Grieteke Pool

Do patients trust their physician? The role of attachment style in the patient-physician relationship within one year after a cancer diagnosis.

Abstract Background. The degree of trust in and satisfaction with the physician has been shown to have important implications for treatment outcomes. This study aims to examine individual differences in patients’ trust, satisfaction and general distress from an attachment theoretical perspective. Material and methods. One hundred and thirty recently diagnosed cancer patients of three medical hospitals were extensively interviewed by trained psychologists to assess attachment style. Patients completed standardized questionnaires three and nine months after diagnosis to assess trust, satisfaction and distress. t-tests and repeated measures ANOVAs were used to examine differences between securely and insecurely attached patients and changes over time. A mediation model based on a bootstrapping method was used to examine whether trust mediated between attachment and satisfaction, and attachment and distress. Results. Insecurely attached patients (N = 45, 35%) reported less trust in and satisfaction with their physician, and reported more general distress than securely attached patients three and nine months after diagnosis (p < 0.05). Trust and distress levels did not change over time. Trust mediated between attachment and satisfaction, but not between attachment and distress. Conclusion. Insecurely attached patients trusted their physician less than securely attached patients, and in turn were less satisfied with their physician. Their higher levels of general distress were not related to their lower levels of trust. Attachment theory provides a framework to interpret differences in patients’ trust, satisfaction and distress, and may help physicians respond in such a way that their patients feel secure, which in turn is expected to result in better health outcomes.

Lower levels of trust in one's physician is associated with more distress over time in more anxiously attached individuals with cancer

OBJECTIVE In the present study, we investigated individual differences in the outcome of patient-physician trust when confronted with cancer from an attachment theoretical perspective. We expected that lower levels of trust are associated with more emotional distress and more physical limitations within the first 15 months after diagnosis, especially in those who score relatively high on attachment anxiety. No such association was expected for more avoidantly attached individuals. METHOD A group of 119 patients with different types of cancer (breast, cervical, intestinal and prostate) completed questionnaires concerning trust (short version of the Wake Forest Physician Trust Scale) and attachment (Experiences in Close Relationship scale Revised) at 3 months after diagnosis. Emotional distress (Hospital Anxiety and Depression Scale) and physical limitations (physical functioning subscales of the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire-C30) were assessed at 3, 9 and 15 months after diagnosis. To test the hypotheses, multiple hierarchical regression analyses were performed. RESULTS Lower levels of trust were associated with more emotional distress and more physical limitations at 3, 9 and 15 months after diagnosis in more anxiously attached patients, but not in less anxiously attached patients. DISCUSSION These results indicate an attachment-dependent effect of trust in ones physician. Explanations and clinical implications are discussed.

Is implementing screening for distress an efficient means to recruit patients to a psychological intervention trial

Psychological interventions show greater efficacy when evaluated with distressed patients. We report on the feasibility of implementing screening for recruiting distressed cancer patients to a randomized controlled trial of problem‐solving therapy (PST), characteristics associated with enrolment, and time investment and challenges of implementing screening.

Concerns of terminally ill cancer patients in their home environment.

The concerns of Dutch terminally ill cancer patients who stayed in their home environment were explored, and in this ‘Letter to the editor’, we communicate some of our findings. In order to relate the actual physical state of the patients to their concerns, we constructed a relatively short self-report questionnaire of 19 items (partly open questions, partly using a Visual-analogue scale 0 10), including the WHO-functional scale. A total of 280 general practices in the northern part of the country were enlisted to approach patients with a life-expectancy of less then six months. The average general practice in the Netherlands takes care of about three to four terminally ill patients per year. Therefore, during the recruitment period of seven months, about 500 patients were expected to meet our inclusion criteria. In principle, every Dutch inhabitant has access to basic homecare. In actuality, a total of 51 patients were included (by 34 GPs); 34 questionnaires were used for analysis (respondents: 14 male (mean age: 63.9, SD: 9.2); 20 female (mean age: 67.5, SD: 10.5); median time since diagnosis: 14 months; 28 patients (82%) lived with a partner). Six patients died before completion of the questionnaire, 11 questionnaires were incomplete. Concerning the functional state, about half of the 34 patients was partially/totally confined to bed and partially/totally disabled. A majority, 26 patients (76%) suffered from two or more physical problems. Pain was most frequently mentioned (n /23, 61%), followed by fatigue (n /13, 39%). A majority of the patients reported concerns about the further physical course of the disease (n /22, 60%), as well as non-physical concerns (n /23, 68%, eg, concerns about partner, children, loosing control, loss of independence, not being able to say good-bye). Patients with a WHO-functional state of 3 4 reported significantly more concerns (physical as well as non -physical) than patients with a score of 0 2 (P / 0.04). Almost half of the patients (n /16, 47%) reported a threat to their dignity. Important aspects concerning ‘maintenance of dignity’ were: being able to say goodbye; dying at home; dying without symptoms; dying in peace; being clear of mind; being able to control the end (by euthanasia). Interestingly, ten patients (29%) stated they had no concerns at all (physical or non-physical). Furthermore, the majority (n /28, 82%) reported not being afraid of dying. Of course, the results of our study permit only limited conclusions. Although many patients were approached, only 10% of the potential population (n /51) was included. This confirms the structural difficulty of including terminal patients in a study. However, this study evokes several considerations. A high level of physical complaints in the terminally ill, as reported here and by others, 5 may indicate that, for many patients, symptoms are not under optimal (medical) control. Another notable point from our study is that not dying as such, but the uncertainty about the dying process was related to the severity of actual physical symptoms. This was also mentioned in other recent studies. (Although Heaven and Maguire, reported that loss of independence seems to be the major concern in terminally ill, we think this may be due to the fact that their study was performed in a hospice population, where symptom control may be more optimal than in home situations, and the threat of loosing control and independence may be greater. A wish for euthanasia (mentioned a few times by patients), or the wish to die at home, can be viewed as an attempt to maintain personal control. Of course, cultural aspects may influence patients’ perceptions on suffering, dying, death and euthanasia.) In conclusion, we believe our exploratary study stresses the high value of symptom control. A lack of (feelings of) symptom-control may evoke concerns regarding the course of the disease, as well as concerning the process of dying. Adequate symptom management may not only alleviate current suffering, but also prevent physical and non-physical concerns in the future.

Psychologische interventies bij kanker - zoeken naar de juiste maat

SummaryPsychological interventions in cancerCurrently cancer is the first cause of death in Western society, but also: many patients survive, due to improved treatments. During the past 30 years psycho-oncology has grown from a non-issue to an important aspect of cancer-rehabilitation. Psychological adaptation to cancer is a complex process, where daily hassles go along with existential concerns. Depending on the phase of disease-treatment-outcome, the patient struggles with loss of health, loss of control and with anxiety. Ego documents may show impressive qualitative narratives or artistic work. However outcomes of scientific psychological research concerning distress, depression or anxiety are ambiguous (ranges vary from 0-50%). Currently, experiences of ‘growth’ are investigated and appear to be present in at least half of the patients. Psychological screening during treatment is also an actual topic; it seems that only a small part of patients that report high levels of distress have a need for professional help. Scientifically, the measurement of the efficacy of psycho-oncological interventions is an important topic; there is a large variety of research-outcomes and this has led to a critical stance concerning research designs and review-strategies. In clinical practice however, a quite broad spectrum of psycho-oncological intervention options has been developed during the past two decades in The Netherlands.

Identifying Patients with COPD in Need for Psychosocial Care Through Screening with the HSCL-25 and the CCQ Mental State

ABSTRACT High levels of psychological distress are documented in patients with COPD. This study investigates the extent to which patients with a high score on the Hopkins Symptoms Checklist-25 (HSCL-25) or with a high score on the Mental State scale of the Clinical COPD Questionnaire (CCQ) endorse a need for psychosocial care, and investigates several characteristics of patients with a need. Outpatients with COPD of the Department of Pulmonary Diseases of a University Medical Center were assessed with the HSCL-25, CCQ and a question on need for psychosocial care. For patients indicating a need, the percentage of patients with HSCL-25 ≥39 was compared with the percentage of patients with CCQ Mental State >2 and tested with a Chi-square. In total 323 patients participated; 57% of them were distressed according to the HSCL-25 (≥39) and 20% according to the CCQ Mental State (>2); 28% reported a need for psychosocial care. For patients reporting a need for psychosocial care a higher percentage was identified by the HSCL-25 than by the CCQ Mental State (χ2 = 9.41, p <. 002) and they were younger than patients without a need (t = 4.48, p <. 001). No differences existed for sex, FEV1, FEV1% predicted or medical comorbidities. The HSCL-25 identified more patients in need than the CCQ Mental State scale. However, not all patients with a need were identified. No relationship was found between need for psychosocial care and illness variables or comorbidities. Distress screening is questioned as the most effective way to identity patients with COPD in need for psychosocial care.

FORUM - Spiritualiteit in de gezondheidszorg. Visies en ervaringen van zorgverleners en onderzoekers

De afgelopen jaren heeft er een explosieve groei plaats gevonden van het aantal publicaties over spiritualiteit in relatie tot gezondheid; het aantal artikelen is de laatste tien jaar zes maal zo veel geworden.1 Spiritualiteit lijkt vooral een belangrijke rol te spelen bij het omgaan met stressvolle gebeurtenissen, zoals een chronische of levensbedreigende ziekte.1-3 Het lijkt dan ook voor de hand te liggen dat zorgverleners in de gezondheidszorg aandacht besteden aan dit thema. In dit artikel geven zorgverleners en onderzoekers hun visie over de manier waarop zorgverleners hieraan aandacht zouden kunnen besteden.SamenvattingDe afgelopen jaren heeft er een explosieve groei plaats gevonden van het aantal publicaties over spiritualiteit in relatie tot gezondheid; het aantal artikelen is de laatste tien jaar zes maal zo veel geworden.1 Spiritualiteit lijkt vooral een belangrijke rol te spelen bij het omgaan met stressvolle gebeurtenissen, zoals een chronische of levensbedreigende ziekte.1-3 Het lijkt dan ook voor de hand te liggen dat zorgverleners in de gezondheidszorg aandacht besteden aan dit thema. In dit artikel geven zorgverleners en onderzoekers hun visie over de manier waarop zorgverleners hieraan aandacht zouden kunnen besteden.

Response to the letter of Liccardi et al

Gemma A. Maters, Grieteke Pool, Robbert Sanderman, Johan B. Wempe, and Joke Fleer Department of Health Sciences, Health Psychology Section, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Psychology, Health and Technology, University of Twente, The Netherlands.; Center for Rehabilitation, University Medical Center Groningen, University of Groningen, The Netherlands; Department of Pulmonary Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

Een handboek – altijd handig?

SamenvattingBespreking van: Kees Meijer (2004). Handboek Psychosomatiek. Baarn, HBuitgevers (4e druk).