Current wishes to die; characteristics of middle-aged and older Dutch adults who are ready to give up on life: a cross-sectional study.

BACKGROUND: Literature shows that middle-aged and older adults sometimes experience a wish to die. Reasons for these wishes may be complex and involve multiple factors. One important question is to what extent people with a wish to die have medically classifiable conditions. AIM: (1) Estimate the prevalence of a current wish to die among middle-aged and older adults in The Netherlands; (2) explore which factors within domains of vulnerability (physical, cognitive, social and psychological) are associated with a current wish to die; (3) assess how many middle-aged and older adults with a current wish to die do not have a medically classifiable condition and/or an accumulation of age-related health problems. METHODS: Data of 2015/16 from the Longitudinal Aging Study Amsterdam were used for this cross-sectional study (1563 Dutch middle-aged and older adults aged between 57 and 99 years), obtained through structured medical interviews and self-reported questionnaires. Three experienced physicians assessed whether the participants with a current wish to die could be classified as having a medically classifiable condition and/or an accumulation of age-related health problems. RESULTS: N = 62 participants (4.0%) had a current wish to die. Having a current wish to die was associated with multiple characteristics across four domains of vulnerability, among which: self-perceived health, problems with memory, self-perceived quality of life and meaningfulness of life. Fifty-four participants with a current wish to die were assessed with having a medically classifiable condition, of which one was also assessed with having an accumulation of age-related health problems. Six people were assessed to have neither, and for two people it was unclear. CONCLUSION: A small minority of middle-aged and older adults in the Netherlands have a current wish to die. Most of them can be classified with a medical condition and one person with an accumulation of age-related health problems. Furthermore, the findings show that having a current wish to die is multi-faceted. There is still a need for more knowledge, such as insight in to what extent suffering stemming from the medical classifiable disease contributes to the development of the wish to die.

DOC questionnaire: measuring how GPs and medical specialists rate collaboration.

PURPOSE: This paper aims to assess the validity of a questionnaire aimed at assessing how general practitioners (GPs) and specialists rate collaboration. DESIGN/METHODOLOGY/APPROACH: Primary data were collected in The Netherlands during March to September 2006. A cross-sectional study was conducted among 259 GPs and 232 specialists. Participants were randomly selected from The Netherlands Medical Address Book. Specialists rarely contacting a GP were not invited to participate. FINDINGS: Exploratory factor analysis indicated that the questionnaire, consisting of 20 items, measured five domains: organisation; communication; professional expertise; image; and knowing each other. Cronbach's alpha coefficients ranged from 0.64 to 0.83 indicating sufficient internal consistency. Correlation coefficients between domains were all < 0.4. All but "communication" clearly produced distinguishing scores for different respondent groups. RESEARCH LIMITATIONS/IMPLICATIONS: This study shows that the doctors' opinions on collaboration (DOC) questionnaire is valid and that it may have the potential to give feedback to both medical professionals and policy makers. Such feedback creates an opportunity to improve collaboration. ORIGINALITY/VALUE: The DOC questionnaire is a useful instrument for assessing collaboration among GPs and specialists. It can provide feedback to both medical professionals and policy makers. Such feedback creates an opportunity to improve collaboration.

How do general practitioners and specialists value their mutual communication? A survey.

BACKGROUND: Communication between general practitioners (GPs) and specialists is important, if we want patients to receive the right type of care at the right moment. Most communication takes place through telephone contact, letters concerning information on patients more recently also by email, and joint postgraduate training. As much research has been aimed at the content of communication between GPs and specialists, we wished to address the procedural aspects of this communication. We addressed the following research question. How do GPs and specialists assess their mutual communication through telephone, letters and postgraduate courses? METHODS: A cross-sectional study was conducted among a random sample of 550 GPs and 533 specialists selected from the Netherlands Medical Address Book. The response rate was 47% GPs (n = 259) and 44% specialists (n = 232). RESULTS: Specialists qualify the GPs' telephone accessibility as poor; while GPs themselves do not. Specialists think poorly of the GPs' referral letter. Merely half of GPs feels their questions are addressed appropriately by the specialist, whereas specialists think this number is considerably higher. According to specialists, GPs often do not follow the advice given by them. GPs rate their compliance much higher. Less than a quarter of GPs feel the specialist's letter arrives on time. Specialists have a different perception of this.Both parties wish to receive feedback from one and other, while in practice they do so very little. CONCLUSION: GPs and specialists disagree on several aspects of their communication. This impedes improvements. Both GP's accessibility by phone and time span to the specialist's report could be earmarked as performance indicators. GPs and specialists should discuss amongst themselves how best to compose a format for the referral letter and the specialist's report and how to go about exchanging mutual feedback.

Motives and preferences of general practitioners for new collaboration models with medical specialists: a qualitative study.

BACKGROUND: Collaboration between general practitioners (GPs) and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates GPs to initiate and continue participating with medical specialists in new collaborative care models. The following two questions are addressed in this study: What motivates GPs to initiate and sustain new models for collaborating with medical specialists? What kind of new collaboration models do GPs suggest? METHODS: A qualitative study design was used. Starting in 2003 and finishing in 2005, we conducted semi-structured interviews with a purposive sample of 21 Dutch GPs. The sampling criteria were age, gender, type of practice, and practice site. The interviews were recorded, fully transcribed, and analysed by two researchers working independently. The resulting motivational factors and preferences were grouped into categories. RESULTS: 'Developing personal relationships' and 'gaining mutual respect' appeared to dominate when the motivational factors were considered. Besides developing personal relationships with specialists, the GPs were also interested in familiarizing specialists with the competencies attached to the profession of family medicine. Additionally, they were eager to increase their medical knowledge to the benefit of their patients. The GPs stated a variety of preferences with respect to the design of new models of collaboration. CONCLUSION: Developing personal relationships with specialists appeared to be one of the dominant motives for increased collaboration. Once the relationships have been formed, an informal network with occasional professional contact seemed sufficient. Although GPs are interested in increasing their knowledge, once they have reached a certain level of expertise, they shift their focus to another specialty. The preferences for new collaboration models are diverse. A possible explanation for the differences in the preferences is that professionals are more knowledge driven than organisation driven as the acquiring of new knowledge is considered more important than the route by which this is achieved. A new collaboration model seems a way to acquire knowledge. Once this is achieved the importance of a model possibly diminishes, whereas the professional relationships last.

Collaboration with general practitioners: preferences of medical specialists--a qualitative study.

BACKGROUND: Collaboration between general practitioners (GPs) and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates medical specialists to initiate and continue participating with GPs in new collaborative care models. The following question is addressed in this study: What motivates medical specialists to initiate and sustain new models for collaborating with GPs? METHODS: We conducted semi-structured interviews with eighteen medical specialists in the province of Groningen, in the North of The Netherlands. The sampling criteria were age, gender, type of hospital in which they were practicing, and specialty. The interviews were recorded, fully transcribed, and analysed by three researchers working independently. The resulting motivational factors were grouped into categories. RESULTS: 'Teaching GPs' and 'regulating patient flow' (referrals) appeared to dominate when the motivational factors were considered. In addition, specialists want to develop relationships with the GPs on a more personal level. Most specialists believe that there is not much they can learn from GPs. 'Lack of time', 'no financial compensation', and 'no support from colleagues' were considered to be the main concerns to establishing collaborative care practices. Additionally, projects were often experienced as too complex and time consuming whereas guidelines were experienced as too restrictive. CONCLUSION: Specialists are particularly interested in collaborating because the GP is the gatekeeper for access to secondary health care resources. Specialists feel that they are able to teach the GPs something, but they do not feel that they have anything to learn from the GPs. With respect to professional expertise, therefore, specialists do not consider GPs as equals. Once personal relationships with the GPs have been established, an informal network with incidental professional contact seems to be sufficient to satisfy the collaborative needs of the specialist. The concerns seem to outweigh any positive motivational forces to developing new models of collaborative practice.