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8. Explaining Academic Progress via Combining Concepts of Integration Theory and Rational Choice Theory.

Author

Beekhoven, S., De Jong, U., and Van Hout, H.

Abstract

Compared elements of rational choice theory and integration theory on the basis of their power to explain variance in academic progress. Asserts that the concepts should be combined, and the distinction between social and academic integration abandoned. Empirical analysis showed that an extended model, comprising both integration and rational choice theory, provided the best explanation of academic progress. (EV)

Published
2002

9. Everyday functioning in a community-based volunteer population: Differences between participant- and study partner-report

Author

Roos J. Jutten, van Hout H, Merike Verrijp, van der Flier W, Nijhuis E, P. Scheltens, Sietske A.M. Sikkes, Marissa D. Zwan, Mark A. Dubbelman, and Leonie N C Visser

Subjects
education.field_of_study, Activities of daily living, Intraclass correlation, Concordance, Population, Odds ratio, medicine.disease, Odds, medicine, Dementia, education, Psychology, Psychosocial, Clinical psychology
Abstract

INTRODUCTIONImpaired awareness in dementia due to Alzheimer’s disease and related disorders, made study partner-report the preferred method of measuring interference in ‘instrumental activities of daily living’ (IADL). However, with a shifting focus towards earlier disease stages and prevention, the question arises whether self-report might be equally or even more appropriate. This study aims to investigate how participant and study partner report IADL perform in a community-based volunteer population without dementia, and which factors relate to differences between participant and study partner report.METHODSParticipants (N=3288; 18–97 years, 70.4% females) and their study partners (N=1213; 18–88 years, 45.8% females) were recruited from the Dutch brain research registry. IADL was measured using the Amsterdam IADL Questionnaire. Concordance between participant and study partner-reported IADL difficulties was examined using intraclass correlation coefficient (ICC). Multinomial logistic regressions were used to investigate which demographic, cognitive and psychosocial factors related to participant and study partner differences, by looking at the over- and underreport of IADL difficulties by the participant, relative to their study partner.RESULTSThe vast majority of A-IADL-Q scores represented no difficulties for both participants (87.9%) and study partners (89.4%). Concordance between participants and study partners was moderate (ICC=.55, 95%CI=[.51, .59]), 24.5% (N=297) of participants overreported their IADL difficulties compared to study partners, and 17.8% (N=216) underreported difficulties. The presence of depressive symptoms (odds ratio (OR)=1.31, 95%CI=[1.12, 1.54]), as well as memory complaints (OR=2.45, 95%CI=[1.80, 3.34]), increased the odds of participants overreporting their IADL difficulties. Higher IADL ratings decreased the odds of participant underreport (OR=0.71, 95%CI=[0.67, 0.74]).CONCLUSIONIn this sample of community-based volunteers, the majority of participants and study partners reported no major IADL difficulties. Differences between participant and study partner were, however, quite prevalent, with subjective factors indicative of increased report of IADL difficulties by the participant in particular. These findings suggest that self- and study partner-report measures may not be interchangeable, and that the level of awareness needs to be taken into account, even in cognitively healthy individuals.

Published
2021

11. No difference in effects of ‘PACE steps to success’ palliative care program for nursing home residents with and without dementia:a pre-planned subgroup analysis of the seven-country PACE trial

Author

Miranda, R., Smets, T., Van Den Noortgate, N., van der Steen, J.T., Deliens, L., Payne, S., Szczerbińska, K., Pautex, S., Van Humbeeck, L., Gambassi, G., Kylänen, M., Van den Block, L., Gatsolaeva, Y., Pivodic, L., Honinx, E., Tanghe, M., van Hout, H., Froggatt, K., Onwuteaka-Philipsen, B., Pasman, H.R.W., Piers, R., Baranska, I., Oosterveld-Vlug, M., Wichmann, A.B., Engels, Y., Vernooij-Dassen, M., Hockley, J., Leppäaho, S., Bassal, C., Mammarella, F., Mercuri, M., Rossi, P., Segat, I., Stodolska, A., Adang, E., Andreasen, P., Kuitunen-Kaija, O., Hammar, T., Heikkilä, R., Moore, D.C., Kijowska, V., ten Koppel, M., de Paula, E.M., PACE, on behalf of, Miranda, R., Smets, T., Van Den Noortgate, N., van der Steen, J.T., Deliens, L., Payne, S., Szczerbińska, K., Pautex, S., Van Humbeeck, L., Gambassi, G., Kylänen, M., Van den Block, L., Gatsolaeva, Y., Pivodic, L., Honinx, E., Tanghe, M., van Hout, H., Froggatt, K., Onwuteaka-Philipsen, B., Pasman, H.R.W., Piers, R., Baranska, I., Oosterveld-Vlug, M., Wichmann, A.B., Engels, Y., Vernooij-Dassen, M., Hockley, J., Leppäaho, S., Bassal, C., Mammarella, F., Mercuri, M., Rossi, P., Segat, I., Stodolska, A., Adang, E., Andreasen, P., Kuitunen-Kaija, O., Hammar, T., Heikkilä, R., Moore, D.C., Kijowska, V., ten Koppel, M., de Paula, E.M., and PACE, on behalf of

Abstract

Background: ‘PACE Steps to Success’ is a multicomponent training program aiming to integrate generalist and non-disease-specific palliative care in nursing homes. This program did not improve residents’ comfort in the last week of life, but it appeared to improve quality of care and dying in their last month of life. Because this program included only three dementia-specific elements, its effects might differ depending on the presence or stage of dementia. We aimed to investigate whether the program effects differ between residents with advanced, non-advanced, and no dementia. Methods: Pre-planned subgroup analysis of the PACE cluster-randomized controlled trial in 78 nursing homes in seven European countries. Participants included residents who died in the previous 4 months. The nursing home staff or general practitioner assessed the presence of dementia; severity was determined using two highly-discriminatory staff-reported instruments. Using after-death questionnaires, staff assessed comfort in the last week of life (Comfort Assessment in Dying–End-of-Life in Dementia-scale; primary outcome) and quality of care and dying in the last month of life (Quality of Dying in Long-Term Care scale; secondary outcome). Results: At baseline, we included 177 residents with advanced dementia, 126 with non-advanced dementia and 156 without dementia. Post-intervention, respectively in the control and the intervention group, we included 136 and 104 residents with advanced dementia, 167 and 110 with non-advanced dementia and 157 and 137 without dementia. We found no subgroup differences on comfort in the last week of life, comparing advanced versus without dementia (baseline-adjusted mean sub-group difference 2.1; p-value = 0.177), non-advanced versus without dementia (2.7; p = 0.092), and advanced versus non-advanced dementia (− 0.6; p = 0.698); or on quality of care and dying in the last month of life, comparing advanced and without dementia (− 0.6; p = 0.741), non-advanced and

Published
2021

12. No difference in effects of ‘PACE steps to success’ palliative care program for nursing home residents with and without dementia : a pre-planned subgroup analysis of the seven-country PACE trial

Author

Miranda, R., Smets, T., Van Den Noortgate, N., van der Steen, J.T., Deliens, L., Payne, S., Szczerbińska, K., Pautex, S., Van Humbeeck, L., Gambassi, G., Kylänen, M., Van den Block, L., Gatsolaeva, Y., Pivodic, L., Honinx, E., Tanghe, M., van Hout, H., Froggatt, K., Onwuteaka-Philipsen, B., Pasman, H.R.W., Piers, R., Baranska, I., Oosterveld-Vlug, M., Wichmann, A.B., Engels, Y., Vernooij-Dassen, M., Hockley, J., Leppäaho, S., Bassal, C., Mammarella, F., Mercuri, M., Rossi, P., Segat, I., Stodolska, A., Adang, E., Andreasen, P., Kuitunen-Kaija, O., Hammar, T., Heikkilä, R., Moore, D.C., Kijowska, V., ten Koppel, M., de Paula, E.M., PACE, on behalf of, Miranda, R., Smets, T., Van Den Noortgate, N., van der Steen, J.T., Deliens, L., Payne, S., Szczerbińska, K., Pautex, S., Van Humbeeck, L., Gambassi, G., Kylänen, M., Van den Block, L., Gatsolaeva, Y., Pivodic, L., Honinx, E., Tanghe, M., van Hout, H., Froggatt, K., Onwuteaka-Philipsen, B., Pasman, H.R.W., Piers, R., Baranska, I., Oosterveld-Vlug, M., Wichmann, A.B., Engels, Y., Vernooij-Dassen, M., Hockley, J., Leppäaho, S., Bassal, C., Mammarella, F., Mercuri, M., Rossi, P., Segat, I., Stodolska, A., Adang, E., Andreasen, P., Kuitunen-Kaija, O., Hammar, T., Heikkilä, R., Moore, D.C., Kijowska, V., ten Koppel, M., de Paula, E.M., and PACE, on behalf of

Abstract

Background: ‘PACE Steps to Success’ is a multicomponent training program aiming to integrate generalist and non-disease-specific palliative care in nursing homes. This program did not improve residents’ comfort in the last week of life, but it appeared to improve quality of care and dying in their last month of life. Because this program included only three dementia-specific elements, its effects might differ depending on the presence or stage of dementia. We aimed to investigate whether the program effects differ between residents with advanced, non-advanced, and no dementia. Methods: Pre-planned subgroup analysis of the PACE cluster-randomized controlled trial in 78 nursing homes in seven European countries. Participants included residents who died in the previous 4 months. The nursing home staff or general practitioner assessed the presence of dementia; severity was determined using two highly-discriminatory staff-reported instruments. Using after-death questionnaires, staff assessed comfort in the last week of life (Comfort Assessment in Dying–End-of-Life in Dementia-scale; primary outcome) and quality of care and dying in the last month of life (Quality of Dying in Long-Term Care scale; secondary outcome). Results: At baseline, we included 177 residents with advanced dementia, 126 with non-advanced dementia and 156 without dementia. Post-intervention, respectively in the control and the intervention group, we included 136 and 104 residents with advanced dementia, 167 and 110 with non-advanced dementia and 157 and 137 without dementia. We found no subgroup differences on comfort in the last week of life, comparing advanced versus without dementia (baseline-adjusted mean sub-group difference 2.1; p-value = 0.177), non-advanced versus without dementia (2.7; p = 0.092), and advanced versus non-advanced dementia (− 0.6; p = 0.698); or on quality of care and dying in the last month of life, comparing advanced and without dementia (− 0.6; p = 0.741), non-advanced and

Published
2021

15. Factors Associated with Perception of the Quality of Physicians' End-of-life Communication in Long-Term Care Facilities:PACE Cross-Sectional Study

Author

Barańska, I., Kijowska, V., Engels, Y., Finne-Soveri, H., Froggatt, K., Gambassi, G., Hammar, T., Oosterveld-Vlug, M., Payne, S., Van Den Noortgate, N., Smets, T., Deliens, L., Van den Block, L., Szczerbińska, K., Adang, E., Andreasen, P., Collingridge Moore, D., van Hout, H., Ten Koppel, M., Mammarella, F., Mercuri, M., Onwuteaka-Philipsen, B.D., Pivodic, L., Rossi, P., Sowerby, E., Stodolska, A., Wichmann, A., van der Steen, J.T., Vernooij-Dassen, M., Barańska, I., Kijowska, V., Engels, Y., Finne-Soveri, H., Froggatt, K., Gambassi, G., Hammar, T., Oosterveld-Vlug, M., Payne, S., Van Den Noortgate, N., Smets, T., Deliens, L., Van den Block, L., Szczerbińska, K., Adang, E., Andreasen, P., Collingridge Moore, D., van Hout, H., Ten Koppel, M., Mammarella, F., Mercuri, M., Onwuteaka-Philipsen, B.D., Pivodic, L., Rossi, P., Sowerby, E., Stodolska, A., Wichmann, A., van der Steen, J.T., and Vernooij-Dassen, M.

Abstract

Objective: To examine factors associated with perceived quality of communication with physicians by relatives of dying residents of long-term care facilities (LTCFs). Design: A cross-sectional retrospective study in a representative sample of LTCFs conducted in 2015. In each LTCF, deaths of residents during the 3 months before the researcher's visit were reported. Structured questionnaires were sent to the identified relatives of deceased residents. Settings and participants: A total of 736 relatives of deceased residents in 210 LTCFs (in Belgium, Finland, Italy, the Netherlands, and Poland). Methods: The Family Perception of Physician-Family Communication scale (FPPFC) was used to assess the quality of end-of-life (EOL) communication with physicians as perceived by relatives. We applied multilevel linear regression models to find factors associated with the FPPFC score. Results: The quality of EOL communication with physicians was perceived by relatives as higher when the relative spent more than 14 hours with the resident in the last week of the resident's life (b = 0.205; P = .044), and when the treating physician visited the resident at least 3 times in the last week of the resident's life (b = 0.286; P = .002) or provided the resident with palliative care (b = 0.223; P = .003). Relatives with higher emotional burden perceived the quality of EOL communication with physicians as lower (b = −0.060; P < .001). These results had been adjusted to countries and LTCF types with physicians employed on-site or off-site of the facility. Conclusion: The quality of EOL communication with physicians, as perceived by relatives of dying LTCF residents, is associated with the number of physician visits and amount of time spent by the relative with the resident in the last week of the resident's life, and relatives' emotional burden. Implications: LTCF managers should organize care for dying residents in a way that enables frequent interactions between physicians and relatives

Published
2020

16. Factors Associated with Perception of the Quality of Physicians' End-of-life Communication in Long-Term Care Facilities : PACE Cross-Sectional Study

Author

Barańska, I., Kijowska, V., Engels, Y., Finne-Soveri, H., Froggatt, K., Gambassi, G., Hammar, T., Oosterveld-Vlug, M., Payne, S., Van Den Noortgate, N., Smets, T., Deliens, L., Van den Block, L., Szczerbińska, K., Adang, E., Andreasen, P., Collingridge Moore, D., van Hout, H., Ten Koppel, M., Mammarella, F., Mercuri, M., Onwuteaka-Philipsen, B.D., Pivodic, L., Rossi, P., Sowerby, E., Stodolska, A., Wichmann, A., van der Steen, J.T., Vernooij-Dassen, M., Barańska, I., Kijowska, V., Engels, Y., Finne-Soveri, H., Froggatt, K., Gambassi, G., Hammar, T., Oosterveld-Vlug, M., Payne, S., Van Den Noortgate, N., Smets, T., Deliens, L., Van den Block, L., Szczerbińska, K., Adang, E., Andreasen, P., Collingridge Moore, D., van Hout, H., Ten Koppel, M., Mammarella, F., Mercuri, M., Onwuteaka-Philipsen, B.D., Pivodic, L., Rossi, P., Sowerby, E., Stodolska, A., Wichmann, A., van der Steen, J.T., and Vernooij-Dassen, M.

Abstract

Objective: To examine factors associated with perceived quality of communication with physicians by relatives of dying residents of long-term care facilities (LTCFs). Design: A cross-sectional retrospective study in a representative sample of LTCFs conducted in 2015. In each LTCF, deaths of residents during the 3 months before the researcher's visit were reported. Structured questionnaires were sent to the identified relatives of deceased residents. Settings and participants: A total of 736 relatives of deceased residents in 210 LTCFs (in Belgium, Finland, Italy, the Netherlands, and Poland). Methods: The Family Perception of Physician-Family Communication scale (FPPFC) was used to assess the quality of end-of-life (EOL) communication with physicians as perceived by relatives. We applied multilevel linear regression models to find factors associated with the FPPFC score. Results: The quality of EOL communication with physicians was perceived by relatives as higher when the relative spent more than 14 hours with the resident in the last week of the resident's life (b = 0.205; P = .044), and when the treating physician visited the resident at least 3 times in the last week of the resident's life (b = 0.286; P = .002) or provided the resident with palliative care (b = 0.223; P = .003). Relatives with higher emotional burden perceived the quality of EOL communication with physicians as lower (b = −0.060; P < .001). These results had been adjusted to countries and LTCF types with physicians employed on-site or off-site of the facility. Conclusion: The quality of EOL communication with physicians, as perceived by relatives of dying LTCF residents, is associated with the number of physician visits and amount of time spent by the relative with the resident in the last week of the resident's life, and relatives' emotional burden. Implications: LTCF managers should organize care for dying residents in a way that enables frequent interactions between physicians and relatives

Published
2020

19. Evaluation of a Palliative Care Program for Nursing Homes in 7 Countries:The PACE Cluster-Randomized Clinical Trial

Author

Van Den Block, L., Honinx, E., Pivodic, L., Miranda, R., Onwuteaka-Philipsen, B.D., Van Hout, H., Pasman, H.R.W., Oosterveld-Vlug, M., Ten Koppel, M., Piers, R., Van Den Noortgate, N., Engels, Y., Vernooij-Dassen, M., Hockley, J., Froggatt, K., Payne, S., Szczerbińska, K., Kylänen, M., Gambassi, G., Pautex, S., Bassal, C., De Buysser, S., Deliens, L., Smets, T., Van Den Block, L., Honinx, E., Pivodic, L., Miranda, R., Onwuteaka-Philipsen, B.D., Van Hout, H., Pasman, H.R.W., Oosterveld-Vlug, M., Ten Koppel, M., Piers, R., Van Den Noortgate, N., Engels, Y., Vernooij-Dassen, M., Hockley, J., Froggatt, K., Payne, S., Szczerbińska, K., Kylänen, M., Gambassi, G., Pautex, S., Bassal, C., De Buysser, S., Deliens, L., and Smets, T.

Published
2019

20. Evaluating the implementation of the PACE Steps to Success Programme in long-term care facilities in seven countries according to the RE-AIM framework

Author

Oosterveld-Vlug, M., Onwuteaka-Philipsen, B., Ten Koppel, M., Van Hout, H., Smets, T., Pivodic, L., Tanghe, M., Van Den Noortgate, N., Hockley, J., Payne, S., Moore, D.C., Kijowska, V., Szczerbińska, K., Kylänen, M., Leppaäho, S., Mercuri, C., Rossi, P., Mercuri, M., Gambassi, G., Bassal, C., De Paula, E.M., Engels, Y., Deliens, L., Van Den Block, L., Pasman, H.R., Oosterveld-Vlug, M., Onwuteaka-Philipsen, B., Ten Koppel, M., Van Hout, H., Smets, T., Pivodic, L., Tanghe, M., Van Den Noortgate, N., Hockley, J., Payne, S., Moore, D.C., Kijowska, V., Szczerbińska, K., Kylänen, M., Leppaäho, S., Mercuri, C., Rossi, P., Mercuri, M., Gambassi, G., Bassal, C., De Paula, E.M., Engels, Y., Deliens, L., Van Den Block, L., and Pasman, H.R.

Abstract

Background The PACE ‘Steps to Success’ programme is a complex educational and development intervention for staff to improve palliative care in long-term care facilities (LTCFs). In a cluster randomized controlled trial, this programme has been implemented in 37 LTCFs in 7 European countries. Alongside an effectiveness study, a process evaluation study was conducted. This paper reports on the results of this process evaluation, of which the aim was to provide a more detailed understanding of the implementation of the PACE Programme across and within countries. Methods The process evaluation followed the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and involved various measures and tools, including diaries for country trainers, evaluation questionnaires for care staff, attendance lists and interviews (online and face-to-face, individual and in groups) with country trainers, managers, PACE coordinators and other staff members. Based on key elements of the PACE Programme, a priori criteria for a high, medium and low level of the RE-AIM components Reach, Adoption, Implementation and intention to Maintenance were defined. Qualitative data on factors affecting each RE-AIM component gathered in the online discussion groups and interviews were analysed according to the principles of thematic analysis. Results The performance of the PACE Programme on the RE-AIM components was highly variable within and across countries, with a high or medium score for in total 28 (out of 37) LTCFs on Reach, for 26 LTCFs on Adoption, for 35 LTCFs on Implementation and for 34 LTCFs on intention to Maintenance. The factors affecting performance on the different RE-AIM components could be classified into three major categories: (1) the PACE Programme itself and its way of delivery, (2) people working with the PACE Programme and (3) contextual factors. Several country-specific challenges in implementing the PACE Programme were identified. Conclusions The implement

Published
2019

21. Palliative care provision in long-term care facilities differs across Europe:Results of a cross-sectional study in six European countries (PACE)

Author

ten Koppel, M., Onwuteaka-Philipsen, B.D., Van den Block, L., Deliens, L., Gambassi, G., Heymans, M.W., Kylänen, M., Oosterveld-Vlug, M.G., Pasman, H.R.W., Payne, S., Smets, T., Szczerbińska, K., Twisk, J.W.R., van der Steen, J.T., De Groote, Z., Mammarella, F., Mercuri, M., Pivodic, L., Pac, A., Rossi, P., Segat, I., Sowerby, E., Stodolska, A., van Hout, H., Wichmann, A., Adang, E., Andreasen, P., Finne-Soveri, H., Collingridge Moore, D., Froggatt, K., Kijowska, V., Van Den Noortgate, N., Vernooij-Dassen, M., PACE, on behalf of, ten Koppel, M., Onwuteaka-Philipsen, B.D., Van den Block, L., Deliens, L., Gambassi, G., Heymans, M.W., Kylänen, M., Oosterveld-Vlug, M.G., Pasman, H.R.W., Payne, S., Smets, T., Szczerbińska, K., Twisk, J.W.R., van der Steen, J.T., De Groote, Z., Mammarella, F., Mercuri, M., Pivodic, L., Pac, A., Rossi, P., Segat, I., Sowerby, E., Stodolska, A., van Hout, H., Wichmann, A., Adang, E., Andreasen, P., Finne-Soveri, H., Collingridge Moore, D., Froggatt, K., Kijowska, V., Van Den Noortgate, N., Vernooij-Dassen, M., and PACE, on behalf of

Abstract

Background: While the need for palliative care in long-term care facilities is growing, it is unknown whether palliative care in this setting is sufficiently developed. Aim: To describe and compare in six European countries palliative care provision in long-term care facilities and to assess associations between patient, facility and advance care planning factors and receipt and timing of palliative care. Design: Cross-sectional after-death survey regarding care provided to long-term care residents in Belgium, England, Finland, Italy, the Netherlands and Poland. Generalized estimating equations were used for analyses. Setting/participants: Nurses or care assistants who are most involved in care for the resident. Results: We included 1298 residents in 300 facilities, of whom a majority received palliative care in most countries (England: 72.6%–Belgium: 77.9%), except in Poland (14.0%) and Italy (32.1%). Palliative care typically started within 2 weeks before death and was often provided by the treating physician (England: 75%–the Netherlands: 98.8%). A palliative care specialist was frequently involved in Belgium and Poland (57.1% and 86.7%). Residents with cancer, dementia or a contact person in their record more often received palliative care, and it started earlier for residents with whom the nurse had spoken about treatments or the preferred course of care at the end of life. Conclusion: The late initiation of palliative care (especially when advance care planning is lacking) and palliative care for residents without cancer, dementia or closely involved relatives deserve attention in all countries. Diversity in palliative care organization might be related to different levels of its development.

Published
2019

22. Agreement of Nursing Home Staff With Palliative Care Principles:A PACE Cross-sectional Study Among Nurses and Care Assistants in Five European Countries

Author

Honinx, E., Smets, T., Piers, R., Deliens, L., Payne, S., Kylänen, M., Barańska, I., Pasman, H.R.W., Gambassi, G., Van den Block, L., Gatsolaeva, Y., Miranda, R., Pivodic, L., Tanghe, M., van Hout, H., Van Den Noortgate, N., Froggatt, K., Onwuteaka-Philipsen, B., Szczerbińska, K., Oosterveld-Vlug, M., Wichmann, A.B., Engels, Y., Vernooij-Dassen, M., Hockley, J., Leppäaho, S., Pautex, S., Bassal, C., Mammarella, F., Mercuri, M., Rossi, P., Segat, I., Stodolska, A., Adang, E., Andreasen, P., Kuitunen-Kaija, O., Moore, D.C., Pac, A., Kijowska, V., Koppel, M.T., van der Steen, J.T., Morgan de Paula, E., Honinx, E., Smets, T., Piers, R., Deliens, L., Payne, S., Kylänen, M., Barańska, I., Pasman, H.R.W., Gambassi, G., Van den Block, L., Gatsolaeva, Y., Miranda, R., Pivodic, L., Tanghe, M., van Hout, H., Van Den Noortgate, N., Froggatt, K., Onwuteaka-Philipsen, B., Szczerbińska, K., Oosterveld-Vlug, M., Wichmann, A.B., Engels, Y., Vernooij-Dassen, M., Hockley, J., Leppäaho, S., Pautex, S., Bassal, C., Mammarella, F., Mercuri, M., Rossi, P., Segat, I., Stodolska, A., Adang, E., Andreasen, P., Kuitunen-Kaija, O., Moore, D.C., Pac, A., Kijowska, V., Koppel, M.T., van der Steen, J.T., and Morgan de Paula, E.

Abstract

Context: To provide high-quality palliative care to nursing home residents, staff need to understand the basic principles of palliative care. Objectives: To evaluate the extent of agreement with the basic principles of palliative care of nurses and care assistants working in nursing homes in five European countries and to identify correlates. Methods: This is a cross-sectional study in 214 homes in Belgium, England, Italy, the Netherlands, and Poland. Agreement with basic principles of palliative care was measured with the Rotterdam MOVE2PC. We calculated percentages and odds ratios of agreement and an overall score between 0 (no agreement) and 5 (total agreement). Results: Most staff in all countries agreed that palliative care involves more than pain treatment (58% Poland to 82% Belgium) and includes spiritual care (62% Italy to 76% Belgium) and care for family or relatives (56% Italy to 92% Belgium). Between 51% (the Netherlands) and 64% (Belgium) correctly disagreed that palliative care should start in the last week of life and 24% (Belgium) to 53% (Poland) agreed that palliative care and intensive life-prolonging treatment can be combined. The overall agreement score ranged between 1.82 (Italy) and 3.36 (England). Older staff (0.26; 95% confidence interval [CI]: 0.09–0.43, P = 0.003), nurses (0.59; 95% CI: 0.43–0.75, P < 0.001), and staff who had undertaken palliative care training scored higher (0.21; 95% CI: 0.08–0.34, P = 0.002). Conclusions: The level of agreement of nursing home staff with basic principles of palliative care was only moderate and differed between countries. Efforts to improve the understanding of basic palliative care are needed.

Published
2019

23. Evaluation of a Palliative Care Program for Nursing Homes in 7 Countries : The PACE Cluster-Randomized Clinical Trial

Author

Van Den Block, L., Honinx, E., Pivodic, L., Miranda, R., Onwuteaka-Philipsen, B.D., Van Hout, H., Pasman, H.R.W., Oosterveld-Vlug, M., Ten Koppel, M., Piers, R., Van Den Noortgate, N., Engels, Y., Vernooij-Dassen, M., Hockley, J., Froggatt, K., Payne, S., Szczerbińska, K., Kylänen, M., Gambassi, G., Pautex, S., Bassal, C., De Buysser, S., Deliens, L., Smets, T., Van Den Block, L., Honinx, E., Pivodic, L., Miranda, R., Onwuteaka-Philipsen, B.D., Van Hout, H., Pasman, H.R.W., Oosterveld-Vlug, M., Ten Koppel, M., Piers, R., Van Den Noortgate, N., Engels, Y., Vernooij-Dassen, M., Hockley, J., Froggatt, K., Payne, S., Szczerbińska, K., Kylänen, M., Gambassi, G., Pautex, S., Bassal, C., De Buysser, S., Deliens, L., and Smets, T.

Published
2019

24. Agreement of Nursing Home Staff With Palliative Care Principles : A PACE Cross-sectional Study Among Nurses and Care Assistants in Five European Countries

Author

Honinx, E., Smets, T., Piers, R., Deliens, L., Payne, S., Kylänen, M., Barańska, I., Pasman, H.R.W., Gambassi, G., Van den Block, L., Gatsolaeva, Y., Miranda, R., Pivodic, L., Tanghe, M., van Hout, H., Van Den Noortgate, N., Froggatt, K., Onwuteaka-Philipsen, B., Szczerbińska, K., Oosterveld-Vlug, M., Wichmann, A.B., Engels, Y., Vernooij-Dassen, M., Hockley, J., Leppäaho, S., Pautex, S., Bassal, C., Mammarella, F., Mercuri, M., Rossi, P., Segat, I., Stodolska, A., Adang, E., Andreasen, P., Kuitunen-Kaija, O., Moore, D.C., Pac, A., Kijowska, V., Koppel, M.T., van der Steen, J.T., Morgan de Paula, E., Honinx, E., Smets, T., Piers, R., Deliens, L., Payne, S., Kylänen, M., Barańska, I., Pasman, H.R.W., Gambassi, G., Van den Block, L., Gatsolaeva, Y., Miranda, R., Pivodic, L., Tanghe, M., van Hout, H., Van Den Noortgate, N., Froggatt, K., Onwuteaka-Philipsen, B., Szczerbińska, K., Oosterveld-Vlug, M., Wichmann, A.B., Engels, Y., Vernooij-Dassen, M., Hockley, J., Leppäaho, S., Pautex, S., Bassal, C., Mammarella, F., Mercuri, M., Rossi, P., Segat, I., Stodolska, A., Adang, E., Andreasen, P., Kuitunen-Kaija, O., Moore, D.C., Pac, A., Kijowska, V., Koppel, M.T., van der Steen, J.T., and Morgan de Paula, E.

Abstract

Context: To provide high-quality palliative care to nursing home residents, staff need to understand the basic principles of palliative care. Objectives: To evaluate the extent of agreement with the basic principles of palliative care of nurses and care assistants working in nursing homes in five European countries and to identify correlates. Methods: This is a cross-sectional study in 214 homes in Belgium, England, Italy, the Netherlands, and Poland. Agreement with basic principles of palliative care was measured with the Rotterdam MOVE2PC. We calculated percentages and odds ratios of agreement and an overall score between 0 (no agreement) and 5 (total agreement). Results: Most staff in all countries agreed that palliative care involves more than pain treatment (58% Poland to 82% Belgium) and includes spiritual care (62% Italy to 76% Belgium) and care for family or relatives (56% Italy to 92% Belgium). Between 51% (the Netherlands) and 64% (Belgium) correctly disagreed that palliative care should start in the last week of life and 24% (Belgium) to 53% (Poland) agreed that palliative care and intensive life-prolonging treatment can be combined. The overall agreement score ranged between 1.82 (Italy) and 3.36 (England). Older staff (0.26; 95% confidence interval [CI]: 0.09–0.43, P = 0.003), nurses (0.59; 95% CI: 0.43–0.75, P < 0.001), and staff who had undertaken palliative care training scored higher (0.21; 95% CI: 0.08–0.34, P = 0.002). Conclusions: The level of agreement of nursing home staff with basic principles of palliative care was only moderate and differed between countries. Efforts to improve the understanding of basic palliative care are needed.

Published
2019

25. Palliative care provision in long-term care facilities differs across Europe : Results of a cross-sectional study in six European countries (PACE)

Author

ten Koppel, M., Onwuteaka-Philipsen, B.D., Van den Block, L., Deliens, L., Gambassi, G., Heymans, M.W., Kylänen, M., Oosterveld-Vlug, M.G., Pasman, H.R.W., Payne, S., Smets, T., Szczerbińska, K., Twisk, J.W.R., van der Steen, J.T., De Groote, Z., Mammarella, F., Mercuri, M., Pivodic, L., Pac, A., Rossi, P., Segat, I., Sowerby, E., Stodolska, A., van Hout, H., Wichmann, A., Adang, E., Andreasen, P., Finne-Soveri, H., Collingridge Moore, D., Froggatt, K., Kijowska, V., Van Den Noortgate, N., Vernooij-Dassen, M., PACE, on behalf of, ten Koppel, M., Onwuteaka-Philipsen, B.D., Van den Block, L., Deliens, L., Gambassi, G., Heymans, M.W., Kylänen, M., Oosterveld-Vlug, M.G., Pasman, H.R.W., Payne, S., Smets, T., Szczerbińska, K., Twisk, J.W.R., van der Steen, J.T., De Groote, Z., Mammarella, F., Mercuri, M., Pivodic, L., Pac, A., Rossi, P., Segat, I., Sowerby, E., Stodolska, A., van Hout, H., Wichmann, A., Adang, E., Andreasen, P., Finne-Soveri, H., Collingridge Moore, D., Froggatt, K., Kijowska, V., Van Den Noortgate, N., Vernooij-Dassen, M., and PACE, on behalf of

Abstract

Background: While the need for palliative care in long-term care facilities is growing, it is unknown whether palliative care in this setting is sufficiently developed. Aim: To describe and compare in six European countries palliative care provision in long-term care facilities and to assess associations between patient, facility and advance care planning factors and receipt and timing of palliative care. Design: Cross-sectional after-death survey regarding care provided to long-term care residents in Belgium, England, Finland, Italy, the Netherlands and Poland. Generalized estimating equations were used for analyses. Setting/participants: Nurses or care assistants who are most involved in care for the resident. Results: We included 1298 residents in 300 facilities, of whom a majority received palliative care in most countries (England: 72.6%–Belgium: 77.9%), except in Poland (14.0%) and Italy (32.1%). Palliative care typically started within 2 weeks before death and was often provided by the treating physician (England: 75%–the Netherlands: 98.8%). A palliative care specialist was frequently involved in Belgium and Poland (57.1% and 86.7%). Residents with cancer, dementia or a contact person in their record more often received palliative care, and it started earlier for residents with whom the nurse had spoken about treatments or the preferred course of care at the end of life. Conclusion: The late initiation of palliative care (especially when advance care planning is lacking) and palliative care for residents without cancer, dementia or closely involved relatives deserve attention in all countries. Diversity in palliative care organization might be related to different levels of its development.

Published
2019

27. Physician involvement and recognition of the resident's last phase of life in long-term care facilities: Findings from an EU FP7 funded cross-sectional study in 6 European countries (PACE)

Author

Oosterveld-Vlug, M., Pasman, R., Ten Koppel, M., Van Hout, H., Van Der Steen, J.T., Collingridge Moore, D., Deliens, L., Gambassi, G., Kylanen, M., Smets, T., Szczerbińska, K., van Den Block, L., Onwuteaka-Philipsen, B.D., APH - Aging & Later Life, APH - Quality of Care, CCA - Cancer Treatment and quality of life, Public and occupational health, and General practice

Abstract

Research aims: Ensuring the delivery of prompt, comprehensive palliative care in long-term care facilities (LTCFs) requires a multidisciplinary approach, including involvement of the physician. This study aims to describe and compare among 6 European countries (1) to what extent physicians are involved in the care of residents living in LTCFs; (2) to what extent physicians recognize the resident's last phase of life and; (3) how (1) and (2) are associated. Study population: 1094 deceased residents of 239 LTCFs, about whom 505 physicians in Belgium (BE), Finland (FI), Poland (PL), Italy (IT), The Netherlands (NL) and England (EN) reported on the number of visits they paid to the resident, treatment goals, whether they recognized a resident's terminal illness and whether they expected death. Study design and methods: In each country, a cross-sectional study was conducted within representative samples of LTCFs. Participating LTCFs reported all deaths of residents in the previous 3 months, and structured questionnaires were sent to several proxies among which the treating physician. Method of statistical analysis: To control for clustering within LTCFs and countries, differences in involvement in care and recognition of the last phase of life were analyzed using multilevel analyses. Results and interpretation: Physician involvement varied widely between countries; in the last 3 months of life, residents from PL were visited most often (median: 15 times), compared to residents from FI (12), NL (10), BE (7), IT (6) and EN (5). In the last week of life, this ranged from 4 visits (NL) to 1 visit (EN). Among all countries, physicians from PL and IT least often recognized the resident's terminal phase in the last week of life (63.0% in PL up to 80.3% in NL), and least often initiated a palliative treatment (31.8% in IT up to 92.6% in NL). On overall level though, positive associations were found between the level of involvement and the recognition of the last phase of life and initiation of palliative care. LTCFs should therefore work together with and involve physicians as much as possible in caring for their residents.

Published
2018

28. Integrating palliative care in long-term care facilities across Europe (PACE): protocol of a cluster randomized controlled trial of the 'PACE Steps to Success' intervention in seven countries

Author

Smets, T, Onwuteaka-Philipsen, Bbd, Miranda, R, Pivodic, L, Tanghe, M, van Hout, H, Pasman, Rhrw, Oosterveld-Vlug, M, Piers, R, Van Den Noortgate, N, Wichmann, Ab, Engels, Y, Vernooij-Dassen, M, Hockley, J, Froggatt, K, Payne, S, Szczerbinska, K, Kylanen, M, Leppaaho, S, Baranska, I, Gambassi, G, Pautex, S, Bassal, C, Deliens, L, Van den Block, L, Gambassi, G (ORCID:0000-0002-7030-9359), Smets, T, Onwuteaka-Philipsen, Bbd, Miranda, R, Pivodic, L, Tanghe, M, van Hout, H, Pasman, Rhrw, Oosterveld-Vlug, M, Piers, R, Van Den Noortgate, N, Wichmann, Ab, Engels, Y, Vernooij-Dassen, M, Hockley, J, Froggatt, K, Payne, S, Szczerbinska, K, Kylanen, M, Leppaaho, S, Baranska, I, Gambassi, G, Pautex, S, Bassal, C, Deliens, L, Van den Block, L, and Gambassi, G (ORCID:0000-0002-7030-9359)

Abstract

Background: Several studies have highlighted the need for improvement in palliative care delivered to older people long-term care facilities. However, the available evidence on how to improve palliative care in these settings is weak, especially in Europe. We describe the protocol of the PACE trial aimed to 1) evaluate the effectiveness and cost-effectiveness of the 'PACE Steps to Success' palliative care intervention for older people in long-term care facilities, and 2) assess the implementation process and identify facilitators and barriers for implementation in different countries.Methods: We will conduct a multi-facility cluster randomised controlled trial in Belgium, Finland, Italy, the Netherlands, Poland, Switzerland and England. In total, 72 facilities will be randomized to receive the 'Pace Steps to Success intervention' or to 'care as usual'. Primary outcome at resident level: quality of dying (CAD-EOLD); and at staff level: staff knowledge of palliative care (Palliative Care Survey). Secondary outcomes: resident's quality of end-of-life care, staff self-efficacy, self-perceived educational needs, and opinions on palliative care. Economic outcomes: direct costs and quality-adjusted life years (QALYs).Measurements are performed at baseline and after the intervention. For the resident-level outcomes, facilities report all deaths of residents in and outside the facilities over a previous four-month period and structured questionnaires are sent to (1) the administrator, (2) staff member most involved in care (3) treating general practitioner, and (4) a relative. For the staff-level outcomes, all staff who are working in the facilities are asked to complete a structured questionnaire. A process evaluation will run alongside the effectiveness evaluation in the intervention group using the RE-AIM framework.Discussion: The lack of high quality trials in palliative care has been recognized throughout the field of palliative care research. This cross-national cluste

Published
2018

33. Depressie, angst en subklinische vaatschade

Author

Seldenrijk, A., Van Hout, H. P.J., Van Marwijk, H. W.J., Diamant, M., Penninx, B. W.J.H., Psychiatry, EMGO - Mental health, General practice, Internal medicine, and ICaR - Heartfailure and pulmonary arterial hypertension

Published
2011

35. Studiemethoden

Author

Pilot, A., van Hout-Wolters, B., van Berkel, H., Bax, A., van Hout, H., and ILO (RICDE, FMG)

Published
2010

37. Geven huisartsen aan dementerende patiënten en hun verzorgers de juiste informatie? Een prospectief observationeel onderzoek

Author

Van Hout, H. P., Vernooij-Dassen, M. J., Jansen, D. A., Stalman, W. A., VU University medical center, and General practice

Subjects
mental disorders, health care economics and organizations, humanities
Abstract

Background: Many professional carers are hesitant about confronting dementia patients with their diagnosis. We wanted to know how often the GP communicates his diagnosis to patients in whom he suspects dementia and how often he tells the patient's carers. In addition we investigated the frequency with which the diagnosis was correct and how often it was not. Method: We carried out a prospective observational study. We instructed 64 GPs to apply, during the period of the study, the NHG Standard for Dementia to all patients aged 55 and older in whom they first suspected dementia and to refer these patents to a multidisciplinary memory clinic which would serve as diagnostic reference. Both the GPs and the team at the memory clinic entered their findings on a previously drawn up standard form. Results: The GPs recorded a total of 107 possible cases of dementia, 82 of whom were accompanied by their carers. Subsequent assessment showed dementia in 69 persons, absent in 29 and unsure in 9 cases. In most cases the GP's diagnosis was correct; two patients were wrongly diagnosed who, according to the memory clinic, did not have dementia and two who were indeed suffering from the condition. The GPs passed on their diagnosis to 42% of the patients with probable dementia and to 74% of the carers. Generally they asked about the carers' experiences but gave targeted advice in less than half the cases. Only when the dementia was relatively serious were the GPs somewhat more communicative, but were far more reluctant to pass on their diagnosis to the patients than to their carers. Conclusion: This study clearly shows that GPs ate ambivalent in their approach to patients with early signs of dementia and to their carers. They often leave the patients in ignorance but generally inform the carers.

Published
2007

38. Flexibilisering in het hoger onderwijs

Author

Kessels, Joseph, Ehlen, C.G.J.M., van Hout, H., ten Dam, G., Mirande, M., Terlouw, C., and Willems, J.

Subjects
METIS-234290
Published
2006

40. Competentiegericht onderwijs

Author

van Alebeek, F.M.T., Kouwenhoven, G.W., van Hout, H., ten Dam, G., Mirande, M., Terlouw, C., Willems, J., and Instituut voor de Lerarenopleiding (tot 2012)

Published
2006

41. Leren en leeromgevingen

Author

ten Dam, G.T.M., van Hout, H., ten Dam, G., Mirande, M., Terlouw, C., Willems, J., and Instituut voor de Lerarenopleiding (tot 2012)

Published
2006

43. A Pharmacy-Based Coaching Program to Improve Adherence to Antidepressant Treatment Among Primary Care Patients

Author

Brook, O.H., van Hout, H., Stalman, W.A.B., Nieuwenhuyse, H., Bakker, B, Heerdink, E.R., de Haan, M., Population-based studies of drug treatment: from molecule to patient outcomes, Universiteit Utrecht, and Dep Farmaceutische wetenschappen

Subjects
Farmacie/Biofarmaceutische wetenschappen (FARM), Ziekenhuisstructuur en organisatie van de gezondheidszorg, Epidemiology, Farmacie(FARM), Public Health, Biomedische technologie en medicijnen
Published
2005

44. Het belang van equivalentieonderzoek om de waarde van behandelingen aan te tonen

Author

Hermens, M. L.M., Van Hout, H. P.J., Terluin, B., Adér, H. J., De Haan, M., General practice, and APH - Aging & Later Life

Abstract

There are different kinds of randomised controlled trials: trials in which the superiority of a treatment can be demonstrated (superiority trials) and trials in which the equal efficacy of two treatments can be shown (equivalence trials). The main reason for performing an equivalence trial is that for many diseases and disorders an effective treatment already exists. Equivalence trials are appropriate when a new treatment offers some advantages over an existing treatment (less cost, greater safety, improved convenience or freedom of choice for the patient), in addition to the expected equal therapeutic effectiveness. The design of equivalence trials is to a large extent comparable to that of superiority trials, but there are some methodological differences. In equivalence trials, the null hypothesis and alternative hypothesis are interchanged, compared to superiority trials. In equivalence trials, an equivalence margin is defined for the different treatments. Clinical professionals decide on the equivalence margin beforehand on the basis of the clinical relevance. To demonstrate equivalence, the confidence interval of the difference between two treatments must lie completely within the equivalence margin. In equivalence trials, there are usually more patients needed: the smaller the equivalence margin, the more patients are needed. In equivalence trials, both per-protocol analyses and intention-to-treat analyses should be used to prove the equal therapeutic effectiveness of the treatments under study.

Published
2003

45. Methods to improve compliance in the use of antidepressants

Author

Vergouwen, A. C.M., Van Hout, H. P.J., Bakker, A., General practice, and APH - Aging & Later Life

Abstract

Compliance during treatment with antidepressants is important, yet about half of the patients stop using antidepressive medication within 3 months. A structured treatment programme, in which the patient actively participates, with extensive education, surveillance of side effects and compliance, simple regimes, improving problem-solving behaviour and eventually engaging and educating family members and friends can improve compliance. This has been demonstrated in published studies. Research has shown that interventions that enhance compliance can lead to a better outcome of the depression.

Published
2002

48. Leren binnen het MKB

Author

Wognum, Ida, de Jong, Ton, Bartlett, K.R., van Eck, E., Griffioen, D., van Hout, H., Peetsma, T., and Faculty of Behavioural, Management and Social Sciences

Subjects
IR-96992, METIS-201573
Published
2001

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