Quality of Life Research

, Volume 25, Issue 9, pp 2257–2267 | Cite as

Patient-centered outcomes on quality of life and anthroposophic healthcare: a qualitative triangulation study

  • Evi B. Koster
  • Erik W. Baars
  • Diana M. J. Delnoij
Article

Abstract

Purpose

To provide a qualitative investigation of aspects that matter to patients regarding quality of life (QOL) and other perceived treatment effects of anthroposophic healthcare (AH). It is a first step in the development of patient reported outcome measures (PROMs) for AH. Hence, it will contribute to the evaluation of AH quality from patients’ perspectives.

Method

Within-method triangulation of four qualitative data sources is: (1) Survey of 2063 patients of AH general practitioners; single open item; (2) Survey of 34 patients of AH nurses; single open item; (3) and (4) Sixteen semi-structured interviews with patients. The data sources contained patients’ qualitative reports on contribution of treatment to QOL, other perceived treatment effects and/or quality of care aspects. Content analysis Construction of items and domains by open, axial and selective coding.

Results

Twelve domains regarding quality of life are found: Recovery/Symptom reduction, Active contribution/Autonomy, General well-being, Meaning, Rest/Relaxation, Functioning, Energy/Strength, Care relationship, Natural healing, Mindful inner attitude, Being well informed and Social relations. The interviews demonstrate relations between domains.

Conclusions

The findings give a comprehensive insight into aspects of care that are relevant to patients, providing a first step to develop PROMs for AH. Findings show a broadening of domains compared to existing measurement instruments and show close similarities with the recently developed concept of “positive health.” Extending QOL instruments with a broader set of domains would give concrete tools to improve evaluation of quality of care and make this evaluation more in line with aspects that matter to AH patients.

Keywords

Quality of life Quality of care Patient reported outcomes measures Patient-centered care Anthroposophic healthcare Qualitative triangulation 

References

  1. 1.
    Cleary, P. D., & Edgman-Levitan, S. (1997). Health care quality. Incorporating consumer perspectives. Journal of the American Medical Association, 278(19), 1608–1612.CrossRefPubMedGoogle Scholar
  2. 2.
    Sixma, H., Kerssens, J. J., van Campen, C., & Peters, L. (1998). Quality of care form the patients’ perspective: From Theoretical concept to a new measuring instrument. Health Expectations, 1(2), 82–95.CrossRefPubMedGoogle Scholar
  3. 3.
    Koopman, L. et al. (2011). Handboek meetinstrumenten: een handleiding voor de ontwikkeling en het gebruik van Consumer Quality Index (CQI) vragenlijsten (Handbook measurement instruments: a manual for developing en using Consumer Quality Index (CQI) questionnaires) Utrecht: Centrum Klantervaring Zorg.Google Scholar
  4. 4.
    Kessel, P. V., Triemstra, M., & de Boer, D. (2014). Handreiking voor het meten van kwaliteit van zorg met patient reported outcome measures (Assistance for measuring quality of care with patient reported outcome Measures). Utrecht: Nivel.Google Scholar
  5. 5.
    Turner, R. R., et al. (2007). Patient-reported outcomes: Instrument development and selection issues. Value in Health, 10(2), S86–S93.CrossRefPubMedGoogle Scholar
  6. 6.
    McKenna, S. P. (2011). Measuring patient-reported oucomes: Moving beyond misplaced common sense to hard science. BMC Medicine, 9(86).Google Scholar
  7. 7.
    Boyce, M., & Brown, J. P. (2013). Does providing feedback on patient-reported oucomes to healthcare professionals result in better outcomes for patients? A systematic review. Quality of Life Research, 22, 2265–2278. doi:10.1007/s11136-013-0390-0.CrossRefPubMedGoogle Scholar
  8. 8.
    Greeson, J. M., Rosenzweig, S., Halbert, S. C., Cantor, I. S., Keener, M. T., & Brainard, G. C. (2008). Integrative Medicine research at an academic medical center: patient characteristics and health-related quality-of-life outcomes. The Journal of Alternative and Complementary Medicine, 14(6), 763–767.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) Definition of integrative medicine. (2007). http://imconsortium.org/cahcim/about/home.html.
  10. 10.
    Frenkel, M., Arye, E. B., Carlson, C., & Sierpina, V. (2008). Integrating complementary and alternative medicine ino conventional primary care: The patient perspective. Explore, 4, 178–186.CrossRefPubMedGoogle Scholar
  11. 11.
    Fischer, F., et al. (2014). High prevalence but limited evidence in complementary and alternative medicine: Guidelines for future research. BMC complementary and alternative medicine, 14(46).Google Scholar
  12. 12.
    Xu, H., & Chen, K. (2011). Integrating traditional medicine with biomedicine. Towards a patient-centered healthcare system. Chinese Journal of Integrative Medicine, 17(2), 83–84.CrossRefPubMedGoogle Scholar
  13. 13.
    Kienle, G., Albonico, H., Baars, E., Hamre, H. J., Zimmermann, P., & Kiene, H. (2013). Anthroposphic Medicine: an integrative medical system originating in Europe. Global advances in health and medicine, 2(6), 20–31.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Arman, M., Hammarqvist, A. S., & Kullberg, A. (2011). Anthroposophic health care in Sweden—A patient evaluation. Complementary Therapies in Clinical Practice, 17(3), 170–178. doi:10.1016/j.ctcp.2010.11.001.CrossRefPubMedGoogle Scholar
  15. 15.
    Baars, E. W. (2011). Evidence-based curative health promotion. A systems based biology-orientated treatment of seasonal allergic rhinitis with Citrus/Cydonia comp. Wageningen: Wageningen University.Google Scholar
  16. 16.
    Baars, E. (Ed.). (2005). Goede zorg. Ethische en methodische aspecten (Good care. Ethical and methodical aspects). Christofoor: Zeist.Google Scholar
  17. 17.
    Hamre, H., Fisher, M., Heger, M., Riley, D., Haidvogl, M., Baars, E., et al. (2005). Anthroposophic therapy of respiratory and ear infections. Wiener Klinische Wochenschrift, 117(13), 500–501.CrossRefPubMedGoogle Scholar
  18. 18.
    Baars, E. W., Gans, S., & Ellis, E. L. (2008). The effect of hepar magnesium on seasonal fatigue symptoms: A pilot study. The Journal of Alternative and Complementary Medicine, 14(4), 395–402.CrossRefPubMedGoogle Scholar
  19. 19.
    Kienle, G., Kiene, H., & Albonico, H. (2006). Anthroposophic medicine, effectiveness, utility, costs, safety. Stuttgart: Schattauer.Google Scholar
  20. 20.
    Baars, E., & van der Bie, G. (Eds.). (2009). Praktijkonderzoek in de antroposofische gezondheidszorg (Practice research in anthroposophic healthcare). Leiden: Hogeschool Leiden.Google Scholar
  21. 21.
    Baars, E. W., en G.H. van der Bie (Ed.). (2008). Praktijkonderzoek in de Antroposofische Gezondheidszorg. Eerste stappen in de ontwikkeling van practice-based evidence, ondersteuning in de therapeutische besluitvorming en evalueren van kwaliteit en effect (Practice research in anthroposophic healthcare. First steps in developing practice-based evidence, support of therapeutic decisionmaking and evaluating quality and effect). Leiden: Hogeschool Leiden.Google Scholar
  22. 22.
    Kienle, G., Glockmann, A., Grugel, R., Hamre, H. J., & Kiene, H. (2011). Klinische Forschung zur Anthroposphischen Medizin—Update eines Health Technology Assesment-Berichts und Status Quo (Clinical Research in Anthroposophic Medicine—Update of a Health Technology Assesment Report and Status Quo). Forschende Komplementärmedizin, 18(5), 4.CrossRefGoogle Scholar
  23. 23.
    Hamre, H., Kiene, H., Ziegler, R., Troger, W., Meinecke, C., Schnurer, C., et al. (2014). Overview of the publication from the anthroposophic medicine outcome study (AMOS): A whole system evaluation study. Global advances in health and medicine, 3(1), 54–70. doi:10.7453/gahmj.2013.010.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Koster, E., et al. (2014). The consumer quality index anthroposophic healthcare: A construction and validation study. BMC Health Services Research,. doi:10.1186/1472-6963-14-148.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Meuwissen, L. E., & de Bakker, D. H. (2009). Consumer quality-index Huisartsenzorg meet patiëntervaringen en vergelijkt huisartspraktijken (CQ-index General Practice measures patient experiences and compares GP practices). Nederlands Tijdschrijft voor Geneeskunde, 153(A180).Google Scholar
  26. 26.
    Appleby, J. (2012). Patient reported outcome measures: How are we feeling today? British Medical Journal, 344(d8191).Google Scholar
  27. 27.
    Trujols, J., et al. (2013). Patient-reported outcomes measures: Are they patient-generated, patient-centred or patient-valued? Journal of mental health, 22(6), 555–562. doi:10.3109/09638237.2012.734653.CrossRefPubMedGoogle Scholar
  28. 28.
    Haywood, K. L., Staniszewska, S., & Chapman, S. (2012). Quality and acceptability of patient-reported outcome measures used in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): A systematice review. Quality of Life Research, 21, 35–52. doi:10.1007/s11136-011-9921-8.CrossRefPubMedGoogle Scholar
  29. 29.
    Wiering, B. M., de Boer, D., Delnoij, D. M. J. (2016). Patient involvement in the development of patient reported outcome measures: A scoping review. Health Expect. doi:10.1111/hex.12442.PubMedGoogle Scholar
  30. 30.
    Lin, X., Lin, I. M., & Fan, S. Y. (2013). Methodological issues in measuring health-related quality of life. Tzu Chi Medical Journal, 25, 8–12. doi:10.1016/j.tcmj.2012.09.002.CrossRefGoogle Scholar
  31. 31.
    Corner, J., et al. (2013). Qualitative analysis of patients’ feedback from a PROMs survey of cancer patients in England. British Medical Journal Open. doi:10.1136/bmjopen-2012-002316.Google Scholar
  32. 32.
    De Smedt, M. (2013). Measuring subjective issues of well-being and quality of life in the European Statistical System. Social Indicators Research, 114, 153–167. doi:10.1007/s11205-013-0389-5.CrossRefGoogle Scholar
  33. 33.
    Fagerlind, H., et al. (2010). Patients’ understanding of the concepts of health and quality of life. Patient Education and Counseling, 78, 104–110. doi:10.1016/j.pec.2009.05.016.CrossRefPubMedGoogle Scholar
  34. 34.
    Aaronson, N. K., Muller, M., Cohen, P. D., Essink-Bot, M.-L., Fekkes, M., Sanderman, R., et al. (1998). Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. Journal of Clinical Epidemiology, 51(11), 1055–1068.CrossRefPubMedGoogle Scholar
  35. 35.
    Skevington, S. M., Lotfy, M., & O’Connell, K. A. (2004). The World Health Organization’s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A report from the WHOQOL group. Quality of Life Research, 13(2), 299–310.CrossRefPubMedGoogle Scholar
  36. 36.
  37. 37.
    Ketelaars, D., Baars, E., & Kroon, H. (2001). Healing through working. A study of therapeutic communities for persons with psychiatric problems. New York: Mercury Press.Google Scholar
  38. 38.
    Thurmond, V. (2001). The point of triangulation. Journal of Nursing Scholarship, 33(3), 253–258.CrossRefPubMedGoogle Scholar
  39. 39.
    Shih, F. (1998). Triangulation in nursing research: Issues of conceptual clarity and purpose. Journal of advanced nursing, 28(3), 631–641.CrossRefPubMedGoogle Scholar
  40. 40.
    Baars, E. W., et al. (2012). Routine outcome monitoring naar uitwendige therapie in de eerstelijnsgezondheidszorg: resultaten van een eerste pilotonderzoek (Routine outcome monitoring of external applications therapy in primary care: results of a pilot study). In E. W. Baars & J. Hoekman (Eds.), De wetenschappelijke stand van zaken van de uitwendige therapie (Scientific state of affairs of external applications therapy). Hogeschool Leiden: Leiden.Google Scholar
  41. 41.
    Ponstein, A., van Gerven, M., & van der Bie, G. (2011). Healthcare program for depressive disorders: An anthroposophic approach. Leiden: University of Applied Sciences Leiden.Google Scholar
  42. 42.
    Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validation of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Wester, F. (1987/1995). Strategieën voor kwalitatief onderzoek (Strategies for qualitative research). Bussum: Coutinho.Google Scholar
  44. 44.
    Baarda, B. (2013). Basisboek kwalitatief onderzoek (Handbook qualitative research). Groningen/Houten: Noordhoff.Google Scholar
  45. 45.
    Glaser, B., & Strauss, A. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine.Google Scholar
  46. 46.
    Nederlands Centrum Geestelijke Gezondheidszorg. (1995). Handboek concept mapping met Ariadne. Utrecht: Author/Talbott.Google Scholar
  47. 47.
    Strauss, A. L., & Corbin, J. M. (1990). Basics of qualitative research (Vol. 15). Newbury Park, CA:Sage.Google Scholar
  48. 48.
    Huber, M., Knottnerus, J. A., Green, L., van de Horst, H., Jadad, A. R., Kromhout, S., et al. (2011). How should we define health? British Medical Journal. doi:10.1136/bmj.d4163.PubMedGoogle Scholar
  49. 49.
    Huber, M., van Vliet, M., Giezenberg, M., & Knottnerus, A. (2013). Towards a conceptual framework relating to “Health as the ability to adapt and self manage’ Operationalisering Gezondheidsconcept. Driebergen: Louis Bolk Instituut.Google Scholar
  50. 50.
    Van der Greef, J. (2011). Perspective: All systems go. Nature, 480(7378), S87.CrossRefPubMedGoogle Scholar
  51. 51.
    Alivia, M., Guadagni, P., & di Sarsina, P. R. (2011). Towards salutogenesis in the development of personalised and preventive healthcare. The EPMA Journal, 2(4), 381–384.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Döring, T. F., Vieweger, A., Pautasso, M., Vaarst, M., Finckh, M. R., & Wolfe, M. S. (2015). Resilience as a universal criterion of health. Journal of the Science of Food and Agriculture, 95(3), 455–465.CrossRefPubMedGoogle Scholar
  53. 53.
    Rosenbaum, P., & Gorter, J. (2012). The ‘F-words’ in childhood disability: I swear this is how we should think! Child: Care, Health and Development, 38(4), 457–463.Google Scholar
  54. 54.
    Timmermans, S. (2013). Seven warrants for qualitative health sociology. Social Science and Medicine, 77, 1–8.CrossRefPubMedGoogle Scholar
  55. 55.
    Seligman, M. E., Parks, A. C., & Steen, T. (2004). A balanced psychology and a full life. Philosophical Transactions-Royal Society of London Series B Biological Sciences, 359, 1379–1382.CrossRefGoogle Scholar
  56. 56.
    Lee Duckworth, A., Steen, T. A., & Seligman, M. E. (2005). Positive psychology in clinical practice. Annual Review of Clinical Psychology, 1, 629–651.CrossRefGoogle Scholar
  57. 57.
    Ryff, C. D., & Keyes, C. L. M. (1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69(4), 719.CrossRefPubMedGoogle Scholar
  58. 58.
    Fava, G. A., & Ruini, C. (2003). Development and characteristics of a well-being enhancing psychotherapeutic strategy: Well-being therapy. Journal of Behavior Therapy and Experimental Psychiatry, 34(1), 45–63.CrossRefPubMedGoogle Scholar
  59. 59.
    Centrale Commissie Mensgebonden Onderzoek. http://www.ccmo-online.nl.

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.University of Applied Sciences LeidenLeidenThe Netherlands
  2. 2.Tilburg School of Social and Behavioral Sciences, Scientific Centre for Transformation in Care and Welfare (Tranzo)Tilburg UniversityTilburgThe Netherlands

Personalised recommendations