Self-management of patients with advanced cancer

BACKGROUND: Patients with advanced cancer are increasingly expected to self-manage. Thus far, this topic has received little systematic attention. AIM: To summarise studies describing self-management strategies of patients with advanced cancer and associated experiences and personal characteristics. Also, to summarise attitudes of relatives and healthcare professionals towards patient self-management. DESIGN: A systematic review including non-experimental quantitative and qualitative studies. Data were analysed using critical interpretive synthesis. Included studies were appraised on methodological quality and quality of reporting. DATA SOURCES: MEDLINE, Embase, Cochrane Central, PsycINFO, CINAHL, Web of Science and Google Scholar (until 11 June 2019). RESULTS: Of 1742 identified articles, 31 moderate-quality articles describing 8 quantitative and 23 qualitative studies were included. Patients with advanced cancer used self-management strategies in seven domains: medicine and pharmacology, lifestyle, mental health, social support, knowledge and information, navigation and coordination and medical decision-making (29 articles). Strategies were highly individual, sometimes ambivalent and dependent on social interactions. Older patients and patients with more depressive symptoms and lower levels of physical functioning, education and self-efficacy might have more difficulties with certain self-management strategies (six articles). Healthcare professionals perceived self-management as desirable and achievable if based on sufficient skills and knowledge and solid patient-professional partnerships (three articles). CONCLUSION: Self-management of patients with advanced cancer is highly personal and multifaceted. Strategies may be substitutional, additional or even conflicting compared to care provided by healthcare professionals. Self-management support can benefit from an individualised approach embedded in solid partnerships with relatives and healthcare professionals

The urban hospital in the public realm

The design of a highly accessible medical setting what is mixed with urban everyday life, and thus embedded in its contextArchitecture & UrbanismArchitectur

Intervening via chat: an opportunity for adolescents' mental health promotion?

Mental health problems are highly prevalent among adolescents, but a majority of adolescents is reluctant to seek help at mental health services because of shame and lack of anonymity. Intervening via chat (i.e. offering online support) could be a solution to remove these barriers and to reach adolescents. The dimensions of the RE-AIM model (reach, efficacy, adoption, implementation and maintenance) served as a guiding principle for discussing the potential of offering online support via chat. It appeared that the use of chat may be an appropriate way to reach adolescents and may have a positive impact on outcome measures related to mental health. Additional efforts are needed to stimulate adoption at the individual level (target group, intermediaries) and the organizational level. Future research needs to focus on the dissemination of chat-based interventions, differences between online peer support and online professional support, and the content of conversations via chat about mental health problems

Monitoring health risk behavior of Dutch adolescents and the development of health promoting policies and activities: the E-MOVO project

This paper describes a new way of monitoring the health status of Dutch adolescents in order to stimulate the development of health policies at school and local levels and providing individual feedback using modern technology. The project is called E-MOVO that stands for Electronic Monitor and Health Education, in which seven Regional Health Authorities and the University of Maastricht collaborate. In this project, adolescents completed an electronic questionnaire via the Internet which measured topics related to demographics, school, physical health, mental health, well-being, lifestyle, criminality and leisure time activities. These data were used for feedback at three levels. On the basis of their answers, adolescents received tailored feedback on lifestyle in a personal 'E-MOVO score', including links to relevant websites or other tailored information. The aggregated data were used to provide schools and municipalities with information on the health and well-being of their adolescent population. These data were used to encourage the development of health promoting policies and activities at both levels. This project was evaluated and is now adapted to implement at a national level

Why young Dutch in-line skaters do (not) use protection equipment

Background: In-line skate injuries are highly preventable by the use of protective gear. We investigated how young Dutch skaters protect themselves and what factors predict the use of protective gear in order to develop campaigns to increase their safety behaviour. Methods: A survey was conducted to study protection behaviour of 872 Dutch skaters and factors influencing the use of protective gear. Written questionnaires were used, measuring behaviour and social psychological determinants towards the use of protective behaviour. Results: Protective gear was not often used: 36% used wrist guards, 28% used kneepads, 14% used elbow pads and 5% used helmets. The use of protective gear was influenced by social influences, self-efficacy expectations and intention (R-2=54%). Conclusions: The present study shows that young Dutch skaters should improve their safety behaviour in order to prevent skate injuries. Furthermore, the study provides clear recommendations for developing prevention programmes

Breast self-examination: longitudinal predictors of intention and subsequent behaviour

Breast self-examination: longitudinal predictors of intention and subsequent behaviour. Lechner L, De Nooijer J, De Vries H. School of Psychology, Open University of the Netherlands, PO Box 2960, 6401 DL Heerlen, The Netherlands. [email protected] This study analysed in a longitudinal design the relationship between past breast self-examination (BSE) behaviour, determinants, intention and future BSE behaviour in a population of adult Dutch women. Past behaviour and psychosocial determinants were assessed at T1, followed 6 weeks later (T2) with the assessment of the intention to perform BSE monthly. Half a year after the first measurement the current BSE behaviour was assessed by means of a telephone survey (T3) (total end response 78%, n=364). The questionnaires included BSE behaviour, intention, attitude (pros and cons of BSE, anticipated regret, moral obligation), social influence (support, modelling) and self-efficacy. Other background variables assessed were past BSE behaviour, and demographics. Although 81% of the women stated that they performed BSE, only 41% of the women performed BSE correctly. Women who performed BSE correctly differed from women who did not on all psychosocial determinants assessed a half year earlier, with the exception of anticipated regret. Stepwise multiple regression analyses showed that the psychosocial determinants explained 51% of the variance in intention to perform BSE, assessed 6 weeks later; past behaviour accounted for 2% of extra explained variance. Logistic regression analyses showed that past behaviour, the psychosocial determinants and intention were significant predictors of correct BSE behaviour a half year later (Nagelkerke's total explained variance was 47%). It was concluded that misperceptions of correct BSE behaviour was highly prevalent. Both the psychosocial determinants as well as past behaviour were important predictors of intention to perform BSE and subsequent BSE behaviour