Publications by authors named "Daan Brandenbarg"

14 Publications

  • Page 1 of 1

Identifying women's preferences for treatment of urinary tract infection: a discrete choice experiment.

BMJ Open 2021 11 16;11(11):e049916. Epub 2021 Nov 16.

Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Objective: To identify the preferences of women regarding management of urinary tract infections (UTIs).

Design: A discrete choice experiment of the preferences for certain treatment attributes was conducted by survey. Attributes included treatment duration, time to complaint resolution, complication risk, side effect risk and contribution to antimicrobial resistance.

Setting: General population in the Netherlands, recruited via social media.

Participants: Women aged 18 years or older.

Primary And Secondary Outcome Measures: The primary outcome was the relative importance of the attributes for treatment choice, using a conditional logit model. The secondary outcome was the heterogeneity in these preferences.

Results: The discrete choice experiment was completed by 833 women. Most attributes were important to decisions for UTI treatment. Women were willing to accept management with, for example, a higher chance of complications or longer time to resolution, if it could help avoid antimicrobial resistance. However, there was heterogeneity in the preferences. Women who had one previous UTI had a stronger preference for faster symptom resolution compared with those who had no previous UTI. Younger women also preferred faster symptom resolution. Finally, women with a low or middle education level gave less importance to preventing antimicrobial resistance than women with a high education level.

Conclusions: The current study indicated that a considerable part of women valued alternatives to antimicrobial treatment and were prepared to tolerate management that was less optimal in certain respects to avoid antimicrobial treatment.
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http://dx.doi.org/10.1136/bmjopen-2021-049916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8596048PMC
November 2021

Home-based Physical Activity to Alleviate Fatigue in Cancer Survivors: A Systematic Review and Meta-analysis.

Med Sci Sports Exerc 2021 Dec;53(12):2661-2674

Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, THE NETHERLANDS.

Purpose: Physical activity (PA) affects fatigue and mental health in cancer survivors favorably, but participation in PA interventions tends to be low. More participants may be reached by home-based PA owing to greater accessibility and self-monitoring. This systematic review therefore evaluated the effects of home-based PA of low to moderate intensity on symptoms of fatigue, depression, and anxiety among cancer survivors.

Methods: PubMed, CINAHL, PsycINFO, and Web of Science were systematically searched for randomized controlled trials. We included investigations of home-based PA interventions in adults treated curatively for cancer and evaluating fatigue, depression, or anxiety as outcomes. We performed a random-effect meta-analysis for the effects of PA interventions on fatigue in the short and long terms. Subgroup analyses were performed for the frequency of counseling. Standardized mean differences (SMD) and 95% confidence intervals are reported.

Results: Eleven articles comprising 1066 participants were included: 77% had a history of breast cancer; 14%, ovarian cancer; 4%, colorectal cancer; 4%, prostate cancer; and 1%, "other" cancer (not specified). Concerning the outcomes, nine articles reported on fatigue and two reported on depression or anxiety. Meta-analyses showed a significant effect of home-based PA on fatigue immediately after the intervention (SMD = 0.22 [0.06-0.37]), at 3 months' follow-up (SMD = 0.27 [0.04-0.51]), and at 6-9 months' follow-up (SMD = 0.31 [0.08-0.55]). PA interventions that used frequent counseling were associated with larger improvements in fatigue than those using no or infrequent counseling.

Conclusions: Home-based PA interventions can reduce fatigue among adult cancer survivors for up to 9 months, and frequent counseling may improve the benefits of these interventions.
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http://dx.doi.org/10.1249/MSS.0000000000002735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594505PMC
December 2021

[Care for mental well-being of cancer patients: Support during and after primary treatment].

Ned Tijdschr Geneeskd 2021 07 8;165. Epub 2021 Jul 8.

Radboudumc, afd. Medische Oncologie, Nijmegen.

Cancer is associated with sometimes strong emotions. However, emotions are mostly adaptive - they help people adapt to cancer. Adaptive emotions do not need to be treated; instead, emotional support is key. Professional mental health care is indicated only when emotions are no longer adaptive. Oncologists, nurses, and especially general practitioners play an important role in identifying people who qualify for referral to mental health care. Prior mental health problems, a weak social support system, and a relatively stressful disease course or treatment are risk factors for cancer-related emotional problems. Training and the development of professional networks can contribute to optimizing the availability, accessibility and quality of supportive care for mental well-being during and after cancer treatment. In addition, providing good information to patients is important, to enable them to find supportive care.
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July 2021

Improving Care for Patients Living with Prolonged Incurable Cancer.

Cancers (Basel) 2021 May 23;13(11). Epub 2021 May 23.

University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, University of Groningen, 9700CC Groningen, The Netherlands.

The number of patients that can no longer be cured but may expect to live with their cancer diagnosis for a substantial period is increasing. These patients with 'prolonged incurable cancer' are often overlooked in research and clinical practice. Patients encounter problems that are traditionally seen from a palliative or survivorship perspective but this may be insufficient to cover the wide range of physical and psychosocial problems that patients with prolonged incurable cancer may encounter. Elements from both fields should, therefore, be delivered concordantly to further optimize care pathways for these patients. Furthermore, to ensure future high-quality care for this important patient population, enhanced clinical awareness, as well as further research, are urgently needed.
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http://dx.doi.org/10.3390/cancers13112555DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8196984PMC
May 2021

Fatigue among Long-Term Breast Cancer Survivors: A Controlled Cross-Sectional Study.

Cancers (Basel) 2021 Mar 15;13(6). Epub 2021 Mar 15.

Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands.

Background: Fatigue is the most common and persistent symptom among women in the first five years after a breast cancer diagnosis. However, long-term prevalence of fatigue, among breast cancer survivors, needs further investigation.

Aim: To compare fatigue experienced by long-term breast cancer survivors with that in a reference population and to evaluate the determinants of that fatigue.

Design And Setting: A cross-sectional cohort study of 350 breast cancer survivors ≥5 years after diagnosis and a reference population of 350 women matched by age and general practitioner.

Method: Fatigue was measured using the Multidimensional Fatigue Inventory (MFI-20), and a sum score of >60 (multidimensional fatigue) was the primary outcome. Logistic regression was applied to compare the prevalence of multidimensional fatigue between the survivor and reference populations, adjusted for body mass index (BMI) and for cardiovascular and psychological variables. Odds ratios (ORs) and 95% confidence intervals (95%CIs) were estimated. Logistic regression was applied to evaluate the determinants of multidimensional fatigue among the survivors.

Results: Breast cancer survivors (median 10 years after diagnosis), more often experienced multidimensional fatigue than the reference population (26.6% versus 15.4%; OR, 2.0 [95%CI, 1.4-2.9]), even after adjusting for confounders. The odds of multidimensional fatigue were also higher among survivors with symptoms of depression (32.2% versus 2.7%; OR, 17.0 [95%CI, 7.1-40.5]) or anxiety (41.9% versus 10.1%; OR, 6.4 [95%CI, 3.6-11.4]).

Conclusion: One in four breast cancer survivors experience multidimensional fatigue and fatigue occurs more frequently than in women of the same age and general practitioner. This fatigue appears to be associated with symptoms of depression and anxiety.
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http://dx.doi.org/10.3390/cancers13061301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001130PMC
March 2021

Diagnostic accuracy of follow-up tests for detecting colorectal cancer recurrences in primary care: A systematic review and meta-analysis.

Eur J Cancer Care (Engl) 2021 Sep 11;30(5):e13432. Epub 2021 Mar 11.

Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Introduction: Traditionally, follow-up of colorectal cancer (CRC) is performed in secondary care. In new models of care, the screening part care could be replaced to primary care. We aimed to synthesise evidence on the diagnostic accuracy of commonly used screeners in CRC follow-up applicable in primary care: carcinoembryonic antigen (CEA), ultrasound and physical examination.

Methods: Medline, EMBASE, Cochrane Trial Register and Web of Science databases were systematically searched. Studies were included if they provided sufficient data for a 2 × 2 contingency tables. QUADAS-2 was used to assess methodological quality. We performed bivariate random effects meta-analysis, generated a hypothetical cohort, and reported sensitivity and specificity.

Results: We included 12 studies (n = 3223, median recurrence rate 19.6%). Pooled estimates showed a sensitivity for CEA (≤ 5 μg/l) of 59% [47%-70%] and a specificity of 89% [80%-95%]. Only few studies reported sensitivities and specificities for ultrasound (36-70% and 97-100%, respectively) and clinical examination (23% and 27%, respectively).

Conclusion: In practice, GPs could perform CEA screening. Radiological examination in a hospital setting should remain part of the surveillance strategy. Personalised algorithms accounting for recurrence risk and changes of CEA-values over time might add to the diagnostic value of CEA in primary care.
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http://dx.doi.org/10.1111/ecc.13432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8518902PMC
September 2021

How well do healthcare professionals know of the priorities of their older patients regarding treatment outcomes?

Patient Educ Couns 2021 09 27;104(9):2358-2363. Epub 2021 Feb 27.

University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands.

Objectives: For shared decision making, it is crucial to identify patients' priorities regarding health outcomes. Our aim was to study whether healthcare professionals know these priorities.

Methods: In this cross-sectional study we included older patients who had to make a treatment decision, their general practitioners (GPs) and their medical specialists. Agreement between the patients' main health outcome as prioritised by using the Outcome Prioritization Tool (OPT) and the perception of the same outcome by their healthcare professionals.

Results: Eighty-seven patients were included. Median age was 76 years, 87.4% of patients presented with malignant disease. The majority prioritised maintaining independence (51.7%), followed by extending life (27.6%). The agreement between patients and healthcare professionals was low (GPs 41.7%, kappa 0.067, p = 0.39), medical specialists 40.3%, kappa 0.074, p = 0.33). Positively related to agreement was patient's age > 75, and a longer relation with their patients (for GPs), and the patient having no partner (for medical specialist). Having a malignant disease, dependent living and functional deficits were negatively related to agreement.

Conclusions: Healthcare professionals have poor perceptions of their patients' priorities.

Practice Implications: To realise patient-centered care, it is crucial to discuss priorities explicitly with all patients.
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http://dx.doi.org/10.1016/j.pec.2021.02.044DOI Listing
September 2021

Prioritisation of treatment goals among older patients with non-curable cancer: the OPTion randomised controlled trial in Dutch primary care.

Br J Gen Pract 2020 07 25;70(696):e450-e456. Epub 2020 Jun 25.

Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.

Background: Older patients with cancer often find it difficult to take part in shared decision making.

Aim: To assess the utility of the Outcome Prioritisation Tool (OPT), designed to aid discussion with a patient in regards to their treatment goals, to empower patients with cancer through structured conversations about generic treatment goals with GPs.

Design And Setting: A randomised controlled trial of 114 Dutch participants recruited between November 2015 and January 2019, aged ≥60 years with non-curable cancer who had to make a treatment decision with an oncologist. The intervention group used the OPT while the control group received care as usual.

Method: The primary outcome was patient empowerment using the score on the decision self-efficacy (DSE) scale. Secondary outcomes were symptoms measures of fatigue, anxiety, and depression. The experiences of participants were also explored.

Results: No effect was found on patient empowerment between the OPT group ( = 48; DSE 86.8; standard deviation [SD] = 18.2) and the control group ( = 58; DSE 84.2; SD = 17.6; = 0.47). In the OPT group, although statistically non-significant, fewer patients had low empowerment (18.8%, = 9 versus 24.1%, = 14; P = 0.50), but they did have statistically significant lower mean anxiety scores (6.0, SD = 4.6 versus 7.6, SD = 4.4; P<0.05) and less mild fatigue (58.8%, = 30 versus 77.2%, = 44; = 0.05). Overall, 44.8% ( = 13) of patients indicated that the OPT-facilitated conversation helped them make a treatment decision, and 31.1% ( = 14) of the GPs reported that they gained new insights from the conversation.

Conclusion: An OPT-facilitated conversation about generic treatment goals between patients and their GPs is associated with less anxiety and fatigue, but did not show statistically significant improvements in patient empowerment. Adding the OPT to routine care might ensure more patient-tailored care.
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http://dx.doi.org/10.3399/bjgp20X710405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274544PMC
July 2020

Using the Outcome Prioritization Tool (OPT) to assess the preferences of older patients in clinical decision-making: A review.

Maturitas 2019 Oct 30;128:49-52. Epub 2019 Jul 30.

University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, the Netherlands.

Shared decision making can guide patients facing difficult treatment decisions, with a trade-off between risks and benefits, taking patient goals and preferences into account. The Outcome Prioritization Tool (OPT) was developed to facilitate the discussion of goals and preferences with older patients in an encompassing, non-disease-specific way. The OPT is used in both primary and secondary healthcare for several treatment decisions, but data regarding the tool are limited. A concise review yielded two developmental articles, four articles describing three studies using the OPT, and one study protocol. All studies were performed among older patients. In those studies, the majority of patients ranked maintaining independence as most important. The tool has been shown to be feasible for both patients and healthcare providers.
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http://dx.doi.org/10.1016/j.maturitas.2019.07.022DOI Listing
October 2019

A systematic review on the prevalence of symptoms of depression, anxiety and distress in long-term cancer survivors: Implications for primary care.

Eur J Cancer Care (Engl) 2019 May 14;28(3):e13086. Epub 2019 May 14.

Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Introduction: Symptoms of depression, anxiety and distress are common in the first years after a cancer diagnosis, but little is known about the prevalence of these symptoms at the long term. The aim of this review was to describe the prevalence of symptoms of depression, anxiety and distress in long-term cancer survivors, five or more years after diagnosis, and to provide implications for primary care.

Methods: We performed a systematic literature search in the PubMed, PsycINFO and CINAHL databases. Studies were eligible when reporting on the prevalence of symptoms of depression, anxiety and/or distress in long-term cancer survivors (≥5 years after diagnosis), treated with curative intent.

Results: A total of 20 studies were included. The reported prevalence of depressive symptoms (N = 18) varied from 5.4% to 49.0% (pooled prevalence: 21.0%). For anxiety (N = 7), the prevalence ranged from 3.4% to 43.0% (pooled prevalence: 21.0%). For distress (N = 4), the prevalence ranged from 4.3% to 11.6% (pooled prevalence: 7.0%).

Conclusion: Prevalences of symptoms of depression, anxiety and distress among long-term survivors of cancer do not fundamentally differ from the general population. This is reassuring for primary care physicians, as they frequently act as the primary physician for long-term survivors whose follow-up schedules in the hospital have been completed.
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http://dx.doi.org/10.1111/ecc.13086DOI Listing
May 2019

Effects of Shared Decision Making on Distress and Health Care Utilization Among Patients With Lung Cancer: A Systematic Review.

J Pain Symptom Manage 2018 12 24;56(6):975-987.e5. Epub 2018 Aug 24.

Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Context: Lung cancer is associated with significant distress, poor quality of life, and a median prognosis of less than one year. Benefits of shared decision making (SDM) have been described for multiple diseases, either by the use of decisions aids or as part of supportive care interventions.

Objectives: The objective of this study was to summarize the effects of interventions facilitating SDM on distress and health care utilization among patients with lung cancer.

Methods: We performed a systematic literature search in the CINAHL, Cochrane, EMBASE, MEDLINE, and PsychINFO databases. Studies were eligible when conducted in a population of patients with lung cancer, evaluated the effects of an intervention that facilitated SDM, and measured distress and/or health care utilization as outcomes.

Results: A total of 12 studies, detailed in 13 publications, were included: nine randomized trials and three retrospective cohort studies. All studies reported on a supportive care intervention facilitating SDM as part of their intervention. Eight studies described effects on distress, and eight studies measured effects on health care utilization. No effect was found in studies measuring generic distress. Positive effects, in favor of the intervention groups, were observed in studies using anxiety-specific measures (n = 1) or depression-specific measures (n = 3). Evidence for reductions in health care utilization was found in five studies.

Conclusion: Although not supported by all studies, our findings suggest that facilitating SDM in the context of lung cancer may lead to improved emotional outcomes and less aggressive therapies. Future studies, explicitly studying the effects of SDM by using decision aids, are needed to better elucidate potential benefits.
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http://dx.doi.org/10.1016/j.jpainsymman.2018.08.011DOI Listing
December 2018

Possible missed opportunities for diagnosing colorectal cancer in Dutch primary care: a multimethods approach.

Br J Gen Pract 2018 01 4;68(666):e54-e62. Epub 2017 Dec 4.

Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Background: Early detection of colorectal cancer (CRC) is important to achieve better survival. Discriminating symptoms suggestive of CRC from benign conditions is a challenge for GPs because most known 'alarm symptoms' have low predictive values.

Aim: To further understand the diagnostic process of CRC in general practice in terms of healthcare use and by analysing factors related to diagnostic intervals.

Design And Setting: A multimethod approach comprising a historical, prospective registry study and qualitative content analysis.

Method: Healthcare use in the year before referral for colonoscopy was compared between patients diagnosed with CRC and an age-, sex,- and GP-matched control population. Qualitative content analysis was performed on free texts in electronic patient records from a purposive sample of patients with CRC.

Results: Patients with CRC ( = 287) had 41% (25-59%) more face-to-face contacts and 21% (7-37%) more medication prescriptions than controls ( = 828). Forty-six per cent of patients with CRC had two or more contacts for digestive reasons, compared with 12.2% of controls, more often for symptoms than diagnoses. From qualitative analysis two themes emerged: 'possible missed diagnostic opportunities' and 'improvements in diagnostic process unlikely'. Possible missed diagnostic opportunities were related to patients waiting before presenting symptoms, doctors attributing symptoms to comorbid conditions or medication use, or doctors sticking to an initial diagnosis.

Conclusion: Fewer missed diagnostic opportunities might occur if GPs are aware of pitfalls in diagnosing CRC: the assumption that symptoms are caused by comorbid conditions or medication, or relating complaints to pre-existing medical conditions. GPs also need to be aware that repeated digestive complaints warrant rethinking an earlier diagnosis.
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http://dx.doi.org/10.3399/bjgp17X693905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5737320PMC
January 2018

Patients' views on general practitioners' role during treatment and follow-up of colorectal cancer: a qualitative study.

Fam Pract 2017 04;34(2):234-238

Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Purpose: To clarify experiences and preferences of patients regarding the current and future role of GPs during treatment and follow-up care of colorectal cancer (CRC).

Methods: Qualitative semi-structured, audio-recorded, face-to-face interviews in patients' homes in the north of the Netherlands were performed. Patients were sampled purposively on age, gender, time since diagnoses and primary health care use. Data were transcribed verbatim and analysed thematically by two independent researchers until saturation was reached.

Results: Twenty-two patients were interviewed. GPs played a significant and highly valued role directly after surgery by proactively contacting their patients and offered support in clarification of medical issues, lifestyle advice and care for treatment-related side effects. During follow-up, GPs provided psychosocial support for patients and family members, besides routine health care. Concerning the organization of future follow-up care, most patients expressed a preference for specialist-led services; some said that primary care-led care would be more accessible and less expensive.

Conclusion: Although at present patients perceived their GP is involved in CRC care, they would prefer their follow-up care in a hospital setting. If, in line with recent insights, future follow-up care might become more relying on testing for markers instead of imaging, there may be scope for incorporating this care in current GP routines.
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http://dx.doi.org/10.1093/fampra/cmw124DOI Listing
April 2017

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

Scand J Prim Health Care 2014 Jun 15;32(2):55-61. Epub 2014 Jun 15.

Department of General Practice, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands.

Objective: The view that the general practitioner (GP) should be more involved during the curative treatment of cancer is gaining support. This study aimed to assess the current role of the GP during treatment of patients with colorectal cancer (CRC).

Design: Historical prospective study, using primary care data from two cohorts.

Setting: Registration Network Groningen (RNG) consisting of 18 GPs in three group practices with a dynamic population of about 30,000 patients.

Subjects: Patients who underwent curative treatment for CRC (n = 124) and matched primary care patients without CRC (reference population; n = 358).

Main Outcome Measures: Primary healthcare use in the period 1998-2009.

Findings: Patients with CRC had higher primary healthcare use in the year after diagnosis compared with the reference population. After correction for age, gender, and consultation behaviour, CRC patients had 54% (range 23-92%) more face-to-face contacts, 68% (range 36-108%) more drug prescriptions, and 35% (range -4-90%) more referrals compared with reference patients. Patients consulted their GP more often for reasons related to anaemia, abdominal pain, constipation, skin problems, and urinary infections. GPs also prescribed more acid reflux drugs, laxatives, anti-anaemic preparations, analgesics, and psycholeptics for CRC patients.

Conclusions: The GP plays a significant role in the year after CRC diagnosis. This role may be associated with treatment-related side effects and psychological problems. Formal guidelines on the involvement of the GP during CRC treatment might ensure more effective allocation and communication of care between primary and secondary healthcare services.
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http://dx.doi.org/10.3109/02813432.2014.929811DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4075017PMC
June 2014
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