Harry B. M. van de Wiel

Burnout in medical residents : a review

Objectives  This study aimed to review current knowledge on burnout in medical residents, including reported prevalence rates, and to establish which risk and resistance factors contribute to or prevent burnout in medical residents.

Nurse-patient communication in cancer care - A review of the literature

Patients with cancer seem to experience distress particularly in the first period after diagnosis, and are likely to develop an affective disorder in the first 2 to 3 months. Communicative behaviors of nurses seem to play an important role in meeting the cognitive and affective needs of patients with cancer. This review of the literature examines the communicative behaviors of nurses during care activities with patients who have cancer. The studies show that emphasis is placed on the affective side, in which facilitating behaviors such as empathy, touch, comforting, and supporting are considered essential in caring for patients with cancer. Unfortunately, further studies in this review demonstrate that communication in oncologic care is complicated by such emotionally laden issues as the consequences associated with the life-threatening character of the disease and the far-reaching consequences of the medical treatment. This results in barriers to effective communication between patients with cancer and nurses. It is important, therefore, that nurses working with patients who have cancer are provided both structurally and repeatedly with continuing education programs in communication. Finally, most of the studies covered in this review have an explorative character. Future research in this area should pay attention to the use of controlled studies, large sample sizes, and observational instruments.

Vaginal plethysmography in women with dyspareunia

We investigated by means of vaginal plethysmography the extent to which the genital reactions of women with dyspareunia (N = 18) differed from those of women without dyspareunia (N = 16) during sexual arousal. In addition, we used questionnaires to investigate whether the genital reaction was correlated with the womens subjective experience of sexual arousal. In both groups, there was a clear increase in vaginal vasocongestion while they watched various erotic scenes compared with the situation at rest. While participants watched video fragments showing oral sex (cunnilingus and fellatio), the reactions were the same across the two groups. While participants watched video fragments showing coitus, there was a further increase in vaginal vasocongestion in the women without dyspareunia, but a decrease in vasocongestion in women with dyspareunia. The results of questionnaires assessing their perceived levels of sexual arousal while watching the video fragments showed that this reduction in genital response ...

Male sexuality after cancer treatment - needs for information and support : testicular cancer compared to malignant lymphoma

Testicular cancer (TC) as well as malignant lymphoma (ML), both have nowadays an excellent prognosis. However, both types of cancer may be diagnosed at young adulthood and patients may experience sexual concerns. In this article the need for information and support concerning sexuality will be explored, and the traumatic impact of cancer diagnosis with respect to this will be considered. A total of 264 patients with testicular cancer, median age 36 (S.D. 9.7) years, and 50 patients with malignant lymphoma, median age 42 (S.D. 11.7) years returned a questionnaire concerning sexual functioning; four items assessed the need for information or support concerning sexuality, at diagnosis and at follow-up. It appeared that more than half of the patients with testicular cancer reported a lack of information and support concerning sexuality during treatment; 67% of them still had a need for information at follow-up. These rates were significantly lower for patients with malignant lymphoma. Especially patients with testicular cancer who suffered sexual dysfunction reported extremely high needs for information and support. According to these findings it can be concluded that more attention should be paid to the doctor-patient communication with respect to sexual concerns in general, and especially where it concerns patients with testicular cancer.

Psychosexual functioning after the treatment of cancer of the vulva - a longitudinal-study

Ten couples, the women beginning treatment for carcinoma of the vulva, participated in a 2‐year longitudinal study on sexual functioning before and after treatment. Sexual functioning was measured on admission and at 6, 12, and 24 months posttreatment. Sexual functioning was made operational in terms of current sexual behavior, sexual motivation, sexual (dis)satisfaction, and the perception of genital sensations of sexual arousal. An age‐matched nonpatient control group was added to the study and the impact of physical variables was also evaluated. Within 1 year, all women who were sexually active before the treatment had resumed their sexual activities. At the 6‐month assessment an increase in relational sexual dissatisfaction could be detected. Over the remaining observation period the womens satisfaction with sexual interaction with the partner was not found to be different from their pretreatment satisfaction and not different from the satisfaction in the control group, in spite of the physical damage and persisting poor perception of genital symptoms of sexual arousal during lovemaking. Satisfaction with sexual interaction with the partner under these circumstances appears to be more an expression of satisfaction with the intimate aspects of the sexual relationship than of satisfaction with the physiologic arousal aspects of the sexual relationship. It is argued that psychological and social variables are more crucial for sexual rehabilitation than physical variables. Therefore, psychosocial issues constitute the most promising focus for intervention.

The relationship between reciprocity and burnout in Dutch medical residents

Objective  This study examined reciprocity in medical residents’ relationships with supervisors, fellow residents, nurses and patients, and associations between reciprocity and burnout. Furthermore, we considered if a discrepancy between the perceived and preferred levels of reciprocity influenced the level of burnout complaints.

Education in patient–physician communication: How to improve effectiveness?

OBJECTIVE Despite educational efforts expertise in communication as required by the CanMEDS competency framework is not achieved by medical students and residents. Several factors complicate the learning of professional communication. METHODS We adapted the reflective-impulsive model of social behaviour to explain the complexities of learning professional communication behaviour. We formulated recommendations for the learning objectives and teaching methods of communication education. Our recommendations are based on the reflective-impulsive model and on the model of deliberate practice which complements the reflective-impulsive model. Our recommendations are substantiated by those we found in the literature. RESULTS The reflective-impulsive model explains why the results of communication education fall below expectations and how expertise in communication can be attained by deliberate practice. The model of deliberate practice specifies learning conditions which are insufficiently fulfilled in current communication programmes. CONCLUSION The implementation of our recommendations would require a great deal of effort. Therefore we doubt whether expertise in professional communication can be fully attained during medical training. PRACTICE IMPLICATIONS We propose that the CanMEDS communication competencies not be regarded as endpoints in medical education but as guidelines to improve communication competency through deliberate practice throughout a professional career.

Non-commercial surrogacy : an account of patient management in the first Dutch Centre for IVF Surrogacy, from 1997 to 2004

BACKGROUND Surrogacy was prohibited in the Netherlands until 1994, at which time the Dutch law was changed from the general prohibition of surrogacy to the prohibition of commercial surrogacy. This paper describes the results from the first and only Dutch Centre for Non-commercial IVF Surrogacy between 1997 and 2004. METHODS A prospective study was conducted of all intended parents, and surrogate mothers and their partners (if present), in which medical, psychological and legal aspects of patient selection were assessed by questionnaires and interviews developed for this study. RESULTS More than 500 couples enquired about surrogacy by telephone or e-mail. More than 200 couples applied for surrogacy in the Centre, of which, after extensive screening, 35 couples actually entered the IVF programme and 24 completed the treatment, resulting in 16 children being born to 13 women. Recommendations for non-commercial surrogacy are given, including abandoning the 1-year waiting period before adoption, currently dictated by law, avoiding a period of unnecessary psychological distress. CONCLUSIONS Our study has shown that non-commercial IVF surrogacy is feasible, with good results in terms of pregnancy outcome and psychological outcome for all parents, and with no legal problems relating to the adoption procedures arising. The extensive screening of medical, psychological and legal aspects was a key element in helping to ensure the safety and success of the procedure.

Decision-making process in patients before entering phase III cancer clinical trials: a pilot study.

The present study was performed to gain insight into the decision-making process that patients go through when asked to participate in a cancer clinical trial. Fourteen cancer patients entered a pilot study concerning decision making. They were interviewed in a semistructured manner after consenting or refusing to participate in a randomized phase III clinical trial concerning chemotherapy or immunotherapy. Results from this study showed that patients, after receiving information from the medical oncologist, oncology nurse, or both, decide about participation instantaneously. This means that time for procedural soundness has not been used, which raises questions about the normative quality of the decision.

Sexual Health Problems and Associated Help-Seeking Behavior of People With Physical Disabilities and Chronic Diseases

The aim of this study was to investigate help-seeking behavior in relation to sexual problems among people with a disease or an impairment, as well as determining factors that promote people to seek professional sexological help. A total of 341 respondents (224 men, 117 women) participated. Approximately 50% wanted professional help with finding a sexual partner and sexual adjustment problems. Further, approximately 40% wanted professional help for problems in their sexual relationship, practical sexual problems, and the inability to enjoy their sexuality. In total, two third considered contacting a health care professional of which 35% had indeed had contact with a health care professional. Only a third of those evaluated these contacts as positive. To identify factors associated with the respondents participation in psychosexual therapy, we performed a logistic regression analyses with a participation in a psychosexual intervention as the dependent variable. Sexual dissatisfaction was the strongest predictor of participation in psychosexual therapy. Furthermore, people who indicated that they wanted professional help for their sexual problems and people who had already discussed sexuality issues with a health care professional were more likely to participate. Disease and demographic characteristics did not influence ones decision to participate.