Eric van Rijswijk

An overview of 19 instruments assessing the doctor-patient relationship: different models or concepts are used.

OBJECTIVES The doctor-patient relationship has been linked to patient satisfaction, treatment adherence, and treatment outcome. Many different instruments have been developed to assess this relationship. The large variety makes it difficult to compare results of different studies and choose an instrument for future research. This review aims to provide an overview of the existing instruments assessing the doctor-patient relationship. STUDY DESIGN AND SETTING We performed a systematic search in PubMed, PsychInfo, EMBASE, and Web of Science for questionnaires measuring the doctor-patient relationship. We appraised each instrument ascertaining the questionnaires focused on the doctor-patient relationship. We compared the content and psychometric characteristics of the instruments. RESULTS We found 19 instruments assessing the doctor-patient relationship. The instruments assess a variety of dimensions and use diverse conceptual models for the doctor-patient relationship. The instruments found also vary in terms to which they have been psychometrically tested. CONCLUSION We have provided an overview of 19 instruments assessing the doctor-patient relationship. The selection of an instrument for future research should be based on the model or conceptual basis of the doctor-patient relationship that is most applicable to the study objectives and the health care field in which it will be applied.

The Beck Depression Inventory (BDI-II) and a single screening question as screening tools for depressive disorder in Dutch advanced cancer patients

PurposeDepression is highly prevalent in advanced cancer patients, but the diagnosis of depressive disorder in patients with advanced cancer is difficult. Screening instruments could facilitate diagnosing depressive disorder in patients with advanced cancer. The aim of this study was to determine the validity of the Beck Depression Inventory (BDI-II) and a single screening question as screening tools for depressive disorder in advanced cancer patients.MethodsPatients with advanced metastatic disease, visiting the outpatient palliative care department, were asked to fill out a self-questionnaire containing the Beck Depression Inventory (BDI-II) and a single screening question “Are you feeling depressed?” The mood section of the PRIME-MD was used as a gold standard.ResultsSixty-one patients with advanced metastatic disease were eligible to be included in the study. Complete data were obtained from 46 patients. The area under the curve of the receiver operating characteristics analysis of the BDI-II was 0.82. The optimal cut-off point of the BDI-II was 16 with a sensitivity of 90% and a specificity of 69%. The single screening question showed a sensitivity of 50% and a specificity of 94%.ConclusionsThe BDI-II seems an adequate screening tool for a depressive disorder in advanced cancer patients. The sensitivity of a single screening question is poor.

Early identification of palliative care patients in general practice: development of RADboud indicators for PAlliative Care Needs (RADPAC)

BACKGROUND According to the World Health Organization (WHO) definition, palliative care should be initiated in an early phase and not be restricted to terminal care. In the literature, no validated tools predicting the optimal timing for initiating palliative care have been determined. AIM The aim of this study was to systematically develop a tool for GPs with which they can identify patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and cancer respectively, who could benefit from proactive palliative care. DESIGN A three-step procedure, including a literature review, focus group interviews with input from the multidisciplinary field of palliative healthcare professionals, and a modified Rand Delphi process with GPs. METHOD The three-step procedure was used to develop sets of indicators for the early identification of CHF, COPD, and cancer patients who could benefit from palliative care. RESULTS Three comprehensive sets of indicators were developed to support GPs in identifying patients with CHF, COPD, and cancer in need of palliative care. For CHF, seven indicators were found: for example, frequent hospital admissions. For COPD, six indicators were found: such as, Karnofsky score ≤50%. For cancer, eight indicators were found: for example, worse prognosis of the primary tumour. CONCLUSION The RADboud indicators for PAlliative Care Needs (RADPAC) is the first tool developed from a combination of scientific evidence and practice experience that can help GPs in the identification of patients with CHF, COPD, or cancer, in need of palliative care. Applying the RADPAC facilitates the start of proactive palliative care and aims to improve the quality of palliative care in general practice.

How family physicians address diagnosis and management of depression in palliative care patients.

PURPOSE Depression is highly prevalent in palliative care patients. In clinical practice, there is concern about both insufficient and excessive diagnosis and treatment of depression. In the Netherlands, family physicians have a central role in delivering palliative care. We explored variation in family physicians’ opinions regarding the recognition, diagnosis, and management of depression in palliative care patients. METHODS We conducted a focus group study in a sample of family physicians with varied practice locations and varying expertise in palliative care. Transcripts were analyzed independently by 2 researchers using constant comparative analysis in ATLAS.ti. RESULTS In 4 focus group discussions with 22 family physicians, the physicians described the diagnostic and therapeutic process for depression in palliative care patients as a continuous and overlapping process. Differentiating between normal and abnormal sadness was viewed as challenging. The physicians did not strictly apply criteria of depressive disorder but rather relied on their clinical judgment and strongly considered patients’ context and background factors. They indicated that managing depression in palliative care patients is mainly supportive and nonspecific. Antidepressant drugs were seldom prescribed. The physicians described difficulties in diagnosing and treating depression in palliative care, and gave suggestions to improve management of depression in palliative care patients in primary care. CONCLUSIONS Family physicians perceive the diagnosis and management of depression in palliative care patients as challenging. They rely on open communication and a long-standing physician-patient relationship in which the patient’s context is of great importance. This approach fits with the patient-centered care that is promoted in primary care.

Depressed and a co-morbid condition: more psychotropics prescribed!

Background: Depression often occurs simultaneously with a variety of somatic, psychiatric, and social conditions. Knowledge about differences in the pharmacological treatment of depressed patients with and without co-morbidity is lacking. Objective: To compare GPs’ pharmacological treatment of depressed patients with and without co-morbidity. Methods: Data were extracted from the computerized medical records of 77 general practices participating in the Dutch National Information Network of General Practice (LINH). We used diagnosis and prescription data of newly diagnosed depressed patients aged 18–65 years (n=4372). A mixed-model technique was used for analyzing the medical data. Results: During the year after diagnosing depression, depressed patients who also suffered from chronic somatic or psychiatric morbidity were prescribed more psychotropics than patients with depression only. Prescription patterns of psychotropic drugs for depressed patients with and without co-morbid social problems differed only during the first 3 months after diagnosis. For the whole 1-year period after diagnosis, the pharmacological treatment of depression in patients with and without co-morbid social problems did not differ. Conclusion: Our results indicate that chronic somatic or psychiatric co-morbidity in depressed patients leads to higher GP prescription levels of psychotropics, whereas co-morbid social problems do not seem to influence GPs’ pharmacological treatment decisions for depression.

Low prevalence of depressive disorder in ambulatory advanced cancer patients using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1).

Depressive disorder is assumed to be highly prevalent in advanced cancer patients, but the diagnosis of depressive disorder in patients with advanced cancer is difficult. The more robust the assessment instrument to diagnose depressive disorder is, the lower the reported prevalence of depressive disorder in advanced cancer patients. This study confirms a low prevalence of depressive disorder (3%) in 64 advanced cancer outpatients using a robust structured clinical assessment (SCAN 2.1). Furthermore, in this article we discuss possible implications of using predefined psychiatric labeling in the assessment of mood symptoms in advanced cancer patients.

Duloxetine redelijk effectief bij neuropathische pijn

Context Neuropathische pijn kan ontstaan door beschadiging van centraal of perifeer zenuwweefsel, bijvoorbeeld als gevolg van diabetes mellitus. Antidepressiva, met name de tricyclische, zoals amitryptilline, worden al decennialang gebruikt voor de behandeling van dergelijke pijn.

Communicatie met patiënten met chronische SOLK

SamenvattingOlde Hartman TC, Van Rijswijk E, Van Dulmen S, Van Weel-Baumgarten E, Lucassen PL, Van Weel C. Communicatie met patiënten met chronische SOLK. Huisarts Wet 2014;57(3):114–8.DoelHet onderzoeken van de arts-patiëntcommunicatie in consulten met patiënten met chronische somatisch onvoldoende verklaarde lichamelijke klachten (SOLK).MethodeWe voerden een explorerende kwalitatieve analyse uit van transcripten van twintig videoconsulten.ResultatenDe deelnemende patiënten vertoonden veel verschillende klachten waarover ze op een ongestructureerde manier vertelden, terwijl huisartsen bijna geen structurerende technieken gebruikten. Patiënten met chronische SOLK kregen veel ruimte om hun verhaal te vertellen, maar konden de reden van hun komst, hun ideeën en zorgen niet systematisch bespreken. Hoewel deze onderwerpen tijdens de consulten aan de orde kwamen, waren het meestal de patiënten zelf die het gesprek erover begonnen. De uitgebreide uitleg die huisartsen gaven over het ontstaan van klachten liet meestal geen ruimte voor de eigen ideeën en zorgen van patiënten.ConclusieDoordat patiënten verscheidene klachten hebben en de huisartsen het gesprek niet structureren, verlopen consulten met patiënten met chronische SOLK vaak chaotisch. Wel krijgen patiënten ruim de gelegenheid om hun verhaal te vertellen.