In Nederland gebruiken 65 plussers drie keer zoveel medicijnen als de gemiddelde Nederlander. Voor 75 plussers geldt dat zij vijf keer zoveel medicijnen gebruiken. In combinatie met leeftijdsgerelateerde natuurlijke veranderingen in het metabolisme, verminderde cognitie, multi-morbiditeit, verminderde nierfunctie, polyfarmacie en verminderde capaciteit tot herstel, zijn ouderen kwetsbaar voor medicatiegerelateerde problemen. Thuiszorg cliënten zijn doorgaans ouder dan 65 jaar, waardoor er vaker sprake is van polyfarmacie en verminderde cognitie. Daarom bevinden zich vooral in deze populatie cliënten, die kwetsbaar zijn voor medicatiegerelateerde problemen. Verschillende studies hebben aangetoond dat huisartsen en apothekers een bijdrage kunnen leveren aan het herkennen van medicatiegerelateerde problemen bij hun patiënten. Er is echter weinig aandacht besteed aan het vroegsignaleren van observaties die kunnen duiden op een medicatie gerelateerd probleem door thuiszorgmedewerkers. In aanvulling op de huisarts en apotheker zouden thuiszorgmedewerkers, die hun patiënten op regelmatige basis thuis bezoeken, een bijdrage kunnen leveren aan het vroegsignaleren van potentiële medicatiegerelateerde problemen. Het doel van dit proefschrift is het: 1. verkennen van de opvattingen van ouderen ten aanzien van hun medicatie en hun medicatie management capaciteit gerelateerd aan zelfmanagement vaardigheden en cognitie; 2. beschrijven van de kennis, houding en medicatie management praktijk van thuiszorgmedewerkers; 3. vaststellen of een gestandaardiseerde observatielijst leidt tot vroegsignalering van potentiële medicatiegerelateerde problemen in de thuiszorg
PurposeThis study investigates patients’ experiences of interaction with their healthcare professionals (HCPs) during cancer treatment and identifies elements that HCPs can utilize to improve cancer care provision.MethodsPubMed, CINAHL, PsycINFO, SCOPUS, and Embase were systematically searched for relevant studies published from January 2010 until February 2022. Qualitative studies investigating adult patients’ perspectives on their interaction with HCPs during cancer treatment were included. Studies conducted during the diagnosis or end-of-life treatment phase were excluded. Duplicate removal, screening, and quality appraisal were independently performed by four reviewers using Covidence.org. We performed a thematic meta-synthesis of qualitative data extracted from studies meeting the quality criteria in three stages: excerpts coding, codes categorization, and theme identification by merging similar categories.ResultsEighty-eight studies were included for quality appraisal, of which 50 papers met the quality inclusion criteria. Three themes were identified as essential to positively perceived patient-HCP interaction: “Support, respect and agency”, “Quantity, timing, and clarity of information”, and “Confidence, honesty, and expertise”. Overall, patients experienced positive interaction with HCPs when the approach was person-centered and when HCPs possessed strong interpersonal skills. However, patients expressed negative experiences when their preferences regarding communication and the type of personal support needed were ignored.ConclusionsThis meta-synthesis emphasizes the importance for HCPs to recognize all patients’ needs, including communication and personal support preferences, to provide high-quality care. Consequently, healthcare professionals should continuously train their verbal and non-verbal communication, empathy, active listening, and collaboration skills during their undergraduate and continuing education.
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INTRODUCTION: After treatment with chemotherapy, many patients with breast cancer experience cognitive problems. While limited interventions are available to improve cognitive functioning, physical exercise showed positive effects in healthy older adults and people with mild cognitive impairment. The Physical Activity and Memory study aims to investigate the effect of physical exercise on cognitive functioning and brain measures in chemotherapy-exposed patients with breast cancer with cognitive problems.METHODS AND ANALYTICS: One hundred and eighty patients with breast cancer with cognitive problems 2-4 years after diagnosis are randomised (1:1) into an exercise intervention or a control group. The 6-month exercise intervention consists of twice a week 1-hour aerobic and strength exercises supervised by a physiotherapist and twice a week 1-hour Nordic or power walking. The control group is asked to maintain their habitual activity pattern during 6 months. The primary outcome (verbal learning) is measured at baseline and 6 months. Further measurements include online neuropsychological tests, self-reported cognitive complaints, a 3-tesla brain MRI, patient-reported outcomes (quality of life, fatigue, depression, anxiety, work performance), blood sampling and physical fitness. The MRI scans and blood sampling will be used to gain insight into underlying mechanisms. At 18 months online neuropsychological tests, self-reported cognitive complaints and patient-reported outcomes will be repeated.ETHICS AND DISSEMINATION: Study results may impact usual care if physical exercise improves cognitive functioning for breast cancer survivors.TRIAL REGISTRATION NUMBER: NTR6104.
