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Papers by Jolien Glaudemans

Research paper thumbnail of How do Dutch primary care providers overcome barriers to advance care planning with older people? A qualitative study

Family Practice

Background. Few older people benefit from advance care planning (ACP), due to several barriers re... more Background. Few older people benefit from advance care planning (ACP), due to several barriers related to primary care professionals, such as insufficient knowledge, negative beliefs and a lack of time. Information on overcoming these barriers is limited. We assumed primary care professionals experienced in ACP with older patients are likely to have learned how to overcome these barriers. Objective. To investigate how Dutch primary care professionals experienced in ACP with older patients overcome these barriers. Methods. A qualitative study, based on semi-structured interviews, among a purposive sample of 14 Dutch primary care professionals experienced in ACP with older people. Transcripts were thematically analysed. Results. We interviewed eight general practitioners (GPs), three nurses and three elderly care physicians, experienced in ACP with older people. Respondents overcame their own insufficient knowledge and skills, as well as their negative attitudes and beliefs by gaining experience through practicing ACP in their daily practices, exchanging and reflecting on those experiences with peers, pursuing continuing education, teaching and participating in research. To overcome patients' and families' lack of initiative and openness to ACP, respondents prepared them for further steps in ACP. To overcome a lack of time, respondents used tools and information communication technology, delegated parts of ACP to other primary care professionals, acquired financing and systematized documentation of ACP. Conclusion. Primary care professionals can overcome barriers to ACP with older patients by practicing, reflecting on experiences and pursuing continuing education, by preparing patients and involving family and by investing in support to approach ACP more efficiently.

Research paper thumbnail of Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners

BMJ Open

ObjectivesAdvance care planning (ACP) with older people needs to be approached differently than A... more ObjectivesAdvance care planning (ACP) with older people needs to be approached differently than ACP with patients with a terminal illness. ACP is still used with only a minority of older patients due to a lack of knowledge regarding appropriate approaches to ACP with older people. General practitioners (GPs) may play a key role in ACP with older people. Therefore, we explored their experiences with and views on approaches to ACP with older patients in daily practice.Design, setting and participantsA qualitative study among a purposive sample of 19 Dutch GPs based on semistructured interviews.ResultsApproaches to ACP with older patients can be divided into two categories: systematic and ad hoc. Systematic approaches consisted of discussing a fixed combination of topics with community-dwelling older patients who are frail, cognitively impaired or are aged >75 years, and with older patients living in residential care homes during group information meetings, intakes, comprehensive ge...

Research paper thumbnail of Interprofessional communication between oncologic specialists and general practitioners on end-of-life issues needs improvement

Family Practice, Sep 1, 2016

Background. Timely end-of-life (EOL) discussions between patients and physicians are considered e... more Background. Timely end-of-life (EOL) discussions between patients and physicians are considered essential for high-quality EOL care, but research shows that these discussions frequently do not occur or occur late. In oncology, one barrier for timely EOL discussions is poor collaboration between oncologic specialists and GPs. Objective. To explore interprofessional communication and coordination between oncologic specialists and GPs on EOL discussions. Methods. We conducted in-depth interviews with 16 GPs and 14 oncologic specialists. Interviews were recorded, transcribed verbatim and analysed using qualitative content analysis. Results. EOL discussions were primarily considered the role of the GP, but oncologists' perceptions of their own roles in discussing EOL issues varied. Interprofessional coordination on who discusses what and when was mostly absent. Interprofessional communication of EOL issues usually proceeded using the patient as intermediary. This functioned well but only if three essential conditions were met: the specialist being realistic to patients about limits of treatment, informing the GP adequately and the GP being proactive in initiating EOL issues in time. However, when these conditions were absent, timely EOL discussions did not seem to occur. Conclusions. EOL discussions are rarely a subject of direct interprofessional communication and mainly proceed through the patient as intermediary. For implementation of EOL discussions into regular care, earlier interprofessional communication and coordination is needed, particularly if barriers for such discussions occur.

Research paper thumbnail of Advance care planning in primary care, only for severely ill patients? A structured review

Family practice, 2015

Increasing medical possibilities, ageing of the population and the growing number of people with ... more Increasing medical possibilities, ageing of the population and the growing number of people with chronic illness appears to make advance care planning (ACP) inevitable. However, to what extent and how primary care providers (PCPs) provide ACP in daily practice is largely unknown. To provide an overview of the actual practice of ACP in primary care. We searched MEDLINE, EMBASE, CINAHL, PsycINFO and the Cochrane Library for empirical studies that described the practice of ACP with patients in primary health care. Studies focussing on non-adult patients, and hospital or nursing home settings were excluded. Ten articles met the inclusion criteria. The content of the ACP varied from discussing to refrain from cardiopulmonary resuscitation to existential issues. The prevalence ranged from 21% of PCPs having ACP discussions with the general elderly population to 69% having ACP discussions with terminal patients and 81% with patients with mild to moderate Alzheimer's disease. ACP was mo...

Research paper thumbnail of How do Dutch primary care providers overcome barriers to advance care planning with older people? A qualitative study

Family Practice

Background. Few older people benefit from advance care planning (ACP), due to several barriers re... more Background. Few older people benefit from advance care planning (ACP), due to several barriers related to primary care professionals, such as insufficient knowledge, negative beliefs and a lack of time. Information on overcoming these barriers is limited. We assumed primary care professionals experienced in ACP with older patients are likely to have learned how to overcome these barriers. Objective. To investigate how Dutch primary care professionals experienced in ACP with older patients overcome these barriers. Methods. A qualitative study, based on semi-structured interviews, among a purposive sample of 14 Dutch primary care professionals experienced in ACP with older people. Transcripts were thematically analysed. Results. We interviewed eight general practitioners (GPs), three nurses and three elderly care physicians, experienced in ACP with older people. Respondents overcame their own insufficient knowledge and skills, as well as their negative attitudes and beliefs by gaining experience through practicing ACP in their daily practices, exchanging and reflecting on those experiences with peers, pursuing continuing education, teaching and participating in research. To overcome patients' and families' lack of initiative and openness to ACP, respondents prepared them for further steps in ACP. To overcome a lack of time, respondents used tools and information communication technology, delegated parts of ACP to other primary care professionals, acquired financing and systematized documentation of ACP. Conclusion. Primary care professionals can overcome barriers to ACP with older patients by practicing, reflecting on experiences and pursuing continuing education, by preparing patients and involving family and by investing in support to approach ACP more efficiently.

Research paper thumbnail of Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners

BMJ Open

ObjectivesAdvance care planning (ACP) with older people needs to be approached differently than A... more ObjectivesAdvance care planning (ACP) with older people needs to be approached differently than ACP with patients with a terminal illness. ACP is still used with only a minority of older patients due to a lack of knowledge regarding appropriate approaches to ACP with older people. General practitioners (GPs) may play a key role in ACP with older people. Therefore, we explored their experiences with and views on approaches to ACP with older patients in daily practice.Design, setting and participantsA qualitative study among a purposive sample of 19 Dutch GPs based on semistructured interviews.ResultsApproaches to ACP with older patients can be divided into two categories: systematic and ad hoc. Systematic approaches consisted of discussing a fixed combination of topics with community-dwelling older patients who are frail, cognitively impaired or are aged >75 years, and with older patients living in residential care homes during group information meetings, intakes, comprehensive ge...

Research paper thumbnail of Interprofessional communication between oncologic specialists and general practitioners on end-of-life issues needs improvement

Family Practice, Sep 1, 2016

Background. Timely end-of-life (EOL) discussions between patients and physicians are considered e... more Background. Timely end-of-life (EOL) discussions between patients and physicians are considered essential for high-quality EOL care, but research shows that these discussions frequently do not occur or occur late. In oncology, one barrier for timely EOL discussions is poor collaboration between oncologic specialists and GPs. Objective. To explore interprofessional communication and coordination between oncologic specialists and GPs on EOL discussions. Methods. We conducted in-depth interviews with 16 GPs and 14 oncologic specialists. Interviews were recorded, transcribed verbatim and analysed using qualitative content analysis. Results. EOL discussions were primarily considered the role of the GP, but oncologists' perceptions of their own roles in discussing EOL issues varied. Interprofessional coordination on who discusses what and when was mostly absent. Interprofessional communication of EOL issues usually proceeded using the patient as intermediary. This functioned well but only if three essential conditions were met: the specialist being realistic to patients about limits of treatment, informing the GP adequately and the GP being proactive in initiating EOL issues in time. However, when these conditions were absent, timely EOL discussions did not seem to occur. Conclusions. EOL discussions are rarely a subject of direct interprofessional communication and mainly proceed through the patient as intermediary. For implementation of EOL discussions into regular care, earlier interprofessional communication and coordination is needed, particularly if barriers for such discussions occur.

Research paper thumbnail of Advance care planning in primary care, only for severely ill patients? A structured review

Family practice, 2015

Increasing medical possibilities, ageing of the population and the growing number of people with ... more Increasing medical possibilities, ageing of the population and the growing number of people with chronic illness appears to make advance care planning (ACP) inevitable. However, to what extent and how primary care providers (PCPs) provide ACP in daily practice is largely unknown. To provide an overview of the actual practice of ACP in primary care. We searched MEDLINE, EMBASE, CINAHL, PsycINFO and the Cochrane Library for empirical studies that described the practice of ACP with patients in primary health care. Studies focussing on non-adult patients, and hospital or nursing home settings were excluded. Ten articles met the inclusion criteria. The content of the ACP varied from discussing to refrain from cardiopulmonary resuscitation to existential issues. The prevalence ranged from 21% of PCPs having ACP discussions with the general elderly population to 69% having ACP discussions with terminal patients and 81% with patients with mild to moderate Alzheimer's disease. ACP was mo...