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Background To evaluate the effects of a shared decision making (SDM) intervention for older adults with multiple chronic conditions (MCCs). Methods A pragmatic trial evaluated the effects of the SDMMCC intervention, existing of SDM training for nine geriatricians in two hospitals and a preparatory tool for patients. A prospective pre-intervention post-intervention multi-center clinical study was conducted in which an usual care group of older patients with MCC and their informal caregivers was included before the implementation of the intervention and a new cohort of patients and informal caregivers after the implementation of the intervention. SDM was observed using the OPTIONMCC during video-recorded consultations. Patient- and caregivers reported outcomes regarding their role in SDM, involvement, perceived SDM and decisional conflict were measured. The differences between groups regarding the level of observed SDM (OPTIONMCC) were analyzed with a mixed model analysis. Dichotomous patient-reported outcomes were analyzed with a logistic mixed model. Results From two outpatient geriatric clinics 216 patients with MCCs participated. The mean age was 77.3 years, and 56.3% of patients were female. No significant difference was found in the overall level of SDM as measured with the OPTIONMCC or in patient-reported outcomes. However, at item level the items discussing ‘goals’, ‘options’, and ‘decision making’ significantly improved after the intervention. The items discussing ‘partnership’ and ‘evaluating the decision-making process’ showed a significant decrease. Fifty-two percent of the patients completed the preparatory tool, but the results were only discussed in 12% of the consultations. Conclusion This study provides scope for improvement of SDM in geriatrics. Engaging older adults with MCCs and informal caregivers in the decision making process should be an essential part of SDM training for geriatricians, beyond the SDM steps of explaining options, benefits and harms. More attention should be paid to the integration of preparatory work in the consultation.

This study examined cancer patients’ (N = 355, 65.4 % female, Mage = 54.35, SDage = 11.25) perceived emotional and informational support from a variety of interpersonal and media sources. We recruited patients from cancer patient association websites and online cancer forums and asked them to report to what extent they received support from interpersonal and media sources. Patients rated professional sources (e. g., oncologists) and personal sources (e. g., family) as nearly equal sources of emotional support; however, professional sources were rated as significantly greater sources of informational support. Although family and oncologists were the most mentioned interpersonal sources of support, they were also the most mentioned disappointing sources. Of the media sources, online interaction sources (e. g., online support groups) were rated as nearly equivalent sources of emotional support as interpersonal sources. That patients perceived emotional support, not only informational support, from various media sources is promising since interpersonal sources can be disappointing to some patients.

What was the impact of physical distancing on socially vulnerable groups needing care during the first COVID-19 pandemic lockdown in the Netherlands? We conducted repeated qualitative interviews with 141 people in care relationships and 106 professionals, and two repeated surveys among older populations outside (n = 1697) and inside long-term care facilities (n = 2619). Findings show a diversity of experiences, ranging from relative calmness and feeling socially normal, to loneliness and loss of perspective. Care must be seen as essential social traffic needed to guarantee basic quality of life for these groups during disease outbreaks. Findings emphasise an empirical ethics approach to policy interventions.

Background: Shared decision making (SDM) can be beneficial for patients and healthcare professionals, but is often not applied in practice. A clinical decision support system (CDSS) can facilitate SDM. However, CDSS acceptance rates are rather low. One context in which SDM between a general practitioner (GP) and patient regarding medication can be of great value is older patients’ medication-related fall risk. Applying user-centered design to optimally tailor the CDSS to the needs and wishes of GPs can help overcome the low CDSS-acceptance rates. The current study aims to learn GPs’ needs and wishes for a CDSS focused on diminishing medication-related fall risk.Materials and Methods: Participants were recruited through the Amsterdam Academic Network of General Practice and were sent a web-lecture as preparation. Three online focus groups with a total of 13 GPs were performed and were led by two moderators. The focus groups were recorded and transcribed verbatim. Transcripts were analyzed using Atlas.ti.Results: GPs’ views on the workflow, risk presentation and advice of the system were elicited. The fit with the GPs’ workflow was elaborately discussed, for instance how the CDSS could support the selection of patients at risk. GPs articulated a strong preference for a visual risk presentation, in the form of a gradient scale ranging from bright green to dark red. Furthermore, they preferred receiving both medication-related and non-medication-related advice, which should be presented on request.Discussion: The findings provide a valuable insight into GPs’ needs and wishes for a CDSS focused on medication-related fall prevention. This will inform the design of a first prototype of the CDSS which will be subjected to usability tests. The findings of this study can also be used to support the development of medication-related CDSSs in a broader context.

Background and objectives Many Western countries face a shortage of African blood donors, while their specific blood groups are needed to transfuse chronic transfusion patients of similar ethnic background. Blood donation awareness and attitudes greatly impact the decision to become a blood donor, but how they are related and differ across ethnic groups is understudied. This study investigated blood donation awareness and attitudes of individuals of Dutch and African descent in the Netherlands. Materials and methods Survey data of 257 African and 152 Dutch non-donors measuring donation awareness (i.e. being familiar with the Dutch blood bank organization and knowing others who donated blood), cognitive (evaluative judgements) and affective (emotional reactions) attitudes were included. t-Tests, chi-square tests, linear and logistic regressions were conducted to study differences and associations between donation awareness and attitudes. Results African individuals were less often aware of the Dutch blood bank organization (43%; p < 0·05) or others who donated blood (51%; p < 0·05) than Dutch individuals (55% and 68%, respectively). African individuals had lower cognitive donation attitudes compared with Dutch individuals (p < 0·001), but no differences were found for affective attitudes (p = 0·55). High donation awareness was associated with higher cognitive (p < 0·001) and affective (p < 0·05) donation attitudes among African minorities, but not among Dutch individuals. Conclusion The lower donation awareness and cognitive attitudes of African minorities should be taken into consideration in donor recruitment. Raising awareness through effective communication strategies might be essential in the donor decision making process of this target group.

Objective: To investigate 1) younger (< 65) and older (>= 65) adults' preference for and understanding of graph formats presenting risk information, and 2) the contribution of age, health literacy, numeracy and graph literacy in understanding information.Materials and methods: To assess preferences, participants (n = 219 < 65 and n = 227 >= 65) were exposed to a storyboard presenting six types of graphs. Understanding (verbatim and gist knowledge) was assessed in an experiment using a 6 (graphs: clock, bar, sparkplug, table, pie vs pictograph) by 2 (age: younger [= 65]) between-subjects design.Results: Most participants preferred clock, pie or bar chart. Pie was not well understood by both younger and older people, and clock not by older people. Bar was fairly well understood in both groups. Table yielded high knowledge scores, particularly in the older group. Lower age, higher numeracy and higher graph literacy contributed to higher verbatim knowledge scores. Higher health literacy and graph literacy were associated with higher gist knowledge.Discussion and conclusion: Although not the preferred format, tables are best understood by older adults.Practice implications: Graph literacy skills are essential for both verbatim and gist understanding, and are important to take into account when developing risk information. (C) 2020 The Authors. Published by Elsevier B.V.

Contains fulltext : 251428.pdf (Publisher’s version ) (Open Access) OBJECTIVES: To gain insight into (1) the unfulfilled instrumental and affective needs of Turkish-Dutch and Moroccan-Dutch older cancer patients/survivors, (2) the barriers perceived by healthcare professionals in fulfilling these needs, and (3) how the Health Communicator, a multilingual eHealth tool, can support the fulfillment of patients'/survivors' needs, and decrease professionals' barriers. DESIGN: We conducted a pre-implementation study of the Health Communicator using semi-structured interviews with Turkish-Dutch (n = 10; mean age = 69.10) and Moroccan-Dutch (n = 9; mean age = 69.33) older cancer patients/survivors, and held two focus groups with general practitioners (GPs; n = 7; mean age 45.14) and oncology nurses (ONs; n = 5; mean age = 49.60). Topic list consisted of questions related to needs and perceived barriers. Analysis was based on grounded theory. The acceptance of the Health Communicator was inquired by questions based on the concepts of the Technology Acceptance Model, and analyzed deductively. RESULTS: Patients/survivors reported unfulfilled needs concerning: (1) information about cancer (treatment), (2) information about the healthcare system, (3) possibilities regarding psychosocial support, and (4) doctor-patient relationship. Among professionals, the main perceived barriers were: (1) patients'/survivors' low health literacy and language barrier, (2) cultural taboo, (3) lack of insight into patients' instrumental needs, and (4) patients'/survivors' lack of trust in Dutch healthcare. Both patients/survivors and professionals thought that implementing the Health Communicator could be effective in fulfilling most of the needs and decreasing the barriers. However, a majority of the patients/survivors were hesitant regarding the use of it, because they found it too difficult to use. Professionals showed a positive intention towards using the Health Communicator. CONCLUSIONS: To enhance patient participation among older migrant cancer patients/survivors, the Health Communicator is, under certain conditions, a promising tool for fulfilling patients'/survivors' unfulfilled instrumental and affective needs and for bridging barriers perceived by professionals.

BackgroundRisk information in patient decision aids (PDAs) is often difficult for older patients to process. Providing audiovisual and narrative information may enhance the understanding and use of health-related information. We studied the effects on patients’ information processing and use of audiovisual and narrative information of an early-stage non–small-cell lung cancer treatment decision aid explaining surgery and stereotactic ablative radiotherapy. We further investigated differences between older and younger patients.MethodsWe conducted a 2 (modality: textual v. audiovisual) × 2 (narration style: factual v. narrative) online experiment among cancer patients and survivors ( N = 305; Mage= 62.42, SD = 11.68 y). Age was included as a potential modifier: younger (ResultsIrrespective of patient age, audiovisual information (compared with textual information) led to lower perceived cognitive load, higher satisfaction with information, and lower decisional conflict (subscale Effective Decision). Narrative information (compared with factual information) led to reduced decisional conflict (subscale Uncertainty) but only in younger patients. Combining audiovisual information with factual information also resulted in lower perceived cognitive load in younger patients as compared with older patients.LimitationsPatients who actually face the decision, especially older patients, might be more motivated to process our decision-aid information than the present study participants who responded to a hypothetical situation online.ConclusionsProviding participants with audiovisual information, irrespective of their age, improved their processing and use of information in a decision aid. Narratives did not clearly benefit information processing.

ObjectiveThis study explores how patients with Inflammatory Bowel Disease (IBD) and nurse practitioners (NPs) in the Netherlands communicate about online health information-seeking.MethodsWe analyzed 165 consultations of patients at the start of maintenance treatment using grounded theory. Consultations in which the words; internet, website, Google, Googled, webpages, online (forum/blog/platform) or a website was mentioned, were included. Segments were identified and analyzed that represented a discussion about online health information-seeking (n = 87). We coded the initiator, initiation and reaction communication strategy.ResultsHalf of the sample was female, most patients were moderately to highly educated and aged on average 48 years. One third of the consultations included a discussion about online health information-seeking. Seventeen communication initiation and reactions strategies were identified. Patients and NPs were equally as likely to initiate a neutral discussion about online health information-seeking. Patients repeatedly reacted with disclosing their concerns. NPs responded by taking patients’ online health information-seeking seriously or affirming patients’ beliefs.ConclusionThis exploration makes a unique contribution by demonstrating that NPs particularly adopt a patient-centered communication style while communicating about patients’ online health information-seeking.Practice implicationsResults of this study could guide interventions to train providers in talking about patients’ online health information-seeking.

ObjectivesTailoring medical information to cancer patients’ needs is recommended, but there is little guidance on how to tailor, and limited research exists about its effects. Tailoring to the amount of preferred information may be easily implementable in clinic and is tested here.MethodsA video-vignette experiment was used to systematically vary video patients’ information preferences (limited/extensive) and amount of provided information (additional/no additional). N = 253 cancer patients/survivors evaluated these video-recorded consultations, serving as analogue patients (APs), and completed outcome measures.ResultsTailoring information to video patients’ preferences had no effect on APs’ evaluation of the consultation (satisfaction, trust). Yet, there was a main effect of APs’ own information preferences: Those preferring extensive information recalled (MΔ = 5.8%) and recognized (MΔ = 3.5%) more information than those preferring limited information. Moreover, information provision mattered among APs who preferred limited information: They recognized even less if provided with extensive information.ConclusionsTailoring to the amount of video patient’s information preferences did not affect APs’ evaluation of the consultation (satisfaction, trust), while APs’ personal information preferences determined their recall and recognition of medical information.Practice implicationsInformation preferences should be assessed and tailored to in clinical practice. Overwhelming patients/survivors, who prefer limited information, should be prevented.

Background The online tool PatientVOICE has been developed to enhance older patients’ participation during educational nursing encounters preceding chemotherapy and to increase their information recall.Objective The aim of this study was to evaluate perceived usefulness, usability, satisfaction with emotional support, language use, attractiveness, and visit intention of PatientVOICE by older (ex-)patients with cancer.Methods Older (ex-)patients with cancer were invited to evaluate the website via an online questionnaire. Perceived usefulness, usability, and satisfaction with emotional support were measured using evaluation statements, the System Usability Scale, and an adapted subscale of the Website Satisfaction Scale, respectively. Questions were also included about language use and attractiveness of the website and patients’ intention to visit the website.Results A total of 44 questionnaires were analyzed. Many patients evaluated the provided information and other integrated techniques (such as the question prompt sheet, video fragments, and the audio facility) positively on aspects as usefulness and helpfulness. The usability was considered good (mean scale score, 74.3). Most patients (84.9%) considered the language use on the website clear, and 63.6% of the patients found the website attractive. Many patients (71.9%) would visit the website if they would like to gather information on the encounter preceding chemotherapy, and 62.5% of the patients would do this for information about chemotherapy.Conclusions PatientVOICE is evaluated as a useful and user-friendly tool, enabling patients to prepare themselves for the nursing encounter preceding chemotherapy and to gather information about chemotherapy.Implications for Practice Preparatory online tools, such as PatientVOICE, can be implemented in hospitals to offer patients extra support.

Background: Due to various socio-cultural and language related factors, healthcare providers experience barriers when communicating with older culturally and linguistically diverse (CALD) patients with cancer, which can lower the quality of care received by patients and negatively impact healthcare providers. Studies focusing on communication barriers of older CALD patients with cancer and a systematic comparison of those barriers between different healthcare providers have been largely missing. Objectives: In order to lay out the healthcare providers' perceived barriers to communication, the present study identified and compared communication barriers among different healthcare providers when caring for older CALD patients with cancer. Methods: An online survey was conducted among healthcare providers in the Netherlands who identified as being involved in the care of CALD patients with cancer (N = 191), specifically; GPs (NGPs = 54), specialists (Nspecialists = 29), oncology nurses (Nnurses = 77), and pharmacists (Npharmacists = 31). Providers assessed twelve pre-specified factors on (i) importance and (ii) frequency of these factors as barriers to communication. A composite score by employing the QUOTE (Quality Of care Through the patients' Eyes) methodology was used to rank, and classify factors as either potential or influential barriers. Results and conclusion: Overall, low Dutch language proficiency of older CALD patients with cancer, family interpreters providing inadequate translations, not knowing the extent of patients' informational needs, cultural differences in views about healthcare (i.e., illnesses and treatments) and family members blocking communication were found to be influential communication barriers. Healthcare providers showed several differences in what they perceived to be a potential or an influential barrier: Cultural differences in views about healthcare and patients getting treatment in their home countries were important barriers for GPs, while not knowing the patient's contact person was for pharmacists. Nurses perceived the highest number of influential barriers, while specialists perceived the least. We conclude that specific interventions that address differences in perceived barriers among providers are needed, and we highlight potential interventions that involve digital communication tools, such as the Conversation Starter.

Background Medication is the second most important cause of falls in older adults, after mobility impairments. Doctors struggle to withdraw Fall Risk Increasing Drugs (FRIDs). They tend to overestimate the beneficial effect of medication and underestimate the risk of side effects. With an online survey we explored if 1) European doctors want digital support during medication review of older fallers by presentation of a personalized fall risk estimation of a patient and 2) what potential barriers and facilitators exist for the use of a Clinical Decision Support System (CDSS) that communicates fall risk. Methods We performed online surveys in 10 European countries among 359 European physicians who care for older fallers. 68% of the participants were geriatricians. Results 88% of physicians would like to receive help with performing a medication review. Barriers for usage that were mentioned most frequently were: technical issues (74%), indicating a reason when overriding an alert (62%) and unclear advice (60%). Most important facilitators were if the system: is beneficial to patient care (75%), is user friendly (74%) and fits into the workflow (66%) Conclusion most physicians would like to receive help from a CDSS when performing a medication review. For a successful implementation the barriers and facilitators found must be taken into account during development of the system as well as differences between countries.

Background Falls are the leading cause of injury and functional decline in older adults. Medication is a leading cause of falls, second only to mobility impairments. Older adults with Fall Risk Increasing Drug (FRID) use are not aware of having a risk of falling and most of them don’t relate fall risk to their drug use. With this European survey we explored if: 1) older adults want to know their personal fall risk, 2) if they want this to be shown via a patient portal, 3) what other elements a patient portal should contain and 4) what potential barriers and facilitators exist for usage of a patient portal. Methods We distributed a questionnaire in 10 European countries that was filled in by 58 older fallers (mean age 75,5 years) who visited a geriatric outpatient clinic. Results Most participants wanted to know their fall risk (82,8%). The most important elements for the Portal, besides fall risk, were information on FRIDs and patient’s illnesses (62%) and access to the medical record (57%). Paying for the system (63%) and privacy issues (53%) were the most important barriers for using the Portal. A user-friendly Portal (57%), the ability to share information with the doctor (47%) and recommendation by doctors (47%) were the most important facilitators. Conclusion More knowledge dissemination is needed to make older fallers aware of medications that can cause falls. This can be done via a Patient Portal. For a successful implementation, the barriers and facilitators should be taken into account.

BackgroundA medication-related Clinical Decision Support System (CDSS) is an application that analyzes patient data to provide assistance in medication-related care processes. Despite its potential to improve the clinical decision-making process, evidence shows that clinicians do not always use CDSSs in such a way that their potential can be fully realized. This systematic literature review provides an overview of frequently-reported barriers and facilitators for acceptance of medication-related CDSS.Materials and methodsSearch terms and MeSH headings were developed in collaboration with a librarian, and database searches were conducted in Medline, Scopus, Embase and Web of Science Conference Proceedings. After screening 5404 records and 140 full papers, 63 articles were included in this review. Quality assessment was performed for all 63 included articles. The identified barriers and facilitators are categorized within the Human, Organization, Technology fit (HOT-fit) model.ResultsA total of 327 barriers and 291 facilitators were identified. Results show that factors most often reported were related to (a lack of) usefulness and relevance of information, and ease of use and efficiency of the system.DiscussionThis review provides a valuable insight into a broad range of barriers and facilitators for using a medication-related CDSS as perceived by clinicians. The results can be used as a stepping stone in future studies developing medication-related CDSSs.

BackgroundIn 2018, Alden et al. showed that the desired degree of family involvement in medical decisions is an individual preference that is largely independent from East-West cultural stereotypes. At the same time, individual-level interdependence influenced whether patients preferred more individual or more family involvement in their decision making together with their medical care provider. The present study provides empirical evidence and adds evidence for Europe for which no such data previously existed.MethodsThe present study is a direct replication and extension of the original Alden et al. (2018) study (N = 2031; Australia, China, Malaysia, India, South Korea, Thailand, United States [U.S.]), however, using survey data from four European countries (Austria, Belgium, Germany, Netherlands) and the United States (U.S.) with a total sample size of N = 2750.ResultsRandom effects within-between models replicated the original primary finding that those with higher self-involvement in medical decision making preferred less family involvement. Furthermore, patients with lower self-independence, higher relational interdependence, and stronger beliefs in social hierarchy are more likely to want their families involved in medical decisions besides their health care provider.ConclusionsThese observed relationships are largely consistent both within and across the four European countries and the U.S. In conclusion, the results point to the importance of avoiding cultural stereotypes and instead, recognizing that patient desires for family involvement in medical decision making vary dramatically within cultures depending on multiple individual differences. Furthermore, a growing body of evidence suggests that these antecedents of family involvement as well as the construct itself may be measurable in diverse cultures with high levels of confidence in their reliability and validity.

ObjectiveTo develop a valid and reliable tool to measure triadic decision making between older adults with multiple chronic conditions (MCC), their informal caregivers and geriatricians.MethodsVideo observational study with cross-sectional assessment of interaction during medical consultations between geriatricians (n = 10), patients (n = 108) and informal caregivers (68) by three calibrated raters at the geriatric outpatient department of two Dutch hospitals.The Observer OPTIONMCC instrument was developed, based on the 'Dynamic model of SDM in frail older patients' and the 'Observing Patient Involvement in Decision Making - 5 item scale' (Observer OPTION-5).ResultsFactor analysis confirms that it is acceptable to regard the new scale as a single construct. The 7-item single factor solution explained 62.76% of the variability for geriatricians, 61.60% of the variability for patients and 54.32% of the variability for informal caregivers. The inter-rater ICC for the total Observer OPTIONMCC score was .96, .96, and .95 (resp. geriatricians, patients, informal caregivers), with values ranging from .60 to .95 for individual items, showing good levels of agreement.Conclusion and Practice ImplicationsWe conclude that Observer OPTIONMCC is sufficiently valid and reliable to be used for the assessment of triadic SDM in populations of older patients with MCC.

Individuals can feel more motivated to change health behaviour when perceiving autonomy-support, as induced through non-pressuring message phrasing and the provision of choice: autonomy-supportive message framing. Additionally, controlling message phrasing – commands that do not provide choice – can thwart autonomy and lead to reactance, which is detrimental to the persuasiveness of health messages. Many health messages have not been formulated in an autonomy-supportive manner and therefore could arouse reactance, resulting in reduced intervention effectiveness. We aimed to test the effects of autonomy-supportive vs. controlling alcohol reduction message frames on individuals’ perceived autonomy-support from these messages; and their reactance towards the message while considering the individual need for autonomy in the context of an online computer-tailored alcohol reduction intervention. A 2 (autonomy-supportive language vs. controlling language) × 2 (choice vs. no choice) between-subjects experiment ( N = 521) was conducted using an online computer-tailored alcohol reduction intervention. Outcome measures were perceived autonomy-support and reactance and we investigated whether an individual’s need for autonomy moderated the effect of autonomy-supportive and controlling message frames on those outcome variables. Multiple linear regression analyses showed that neither autonomy-supportive nor controlling message frames had significant effects on perceived autonomy-support or reactance, and there was no moderation from the need for autonomy. Overall, participants evaluated the intervention as positive and perceived high levels of autonomy-support, regardless of the message frame used. Future research needs to test whether the positive intervention evaluation is due to content tailoring, and whether more distinguishable manipulations of message frames could be effective.

ObjectiveTo provide an overview of information and participation preferences and needs of non-Western ethnic minority cancer patients living in Western countries.MethodsA systematic literature review was conducted using the databases PsycINFO, PubMed, CINAHL, and EMBASE. Thematic analysis was carried out to synthesize data, allowing for identification of important themes and synthesis of both qualitative and quantitative studies.ResultsForty-four papers were included. Non- Western ethnic minority cancer patients/survivors have high information preferences and needs regarding topics ranging from diagnosis to treatment and from prevention to the healthcare system. Younger, female, and unmarried patients/survivors, and patients with better language proficiency reported higher information preferences. Latin-American and African-American patients/survivors primarily prefer shared or active participation. Asian and Middle-Eastern patients/survivors prefer primarily passive participation. Younger patients, and those with a higher level of education and acculturation were more likely to prefer active or shared participation.ConclusionFurther (quantitative) research on factors associated with patients’ preferences is needed in order to better understand the underlying reasons of information and participation preferences and needs of diverse non-Western ethnic minority cancer patients.Practice implicationsTo better fulfil ethnic minority patients’/survivors’ preferences and needs healthcare providers should elaborate upon these and tailor their information- provision accordingly.

OBJECTIVE: To test the effect of autonomy-supportive message framing on people's perceived autonomy-support while considering the individual need for autonomy as a moderator. Also, to test whether autonomy-supportive message frames - through increased perceived autonomy-support - lead to more self-determined motivation, and increased intention to quit smoking.DESIGN: An online 2(autonomy-supportive; controlling language) × 2(choice; no choice) between-subjects design with control condition (generic advice) with adult smokers intending to quit (N = 626).MAIN OUTCOME: Intention to quit smoking (Theory of Planned Behaviour).MEASURES: Perceived autonomy-support (Virtual Climate Care Questionnaire), need for autonomy (Health Causality Orientations Scale), self-determined motivation (Treatment Self-Regulation Questionnaire), attitudes, social influence, self-efficacy (I-Change Model).RESULTS: Structural equation modelling revealed no significant effect of autonomy-supportive-message frames on perceived autonomy-support or self-determined motivation, neither did the need for autonomy moderate these effects. Self-determined motivation had a positive, significant effect on intention to quit, mediated by attitudes, social influence, and self-efficacy.CONCLUSION: Although message frames did not affect perceived autonomy-support or self-determined motivation, higher self-determined motivation increased intention to quit via attitudes, social influence, and self-efficacy. Before drawing the conclusion that message framing has no effect, we recommend to replicate this study in a real-life setting with smokers more likely to read and process the message frames more attentively.

Learning from each otherTo begin, our partnership conversations started dis-entangling some fundamental assumptions, strengths, and limitations of communication theory and methods as understood by members from the Health Communication Division of ICA and to connect those strengths to EACH. From a practical perspective, ICA members are Communication scholars and students who most often work in departments of Communication or Media, within Colleges of Arts, Humanities, and Social Sciences. In contrast, while some EACHRelational benefits of the partnershipOverall, we think the partnership between EACH and ICA will be beneficial to members of both organizations. EACH is a global organization dedicated to exploring and improving the ways in which healthcare professionals, patients, and family members communicate with one another. And while EACH focuses on many of the health communication issues that people in ICA examine, including public health communication, patients’ experiences with illness, shared decision-making, personalized healthPartnering opportunities at conferencesMark your calendars and look for a call for a co-sponsored panel to be included at the annual ICA conference in Paris in May 2022. The panel will focus on making connections for research partnerships. Beyond that, look for ongoing future opportunities on both organizations’ websites and your inbox.Also, the ICA Health Communication Division has adopted EACH’s Pairing with Colleagues Mentoring Program and we hope this partnership will strengthen opportunities for graduate students and earlyOrganizational benefits of the partnershipAs mentioned, EACH has chosen to become an affiliate organization to ICA to leverage common interests, perspectives, and expertise in communication in healthcare. At this point, formalizing the relationship translates into panel presentations at annual meetings shared across the organizations. Yet, we are working on how this formal relationship can be institutionalized in additional ways such that members benefit from membership in both organizations. Moreover, we are in conversation about

Contains fulltext : 235017.pdf (Publisher’s version ) (Open Access) BACKGROUND: For many patients with advanced cancer, the decision whether to participate in early phase clinical trials or not is complex. The decision-making process requires an in-depth discussion of patient values. We therefore aimed to synthesize and describe patient values that may affect early phase clinical trial participation. METHODS: We conducted a systematic search in seven electronic databases on patient values in relation to patients' decisions to participate in early phase clinical cancer trials. RESULTS: From 3072 retrieved articles, eleven quantitative and five qualitative studies fulfilled our inclusion criteria. We extracted ten patient values that can contribute to patients' decisions. Overall, patients who seek trial participation usually report hope, trust, quantity of life, altruism, perseverance, faith and/or risk tolerance as important values. Quality of life and humanity are main values of patients who refuse trial participation. Autonomy and social adherence can be reported by both trial seekers or refusers, dependent upon how they are manifested in a patient. CONCLUSIONS: We identified patient values that frequently play a role in the decision-making process. In the setting of discussing early phase clinical trial participation with patients, healthcare professionals need to be aware of these values. This analysis supports the importance of individual exploration of values. Patients that become aware of their values, e.g. by means of interventions focused on clarifying their values, could feel more empowered to choose. Subsequently, healthcare professionals could improve their support in a patients' decision-making process and reduce the chance of decisional conflict.

Contains fulltext : 240024.pdf (Publisher’s version ) (Open Access) Objective: To investigate the applicability of supervised machine learning (SML) to classify health-related webpages as 'reliable' or 'unreliable' in an automated way. Methods: We collected the textual content of 468 different Dutch webpages about early childhood vaccination. Webpages were manually coded as 'reliable' or 'unreliable' based on their alignment with evidence-based vaccination guidelines. Four SML models were trained on part of the data, whereas the remaining data was used for model testing. Results: All models appeared to be successful in the automated identification of unreliable (F1 scores: 0.54–0.86) and reliable information (F1 scores: 0.82–0.91). Typical words for unreliable information are 'dr', 'immune system', and 'vaccine damage', whereas 'measles', 'child', and 'immunization rate', were frequent in reliable information. Our best performing model was also successful in terms of out-of-sample prediction, tested on a dataset about HPV vaccination. Conclusion: Automated classification of online content in terms of reliability, using basic classifiers, performs well and is particularly useful to identify reliable information. Practice implications The classifiers can be used as a starting point to develop more complex classifiers, but also warning tools which can help people evaluate the content they encounter online. 7 p.

Urbanisation and common mental disorders (CMDs; ie, depressive, anxiety, and substance use disorders) are increasing worldwide. In this Review, we discuss how urbanicity and risk of CMDs relate to each other and call for a complexity science approach to advance understanding of this interrelationship. We did an ecological analysis using data on urbanicity and CMD burden in 191 countries. We found a positive, non-linear relationship with a higher CMD prevalence in more urbanised countries, particularly for anxiety disorders. We also did a review of meta-analytic studies on the association between urban factors and CMD risk. We identified factors relating to the ambient, physical, and social urban environment and showed differences per diagnosis of CMDs. We argue that factors in the urban environment are likely to operate as a complex system and interact with each other and with individual city inhabitants (including their psychological and neurobiological characteristics) to shape mental health in an urban context. These interactions operate on various timescales and show feedback loop mechanisms, rendering system behaviour characterised by non-linearity that is hard to predict over time. We present a conceptual framework for future urban mental health research that uses a complexity science approach. We conclude by discussing how complexity science methodology (eg, network analyses, system-dynamic modelling, and agent-based modelling) could enable identification of actionable targets for treatment and policy, aimed at decreasing CMD burdens in an urban context.

Background and objectivesBlood donors of African descent are essential for the availability of specific antigen-negative blood, yet past recruitment strategies yielded limited successes. The aim was to systematically develop an intervention to recruit African blood donors in the Netherlands, following the Intervention Mapping (IM) protocol.Materials and methodsBased on the previous needs-assessment (Step 1), change objectives (Step 2) and practical strategies (Step 3) were developed, and further determined through eight interviews and two focus groups with blood bank staff and experts. The strategies were then translated into a magazine article pilot-experiment (n = 16) as part of the programme production (Step 4). The magazine appraisal and intention-change were studied of the target group and compared with a previously published magazine article and a control group in an online survey.ResultsImportant factors in the needs-assessment related to donation awareness and knowledge and were also rated by staff and experts as most relevant and feasible determinants. The finalized objectives and strategies consisted of awareness raising and understanding how and where to donate blood. In the magazine pilot, the look and feel of the previously published article was higher valued, but the newly developed article’s content was higher rated. Reading the magazine articles increased donation intention as compared to the pre-test and reference, but the increase did not differ between the articles.ConclusionIM helped to define intervention objectives and strategies and gave valuable insights in how to implement (step 5) and evaluate (step 6) a donor recruitment intervention.

Background The use of patient portals for presenting health-related patient data, such as blood test results, is becoming increasingly important in health practices. Patient portals have the potential to enhance patient health engagement, but content might be misinterpreted. Objective This study aimed to discover whether the way of presenting blood test outcomes in an electronic patient portal is associated with patient health engagement and whether this varies across different blood test outcomes. Methods A 2x3 between-subjects experiment was conducted among members of the Nivel Dutch Health Care Consumer Panel. All participants read a scenario in which they were asked to imagine themselves receiving blood test results. These results differed in terms of the presented blood values (ie, normal vs partially abnormal vs all abnormal) as well as in terms of whether the results were accompanied with explanatory text and visualization. Patient health engagement was measured both before (T0) and after (T1) participants were exposed to their fictive blood test results. Results A total 487 of 900 invited members responded (response rate 54%), of whom 50.3% (245/487) were female. The average age of the participants was 52.82 years (SD 15.41 years). Patient health engagement saw either a significant decrease or a nonsignificant difference in the experimental groups after viewing the blood test results. The mean difference was smaller in the groups that received blood test results with additional text and visualization (meanT0 5.33, SE 0.08; meanT1 5.14, SE 0.09; mean difference 0.19, SE 0.08, P=.02) compared with groups that received blood test results without explanatory text and visualization (meanT0 5.19, SE 0.08; meanT1 4.55, SE 0.09; mean difference 0.64, SE 0.08, P Conclusions Adding text and visualization features can attenuate the decrease in patient health engagement in participants who receive outcomes of a blood test via a patient portal, particularly when blood test results are (partly) normal. This suggests that explanatory text and visualization can be reassuring. Future research is warranted to determine whether these results can be generalized to a patient population who receive their actual blood test results.

IntroductionUnderstanding how information needs of older patients with cancer vary is essential for patient-centered communication. Little research has considered the potential complex patterns in information needs among older patients with cancer. This study aims to identify profiles of older patients with cancer based on differences in their information needs.Materials and MethodsTwo-hundred and twenty-three patients with cancer and survivors aged 70 years or older completed an online survey. Based on an extensive scoping review, we included measures on information needs (i.e., monitoring coping style and type of information needs as measured with QUOTE) and related factors (i.e., psychological distress, ability, motivation, participation in decision making, and demographics). Profiles were identified using k-means cluster analysis.ResultsAnalysis revealed three profiles of older patients with cancer exhibiting differences in monitoring coping style and type of information needs: the so-called “information seeker” (38.8%), the “listener” (47.2%), and the “information avoider” (14.0%). Besides differences in information needs, the profiles differed on psychological distress (i.e., intrusive thinking, cancer worry, and intolerance of uncertainty), ability (i.e., self-efficacy in interaction with physician), and motivation (i.e., information goals and future time perspective).DiscussionOur findings revealed a nuanced perspective to information needs of older patients with cancer by combining two measurements of information needs with factors contributing to these needs. Clinicians could use these results to increase their awareness of the complexity and heterogeneity of information needs in older patients with cancer and to tailor their information to the needs of older patients.

Prior online health research has mainly focused on the predictors or outcomes of online health information, leaving online health information itself understudied. Therefore, online health information has remained an umbrella term encompassing different platforms (expert- vs. peer-generated). A hybrid method that combines qualitative and computational methods is used to identify different topics discussed on these different platforms, and an initial model of patients’ social support needs was developed and applied to data obtained from the hybrid method. Using topic modeling (Nposts = 52.990), topics on two expert- and two peer-generated platforms were identified. Differences between and within platforms were found. While peer-generated platforms mainly covered interaction on emotional support topics, expert-generated platforms covered informational topics. Within peer-generated platforms, patients used their experiences differently.

Over the course of March 2020, the everyday life of most people changed from normal to extraordinary around the globe. By the beginning of March, there had been serious outbreaks of COVID-19 in a limited number of countries, such as China, South Korea, Iran and Italy, while many others experienced a lull before the storm. People in unaffected countries understood that the Corona SARS CoV-2 virus might reach their shores at one point; the question was when and how hard it would hit. By the end of March, many governments had ordered drastic measures. Schools and university campuses were shut down. Shops, restaurants and companies were closed. People in many different jobs were asked to work from home, and many were in quarantines.

Background The content of online computer-tailored interventions is often determined to match an individual’s characteristics, beliefs, and behavioral factors. These content-tailored interventions lead to better message processing and a higher likelihood of behavior change such as smoking cessation. However, a meta-analysis of online computer-tailored interventions showed that effect sizes, albeit positive, remain small, suggesting room for improvement. A promising strategy to enhance the effectiveness of online computer-tailored interventions is to tailor the message frame (ie, how a message is communicated) based on the preferred communication style of the user in addition to content-tailoring. One factor that determines an individual’s communication style preference is the need for autonomy; some individuals prefer an autonomy-supportive communication style (offering choice and use of suggestive language), whereas others might prefer a directive communication style, which is replete with imperatives and does not provide choice. Tailoring how messages are presented (eg, based on the need for autonomy) is called message frame-tailoring. Objective The aim of the present study was to test the effectiveness of message frame-tailoring based on the need for autonomy, in isolation and in combination with content-tailoring, within the context of an online computer-tailored smoking cessation intervention. The primary outcome measure was the 7-day point-prevalence of smoking abstinence. Secondary outcomes were perceived message relevance, self-determined motivation to quit smoking, and sociocognitive beliefs. Methods A randomized controlled trial with a 2 (message frame-tailoring vs no message frame-tailoring) by 2 (content-tailoring vs no content-tailoring) design was conducted among adult smokers intending to quit smoking (N=273). Results Structural equation modeling revealed that the content-tailored condition increased smoking abstinence rates 1 month after the start of the intervention (beta=.57, P=.02). However, neither message frame-tailoring nor its interaction with content-tailoring significantly predicted smoking abstinence. In our model, message frame-tailoring, content-tailoring, as well as their interaction significantly predicted perceived relevance of the smoking cessation messages, which consequently predicted self-determined motivation. In turn, self-determined motivation positively affected attitudes and self-efficacy for smoking cessation, but only self-efficacy consequently predicted smoking abstinence. Participants in the control condition perceived the highest level of message relevance (mean 4.78, SD 1.27). However, messages that were frame-tailored for individuals with a high need for autonomy in combination with content-tailored messages led to significantly higher levels of perceived message relevance (mean 4.83, SD 1.03) compared to those receiving content-tailored messages only (mean 4.24, SD 1.05, P=.003). Conclusions Message frame-tailoring based on the need for autonomy seems to be an effective addition to conventional content-tailoring techniques in online smoking cessation interventions for people with a high need for autonomy; however, this is not effective in its current form for people with a low need for autonomy. Trial Registration Dutch Trial Register (NL6512/NRT-6700); https://www.trialregister.nl/trial/6512

Background The aim of this study was to describe barriers and facilitators for shared decision making (SDM) as experienced by older patients with multiple chronic conditions (MCCs), informal caregivers and health professionals. Methods A structured literature search was conducted with 5 databases. Two reviewers independently assessed studies for eligibility and performed a quality assessment. The results from the included studies were summarized using a predefined taxonomy. Results Our search yielded 3838 articles. Twenty-eight studies, listing 149 perceived barriers and 67 perceived facilitators for SDM, were included. Due to poor health and cognitive and/or physical impairments, older patients with MCCs participate less in SDM. Poor interpersonal skills of health professionals are perceived as hampering SDM, as do organizational barriers, such as pressure for time and high turnover of patients. However, among older patients with MCCs, SDM could be facilitated when patients share information about personal values, priorities and preferences, as well as information about quality of life and functional status. Informal caregivers may facilitate SDM by assisting patients with decision support, although informal caregivers can also complicate the SDM process, for example, when they have different views on treatment or the patient’s capability to be involved. Coordination of care when multiple health professionals are involved is perceived as important. Conclusions Although poor health is perceived as a barrier to participate in SDM, the personal experience of living with MCCs is considered valuable input in SDM. An explicit invitation to participate in SDM is important to older adults. Health professionals need a supporting organizational context and good communication skills to devise an individualized approach for patient care.

Background Shared decision making (SDM) contributes to personalized decisions that fit the personal preferences of patients when choosing a treatment for a condition. However, older adults frequently face multiple chronic conditions (MCC). Therefore, implementing SDM requires special features. The aim of this paper is to describe the development of an intervention to improve SDM in older adults with MCC. Methods Following the Medical Research Council framework for developing complex interventions, the SDMMCC intervention was developed step-wise. Based on a literature review and empirical research in a co-creation process with end users, we developed training for geriatricians and a preparatory tool for older patients with MCC and informal caregivers. After assessing feasibility, the intervention was implemented in a pilot study (N = 108) in two outpatient geriatric clinics of an academic and a non-academic teaching hospital in Amsterdam, the Netherlands. Results Key elements of the training for geriatricians include developing skills to involve older adults with MCC and informal caregivers in SDM and following the six-step ‘Dynamic model for SDM with frail older patients’, as well as learning how to explore personal goals related to quality of life and how to form a partnership with the patient and the informal caregiver. Key elements of the preparatory tool for patients include an explicit invitation to participate in SDM, nomination that the patient’s own knowledge is valuable, invitation to form a partnership with the geriatrician, encouragement to share information about daily and social functioning and exploration of possible goals. Furthermore, the invitation of informal caregivers to share their concerns was also a key element. Conclusions Through a process of co-creation, both training for geriatricians and a preparatory tool for older adults and their informal caregivers were developed, tailored to the needs of the end users and based on the ‘Dynamic model of SDM with frail older patients’.

BackgroundOlder migrant patients with cancer face many language- and culture-related barriers to patient participation during medical consultations. To bridge these barriers, an eHealth tool called Health Communicator was developed in the Netherlands. Essentially used as a digital translator that can collect medical history information from patients, the Health Communicator did not include an oncological module so far, despite the fact that the prevalence of Dutch migrant patients with cancer is rising.ObjectiveThis study aims to systematically develop, implement, and conduct a pilot evaluation of an oncological module that can be integrated into the Health Communicator to stimulate patient participation among older Turkish-Dutch and Moroccan-Dutch patients with cancer.MethodsThe Spiral Technology Action Research model, which incorporates 5 cycles that engage key stakeholders in intervention development, was used as a framework. The listen phase consisted of a needs assessment. The plan phase consisted of developing the content of the oncological module, namely the question prompt lists (QPLs) and scripts for patient education videos. On the basis of pretests in the do phase, 6 audiovisual QPLs on patient rights, treatment, psychosocial support, lifestyle and access to health care services, patient preferences, and clinical trials were created. Additionally, 5 patient education videos were created about patient rights, psychosocial support, clinical trials, and patient-professional communication. In the study phase, the oncological module was pilot-tested among 27 older Turkish-Dutch and Moroccan-Dutch patients with cancer during their consultations. In the act phase, the oncological model was disseminated to practice.ResultsThe patient rights QPL was chosen most often during the pilot testing in the study phase. Patients and health care professionals perceived the QPLs as easy to understand and useful. There was a negative correlation between the tool’s ease of use and patient age. Patients reported that using the module impacted the consultations positively and thought they were more active compared with previous consultations. Health care professionals also found patients to be more active than usual. Health care professionals asked significantly more questions than patients during consultations. Patients requested to see the patients’ rights video most often. Patients rated the videos as easy to understand, useful, and informative. Most of the patients wanted to use the tool in the future.ConclusionsOlder migrant patients with cancer, survivors, and health care professionals found the oncological module to be a useful tool and have shown intentions to incorporate it into future consultation sessions. Both QPLs and videos were evaluated positively, the latter indicating that the use of narratives to inform older, low-literate migrant patients with cancer about health-related topics in their mother tongue is a viable approach to increase the effectiveness of health care communication with this target group.

Audiovisual and narrative information are often used in online decision aids. However, few studies have tested whether these strategies are more effective compared to other types of information. We tested the effect of these strategies on satisfaction with the information, recall and informed decision-making in a 2 (Modality: audiovisual vs. textual) x 2 (Narration style: narrative vs. factual) experimental design. Data was collected in an online experiment among 262 analogue cancer patients. Since most cancer patients are older people, we also assessed if the effectiveness of these strategies differs depending on the patient's age. Data was analyzed using Structural Equation Modeling. Findings showed audiovisual modality had a positive effect on satisfaction. Moreover, audiovisual modality improved recall, both directly and indirectly via satisfaction, which subsequently resulted in better-informed decision-making. Narratives resulted in more satisfaction, but not better recall or informed decision-making. These effects were found in patients of all ages.

Background Patients are increasingly taking an active role in their health. In doing so, they combine both mass and interpersonal media to gratify their cognitive and affective needs (ie, convergence). Owing to methodological challenges when studying convergence, a detailed view of how patients are using different types of media for needs fulfillment is lacking. Objective The aim of this study was to obtain insight into the frequency of reported convergence, how convergence affects what posters write online, motives for posting, and the needs posters are trying to fulfill. Methods Using a hybrid method of content analysis and supervised machine learning, this study used naturally available data to fill this research gap. We analyzed opening posts (N=1708) of an online forum targeting cancer patients and their relatives (Kanker.nl). Results Nearly one-third of the forum opening posts contained signs of convergence in mass or interpersonal media. Posts containing mass media references disclosed less personal information and were more geared toward community enhancement and sharing experiences compared to posts without convergence. Furthermore, compared to posts without signs of convergence, posts that included interpersonal media references disclosed more personal information, and posters were more likely to ask for the experiences of fellow users to fulfill their needs. Within posts containing signs of convergence, posts including interpersonal media references reported fewer shortages of information, disclosed more information about the disease, and were more active in seeking other posters’ experiences compared to posts containing mass media references. Conclusions The current study highlights the intertwining of media platforms for patients. The insights of this study can be used to adapt the health care system toward a new type of health information–seeking behavior in which one medium is not trusted to fulfill all needs. Instead, providers should incorporate the intertwinement of sources by providing patients with reliable websites and forums through which they can fulfill their needs.

ObjectivesPatient recall of medical information is usually poor. Healthcare providers can employ affect-oriented (i.e., showing care) or cognition-oriented communication styles (i.e., structuring information) to enhance recall, but research evidence is limited especially among clinical and/or older patient populations. This video-vignette study manipulated provider caring and information structuring to examine effects on recall and trust among cancer patients/survivors.MethodsIn an online survey, 148 participants (Mage = 62) were randomized to one of four video conditions in a two (standard communication vs. enhanced caring) by two (standard vs. enhanced structuring) design, and completed measures of active recall, recognition, and trust.ResultsIncreased caring or structuring did not enhance active recall or recognition, instead both were higher among younger, female, or highly educated participants. The caring condition induced higher perceived trust in the provider within the whole sample, but trust was significantly correlated with decreased recall (r = −.268) among younger participants.ConclusionsProvider caring can strengthen the patient-provider relationship by enhancing trust. Yet, increased trust may impair recall among younger patients. Structuring treatment information did not enhance recall and recognition, but additional research is needed.Practice implicationsProviders may use additional ways of structuring/organizing information to help enhance recall (e.g., written information).

Objective: To explore the perspective of Turkish-Dutch general practitioner (GP) patients on informal interpreting from an integrated theory base, focusing on interpreters’ roles, trust and power.Design: Semi-structured in depth interviews were conducted with 21 first-generation Turkish-Dutch migrant patients who made use of informal interpreters to communicate with their GPs. An interview guide was designed based on the theoretical framework of interpreter’s roles, trust and power, covering questions about interpreters’ role, trust in informal/professional interpreters and power division in the medical consultation. The interviews were transcribed verbatim and analyzed according to the constant comparative method.Results: Besides providing linguistic translation, informal interpreters were expected to perform the roles of advocates and caregivers of the patients. Informal interpreters were trusted more than professional interpreters, mainly for fidelity reasons, that is, because the patients assumed that informal interpreters would act in their best interests. Although informal interpreters were often perceived as the primary interlocutor, the patients did not feel dominated by them, but rather empowered by their presence.Conclusion: Our findings indicate a connection between the role of the advocate, the fidelity dimension of trust and the perceived empowerment of the patients. By linking interpreters’ role to trust and power, this study contributes to theory building in the field of informal interpreting, which is needed to design evidence-based interventions to improve health care delivery to patients with insufficient language ability and thus to advance health care delivery to migrant patients, which is currently lagging behind.

This article provides a more differentiated understanding of mobile health consumers, and considers whether health app use may contribute to new digital inequalities. It focuses on factors associated with mobile health app use, and identifies which factors explain the use of different types of health apps. Data from a large representative sample of the Dutch population (N = 1,079) show that mobile health app users were generally younger, higher educated, and had higher levels of e-health literacy skills than non-users. Interestingly, different usage patterns were found for specific types of health apps. Theory and policy implications are discussed.

Objective Studies on anxiety within oncology show a high prevalence of anxiety both during and after the course of the disease. However, little is known about factors that influence the level of anxiety in the diagnostic phase. This study examines the presence of anxiety during diagnosis and treatment planning and explores how a monitoring (ie, information seeking) coping style and the suggested treatment plan (ie, with or without chemotherapy) interact with anxiety. Methods Anxiety scores (6‐item State‐Trait Anxiety Inventory) were collected from 81 colorectal cancer patients before and after their visit to the outpatient Gastrointestinal Oncological Center Amsterdam. A cut‐off score (>44) was used to indicate highly anxious patients. Results More than half (59%) of the patients were classified as highly anxious before consultation. Although anxiety scores significantly decreased after consultation (t = 3.149, P = .002), 37% of the patients remained highly anxious. Reductions in anxiety were specifically observed for patients with a higher monitoring coping style and patients for whom a treatment plan without chemotherapy was proposed. Interestingly, high monitors for whom treatment without chemotherapy was proposed showed a major decrease in anxiety, whereas low monitors for whom treatment starting with chemotherapy was proposed showed a great increase in anxiety. Conclusions The diagnostic phase is associated with high levels of anxiety. Distinct patterns of anxiety were identified, depending on patients' coping style and the suggested treatment plan. Remarkably, patients with a lower monitoring coping style became particularly anxious when they were advised to start treatment with chemotherapy.

Objectives: People with dementia in nursing homes benefit from person-centred care methods. Studies examining the effect of these methods often fail to report about the implementation of these methods. The present study aims to describe the implementation of the Veder contact method (VCM) in daily nursing home care.Method: A process analysis will be conducted based on qualitative data from focus groups with caregivers and interviews with key figures. To investigate whether the implementation of VCM is reflected in the attitude and behaviour of caregivers and in the behaviour and quality of life of people with dementia, a controlled observational cohort study will be conducted. Six nursing home wards implementing VCM will be compared with six control wards providing Care As Usual. Quantitative data from caregivers and residents will be collected before (T0), and 9–12 months after the implementation (T1). Qualitative analysis and multilevel analyses will be carried out on the collected data and structured based on the constructs of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance).Conclusion: By using the RE-AIM framework this study introduces a structured and comprehensive way of investigating the implementation process and implementation effectiveness of person-centred care methods in daily dementia care.

Research on the longitudinal impact of using the internet as an information source on patients’ beliefs and medication adherence is scarce. Chronic patients (N = 107) from six hospitals were surveyed to longitudinally explore their online information seeking behavior throughout treatment (i.e., before the consultation about their newly prescribed medication in the initiation phase and after six months in the implementation phase) and how this affects their medication beliefs (concerns and necessity) and medication adherence after three weeks (T1) and six months (T2). Most patients (79%) used the internet. Patients who used the internet before the consultation reported to have more concerns about their medication at T1 and T2 compared to those who did not. Moreover, patients who used the internet throughout treatment valued their concerns higher than the necessity after six months (T2). Patients who used the internet after the consultation reported to be more non-adherent after three weeks (T1) compared to those who did not. Because of the longitudinal nature of this study, we were able to pinpoint in which treatment phase patients’ online information seeking behavior is particular relevant in affecting patients’ beliefs and medication adherence.

Background Patients with advanced cancer for whom standard systemic treatment is no longer available may be offered participation in early phase clinical trials. In the decision making process, both medical-technical information and patient values and preferences are important. Since patients report decisional conflict after deciding on participation in these trials, improving the decision making process is essential. We aim to develop and evaluate an Online Value Clarification Tool (OnVaCT) to assist patients in clarifying their values around this end-of-life decision. This improved sharing of values is hypothesized to support medical oncologists in tailoring their information to individual patients’ needs and, consequently, to support patients in taking decisions in line with their values and reduce decisional conflict. Methods In the first part, patients’ values and preferences and medical oncologists’ views hereupon will be explored in interviews and focus groups to build a first prototype OnVaCT using digital communication (serious gaming). Next, we will test feasibility during think aloud sessions, to deliver a ready-to-implement OnVaCT. In the second part, the OnVaCT, with accompanied training module, will be evaluated in a pre-test (12–18 months before implementation) post-test (12–18 months after implementation) study in three major Dutch cancer centres. We will include 276 patients (> 18 years) with advanced cancer for whom standard systemic therapy is no longer available, and who are referred for participation in early phase clinical trials. The first consultation will be recorded to analyse patient-physician communication regarding the discussion of patients’ values and the decision making process. Three weeks afterwards, decisional conflict will be measured. Discussion This project aims to support the discussion of patient values when considering participation in early phase clinical trials. By including patients before their first appointment with the medical oncologist and recording that consultation, we are able to link decisional conflict to the decision making process, e.g. the communication during consultation. The study faces challenges such as timely including patients within the short period between referral and first consultation. Furthermore, with new treatments being developed rapidly, molecular stratification may affect the patient populations included in the pre-test and post-test periods. Trial registration Netherlands Trial Registry number: NTR7551 (prospective; July 17, 2018).

Ethnic minority patients are less participative in medical consultations compared to ethnic majority patients. It is thus important to find effective strategies to enhance ethnic minority patients’ participation and improve subsequent health outcomes. This study therefore aimed to investigate the relation between the match between patients’ preferred and perceived participation and doctor–patient concordance in preferred doctor–patient relationship on patient satisfaction, fulfillment of information needs, and understanding of information among Turkish-Dutch and Dutch patients. Pre- and postconsultation questionnaires were filled out by 136 Dutch and 100 Turkish-Dutch patients in the waiting rooms of 32 general practitioners (GPs). GPs completed a questionnaire too. Results showed that a match between patients’ preferred and perceived participation was related to higher patient satisfaction, more fulfillment of information needs, and more understanding of information than a mismatch for both patient groups. For doctor–patient concordance a conditional main effect on all outcome measures emerged only among Turkish-Dutch patients. That is, for patients who were discordant with their GP, higher perceived participation was related to lower satisfaction, worse fulfillment of information needs, and worse understanding of the information. In order to improve medical communication GPs should thus primarily be trained to tailor their communication styles to match patients’ preferences for participation.

Previous studies have mainly focused on tailoring message content to match individual characteristics and preferences. This study investigates the effect of a website tailored to individual preferences for the mode of information presentation, compared to 4 nontailored websites on younger and older adults' attention and recall of information, employing a 5 (condition: tailored vs. text, text with illustrations, audiovisual, combination) × 2 (age: younger [25–45] vs. older [≥65] adults) design (N = 559). The mode-tailored condition (relative to nontailored conditions) improved attention to the website and, consequently, recall in older adults, but not in younger adults. Younger adults recalled more from nontailored information such as text only or text with illustrations, relative to tailored information.

ObjectiveTo gain new insights into the relationship between health literacy and evaluation of online health information.MethodsUsing a mixed-methods approach, forty-four semi-structured interviews were conducted followed by a short questionnaire on health literacy and eHealth literacy. Qualitative and quantitative data were merged to explore differences and similarities among respondents with different health literacy levels.ResultsThematic analysis showed that most respondents did not question the quality of online health information and relied on evaluation criteria not recognized by existing web quality guidelines. Individuals with low health literacy, despite presenting higher eHealth literacy scores, appeared to use less established criteria and to rely more heavily on non-established ones compared to those with high health literacy.ConclusionDisparities in evaluation ability among people with different health literacy might be related to differences in awareness of the issue and to the use of different evaluation criteria. Future research should quantitatively investigate the interplay between health literacy, use of established and non-established criteria, and ability to evaluate online health information.Practice implicationsCommunication and patient education efforts should aim to raise awareness on online health information quality and to promote use of established evaluation criteria, especially among low health literate citizens.

The usefulness of the Internet as a health information source largely depends on the receiver's health literacy. This study investigates the mechanisms through which health literacy affects information recall and website attitudes. Using 2 independent surveys addressing different Dutch health websites (N = 423 and N = 395), we tested the mediating role of cognitive load, imagination ease, and website involvement. The results showed that the influence of health literacy on information recall and website attitudes was mediated by cognitive load and imagination ease but only marginally by website involvement. Thus, to improve recall and attitudes among people with lower health literacy, online health communication should consist of information that is not cognitively demanding and that is easy to imagine.