Adriaan Visser

Measuring Spirituality as a Universal Human Experience: A Review of Spirituality Questionnaires

Spirituality is an important theme in health research, since a spiritual orientation can help people to cope with the consequences of a serious disease. Knowledge on the role of spirituality is, however, limited, as most research is based on measures of religiosity rather than spirituality. A questionnaire that transcends specific beliefs is a prerequisite for quantifying the importance of spirituality among people who adhere to a religion or none at all. In this review, we discuss ten questionnaires that address spirituality as a universal human experience. Questionnaires are evaluated with regard to psychometric properties, item formulation and confusion with well-being and distress. Although none of the questionnaires fulfilled all the criteria, the multidimensional Spiritual Well-Being Questionnaire is promising.

A history of patient education by health professionals in Europe and North America: From authority to shared decision making education

OBJECTIVE This paper describes the development of patient education from the 1960s until now and identifies future challenges to improve patient education. RESULTS Patient education developed from the health care professional deciding what the patient needed to know to a shared decision making design where physician and patient are equally influential on the decision making process. The development of patient education is described for primary and secondary health care, as well as the impact of biomedical advances, an ageing population and cultural diversity on patient education. Some of the challenges for future patient education are identified: training health professionals as well as patients, involvement of the patients social environment and application of e-Health techniques to patient education. CONCLUSION Patient education has made several developmental changes, has spread to different settings in health care and has now finally established itself as a valuable part of health care for patients. Nevertheless, both patients and health professionals still need to be provided with skills to optimize patient education. A good science-practice fit for future interventions to facilitate patient education is paramount. PRACTICE IMPLICATION Lessons from the past of patient education are important for the growth and future development of patient education.

Has patients’ involvement in the decision-making process changed over time?

Objective  To get insight into the changes over time of patients’ involvement in the decision‐making process, and into the factors contributing to patients’ involvement and general practitioners’ (GPs) communication related to the Medical Treatment Act (MTA) issues: information about treatment, other available treatments and side‐effects; informed decision making; asking consent for treatment.

Contraception in the Netherlands: the low abortion rate explained

This article gives a review of the main factors that are related to the low abortion rate in the Netherlands. Attention is payed to figures on abortion and the use of contraceptive methods since the beginning of the 1960s up to the end of the 1980s. The strong acceptance of family planning was influenced by changing values regarding sexuality and the family, the transition from an agricultural to a modern industrial society, rapid economic growth, declining influence of the churches on daily life, introduction of modern mass media and the increased general educational level. The introduction of modern contraceptives (mainly the pill and contraceptive sterilization) was stimulated by a strong voluntary family planning movement, fear for overpopulation, a positive role of GPs, and the public health insurance system. A reduction of unwanted pregnancies has been accomplished through successful strategies for the prevention of teenage pregnancy (including sex education, open discussions on sexuality in mass media, educational campaigns and low barrier services) as well as through wide acceptance of sterilization. The Dutch experience with family planning shows the following characteristics: a strong wish to reduce reliance on abortion, ongoing sexual and contraceptive education related to the actual experiences of the target groups, and low barrier family planning services.

Determinants of active self-care behaviour of insulin treated patients with diabetes: Implications for diabetes education

The most important aim of diabetes education is to alter the self-care behaviour of patients with diabetes. In order to change their behaviour its determinants must be known. The pretest of a multicentre evaluation study with 558 participating insulin treated patients with diabetes was analysed to test the usefulness of the attitude-behaviour theory of Fishbein & Ajzen in explaining and possibly changing diabetes related active self-care behaviour. The theory of Fishbein & Ajzen is based on the assumption that human behaviour is reasoned behaviour. The theory views a persons intention as the immediate determinant of action. Determinants of intention are attitude and social norm. The results showed that the attitude was the most important determinant of active self-care, while a sufficient level of knowledge and a low orientation on the powerful others health locus of control scale were prerequisites for a positive attitude. The influence of the social environment was detrimental; although people tried to motivate patients to active self-care, they could not provide any real help in performing this desired behaviour. According to the results of this study, diabetes education should first aim at improving the level of knowledge and the health locus of control of the patients and second, at a positive attitude to active self-care. It is necessary to educate the social environment to create a more supportive atmosphere for the patient with diabetes.

Communication: the royal pathway to patient-centered medicine.

The papers in this special issue on communication in health care can be summarized in one easy and powerful message: communication is the royal pathway to patient-centerd medicine. Approached from differen angles, the linkage between communication and patient-centered medicine is the common theme that is covered by all authors. Underlying are two distinct assumptions: the first is, that patient-centerd medicine is a relevant aim in health care; the second, that communication is an important tool to achieve that aim. Both assumptions deserve some explorations. (aut. ref.)

Mindfulness-based stress reduction training for oncology patients: Patients’ appraisal and changes in well-being

OBJECTIVE This study explores satisfaction and changes in well-being in cancer patients following mindfulness-based stress reduction training. METHOD Data were collected in 47 cancer patients before and after the training, and also 1 year later. Standardized questionnaires were used to measure quality of life, joy in life, mood disturbances (depression, anger, vigor, fatigue, and tension), meaning in life and physical symptoms. RESULTS Participants were highly satisfied and said they had reached their goals with the training. The results show that directly after the training patients reported a better quality of life, more joy in life, less tension, and fewer physical symptoms. These effects appeared even stronger at follow-up. A year after the training a decrease was also found in depression, anger, vigor and total mood disturbance. No changes could be established for meaning in life and fatigue. Effect sizes varied between 0.28 and 0.60, indicating small-to-moderate changes. CONCLUSION Mindfulness training potentially supports cancer patients in handling the stress due to their life-threatening disease and increases their well-being. Several suggestions for further research are discussed. PRACTICE IMPLICATIONS Mindfulness training provides cancer patients with tools to deal with their limitations and worries, both during and after their treatment.

Information needs of patients with incurable cancer

GoalsThe aims of this study were to describe to what extent cancer patients with incurable cancer report to have been informed about disease-related topics and how they evaluate the quality of the information giving.Patients and methodsOne hundred and twenty-eight patients participated in our study within 2 months after having had a diagnosis of incurable cancer. They filled out a questionnaire and were interviewed personally. We assessed the level of information, information needs and demographic factors, and we registered the type and duration of the cancer, cancer therapy, other types of received care and contacts with health care professionals. Furthermore, we assessed patients’ appreciation of the information giving by their health care professionals.Main resultsThe majority of the patients said to have been informed about treatment options, side effects of their treatment, physical symptoms, where to get help, helpful devices, and diet, whereas less than half of the patients were informed about psychosocial care, euthanasia, and complementary care. Of all patients, 39% felt a need for additional information about topics such as physical symptoms, diet, euthanasia, and alternative or complementary care, whereas 19% would have appreciated extra written information. Most patients (78–88%) were satisfied with the information giving by the clinical specialist, oncology nurses, and non-specialised nurses, but only 63% evaluated the information giving by general practitioners as good.ConclusionWe conclude that most patients feel sufficiently informed about important disease-specific issues and are satisfied with the information giving by health care professionals. Nevertheless, a considerable number of patients appreciate additional information.

Adjustment to breast cancer: The psychobiological effects of psychosocial interventions

This review focuses on the effects of psychosocial interventions on psychological and biological functioning of breast cancer patients. Once in their lifetime, one out of eleven women receive a diagnosis of breast cancer. A diagnosis of breast cancer is a severe stressful life event with profound consequences on all aspects of human life. Whether a woman will regain emotional balance and accept the idea of living with a potentially life threatening disease depends on her psychological resiliency. Provision of psychosocial interventions can improve these womens coping abilities and reduce emotional distress and feelings of isolation, and improve psychosexual functioning. Additionally, there exists some evidence that psychotherapy may prolong survival. Prolongation of survival may be related, in part, to an increase in certain aspects of immune function (e.g., natural killer cell activity). This is plausible because the function of the immune system seems to be related to mammary tumor growth. Therefore, future research should examine the degree to which the effects on mammary tumor growth relate to immune system changes.

Patient education in Europe: united differences

This issue of Patient Education and Counseling presents the state of the art of patient education in several European countries. It is based on papers presented at a meeting in Paris on the evolution and development of patient education in western, central and eastern Europe (May 1999). Also patient education in the US is presented in this issue. Patient education is defined as all the educational activities directed to patients, including aspects of therapeutic education, health education and clinical health promotion. Five important factors are identified in the development of patient education: (1) research and evidence based standards; (2) the organization of care; (3) training and methodological support; (4) professional values; and (5) acknowledgment, funding and place of patient education in health policy. Several of the discussed common orientations and priorities in the patient education in the reviewed countries are highlighted in this issue. And finally, an example of the possible integrated international practice in patient education in the field of diabetes is described in this issue. Several conclusions are drawn concerning future development of communication in health care within the framework of patient education in Europe.