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Background: Patients with incurable cancer face complex medical decisions. Their family caregivers play a prominent role in shared decision making processes, but we lack insights into their experiences. In this study, we explored how bereaved family caregivers experienced the shared decision making process. Methods: We performed a qualitative interview study with in-depth interviews analysed with inductive content analysis. We used a purposive sample of bereaved family caregivers (n = 16) of patients with cancer treated in a tertiary university hospital in the Netherlands. Results: Four themes were identified: 1. scenarios of decision making, 2. future death of the patient 3. factors influencing choices when making a treatment decision, and 4. preconditions for the decision making process. Most family caregivers deferred decisions to the patient or physician. Talking about the patient's future death was not preferred by all family caregivers. All family caregivers reported life prolongation as a significant motivator for treatment, while the quality of life was rarely mentioned. A respectful relationship, close involvement, and open communication with healthcare professionals in the palliative setting were valued by many interviewees. Family caregivers' experiences and needs seemed to be overlooked during medical encounters. Conclusions: Family caregivers of deceased patients with cancer mentioned life prolongation, and not quality of life, as the most important treatment aim. They highly valued interactions with the medical oncologist and being involved in the conversations. We advise medical oncologists to take more effort to involve the family caregiver, and more explicitly address quality of life in the consultations. [ABSTRACT FROM AUTHOR]

Background: Hope for future treatments to prevent or slow down dementia motivates researchers to strive for ever-earlier diagnoses of Alzheimer's disease (AD) based on biomarkers, even before symptoms occur. But is a biomarker-based early diagnosis desirable in clinical practice?Objective: This study explores the ethical considerations that shape current clinical practice regarding early AD diagnostics and the use of biomarkers.Methods: In this qualitative study, Dutch physicians were interviewed. Topics included physicians' views concerning early AD diagnosis in persons with no or mild cognitive impairment, physicians' considerations regarding current and expected future practices of early AD diagnosis, the use of biomarkers, and the use of the concepts preclinical and prodromal AD. We analyzed the transcripts using directed content analysis.Results: 15 general practitioners, neurologists, and geriatricians in the Netherlands were interviewed. Most of them interpreted an early AD diagnosis with an early diagnosis of dementia. We identified six clusters of considerations sometimes in favor but most often against pursuing an early AD diagnosis in people with no or mild cognitive impairment that influence physicians' diagnostic decision-making: preferences and characteristics of persons, test characteristics, impact on care, type of setting, disease concepts, and issues on a societal level.Conclusion: The discussion concerning an early AD diagnosis based on biomarkers which is widely held in the scientific field, has not entered clinical practice structurally. A biomarker-based early diagnosis does not fit within Dutch physicians' views on what good care for people with no, subjective, or mild cognitive impairment should entail. [ABSTRACT FROM AUTHOR]

Introduction: Care for the frail elderly is often provided by several professionals. Collaboration between them is essential, but remains difficult to achieve. Interprofessional education (IPE) can improve this collaboration. We developed a 9-hour IPE program for primary care professionals from 7 disciplines caring for the frail elderly, and aimed to establish whether the program improved professionals' interprofessional attitudes and attitudes toward collaboration, collaboration skills, and collaborative behavior. We also evaluated learners' reactions to the program. Methods: Before-after study, using the Interprofessional Attitudes Questionnaire (IAQ, score:1 to 7); Attitudes Toward Health Care Teams Scale (ATHCTS, score: 0 to 105); and Team Skills Scale (TSS, score:17 to 85). Additionally, semistructured interviews were conducted with 10 selected participants. Results: Participants' ( N = 80) overall interprofessional attitudes improved (IAQ baseline: 5.49; follow-up: 5.67, p = 0.001); attitudes toward geriatric teams did not change (ATHCTS baseline: 69.9; follow-up: 69.1, p = 0.32). Participants' self-reported team skills improved (TSS baseline: 45.7; follow-up: 48.1, p = 0.001). In the interviews, many interviewees reported increased collaboration with professionals of other disciplines due to the program. Interviewees considered the program's interprofessional nature and attending the program with local professionals important contributing factors to the experienced improvements in collaboration. However, they also noted that not all parts of the program had met the needs of all participating disciplines, due to differences in professional background and knowledge. Discussion: A brief IPE program can improve interprofessional attitudes, collaboration skills, and collaborative behavior. That such a program allows professionals to get acquainted with each other and each other's viewpoints appears to be as important as the educational content. [ABSTRACT FROM AUTHOR]

The complex care needs of frail older persons living at home is a major challenge for health care systems worldwide. One possible solution is to employ a primary care physician (PCP) with additional geriatric expertise. In the Netherlands, elderly care physicians (ECPs), who traditionally work in nursing homes, are increasingly encouraged to utilize their expertise within primary care. However, little is known about how PCPs and ECPs collaborate. Therefore, we aimed to unravel the nature of the current PCP-ECP collaboration in primary care for frail older persons, and to identify key concepts for success. A qualitative multiple case study with semistructured interviews. A selection of 22 participants from 7 "established collaboration practices" within the primary care setting in the Netherlands, including at least 1 ECP, 1 PCP, and 1 other health care professional for every included established collaboration practice. Transcripts of individual interviews were analyzed using largely double and independent open and axial coding, and formulation of themes and subthemes. Data analysis revealed 4 key concepts for success: (1) clarification of roles and expectations (ie, patient-centered care and embedding in existing care networks), (2) trust, respect, and familiarity as drivers for collaboration (ie, mutual trust through knowing each other and having shared goals); (3) framework for regular communication (ie, structural meetings and a shared vision); and (4) government, payer, and organization support (ie, financial support and emphasis on the collaboration's urgency by organizations and national policy makers). For a successful generalist-specialist collaboration, health care professionals need to invest in building relationships and mutual trust, and incorporating their efforts in the existing care networks to guarantee patient-centeredness. When provided with reimbursement and appreciation, this collaboration is a promising change in general practice to improve the care and outcomes of frail older persons. [ABSTRACT FROM AUTHOR]