ABSTRACT
AIM: The aim of this study was to explore which factors are associated with a successful treatment outcome in chronic pain patients and professionals participating in a multidisciplinary rehabilitation program, with a specific focus on the patient-professional interaction. METHODS: Patients (n = 16) and professionals (n = 10) were interviewed and/or observed. The transcribed interviews and observations were analyzed and themes were described. RESULTS: Patients with a positive treatment outcome came to a shared understanding of their pain with their professional, demonstrated new learned behavior and were able to continue their learning process at home. Patients with a negative treatment outcome did not reach a shared understanding of their pain with their professional, were not able to change their behavior and wanted more help to achieve this. Both patient groups experienced organizational barriers within the treatment process. Factors associated with a high quality of patient-professional interaction included the patient experience of being taken seriously, the involvement of the professional with the patient, a clear explanation of the pain, and an open interaction between patient and professional. CONCLUSION: This study provides insight into factors which were related to a positively or negatively experienced outcome of pain rehabilitation. A good match within the patient-professional interaction seems essential. IMPLICATIONS OF REHABILITATION: Within chronic pain rehabilitation good didactic skills and a client-centered attitude of the professional may be helpful in order to make the patient feel being taken seriously. An assessment of the patient's learning style might lead to a better fit of the patient education and training according to an individual's learning style. Relapse might be prevented by paying special attention to the integration of new behavior within important life areas as work and sports.
Subject(s)
Chronic Pain/rehabilitation , Patient Satisfaction , Professional-Patient Relations , Adult , Communication , Female , Health Behavior , Humans , Interviews as Topic , Male , Middle Aged , MotivationABSTRACT
OBJECTIVE: To determine in patients with skin melanoma whether disease-free and overall survival are associated with the tumour excision type and the presence of residual tumour cells in the re-excision specimen. DESIGN: Prospective and descriptive. METHOD: In the period August 1993-August 2004, 471 patients were diagnosed with stage I/II skin melanoma after partial or non-partial removal of a pigmented skin lesion, followed by re-excision and a sentinel node biopsy at Amsterdam Free University Medical Centre, the Netherlands. All patients were followed prospectively with a mean follow-up of > 5 years. Patients were divided into two groups according to (a) the type of primary excision (radical excision, narrow/radical excision, non-radical excision biopsy and incisional biopsy) and (b) the presence or absence of residual tumour cells in their re-excision specimen. Survival analysis was done using Cox proportional hazard model adjusted for the 8 known most important determinants of melanoma. RESULTS: Of the 471 patients, the primary excision was radical in 279 patients and narrow/radical in 109 patients; 52 patients underwent a nonradical excision and 31 patients an incisional biopsy. Re-excision was carried out in 441 patients and in 41 of them residual tumour cells were present in the re-excision specimen. Neither the diagnostic biopsy type nor the presence oftumour cells in the re-excision specimen were connected with disease-free or overall survival in the melanoma patients. CONCLUSION: Non-radical diagnostic biopsies were not negatively associated with overall and disease-free survival in melanoma patients.
