional. Os critérios de inclusão dos doentes compreenderam: idade igual ou superior a 18 anos; capacidade mental para dar consentimento informado, avaliado pelos profissionais de saúde participantes ou, caso não tenham essa capacidade, presença de um representante legal para consentir; ser portador de doença incurável, ameaçadora do tempo de vida. As notas de campo serviram fins reflexivos. As medidas de resultados utilizadas foram: escala integrada de cuidados paliativos, pergunta surpresa, fase da doença, estatuto de pedido de encaminhamento, Estado de Desempenho do Grupo de Oncologia Cooperativa Oriental (ECOG) e avaliação das necessidades sociais. A reunião intercalar no período de recolha de dados auxiliou-nos a avaliar os resultados da implementação em cada contexto. No final do período de recolha de dados enviámos um inquérito eletrónico aos profissionais de saúde participantes para explorar experiências globais de participação e resultados de implementação. Resultados: Contactámos 42 serviços em quatro hospitais. Apresentámos o estudo em nove serviços. As notas de campo foram vitais para compreender o processo de recrutamento e as dificuldades vividas: restrições de tempo, medo de trabalho acrescido, dinâmica de serviços e organização, relações entre serviços e necessidade de formação em cuidados paliativos e investigação. Contámos com a participação de um serviço, seis profissionais de saúde e 45 doentes. Três profissionais de saúde participantes responderam ao inquérito eletrónico. Discussão: A taxa de participação foi muito baixa. Não é suficiente legislar sobre os cuidados paliativos. É também necessário implementar um plano integrado de cuidados paliativos a nível nacional e institucional. Conclusão: É urgente a formação em cuidados paliativos generalistas a médicos que trabalham em hospitais.

Risk factors for hospital death in conditions needing palliative care: Nationwide population-based death certificate study.

BACKGROUND: Most people would prefer to die at home as opposed to hospital; therefore, understanding mortality patterns by place of death is essential for health resources allocation. AIM: We examined trends and risk factors for hospital death in conditions needing palliative care in a country without integrated palliative care. DESIGN: This is a death certificate study. We examined factors associated with hospital death using logistic regression. SETTING/PARTICIPANTS: All adults (1,045,381) who died between 2003 and 2012 in Portugal were included. We identified conditions needing palliative care from main causes of death: cancer, heart/cerebrovascular, renal, liver, respiratory and neurodegenerative diseases, dementia/Alzheimer's/senility and HIV/AIDS. RESULTS: Conditions needing palliative care were responsible for 70.7% deaths ( N = 738,566, median age 80); heart and cerebrovascular diseases (43.9%) and cancer (32.2%) accounted for most. There was a trend towards hospital death (standardised percentage: 56.3% in 2003, 66.7% in 2012; adjusted odds ratio: 1.04, 95% confidence interval: 1.04-1.04). Hospital death risk was higher for those aged 18-39 years (3.46, 3.25-3.69 vs aged 90+), decreasing linearly with age; lower in dementia/Alzheimer's/senility versus cancer (0.13, 0.13-0.13); and higher for the married and in HIV/AIDS (3.31, 3.00-3.66). Effects of gender, working status, weekday and month of death, hospital beds availability, urbanisation level and deprivation were small. CONCLUSION: The upward hospital death trend and fact that being married are risk factors for hospital death suggest that a reliance on hospitals may coexist with a tradition of extended family support. The sustainability of this model needs to be assessed within the global transition pattern in where people die.

Psoriatic Arthritis Quality of Life questionnaire: translation, cultural adaptation and validation into Portuguese language.

Psoriatic arthritis (PsA) has a strong negative impact on the quality of life of patients. The Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire is a disease-specific instrument developed to measure the quality of life in patients with PsA. The aims of this study were to culturally adapt the questionnaire for Portugal and evaluate its reliability and validity in patients with PsA. The original UK English version of the PsAQoL was translated into Portuguese by a bilingual and lay panel. Structured cognitive debriefing interviews were conducted with ten PsA patients. The Portuguese PsAQoL was subsequently applied to PsA patients followed at the Rheumatology Department of Centro Hospitalar do Baixo Vouga, E.P.E. To assess reproducibility, 30 patients with PsA completed the Portuguese PsAQoL on two occasions, 2 weeks apart. A larger sample was recruited to determine internal consistency and construct validity. The Nottingham Health Profile (NHP) was used as a comparator instrument. Translation and adaptation were successful. Cronbach´s alpha for the Portuguese version of the PsAQoL was 0.91 and the test-retest reliability was 0.93. The PsAQoL could distinguish between groups of patients defined by self-reported general health status, self-reported severity of PsA and flare of arthritis. There was a positive correlation between the total score of the PsAQoL and each of the sections of the NHP. The Portuguese version of the PsAQoL was found to be relevant, understandable and easy to complete, reliable and valid.

EAPC White Paper on outcome measurement in palliative care: Improving practice, attaining outcomes and delivering quality services - Recommendations from the European Association for Palliative Care (EAPC) Task Force on Outcome Measurement.

BACKGROUND: Outcome measurement plays an increasing role in improving the quality, effectiveness, efficiency and availability of palliative care. AIM: To provide expert recommendations on outcome measurement in palliative care in clinical practice and research. METHODS: Developed by a European Association for Palliative Care Task Force, based on literature searches, international expert workshop, development of outcome measurement guidance and international online survey. A subgroup drafted a first version and circulated it twice to the task force. The preliminary final version was circulated to wider expert panel and 28 international experts across 20 European Association for Palliative Care member associations and the European Association for Palliative Care Board of Directors and revised according to their feedback. The final version was approved by the European Association for Palliative Care Board for adoption as an official European Association for Palliative Care position paper. RESULTS: In all, 12 recommendations are proposed covering key parameters of measures, adequate measures for the task, introduction of outcome measurement into practice, and national and international outcome comparisons and benchmarking. Compared to other recommendations, the White Paper covers similar aspects but focuses more on outcome measurement in clinical care and the wider policy impact of implementing outcome measurement in clinical palliative care. Patient-reported outcome measure feedback improves awareness of unmet need and allows professionals to act to address patients' needs. However, barriers and facilitators have been identified when implementing outcome measurement in clinical care that should be addressed. CONCLUSION: The White Paper recommends the introduction of outcome measurement into practice and outcomes that allow for national and international comparisons. Outcome measurement is key to understanding different models of care across countries and, ultimately, patient outcome having controlled for differing patients characteristics.

[Measuring quality of life in palliative care]. / Medir qualidade de vida em cuidados paliativos.

This paper describes the process followed to create and validate the Portuguese versión of a quality of life measurement instrument for patients in palliative care. After a literature review about the measurement of the quality of life in this particular and very specific kind of patients, we opt by the Irene Higginson's measurement instrument called Palliative Care Outcome Scale (POS). It has been selected as the one most appropriate to Portuguese patients' reality. For the creation of the Portuguese version we followed the recommended methodologies for the forward-backward translations. These methodologies allow us to determine semantic and linguistic equivalences of health outcomes measurement instruments. The validation was performed on a sample of 104 cancer patients aged between 40 and 85 years old. 70% were female, 29% had lung cancer, 46% breast cáncer and 22% had melanoma. Content validity was assured by two cognitive debriefing tests, respectively performed in oncologists and in patients. Construct validation allow us to find five ortogonal factors, including 'emotional well being' (19.7% of variance explained), 'consequences of the disease in life' (18.2%), 'received information and support' (11.7%), 'anxiety' (10.1%), and 'burden of illness' (9.8%). Criterion validity was tested by comparing the results obtained by POS to the ones obtained by the EORTC QLQ-C30, a genetic instrument especially designed for cancer patients. The found correlation values were moderated to strong and ranged from 0.51 to 0.63. The reliability of the Portuguese version was assured through the reproducibility test and the search for the internal consistency. The scores obtained by a one-week testrestest ranged from 0.66 to 1.00. Cronbach's alpha was 0.68, acceptable and allowing us to consider POS as a unique index Time responsiveness and diagnosis responsiveness were also analysed. Comparing values measured with a one-month interval showed sensibility to the lack of the quality of life felt by patients. This measurement instrument was also sensitive to the various pathologies. In conclusion, we may defend the quality of the performance of the Portuguese versión of the POS. This version may be used to prospectively assess the palliative care on advances cancer patients.

[Quality of life 2 years after coronary revascularization]. / Calidad de vida 2 años después de la revascularización coronaria.

OBJECTIVE: To determine the impact of coronary revascularization surgery on patients' quality of life and to identify the presence of lifestyles representing a risk for coronary heart disease. METHOD: We performed a longitudinal prospective study of 150 consecutive patients who underwent coronary surgery over a 6-month period. Perceived quality of life was evaluated before the intervention, at 6 months (n = 132) and 2 years later (n = 119). As measurement instruments, the MOS Health Survey (SF-36), the Nottingham Health Profile (NHP) and a questionnaire to identify lifestyles were used. RESULTS: Most of the patients (95.8%) were men and were aged more than 50 years old (80.7%). Before surgery, significant physical limitations were present in 39.5%, comorbidity in 79%, prior infarction in 8.7% and three-vessel disease in 68%. The mean length of hospital stay was

Calidad de vida 2 años después de la revascularización coronaria / Quality of life 2 years after coronary revascularization

Objetivo. Conocer el impacto de la cirugía de revascularización coronaria en la calidad de vida de los pacientes e identificar la presencia de estilos de vida que constituyen un riesgo para la enfermedad coronaria. Método. Estudio longitudinal prospectivo de 150 pacientes sometidos consecutivamente a cirugía coronaria en un período de 6 meses, con evaluación de la percepción de la calidad de vida antes de la cirugía, a los 6 meses (n = 132) y a los 2 años (n = 119) de ésta. Como instrumentos de medición se utilizaron el cuestionario MOS Health Survey (SF-36), el Nothingham Health Profile (NHP) y un cuestionario para la identificación de estilos de vida. Resultados. La mayoría de los pacientes eran varones (95,8%) de más de 50 años (80,7%). Antes de la intervención quirúrgica un 39,5% presentaba limitaciones físicas importantes, un 79% comorbilidad, un 48,7% infarto previo y un 68% lesión coronaria de 3 vasos. La estancia hospitalaria fue # 8 días en el 88,2% de los casos. Los beneficios en la salud fueron más relevantes a los 6 meses de la intervención que a los 2 años, y se verifican mejores percepciones en todas las dimensiones de los 2 instrumentos de medición de la calidad de vida (p < 0,001). La comorbilidad, el número de factores de riesgo y las complicaciones postoperatorias no influyeron en la calidad de vida 6 meses después de la cirugía. Dos años después de la cirugía, el 33,6% de los pacientes volvió a su actividad profesional y la mayoría adoptó estilos de vida más saludables. Conclusiones. La revascularización coronaria mejora de forma sustancial la calidad de vida de los pacientes, y comporta beneficios en la salud 2 años después de la intervención

Objective. To determine the impact of coronary revascularization surgery on patients' quality of life and to identify the presence of lifestyles representing a risk for coronary heart disease. Method. We performed a longitudinal prospective study of 150 consecutive patients who underwent coronary surgery over a 6-month period. Perceived quality of life was evaluated before the intervention, at 6 months (n = 132) and 2 years later (n = 119). As measurement instruments, the MOS Health Survey (SF-36), the Nottingham Health Profile (NHP) and a questionnaire to identify lifestyles were used. Results. Most of the patients (95.8%) were men and were aged more than 50 years old (80.7%). Before surgery, significant physical limitations were present in 39.5%, comorbidity in 79%, prior infarction in 8.7% and three-vessel disease in 68%. The mean length of hospital stay was # days in 88.2% of the patients. The health benefits were greater at 6 months after the intervention than at 2 years, with better perceived quality of life in all dimensions of the instruments used to assess quality of life (p< 0.001). Comorbidity, the number of risk factors and postoperative complications showed no influence on quality of life 6 months after surgery. Two years after the intervention, 33.6% of the patients resumed their professional activity and most adopted healthier lifestyles. Conclusions. Coronary revascularization substantially improves patients' quality of life, providing health benefits 2 years after the intervention

Elderly patients' and GPs' views on different methods for patient involvement: an international qualitative interview study.

BACKGROUND: Elderly patients' interaction with the GP may be improved through patient involvement techniques, and there is a variety of such techniques which improve patients' involvement in their own care, although little is known about their acceptability. OBJECTIVES: The aim of this study was to identify barriers and facilitators for using patient information leaflets and patient satisfaction questionnaires as methods for increasing elderly patients' involvement in general practice care by comparing their views with the GPs' views on these two types of methods. METHODS: In seven countries (Austria, Denmark, Germany, The Netherlands, Portugal, Slovenia and Switzerland) 146 GPs and 284 patients aged 70 and over were interviewed about the use and the acceptability of these two methods. Interviewers followed a semi-structured interview guide, and all interviews were tape-recorded and transcribed verbatim. RESULTS: The arguments for using patient satisfaction questionnaires were that they would provide the GP with more information, function as a basis for change, increase patients' self-confidence and make them more conscious of what to expect. Barriers for their use were cognitive impairment among patients, fear that they would not answer honestly and opposition to written material. The arguments for patient information leaflets were that they could support patients' memories, educate patients and promote their self-responsibility. The barriers were cognitive impairment among patients and fear that they would give them false impressions of what to expect. CONCLUSION: Both instruments were generally well accepted by both GPs and patients. Their use seemed to be dependent upon the individual GP's attitude and the patients' cognitive capacities.