ARPH 2021

Introduction: Ischemia with No Obstructive Coronary Arteries (INOCA) is a condition caused by vascular dysfunctions and more prevalent in women. INOCA poses a diagnostic and treatment challenge for patients and health care providers (HCP). The Dutch ‘Zorginstituut’ argues the need for a shared decision making tool in this patient group. In this qualitative study, experiences and health care needs were investigated in order to be able to develop and implement a shared decision making product. Methods: Participants were recruited from two Dutch hospitals: Elisabeth-Tweesteden Hospital and Radboud University Medical Center. Patients (N= 36 women) and HCP (cardiologists N = 15, general practitioners N= 11, other specialist N = 4) participated in online semi-structured focus group interviews. Preliminary Results: Both HCP and patients reported a lack of familiarity with the disease and its symptoms. Early in the health care trajectory, patients reported not being taken seriously, repeated hospital admission without a clear diagnosis as important barriers. Later in the trajectory, the need for better information regarding diagnostic testing, medication use, and other treatment options were important. Participants expressed a lack of a multidisciplinary approach as a barrier to symptom management. Conclusion: Our first findings illustrate the need for familiarity and knowledge regarding INOCA, which should be supported by an adequate referral system in both an early and a later stage of the healthcare trajectory. Diagnostic referral tools applicable and understandable by patients and HCP may facilitate the diagnostic/treatment process and/or improve communication between patients and HCP.

Dinah van Schalkwijk (poster 2)

Dept of medical and clinical psychology, Tilburg University

BACKGROUND: We formerly identified 17 informational topics on which health care professionals, patients and care-partners agree that these should be discussed during diagnostic consultations in memory-clinics. In addition, 8 topics were identified as highly relevant by at least one, but not all three groups. Here, we studied to what degree these 25 informational topics are actually discussed during diagnostic consultations and at whose initiative, i.e., the clinician, the patient or the care-partner.

METHODS: Audio-recordings of pre- and post-test clinician-patient consultations of 71 patients (age 70±10 (M±SD), range 43-90, female 32/71(45%)), seen by 32 clinicians (age 43±12 (M±SD), range 25-66, female 11/32(34%)), were collected in eight memory-clinics and independently content-coded by two coders. The coding scheme encompassed the 25 informational topics, grouped into 4 categories; (i) diagnostic testing, (ii) test results, (iii) diagnosis and prognosis, and (iv) practical implications.

FINDINGS: Many topics were discussed frequently, though individual topics ranged from being discussed with 2/71 (3%) to 70/71 (99%) of the patients. On average, 12 (SD=4) of the 25 topics were discussed per patient, during the diagnostic process. Topics in the category ‘diagnosis and prognosis’ were discussed least frequently. Patients and/or care-partners rarely initiated discussion of a topic (topic initiated by clinician: 90%), but when they did, the topic was most often one of the least frequently addressed topics.

DISCUSSION: We found most topics to be addressed quite frequently by clinicians in memory-clinics. Nevertheless, we observed considerable variation when looking at individual topics. Discussion of diagnostic or prognostic information was relatively limited, while patients and care-partners consider this topic highly relevant, as substantiated by initiating discussion on these topics. Hence, this information should receive more attention in clinical practice. In addition, providing the topic list to patients prior to their visit could allow them to better prepare and stimulate active participation.

Agnetha Fruijtier

Amsterdam UMC, department of Medical Psychology

Amsterdam UMC, Alzheimer Center Amsterdam

Introduction: The majority of patients with symptoms suspect of myocardial ischemia show normal or non-obstructive coronary arteries during diagnostic testing. This is a condition termed ‘Ischemia with no obstructive Coronary Arteries’ (INOCA) and is predominantly seen in women. The aim of this study was to investigate the psychosocial functioning and quality of life in patients with INOCA compared to patients with non-cardiac symptoms and patients with obstructive coronary artery disease (CAD). Methods: Participants (N= 373, mean age 65.2 ± 9.3, 57% women) were included from two studies, which examined, respectively, (1) women with (recurrent cardiac) complaints without obstructive coronary artery disease and (2) patients referred for myocardial perfusion imaging. Participants completed questionnaires assessing psychological distress, quality of life and well-being. Medical information was obtained from hospital records. Presence of ischemia and obstructive CAD was used to categorize patients into INOCA or obstructive CAD. Results: INOCA was significantly more prevalent in women (71%) and younger patients compared to patients with obstructive CAD (26%). Patients with INOCA tended to report a better health related quality of life, but this was not significantly different. Accept for anxiety no significant differences were psychological characteristics. Conclusion: Common psychological symptoms (anxiety, depression, stress and fatigue) are prevalent in patients with both obstructive and non-obstructive CAD, but do not differ between patients with INOCA and obstructive CAD accept for anxiety. Differences in timing of measurement between the studies may have affected the outcomes.

Dinah van Schalkwijk

Dept of medical and clinical psychology, Tilburg University

Background. Since the outbreak of COVID-19 several reports have shown that fear relating to COVID-19 has sharply increased. Given that the restrictions and rules for lockdowns were different for Europe and North America, the aim of this study was to examine the differences in fear of COVID-19 between these continents. Methods. Participants filled out an online survey (N=2000) via Prolific every month for six months (March through August 2020). Fear of COVID-19 was assessed with the eight-item Fear of Coronavirus Questionnaire (range 8-40). Repeated measures ANOVA was used to compare fear of COVID-19 between continents (Europe vs. North America) over time. Results. Our results showed that fear of COVID-19 decreases over time (F (3.27, 3266.42) = 68.20, p<.001), and that this decrease in fear differs between continents (time*continent F (3.27, 3266.42) = 16.88, p<.001; see Figure 1a). Lastly, a between-subjects effect of continent was observed (F (1, 1000) = 69.00, p<.001) indicating that fear levels are overall higher in North America compared to Europe. Conclusion. Levels of fear of COVID-19 seem to sharply increase at the start of the pandemic (March to April), but then slowly decrease over time (see Figure 1a). The pattern of decrease differs between North America and Europe, which could be explained by the different patterns of infections between continents (see Figure 1b). Additionally, the larger number of infections in North America may also explain why our results showed that levels of fear are significantly higher in North America compared to Europe.

Stefanie Duijndam

Tilburg University, Department of Medical and Clinical Psychology

COVID-19 has various consequences for people, such as uncertainty regarding infection or infecting others, and may therefore be experienced as a traumatic event. After experiencing a traumatic event, people may perceive positive changes, defined as post-traumatic growth (PTG). To gain more insight into the concept of PTG, the present study aims to examine who perceived PTG during the COVID-19 pandemic, by exploring subgroups based on age, primary and secondary appraisal, stressfulness, rumination, positive reappraisal, and coping flexibility. Only participants who experienced higher levels of PTG were included in the analysis, defined by experiencing at least 2 of the 10 presented positive changes of the post-traumatic growth inventory (PTGI) to a moderate degree. Based on this criterium, 438 individuals of the total 975 participants experienced higher levels of PTG and were included in the analysis. Results of Latent Profile Analysis (LPA), showed two distinct groups reporting PTG: 1) a group reporting higher levels of secondary appraisal, positive reappraisal, and coping flexibility and 2) a group reporting higher levels of primary appraisal, stressfulness, and rumination. Thus, among people experiencing PTG, there seems to be a group who is less impacted by COVID-19 and better able to cope with COVID-19, and a group who perceives a greater impact of COVID-19 and less able to cope with the pandemic.

Denise Blom <d.m.blom@umcg.nl>

University Medical Center Groningen

Introduction: Life events or crises such as COVID-19 may function as ‘teachable moments’. The aim of this study was to explore whether the pandemic can provoke a teachable moment regarding lifestyle change in cardiovascular disease (CVD) patients.

Method: In this cross-sectional study, 830 CVD patients completed an online survey on their intentions to change lifestyle, instigated by the COVID-19 outbreak, and their risk perception, affective response and a change in self-concept on the basis of a ‘teachable moments’ framework. Multivariate regression analyses were conducted to examine the role of these factors on intention to optimize lifestyle.

Results: Between 8-30% of the sample reported increased intentions to optimize health behaviors, in particular related to general lifestyle (28%), physical activity (25%) and dietary behavior (21%) and to a lesser extent to limiting alcohol consumption (13%) and smoking (8%). The multivariate regression analyses revealed changed self-concept as a significant predictor of improving general lifestyle (β = .28), physical activity (β = .25) and smoking (β = .29). Both changed in self-concept and affective response were significant predictors of the intention to improve dietary behavior (resp. β = .29 and β = .12) and limiting alcohol consumption (resp. β = .24 and β = .11).

Conclusion: Our results demonstrate that the COVID-19 crisis may pose a teachable moment towards changing lifestyle for CVD patients, possibly driven by a change in self-concept. The results suggest a window of opportunity for healthcare professionals to utilize the COVID-19 crisis to promote a healthy lifestyle among their patients.

Michelle Brust

LUMC Campus The Hague/Leiden University Medical Centre

Introduction: Providing unpaid care for a loved one or a family member with dementia can have tremendous impact on caregivers’ lives. eHealth technologies aim at relieving the burden of care, but often end up in unsuccessful implementation. Although literature is abundant with review studies about eHealth technologies in the dementia context and generic frameworks of the implementation process, a further synthesis and practical guidelines tailored to the context of informal dementia care are needed. The aims of this umbrella review are to (i) synthesize determinants of eHealth technology implementation aimed at supporting informal dementia care, and (ii) identify gaps between theory and practice. Methods: Medline, Cochrane, PyscInfo, PubmMed, and Scopus were searched and 23 reviews were included. Studies were included if they were review studies about eHealth technologies to support informal care of people with dementia. Results: The NASSS framework was used as analysis framework to interpret this review’s findings. Main determinants of implementation identified in the analysis centered around the physical appearance of devices, the challenge of early-stage involvement of people with dementia and timing of technology introduction, the mismatch of perceived and expected benefits and ethical and privacy concerns. Surprisingly, determinants related to the wider context and embedding and adaptation over time were rarely found. Conclusions: This review identified a greater focus on development and adoption in the short term, thereby highlighting the lack of long term-oriented sustainable implementation strategies of eHealth technologies in the context of informal dementia care.

Sofia Bastoni <s.bastoni@utwente.nl>

Centre for eHealth & Wellbeing Research, University of Twente, Enschede, The Netherlands

Department of Psychology, Universitá Cattolica del Sacro Cuore di Milano

Introduction: Personalizing eHealth interventions can increase the added value of eHealth, as a counterpart to the commonly used one-size-fits-all approach. Yet, there is no unambiguous agreement on how personalization is defined, and how personalization is applied to eHealth interventions. Therefore, our literature study, we aim to describe in detail (1) how personalization is defined in the literature (2) how eHealth users are segmented by investigating which variables are used to describe the groups of users on a more individual level, (3) how the described eHealth intervention is customized to the characteristics or context of the end user, and (4) whether personalized eHealth interventions have larger effect sizes than the same intervention without personalization.

Methods: We aim to review literature describing personalized eHealth intervention(s) that aim to change users’ (determinants of) health-related behaviours. This systematic review consists of three steps, aligned with the aims of the current study with increasingly specific inclusion criteria.

Results: We will search the literature by means of a search string in which terms regarding personalization, tailoring, technology, intervention and eHealth were included. Titles, abstracts, and full texts will be screened by two researchers. The full texts will be further included for each step of the literature search.

Conclusion: Our elaborate systematic review will contribute to gaining insight into if and how personalization increases the effectiveness of eHealth interventions. During the poster presentation we aim to present our protocol, and share our preliminary results. Moreover, we would like to discuss the definition of personalization with participants of the conference.

Iris ten Klooster

Centre for eHealth and Wellbeing Research, University of Twente

Saxion University of Applied Sciences, Optentia Research Focus Area, North-West University, Department of Health Promotion, Care and Public Health Research Institute, University Medical Centre Groningen

Background: Carriers of the PLN p.Arg14del mutation are at increased risk of developing arrhythmias and end-stage heart failure. Clinical features are highly variable, even within families. Several risk factors may be linked to this variability. We aim to examine psychological stress and personality in PLN mutation carriers, as this has been proven to affect cardiovascular disease progression like coronary artery disease. Methods: PLN mutation carriers diagnosed in three University Medical Centers in the Netherlands were asked to fill out a survey assessing psychological stress (e.g. experienced stress and the occurrence of multiple life-events) and personality traits (e.g. Type D-personality). Clinical outcomes (heart failure and arrhythmias) were retrospectively collected from the PLN registry. Preliminary results: Preliminary results in 351 persons indicated no significant association of perceived stress and Type D personality with more severe clinical outcomes at younger age based on log-rank tests. We observed that carriers who experienced more life events earlier in life seem to get major cardiac events at younger age (25-45 year), compared to carriers with less life events. However, this association was not statistically significant (p = 0.287) Discussion: Preliminary findings show no significant associations of stress and personality with the severity of cardiac phenotype in PLN carriers, but there may be a trend in number of life events at young age and risk of more severe clinical outcomes, Increased awareness among cardiologists and adequate referral for psychosocial support may help mutation carriers lower the risk of psychological stress. Data collection will finish in 2021.

Esmée van Drie

1 Department of Genetics, University Medical Center Utrecht, the Netherlands

2 Department of Medical and Clinical Psychology, Tilburg University, the Netherlands, 3. Department of Cardiology, Amsterdam University Medical Center, location AMC, the Netherlands, 4. Department of Cardiology, University Medical Center Groningen, the Netherlands

Background. More than half of the medical student population experience burnout and it impacts their private lives as well as their professional development. To prevent burnout, we need to understand how those who do (not) burn out differ. Experiencing psychological distress (PD) has predictive value for burnout but there is a lack of research that investigates which longitudinal patterns of distress are linked to burnout. Particularly when transitioning from theoretical to practical medical education (i.e., bachelor to master), the burnout risk increases given the sharp increase in demands. The aim of this study is to examine how trajectories of PD in medical students during their bachelor can predict burnout in the master phase.

Methods. We will use data from the Juggle Study, a cohort study (2015-) that follows medical students (n=374) over six years. Students completed yearly measures, including a measure of PD (GHQ-12) and burnout (MBI). This study uses data-driven clustering to investigate PD trajectories of medical students during the bachelor with latent class growth modelling. Subsequently, these trajectories are entered into a multiple linear regression to predict burnout at the beginning of the master.

Results. Preliminary analyses suggest four distinct PD trajectories (group 1= low PD, g2 = decreasing PD, g3 =increasing PD, and g4= peak during the second year). There were no differences between group 1 (reference) and group 3; group 2 had higher levels of cynicism (one dimension of the MBI). However, group 4 had higher levels of burnout on all dimensions.

Discussion. The results suggest that there is a difference in burnout experience in the PD trajectory groups. In future work, we will investigate the effect of engagement within the trajectory groups and their effect on burnout.

Valentina Sagmeister

University of Groningen & Universitair Medisch Centrum Groningen, Department of Health Psychology

College students are often confronted with social facilitation of alcohol abuse and this can be linked to a greater likelihood of alcohol dependence, further abuse and drunk driving later in life. Prevention focused approaches need to receive more attention to educate and train young adults to moderate their drinking and thereby reduce the risk of dependence. Fostering the execution of health- and preventative behaviours to create long-lasting change demands the development of interventions that are personally relevant, engaging and effective to avoid adverse short-term and long-term health outcomes. The current study investigates the potential of applying fear appeal theory, as rooted in the assumptions of the extended parallel processing model, in an interactive digital narrative. The study therefore specifically focuses on the effect of interactivity (low/high agency) on fear appeal effectiveness and the difference between short- and long-term outcomes integrated into an interactive digital narrative about a risk situation appropriate for the target population. Effectiveness of the fear appeal, as measured by severity, susceptibility, self-efficacy and response-efficacy, will be assessed as well as the behavioural intention to abstain from alcohol abuse. We expect higher agency to result in a more effective fear appeal through increased self-efficacy by executing the behaviour in the narrative. We expect this effect to be strengthened by the framing of the narrative in terms of short-term threat outcomes as opposed to long-term threat outcomes.

Hendrik Engelbrecht

Tilburg University

Introduction: If undetected, inherited cardiac diseases can lead to sudden cardiac death, while preventive and treatment options are available. Genetic counselling is deemed important for relatives (who have a 50% risk of disease) to make a well-informed decision regarding predictive DNA testing. Currently, patients are asked to inform relatives. However, less than half of relatives attends genetic counselling. Research suggests that informing relatives directly by the healthcare professional may enhance the uptake, although there are legal, ethical and psychological concerns using such an approach. Methods: Current practice was compared to a tailored approach, in which patients were asked to decide to (initially) inform relatives themselves or by the counsellor, and family letters were sent directly by the healthcare professional 1 month after disclosure of the patients’ test result. Outcomes were uptake of counselling in the first year, impact on psychological and family functioning, and evaluation of the approach (measured with surveys at 3 (T1) and 9 (T2) months after disclosure). Results: 96 patients were included and 482 relatives were eligible for counselling and genetic testing. We observed no significant difference in uptake of genetic counselling between the current (38%) and the tailored (37%) approach. No differences in worry, anxiety and impact on family communication about the disease was observed between the tailored and the current approach. Significantly more patients in the tailored group were satisfied with the used approach, while they also felt more pressure to inform at-risk relatives and perceived room for improvement of the used approach. Conclusions: No differences in uptake and impact on family and psychological functioning between the current and the tailored approach were observed, but patients randomised to the tailored approach more often felt satisfied about the used approach. Further research is needed to identify the most optimal approach to support informing at-risk relatives.

Lieke van den Heuvel

Department of Clinical Genetics, Amsterdam UMC (location AMC)

1. Department of Clinical Genetics, Amsterdam UMC (location AMC), Amsterdam, the Netherlands; 2. Netherlands Heart Institute, Utrecht, the Netherlands; 3. Department of Genetics, University Medical Centre Utrecht, Utrecht, the Netherlands ; 4. Department of Clinical Genetics, Radboud University Medical Centre, Nijmegen, the Netherlands; 5. Department of Medical Psychology, Amsterdam UMC (location AMC), Amsterdam, the Netherlands; 6. Department of Clinical Genetics, University Medical Centre Groningen, Groningen, the Netherlands

Background: The theory-based Adherence Improvement self-Management Strategy (AIMS) is feasible, effective and cost-effective in supporting medication adherence for patients with HIV. AIMS-HIV is comprised of 1-to-1 nurse-patient conversation during routine clinical visits, with electronic medication monitoring and feedback as core components. No (cost)effective interventions have been identified for supporting treatment adherence amongst CHF. The aim of this study was to adapt AIMS to Chronic Heart Failure (AIMS-CHF) and explore its acceptability. Methods: AIMS was adapted using Intervention Mapping, by systematically identifying elements that require adaptation, with the preservation of core programme components. A literature review was conducted and advisory boards with patients and nurses were organized to inform the adaptation process. Results: AIMS-CHF had to become a multiple behaviour intervention, including medication adherence, adherence to physical activity and symptom monitoring. The key determinants of these behaviours were largely similar to those already targeted in AIMS-HIV (e.g., illness perceptions, attitude, self-efficacy, habits, and self-regulatory skills), so intervention methods and strategies could be retained. Findings from the literature review and advisory boards allowed making informed decisions about the modification and translation of the AIMS-materials to CHF (e.g., modifying specific beliefs, barriers/solutions, images, and monitoring devices). Conclusion: The building blocks of AIMS were generally appropriate for supporting the self-management of CHF, although additional behaviours and content modifications were required. The Intervention Mapping approach, complemented with the literature (in particular review and qualitative studies) and advisory boards, allowed systematic adaptation of AIMS to CHF and assess its acceptability to patients and healthcare providers.

Joëlle Dam

Radboud Institute for Health Sciences, Departments of IQ Healthcare and Physiology, Radboud University Medical Center.

Introduction: Pediatric chronic diseases have been associated with emotional and cognitive difficulties. Yet, most studies investigate general psychological outcomes (e.g. quality of life, anxiety; Beale, 2006; Sansom-Daly et al., 2012). At present, no systematic review has specifically analyzed the effectiveness of interventions on processes underlying the effects on these variables. Therefore, we will conduct a systematic review of empirical studies testing the effectiveness of psychological interventions for children with chronic diseases in which we will examine the mediating role of emotional and cognitive processes.

Methods: The systematic review will be conducted according to the PRISMA statement. The search will be conducted on different electronic databases and include a grey literature search. Search terms are defined in five categories referring to the age group (children, 8-12 years), disease types (e.g. diabetes, cystic fibrosis), types of intervention (e.g. CBT, mindfulness, family therapy), outcomes of interest (e.g. emotion regulation, cognition) and study type/design (e.g. intervention study, RCT). The main inclusion criterion for articles concerns the presence of at least one measure of effectiveness on emotional (emotion regulation or coping) or cognitive (executive functions) processes.

Results: The results will allow to better determine the emotional and cognitive processes that underlie beneficial effects on physical and psychological health.

Conclusions: The systematic review is a first step towards the development and implementation of an evidence-based psychological intervention for children with chronic diseases. This intervention will be co-constructed by families, health care professionals and researchers and based on the acquired scientific evidence concerning the implied, targeted processes.

Mareike Kaemmerer <mareike.kaemmerer@uclouvain.be>

UCLouvain

University of Cyprus