Feasibility of implementing the 'Screening for Distress and Referral Need' process in 23 Dutch hospitals.

PURPOSE: In the Netherlands, the three-step process 'Screening for Distress and Referral Need' (SDRN) was developed for helping identifying, and referring cancer patients suffering from clinically relevant distress or needing a referral. This process includes (1) instrument completion, (2) patient-care provider discussion of the responses, and (3) referral based on 1 and 2. The Netherlands Comprehensive Cancer Organisation, location Groningen (IKNL-G), initiated the implementation of SDRN and developed an implementation roadmap, including procedure and materials. This exploratory study examines the feasibility of SDRN implementation in hospitals, seen from healthcare providers' perspective, responsible for implementation, and those executing SDRN. METHODS: Healthcare providers, from 22 hospitals and from 5 oncology departments of the University Medical Center Groningen (=25 % of Dutch hospitals), evaluated their experiences by responding to a 26-item internet survey. RESULTS: Twenty-five participants (response = 93 %) completed the survey. SDRN was implemented in 21 hospitals (implementation = 91 %), in two thirds of these hospitals in more than one patient group. Adoption of IKNL-G's roadmap elements varied between 84 and 100 %. Participants' average satisfaction score with SDRN was 6.5 (possible range = 0-10, range found = 5-8). Significant positive relationships were found between this satisfaction and participants' satisfaction with frequency of SDRN (p = 0.02), and keeping logistical agreements (p = 0.04). Participants were dissatisfied with SDRN's limited current availability to only select patient groups and only certain disease phases. CONCLUSIONS: The implementation of SDRN in daily practice, supported by a pre-developed implementation roadmap, is highly feasible. Continuous attention to SDRN execution, broadening implementation to all forms of cancer, and during the total disease trajectory seems vital to improve healthcare providers' satisfaction.

'It just has to click': Internists' views of: what constitutes productive interactions with chronically ill patients.

BACKGROUND: According to the Chronic Care Model, productive interactions are crucial to patient outcomes. Despite productive interactions being at the heart of the Model, however, it is unclear what constitutes such an interaction. The aim of this study was to gain a better understanding of physician views of productive interactions with the chronically ill. METHOD: We conducted a qualitative study and interviewed 20 internists working in an academic hospital. The data were analyzed using a constructivist approach of grounded theory. To categorize the data, a coding process within which a code list was developed and tested with two other coders was conducted. RESULTS: The participants engaged in goal-directed reasoning when reflecting on productive interactions. This resulted in the identification of four goal orientations: (a) health outcome; (b) satisfaction; (c) medical process; and (d) collaboration. Collaboration appeared to be conditional for reaching medical process goals and ultimately health outcome and satisfaction goals. Achieving rapport with the patient ('clicking,' in the term of the participants) was found to be a key condition that catalyzed collaboration goals. Clicking appeared to be seen as a somewhat unpredictable phenomenon that might or might not emerge, which one had to accept and work with. Goal orientations were found to be related to the specific medical context (i.e., a participant's subspecialty and the nature of a patient's complaint). CONCLUSIONS: The participants viewed a productive interaction as essentially goal-directed, catalyzed by the two parties clicking, and dependent on the nature of a patient's complaint. Using the findings, we developed a conceptual process model with the four goal orientations as wheels and with clicking in the center as a flywheel. Because clicking was viewed as important, but somewhat unpredictable, teaching physicians how to click, while taking account of the medical context, may warrant greater attention.

Subjective sexual well-being and sexual behavior in young women with breast cancer.

OBJECTIVES: The aim of this study was to systematically describe the nature and context of subjective sexual well-being and sexual behavior in young women with breast cancer. METHODS: Data on sexual behavior and subjective sexual well-being were collected through an internet questionnaire. Respondents were included if they had been diagnosed with breast cancer within the past 6 years and were currently 45 years of age or younger. Results were compared with a representative sample of the general Dutch population. RESULTS: In comparison with the general Dutch population of women, young women still undergoing breast cancer treatment are less sexually active and have a more negative experience of sexuality. While women who had already finished their treatment had more or less the same amount of sexual activity as the general Dutch population, there were still major differences in their experience of sexuality. Particularly strong associations were found between these women's sexual well-being in relation to their relationship satisfaction, and sexual interaction competence. CONCLUSION: In the wake of breast cancer treatment, young women have difficulty enjoying sex; it is evidently hard for them to resume their sex lives after breast cancer. In particular, women who find it hard to discuss sexual wishes and the possibilities and impossibilities associated with breast cancer with their partner experience negative consequences when trying to resume their sex lives.

Sexual dysfunction in young women with breast cancer.

OBJECTIVES: The objective of this study was to determine the prevalence of sexual dysfunction in young women with breast cancer in the Netherlands, and to assess the relationship between sexual dysfunction, treatment methods and treatment-related complaints. Also, the interest among women with breast cancer in receiving care for sexual dysfunction was determined. METHODS: Data on sexual functioning were collected through an internet questionnaire. Respondents were included if they had been diagnosed with breast cancer within the past 6 years and were currently 45 years of age or younger. Results were compared with a representative sample of the general Dutch population RESULTS: Of the women who were still undergoing treatment, 64 % had a sexual dysfunction. In women who had completed treatment, this was 45 %. All assessed dysfunctions were more common among these young women with breast cancer in comparison with women in the Dutch population. Particularly, early menopause and hormone therapy caused long-term occurence of genital arousal disorder. Radical mastectomy caused long-term occurrence of female orgasmic disorder, and early menopause dyspareunia. Half of the women reported that the topic "changes in sexual functioning" had been brought up during treatment, mostly on the initiative of the health professional. Six out of 10 women with a sexual dysfunction who felt a need for care did not consult a health professional. CONCLUSION: Sexual dysfunctions are highly prevalent among young women with breast cancer. This appears to improve after treatment has been completed, but women are far from recovered. The initiative to discuss sexuality should lie with the health professional. Including sexuality within treatment guidelines will prevent women with breast cancer from being deprived of care.

Efficacy of sexological healthcare for people with chronic diseases and physical disabilities.

The purpose of this study was to determine whether participation in a short and well-structured psychosexual therapy was effective for people with a broad range of physical impairments and chronic diseases. Data were collected from 37 men and 10 women (between 30 and 70 years of age). The results demonstrated that psychosexual therapy has a positive effect on several areas of sexual well-being: less relational stress and sexual stress and an increase in sexual satisfaction, sexual esteem, sexual interaction competence, and a higher frequency in sexual contact. Although based on a relatively small sample, these findings clearly indicate that people with physical impairments can benefit from psychosexual therapy.

Innovation in medical postgraduate education: a pilot study.

Although widely criticized for its didactical inadequacy, the accepted form for medical postgraduate training is still the symposium. One of its great deficiencies is the inability for participants to put new (scientific) findings into a personal medical context by means of discussion and reflection. To meet the didactical demands an innovative approach to postgraduate education was developed and tested with gynaecologist as teachers and general practitioners as participants. The first results with five courses are very positive: in comparison to the symposium, the new approach stimulates internalisation of provided knowledge much more, information retention is much higher and the reactions of participants are overwhelmingly enthusiastic. A short outline of the didactic model and its procedures is provided.

Burnout, engagement and resident physicians' self-reported errors.

Burnout is a work-related syndrome that may negatively affect more than just the resident physician. On the other hand, engagement has been shown to protect employees; it may also positively affect the patient care that the residents provide. Little is known about the relationship between residents' self-reported errors and burnout and engagement. In our national study that included all residents and physicians in The Netherlands, 2115 questionnaires were returned (response rate 41.1%). The residents reported on burnout (Maslach Burnout Inventory-Health and Social Services), engagement (Utrecht Work Engagement Scale) and self-assessed patient care practices (six items, two factors: errors in action/judgment, errors due to lack of time). Ninety-four percent of the residents reported making one or more mistake without negative consequences for the patient during their training. Seventy-one percent reported performing procedures for which they did not feel properly trained. More than half (56%) of the residents stated they had made a mistake with a negative consequence. Seventy-six percent felt they had fallen short in the quality of care they provided on at least one occasion. Men reported more errors in action/judgment than women. Significant effects of specialty and clinical setting were found on both types of errors. Residents with burnout reported significantly more errors (p < 0.001). Highly engaged residents reported fewer errors (p

Burnout among Dutch medical residents.

We examined levels of burnout and relationships between burnout, gender, age, years in training, and medical specialty in 158 medical residents working at the University Medical Center Groningen, the Netherlands. Thirteen percent of the residents met the criteria for burnout, with the highest percentage of burnout cases among medical residents in Psychiatry. Significantly more male residents than female residents suffered from severe burnout. Medical residents reported significantly lower mean scores on personal accomplishment than medical specialists and other health care workers; they also reported lower mean scores on emotional exhaustion than medical specialists. Male residents had significantly higher depersonalization scores than female residents. Positive significant relationships were found between personal accomplishment and age and years in training. Obstetrics & Gynecology residents reported significantly more personal accomplishment than residents in Psychiatry, Internal Medicine, Pediatrics, and Anesthesiology. Residents in Psychiatry had significantly lower scores on personal accomplishment than residents in Internal Medicine. Our findings show that burnout is present in a small but significant number of medical residents.

Family functioning and adolescents' emotional and behavioral problems: when a parent has cancer.

BACKGROUND: This article focuses on possible relationships between functioning of adolescents with a parent diagnosed with cancer 1-5 years earlier and family environment. PATIENTS AND METHODS: In all, 138 patients, 114 spouses and 221 adolescents completed the Family Environment Scale. Additionally, adolescents filled in the Impact of Event Scale and Youth Self-report and parents reported on the adolescents' functioning using the Child Behavior Checklist. RESULTS: Patients and spouses reported that their families differ from the norm; they are more expressive and social, better organized, less controlling and have less conflict. Adolescents reported the same and additionally find their family. Family environment was weakly to moderately strongly negatively related to the adolescents' functioning; family relationships related more strongly to the adolescents' functioning than family structure did. No significant relationship was found between family environment and the adolescents' cancer-related distress. Discrepancy in reports of family environment between parents and between parents and adolescents, in general, did not relate to the adolescents' functioning or distress. Parent-adolescent discrepancy only correlated with adolescent self-reports of their functioning. CONCLUSION: Families with parental cancer functioned positively. Despite this, family functioning seems to be a risk factor for behavioral and emotional problems in adolescents.

The role of social support in burnout among Dutch medical residents.

Burnout levels among medical residents are considered high. A lack of social support has shown to have a direct effect on emotional exhaustion, and depersonalization, two of the three burnout indicators. In this study, we examined the satisfaction of medical residents with social support (emotional, appreciative and informative) received from supervisors, fellow medical residents, nurses and patients. In addition, the correlation between social support and burnout was studied. Medical residents were significantly more dissatisfied with the emotional, appreciative and informative support received from their supervisors compared with fellow residents and nurses (respectively, 13.4+/-4.0 vs. 9.9+/-2.8 and 10.0+/-2.4; 10.0+/-2.9 vs. 7.4+/-2.0 and 7.3+/-1.8; and 7.2+/-2.3 vs. 5.4+/-1.6 and 5.3+/-1.5; p<.001). Significant independent effects were found on emotional exhaustion: from dissatisfaction with emotional support [Beta=.44, p<.001, total R2=.25] and dissatisfaction with appreciative support from supervisors [Beta=.30, p<.01, total R2=.11]. Moreover, dissatisfaction with emotional support from supervisors had an independent significant effect on depersonalization [Beta=.33, p=.001, total R2=.14]. The best predictor of burnout appeared to be dissatisfaction with emotional support received from supervisors. Our results suggest that intervention programs should not only focus on the medical residents, but also on the supervisors to improve their supportive skills.

Psychological assessment of patients with Menière's disease.

The objective of this study was to evaluate daily stressors, coping, personality, physical and mental health, and quality of life in Menière patients. 110 consecutive patients with definite Menière's disease were assessed using the Dutch Daily Hassles List, Coping Inventory for Stressful Situations (CISS), Symptoms Checklist 90 (SCL-90), NEO Five Factor Inventory (NEO-FFI), General Health Questionnaire (GHQ-12), and the Short Form Health Survey 36 (SF-36). Duration and subjective severity of symptoms were scored using a self-report questionnaire. It was shown that Menière patients had more daily stressors, used certain coping strategies less often, and had more psychopathology (e.g. anxiety and depression), and a worse quality of life compared to healthy reference groups. No abnormalities in personality were found. Patients with more severe symptoms had more psychopathology and a worse quality of life than patients with mild symptoms. The psychological profile of Menière patients seems comparable to patients with other chronic diseases. The outcomes should be used to intensify psychological support in patients with this disabling disease.

Sexuality, intimacy, and gynecological cancer.

On a psychological level, not all changes in sexual functioning following gynecological cancer treatment automatically lead to sexual problems or dysfunctions. Whether sexual dissatisfaction occurs will also depend on personal factors, social factors, and the context in which these negative changes occur.

What importance do women attribute to the size of the penis?

OBJECTIVE: A great deal of men consider that the size of the penis is directly proportional to its sexual power. Some men, who are worried that their penis is too small, wish to be considered for surgical lengthening or thickening procedures. The argumentation for this chiefly points in the direction of women. However, have women actually been asked about the extent to which they consider the size of the penis to be of importance from a sexual point of view? Or asked what they think about ideas surrounding the size of the penis in relation with actual sexual functioning? PATIENTS AND METHODS: To address these questions, 375 sexually active women who had recently given birth at the University Hospital Groningen were asked a number of questions about sexual functioning and the importance they attach to the size of their partner's penis. RESULTS: A total of 170 questionnaires were returned (response rate 45%); 20% of the women found the length of the penis important and 1% very important; 55% and 22% of the women found the length of the penis unimportant and totally unimportant, respectively. Opinions about the girth of the penis followed the same trend. Length was less important than girth: 21% and 32%, respectively. The women who found the girth of the penis important had the same opinion about the length of the penis (correlation 0.71, p=-0.001). Median division into two subgroups (girth important/unimportant; t-test) did not reveal any significant differences in relation with demographic data. Correlation analysis did not reveal any significant correlation between sexual functioning (measured with the NSF) and opinions about the girth of the penis. CONCLUSION: Although clearly in the minority, a nevertheless considerable percentage of the women respondents attached substantial importance to the size of the male sexual organ.