The role of the general practitioner during treatment and follow-up of patients with breast cancer

Voor vrouwen met borstkanker in de voorgeschiedenis is nazorg, waaronder nacontrole, belangrijk. Tot nu toe is het onduidelijk welke zorgverleners - specialisten, huisartsen, verpleegkundigen, of een combinatie hiervan - verantwoordelijk zouden moeten zijn voor de nazorg. Dit proefschrift beschrijft de rol van Nederlandse huisartsen tijdens de behandeling en nacontrole van patiënten met borstkanker. Bovendien beschrijft dit proefschrift de opvattingen en ervaringen van huisartsen en patiënten wat betreft de overdracht van de nacontrole bij borstkanker naar de huisartspraktijk. Er is gebruik gemaakt van verschillende onderzoeksmethoden, waaronder twee longitudinale studies naar het eerstelijns zorggebruik, een kwantitatieve enquête onder huisartsen en kwalitatieve interviews met patiënten. Concluderend laat het verhoogd zorggebruik in dit proefschrift zien dat huisartsen al betrokken zijn bij de zorg voor patiënten met borstkanker tijdens de behandelfase en de fase van nacontrole, alhoewel niet op een formele wijze. Echter, andere resultaten in dit proefschrift laten zien dat de implementatie van de lange termijn nacontrole in de huisartspraktijk nog niet succesvol is. Toch zou 40% van de huisartsen de verantwoordelijkheid voor nacontrole in een eerder stadium (<5 jaar) accepteren. Hoewel de meerderheid van de patiënten een voorkeur had voor specialistische nacontrole, zou meer dan de helft nacontrole in de huisartspraktijk accepteren. Verschillende strategieën zijn beschreven om de ervaren moeilijkheden en barrières van huisartsen en patiënten om eerstelijns nacontrole te accepteren/te implementeren te overwinnen. Vervolgstudies kunnen inzicht bieden in de opvattingen van Nederlandse specialisten over eerstelijns nacontrole

Increased primary health care use in the first year after colorectal cancer diagnosis

OBJECTIVE: The view that the general practitioner (GP) should be more involved during the curative treatment of cancer is gaining support. This study aimed to assess the current role of the GP during treatment of patients with colorectal cancer (CRC). DESIGN: Historical prospective study, using primary care data from two cohorts. SETTING: Registration Network Groningen (RNG) consisting of 18 GPs in three group practices with a dynamic population of about 30,000 patients. SUBJECTS: Patients who underwent curative treatment for CRC (n = 124) and matched primary care patients without CRC (reference population; n = 358). MAIN OUTCOME MEASURES: Primary healthcare use in the period 1998-2009. FINDINGS: Patients with CRC had higher primary healthcare use in the year after diagnosis compared with the reference population. After correction for age, gender, and consultation behaviour, CRC patients had 54% (range 23-92%) more face-to-face contacts, 68% (range 36-108%) more drug prescriptions, and 35% (range -4-90%) more referrals compared with reference patients. Patients consulted their GP more often for reasons related to anaemia, abdominal pain, constipation, skin problems, and urinary infections. GPs also prescribed more acid reflux drugs, laxatives, anti-anaemic preparations, analgesics, and psycholeptics for CRC patients. CONCLUSIONS: The GP plays a significant role in the year after CRC diagnosis. This role may be associated with treatment-related side effects and psychological problems. Formal guidelines on the involvement of the GP during CRC treatment might ensure more effective allocation and communication of care between primary and secondary healthcare services

Increased primary health care use in the fi rst year after colorectal cancer diagnosis

Abstract Objective. The view that the general practitioner (GP) should be more involved during the curative treatment of cancer is gaining support. This study aimed to assess the current role of the GP during treatment of patients with colorectal cancer (CRC). Design. Historical prospective study, using primary care data from two cohorts. Setting. Registration Network Groningen (RNG) consisting of 18 GPs in three group practices with a dynamic population of about 30 000 patients. Subjects. Patients who underwent curative treatment for CRC (n ϭ 124) and matched primary care patients without CRC (reference population; n ϭ 358). Main outcome measures. Primary healthcare use in the period 1998 -2009. Findings . Patients with CRC had higher primary healthcare use in the year after diagnosis compared with the reference population. After correction for age, gender, and consultation behaviour, CRC patients had 54% (range 23 -92%) more face-to-face contacts, 68% (range 36 -108%) more drug prescriptions, and 35% (range -4 -90%) more referrals compared with reference patients. Patients consulted their GP more often for reasons related to anaemia, abdominal pain, constipation, skin problems, and urinary infections. GPs also prescribed more acid refl ux drugs, laxatives, anti-anaemic preparations, analgesics, and psycholeptics for CRC patients. Conclusions. The GP plays a signifi cant role in the year after CRC diagnosis. This role may be associated with treatment-related side effects and psychological problems. Formal guidelines on the involvement of the GP during CRC treatment might ensure more effective allocation and communication of care between primary and secondary healthcare services

Role of the general practitioner during the active breast cancer treatment phase: an analysis of health care use

PURPOSE: Little is known about the actual involvement of the general practitioner (GP) during the active breast cancer treatment phase. Therefore, this study explored (disease-specific) primary health care use among women undergoing active treatment for breast cancer compared with women without breast cancer. METHODS: A total of 185 women with a first diagnosis of early-stage breast cancer between 1998 and 2007 were identified in the primary care database of the Registration Network Groningen and matched with a reference population of 548 women without breast cancer on birth year and GP. RESULTS: Since diagnosis, patients with breast cancer had twice as many face-to-face contacts compared with women from the reference population (median 6.0 vs 3.0/year, Mann-Whitney (M-W) test p < 0.001). The median number of drug prescriptions and referrals was also significantly higher among patients than among the reference population (11.0 vs 7.0/year, M-W test p < 0.001 and 1.0 vs 0.0/year, M-W test p < 0.001). More patients than women from the reference population had face-to-face contacts or were prescribed drugs for reasons related to breast cancer and its treatment, including gastrointestinal problems, psychological reasons and endocrine therapy. CONCLUSIONS: During the active breast cancer treatment phase, GPs are involved in the management of treatment-related side effects and psychological symptoms, as well as in the administration of endocrine therapy. Based on the findings of this study, interventions across the primary/secondary interface can be planned to improve quality of life and other outcomes in patients undergoing breast cancer treatment

Leidinggeven aan liefdewerk: een onderzoek naar de taken en competenties van diakenen in de Gereformeerde Kerken vrijgemaakt

Onderzoek naar het functioneren, de taakopvatting en de (gewenste) competenties van vrijgemaakt-gereformeerde diakenen. Het onderzoek is in 2007 uitgevoerd door medewerkers van het Centrum voor Samenlevingsvraagstukken van de Gereformeerde Hogeschool. Het onderzoek is uitgevoerd in opdracht van het Generaal Diaconaal Deputaatschap (GDD) van de Gereformeerde Kerken vrijgemaakt (GKv). Het GDD wilde een duidelijker beeld van de gereformeerde diaken, mede in het licht van de Wmo en de visie op de betekenis van diaconaat in de lokale samenleving. De hoofdvragen van het onderzoek zijn: Welke taken in kerk en samenleving dienen diakenen uit te voeren en over welke competenties dienen diakenen te beschikken om deze taken in kerk en samenleving te kunnen uitvoeren

Kerk & Caritas: een onderzoek naar vrijwilligerswerk en mantelzorg in vier orthodox-protestantse kerken

Kerkleden zetten zich vaker in voor vrijwilligerswerk dan mensen die niet aan een kerkgenootschap verbonden zijn. Toch bestaat de vrees - onder andere bij zorginstellingen - dat de vrijwillige inzet van kerkelijke mensen aan het afnemen is. Dit onderzoek beoogt het beeld voor wat betreft de orthodox-protestantse (gereformeerde) gezindte te verhelderen. Er is aandacht besteed aan zowel de inzet van leden van orthodox-protestantse kerken (aanbodkant) als aan vrijwilligersinzet specifiek in zorg- en hulpverleningsinstellingen (vraagkant)

The prevalence of long-term symptoms of depression and anxiety after breast cancer treatment:A systematic review

Objectives It is unclear whether breast cancer survivors have a higher risk of long-term symptoms of depression or anxiety. The aim of this study was to systematically review the evidence about long-term symptoms of depression and anxiety in breast cancer survivors. Study design Systematic review. Main outcome measures PubMed, Embase, Cochrane and PsycINFO were searched for studies with at least 100 survivors ≥1 year after diagnosis, and which used common questionnaires measuring symptoms of depression or anxiety, by two independent reviewers. The quality was assessed with the NIH ‘Quality Assessment Tool’ checklist. Prevalence of symptoms of depression and anxiety was compared to time since diagnosis, available control groups and a general female population. Results Seventeen articles were included in this review with an average quality score of 57% (range 38–86%). The prevalence of symptoms of depression varied from 9.4% to 66.1% and of anxiety from 17.9% to 33.3%. The results on the depression scale suggested an increase in risk of symptoms of depression for breast cancer survivors at one year after diagnosis, which decreases over the ensuing years. Symptoms of anxiety were not more prevalent among the women with early stage breast cancer. Conclusions This review suggests a higher prevalence of symptoms of depression among breast cancer survivors than among the general female population, persistent over more than 5 years after diagnosis. Health care providers should be aware of this. There was no indication for an increased prevalence of symptoms of anxiety among breast cancer survivors. (aut. ref.

Patients' beliefs about the aims of breast cancer follow-up:A qualitative study

Objective: To explore patients' beliefs about the aims of breast cancer follow-up, and to compare these with the current literature on best practice for survivor care. Study design: We reviewed the literature on breast cancer and interviewed 61 women with a history of early-stage breast cancer. By means of descriptive content analysis with qualitative and quantitative elements, the patients' verbatim responses were thematically and independently analysed by two researchers. Results were compared with current literature and breast cancer guidelines. Results: When patients were asked to comment on what they thought the aims of breast cancer follow-up were, they most frequently mentioned 'detection of recurrence' and 'receiving reassurance', followed by 'receiving psychological support', and 'collecting data to evaluate care'. Some patients explicitly mentioned 'surveillance for metastatic disease' as an aim of follow-up. However, some patients believed that breast cancer could not recur after 2-5 years of follow-up, and that recurrences could not develop directly after or between follow-up appointments. In relation to follow-up appointments, some patients experienced anxiety, while others felt it made them confront their breast cancer history. Conclusions: Patients' beliefs are often not in line with guidelines. Educating patients about the aims of follow-up, and the evidence underlying it, might be important, in part to make patients' expectations more realistic. (C) 2016 Elsevier Ireland Ltd. All rights reserved

Projectverslag Jaar van de zingeving: Ziekenhuis Van Weel-Bethesda, Hogeschool Viaa

In samenwerking met het lectoraat Zorg en Zingeving van Hogeschool Viaa te Zwolle heeft een stuurgroep activiteiten voorbereid om met het verpleegkundig personeel aandacht te geven aan zingeving. Gedurende het jaar 2018 bevorderen zij via bijeenkomsten en een e-learningmodule bewustwording en deskundigheid. Bovendien zal een aantal verpleegkundigen fungeren als Aandachtsvelder Zingeving, zodat ook de borging in teamfunctioneren, methodisch handelen en multidisciplinaire samenwerking vorm krijgt. Tot slot zal met behulp van onderzoek en kennisdeling aandacht voor zingeving versterkt worden