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

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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.


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.


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.


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.

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Many thanks to Nadine Raaphorst (NR), who did the interviews of DS3 and contributed to the coding process. Thanks to Esther Kok (ETK), Anja de Bruin (AB) for their participation in the group of co-workers and Anne Ponstein for being project leader on developing the care program for depression. The authors also would like to thank the co-funding organizations, the patient organization Antroposana, the Iona Foundation and Stichting Innovatie Alliantie for its RAAK Grant (no. 2010-12-14P).

Author’s contribution

EK was project leader, did the interviews of DS4, performed analyses and drafted the manuscript. EB generated DS2, participated in the design of the study, was involved in the interpretations of the findings and critically revised the manuscript. DD was involved in the interpretation of the findings, involved in writing the manuscript and supervised the study. All authors read and approved the final version.

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Correspondence to Evi B. Koster.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was exempted from a medical ethics committee approval because the study contained the monitoring and evaluation of current practice, and participants were not subject to any experimental conduct or imposed behavior [59]. However, all four data collection procedures are conducted in accordance with necessary ethical guidelines.

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Informed consent was obtained from all individual participants included in the study.

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Koster, E.B., Baars, E.W. & Delnoij, D.M.J. Patient-centered outcomes on quality of life and anthroposophic healthcare: a qualitative triangulation study. Qual Life Res 25, 2257–2267 (2016).

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