Using a retrospective pretest instead of a conventional pretest is replacing biases: a qualitative study of cognitive processes underlying responses to thentest items.

Background: The thentest design aims to detect and control for recalibration response shift. This design assumes (1) more consistency in the content of the cognitive processes underlying patients' quality of life (QoL) between posttest and thentest assessments than between posttest and pretest assessments; and (2) consistency in the time frame and description of functioning referenced at pretest and thentest. Our objective is to utilize cognitive interviewing to qualitatively examine both assumptions.

Differential growth in doctor-patient communications skills.

Context: Although doctor-patient communication is considered a core competency for medical doctors, the effect of training has not been unequivocally established. Moreover, knowledge about the variance in the growth of different skills and whether certain patterns in growth can be detected could help us to develop more efficient programmes. We therefore investigated the growth in general practitioner (GP) trainees' doctor-patient communication skills in their first year and whether the growth was different for distinct categories of skills.

Which barriers affect morbidity registration performance of GP trainees and trainers?

Background: Diagnosis coding percentages in the specialty training of general practitioners (GPs) are generally high, but not perfect, indicating barriers against coding still exist, possibly influencing the validity of data based on electronic patient records (EPRs).

Objective: To study the relationship between barriers to coding diagnoses with the International Classification of Primary Care (ICPC) of GP trainees and trainers and their self-reported and actual coding performance.

Methods: A questionnaire was developed, and returned by 71 (of 73, 97%) GP trainees and 103 (of 108, 95%) GP trainers, affiliated to the GP Specialty Training of the Academic Medical Center, University of Amsterdam.

Steering the patient mix of GP trainees: results of a randomized controlled intervention.

Background: In studies exploring the patient mixes of general practitioner (GP) trainees, gaps were repeatedly found, as there were disparities between the patient mixes of GP trainers and trainees. This reduces the opportunities of trainees to acquire enough competence.

Aims: To investigate whether steering the patient mix can be effectuated by instructing medical receptionist, trainer and trainee, and to study the effects of this intervention on trainee's self-efficacy (SE) and knowledge.

Two-dimensional structure of the MAAS-Global rating list for consultation skills of doctors.

Background: The MAAS-Global (MG) is widely used to assess doctor-patient communication skills. Reliability and validity have been investigated, but little is known about its dimensionality. Assuming physicians tend to adopt certain styles or preferences in their communication with patients, a multi-dimensional structure of the MG can be hypothesized.

SMART, SMARTER, SMARTEST: the influence of peer groups compared to practice visits on the quality of action plans.

Background: It has been reported that appraisal by peers can be effective.

Aim: To investigate whether feedback from a peer group (PG) compared to that by a staff member during a practice visit (PV) is as effective in improving the quality of action plans.

Methods: Seventy-three general practitioner (GP) trainers randomized into either a PG or PV were instructed to draw up action plans using the SMART criteria to realize the goals set in their personal development plans (PDPs).

Do GP trainers use feedback in drawing up their Personal Development Plans (PDPs)? Results from a quantitative study.

Background: General practice (GP) trainers play a key role GP trainees' education. To stimulate development of trainer competencies a Personal Development Plan (PDP) can be helpful, especially when feedback is incorporated.

Aims: To investigate to what extent GP trainers use feedback in PDPs.

The role of recalibration response shift in explaining bodily pain in cancer patients undergoing invasive surgery: an empirical investigation of the Sprangers and Schwartz model.

Objective: This study aims to explain bodily pain using the Sprangers and Schwartz theoretical model (1999) on quality of life (QL) and response shift in its entirety. Response shift refers to the phenomenon that the meaning of a person's self-evaluation changes over time. In this model, response shift mediates effects of changes in health status (catalysts), stable characteristics of the person (antecedents), and coping mechanisms (mechanisms) on QL.

Opening the black box: the patient mix of GP trainees.

Background: The variety of health problems (patient mix) that medical trainees encounter is presumed to be sufficient to master the required competencies.

Aim: To describe the patient mix of GP trainees, to study differences in patient mix between first-year and third-year GP trainees, and to investigate differences in exposure to sex-specific diseases between male and female trainees.

Design And Setting: Prospective cohort study in Dutch primary care.

Exploring differences in patient mix in a cohort of GP trainees and their trainers.

Background During specialty training for general practice, trainees acquire the required competencies through work-based learning. Previous small-scale and older studies suggest that the patient mix of general practitioner (GP) trainees differs from that of their trainers: trainees are exposed to more minor illnesses, and fewer chronic diseases and severe conditions, which may influence the development of their competency. Research question What are the differences in the patient mix between trainees and trainers? Methods 49 first- and 24 third-year trainees and their trainers (n=114) were included in the study.

Opening the black box of cancer patients' quality-of-life change assessments: a think-aloud study examining the cognitive processes underlying responses to transition items.

Transition items are a popular approach to determine the clinical significance of patient-reported change. These items assume that patients (1) arrive at a change evaluation by comparing posttest and pretest functioning, and (2) accurately recall their pretest functioning. We conducted cognitive think-aloud interviews with 25 cancer patients prior to and following radiotherapy.

Who determines the patient mix of GP trainees? The role of the receptionist.

Background: During their specialty training, Dutch GP trainees work at a GP under the supervision of a GP trainer. Research suggests that the patient mix of GP trainees differs from that of their trainers. Receptionists assign patients to either the trainee or the trainer, thereby influencing the patient mix of the trainees.

A 'short walk' is longer before radiotherapy than afterwards: a qualitative study questioning the baseline and follow-up design.

Background: Numerous studies have indirectly demonstrated changes in the content of respondents' QoL appraisal process over time by revealing response-shift effects. This is the first known study to qualitatively examine the assumption of consistency in the content of the cognitive processes underlying QoL appraisal over time. Specific objectives are to examine whether the content of each distinct cognitive process underlying QoL appraisal is (dis)similar over time and whether patterns of (dis)similarity can be discerned across and within patients and/or items.

Somatically ill persons' self-nominated quality of life domains: review of the literature and guidelines for future studies.

Objective: To review which domains somatically ill persons nominate as constituting their QoL. Specific objective is to examine whether the method of enquiry affect these domains.

Methods: We conducted two literature searches in the databases PubMed/Medline, CINAHL and Psychinfo for qualitative studies examining patients' self-defined QoL domains using (1) SEIQoL and (2) study-specific questions.

Formal definitions of measurement bias and explanation bias clarify measurement and conceptual perspectives on response shift.

Objective: Response shift is generally associated with a change in the meaning of test scores, impeding the comparison of repeated measurements. Still, different researchers have different views of response shift. From a measurement perspective, response shift can be considered as bias in the measurement of change, whereas from a more conceptual perspective, it can be considered as bias in the explanation of change.

Clarifying quality of life assessment: do theoretical models capture the underlying cognitive processes?

Objective: To develop an analysis scheme capturing the cognitive processes underlying QoL assessment to increase our understanding on how to interpret responses to QoL items. Tourangeau et al.'s (The psychology of survey response, 2000) and Rapkin and Schwartz' (Health Qual Life Outcomes 2:14, 2004) cognitive process models form the basis for this analysis scheme.

Hirschsprung's disease: healthcare meets the needs.

Objective: The objective of this study was to examine the types of healthcare services used by children, adolescents, and adults with Hirschsprung Disease (HD) in relation to the severity of the initial defect (mild, severe), whether additional care was needed, the provision of information, transfer to adult care, and satisfaction with the care provided.

Methods: Three hundred twenty (71%) HD patients, ages 6 to 54, completed a questionnaire that assessed the use of healthcare services, the need for more healthcare, the provision of information, the transfer to adult care and satisfaction with the provided care.

Results: In 6 months, 45% of the children, 14% of the adolescents, and 15% of the adults consulted a medical specialist.

Quality of life in newly diagnosed cancer patients waiting for surgery is seriously impaired.

Background And Objectives: Newly diagnosed cancer patients waiting for initial surgery experience a stressful time. Study objectives were (1) to examine the quality of life (QL) of these patients by comparing QL (a) between the four diagnostic groups included in this study, (b) to the QL of the general population, (2) to determine the factors that contribute most to patients' overall QL.

Methods: One hundred ninety six patients with lung, periampullary, oesophageal and cervical cancer completed questionnaires on generic QL (SF-36), overall QL, cancer-site specific symptoms (EORTC-modules), anxiety (STAI), health expectations, demographics and comorbidity.

Explaining change over time in quality of life of adult patients with anorectal malformations or Hirschsprung's disease.

Purpose: The aim of this study was to examine changes in the quality of life of adult patients with anorectal malformations or Hirschsprung's disease over a three-year interval and to identify demographic, clinical, and psychosocial variables that explain possible quality-of-life changes. Understanding the factors that affect changes in quality of life over time is particularly important to provide adequate care.

Methods: Questionnaires were administered to 261 patients (77 percent), with a three-year interval.

Anorectal malformations: does healthcare meet the needs?

Objectives: The first aim was to identify the types of healthcare services used by children, adolescents, and adults with anorectal malformation (ARM) in relation to the severity of their disease and to examine whether additional care was needed. The second aim was to evaluate specific areas in the healthcare system, including provided information, transfer from pediatric to adult care, and satisfaction with the provided care.

Methods: Three hundred eighty-six (61%) patients with ARM, ages 6 to 52, completed a questionnaire that assessed their use of healthcare services and the need for additional services.

Methods to detect response shift in quality of life data: a convergent validity study.

When measuring changes in quality of life (QL) with a pretest-posttest design, response shift can affect results. We investigated the convergent validity of three approaches to detect response shift. (1) In the thentest approach, response shift is measured using a retrospective judgment of pretest QL-levels (thentest).

An application of structural equation modeling to detect response shifts and true change in quality of life data from cancer patients undergoing invasive surgery.

The objective is to show how structural equation modeling can be used to detect reconceptualization, reprioritization, and recalibration response shifts in quality of life data from cancer patients undergoing invasive surgery. A consecutive series of 170 newly diagnosed cancer patients, heterogeneous to cancer site, were included. Patients were administered the SF-36 and a short version of the multidimensional fatigue inventory prior to surgery, and 3 months following surgery.

Quality of life after colon interposition by necessity for esophageal cancer replacement.

Background: After esophagectomy for cancer, the first choice for reconstruction of the gastrointestinal continuity is by gastric tube. When this is not feasible, a reconstruction by colon interposition can be performed. The aim of this study was to assess the quality of life in patients at least 6 months after esophageal cancer resection and colon interposition without signs of recurrent disease.

The need for a prophylactic gastrojejunostomy for unresectable periampullary cancer: a prospective randomized multicenter trial with special focus on assessment of quality of life.

Objective: To evaluate the effect of a prophylactic gastrojejunostomy on the development of gastric outlet obstruction and quality of life in patients with unresectable periampullary cancer found during explorative laparotomy.

Summary Background Data: Several studies, including one randomized trial, propagate to perform a prophylactic gastrojejunostomy routinely in patients with periampullary cancer found to be unresectable during laparotomy. Others suggest an increase of postoperative complications.

Stress, satisfaction and burnout among Dutch medical specialists.

Background: Stress and stress-related illnesses are increasing among medical specialists. This threatens the quality of patient care. In this study we investigated (a) levels of job stress and job satisfaction among medical specialists, (b) factors contributing to stress and satisfaction and (c) the effect of stress and satisfaction on burnout.