Gerrit van der Wal

Vrije Universiteit Amsterdam | VU · Department of Public and Occupational Health

Background: In many countries health insurers, employers and especially governments are increasingly using pressure and coercion to enhance healthier lifestyles. For example by ever higher taxes on cigarettes and alcoholic beverages, and ever stricter smoke-free policies. Such interventions can enhance healthier behaviour, but when they become too...

Samenvatting Ruijs CDM, Kerkhof AJFM, Van der Wal G, Onwuteaka-Philipsen BD.Ondraaglijk lijden van terminale kankerpatiënten. Huisarts Wet2015;58(5):238-41. Achtergrond Bij kankerpatiënten in de laatste levensmaanden in de eerste lijn hebben we onderzoek verricht naar de prevalentie van ondraaglijke symptomen, de relatie tussen symptoomintensiteit...

An international discussion about whether or not to legally permit euthanasia and (or) physician assisted suicide (EAS) is ongoing. Unbearable suffering in patients may result in a request for EAS. In the Netherlands EAS is legally permitted, and unbearable suffering is one of the central compulsory criteria. The majority of EAS is performed in can...

The objective of this study is to determine if quality of care, symptoms of depression, disease characteristics and quality of life of patients with amyotrophic lateral sclerosis (ALS) are related to requesting euthanasia or physician-assisted suicide (EAS) and dying due to EAS. Therefore, 102 ALS patients filled out structured questionnaires every...

Primary care physicians provide palliative home care. In cancer patients dying at home in the Netherlands (45% of all cancer patients) euthanasia in about one out of every seven patients indicates unbearable suffering. Symptom prevalence, relationship between intensity of symptoms and unbearable suffering, evolvement of symptoms and unbearability o...

Aims and objectives: To examine whether the relationship between specialty and patient safety is mediated by safety culture. Background: Research has shown that patient safety in hospitals varies by specialty. The safety culture among healthcare professionals in hospital units is believed to influence safety performance. If there is a mediation...

Unbearable suffering most frequently is reported in end-of-life cancer patients in primary care. However, research seldom addresses unbearable suffering. The aim of this study was to comprehensively investigate the various aspects of unbearable suffering in end-of-life cancer patients cared for in primary care. Forty four general practitioners recr...

The national guideline on oesophageal carcinoma's recommendation of a minimum number of 10 resections per year and the intervention of the Dutch Health Care Inspectorate have highlighted hospitals' 'need to score' on the public quality indicator for the annual number of oesophageal resections. To determine whether low-volume hospitals are inclined...

The relationship between faults in diagnostic reasoning, diagnostic errors, and patient harm has hardly been studied. This study examined suboptimal cognitive acts (SCAs; i.e., faults in diagnostic reasoning), related them to the occurrence of diagnostic errors and patient harm, and studied the causes. Four expert internists reviewed patient record...

In the Netherlands, GPs performed euthanasia or physician-assisted suicide (EAS) in ∼1 of 10 end-of-life cancer patients in their care. Of all explicit requests for EAS directed at GPs, ∼44% resulted in EAS. However, the suffering of patients who do and do not request EAS has never been studied. An important barrier for such research is the low pre...

We need to know the scale and underlying causes of surgical adverse events (AEs) in order to improve the safety of care in surgical units. However, there is little recent data. Previous record review studies that reported on surgical AEs in detail are now more than ten years old. Since then surgical technology and quality assurance have changed rap...

The objective of this study was to analyze the variation in the rates of adverse events (AEs), and preventable AEs, between hospitals and hospital departments in order to investigate the room for improvement in reducing AEs at both levels. In addition, we explored the extent to which patient, department and hospital characteristics explain differen...

In the Netherlands, many (45%) cancer patients die at home, in the care of GPs. About 1 out of 10 end-of-life cancer deaths is hastened by GPs through euthanasia or physician-assisted suicide. However, the relationship between depression and requests for euthanasia has never been prospectively studied directly in primary care. This study aimed to a...

Patient record review of hospitalised patients is by far the most applied method to assess adverse events (AEs) in hospitals. The diligence with which information is recorded may influence the visibility of AEs. On the other hand, poor quality of the information in patient records may be a cause or a consequence of poor quality of care and may thus...

Patient record review is believed to be the most useful method for estimating the rate of adverse events among hospitalised patients. However, the method has some practical and financial disadvantages. Some of these disadvantages might be overcome by using existing reporting systems in which patient safety issues are already reported, such as incid...

We thank Dr Lader for his interest in our article and his valuable insights. We agree that there is more to it than just knowledge-based mistakes underlying the occurrence of DAEs. The causes described by Dr Lader constitute plausible reasons that could contribute to the occurrence of DAEs. We agree that evidence-based algorithms should not be foll...

Purpose: The present study aims to examine the occurrence and causes of faults in the diagnostic reasoning process (suboptimal cognitive acts) and relate them to diagnostic error and patient harm. Method: Physicians included 247 dyspnea patients in the study whose patient records were reviewed by expert internists. A questionnaire to review the d...

Medication-related adverse events (MRAEs) form a large proportion of all adverse events in hospitalized patients and are associated with considerable preventable harm. Detailed information on harm related to drugs administered during hospitalization is scarce. Knowledge of the nature and preventability of MRAEs is needed to prioritize and improve m...

Diagnostic errors often result in patient harm. Previous studies have shown that there is large variability in results in different medical specialties. The present study explored diagnostic adverse events (DAEs) across all medical specialties to determine their incidence and to gain insight into their causes and consequences by comparing them with...

To examine the causes of adverse events (AEs) and potential prevention strategies to minimise the occurrence of AEs in hospitalised patients. For the 744 AEs identified in the patient record review study in 21 Dutch hospitals, trained reviewers were asked to select all causal factors that contributed to the AE. The results were analysed together wi...

The aims of this study were to investigate: (1) opinions of medical students regarding quantity and content of education on end-of-life care in the curriculum, (2) medical students' knowledge of different aspects of the euthanasia act, and (3) factors associated with positive opinions about the quantity and content of education on end-of-life care...

In The Netherlands, relatively more patients (20%) with amyotrophic lateral sclerosis (ALS) die due to euthanasia or physician-assisted suicide (EAS) compared with patients with cancer (5%) or heart failure (0.5%). We wanted to gain insight into the reasons for ALS patients requesting EAS and compare these with the reasons of cancer and heart failu...

Background: Medication-related adverse events (MRAEs) form a large proportion of all adverse events in hospitalized patients and are associated with considerable preventable harm. Detailed information on harm related to drugs administered during hospitalization is scarce. Knowledge of the nature and preventability of MRAEs is needed to prioritize a...

SOS-V. the complete SOS-V measuring instrument.

Unbearable suffering is an important issue in end-of-life decisions. However, there has been no systematic, prospective, patient-oriented research which has focused on unbearable suffering, nor is there a suitable measurement instrument. This article describes the methodological development of a quantitative instrument to measure the nature and int...

To describe how Dutch healthcare institutions develop and disseminate institutional practice guidelines on medical end-of-life decisions and policy statements on euthanasia and physician-assisted suicide (EAS) to relevant parties, and to describe supportiveness of EAS guidelines experienced by Dutch physicians. Questionnaires to all Dutch health ca...

To test the claim that the Hospital Survey on Patient Safety Culture (HSOPS) measures patient safety culture instead of mere individual attitudes and to determine the most appropriate level (individual, unit or hospital level) for interventions aimed at improving the culture of patient safety. National patient safety culture data were used from 188...

This study determined the incidence, type, nature, preventability and impact of adverse events (AEs) among hospitalised patients and potentially preventable deaths in Dutch hospitals. Using a three-stage retrospective record review process, trained nurses and doctors reviewed 7926 admissions: 3983 admissions of deceased hospital patients and 3943 a...

To describe awareness, use and supportiveness for physicians of three practice guidelines on medical end-of-life decisions, and to identify factors associated with increased awareness of these guidelines. Questionnaires were sent to 793 physicians from 12 hospitals in 2005 (response 52%). Most physicians were aware of the existence of the practice...

Several studies on patient safety have shown that a substantial number of patients suffer from unintended harm caused by healthcare management in hospitals. Emergency departments (EDs) are challenging hospital settings with regard to patient safety. There is an increased sense of urgency to take effective countermeasures in order to improve patient...

In the Netherlands, the proportion of patients with amyotrophic lateral sclerosis (ALS) who choose the option of euthanasia or physician-assisted suicide (PAS) is relatively high (20%). The objective of this study was to determine which factors influence end-of-life practices in ALS and whether rates are changing over time. In a cohort survey, 204...

Dementia patients frequently die after a pneumonia or prolonged intake problems. Maintaining comfort is a goal of palliative care in end-stage dementia. To compare discomfort in dementia patients dying after a pneumonia with patients dying after intake problems, and to assess associations with treatment, we combined 2 Dutch prospective studies. We...

To evaluate the inter-rater agreement of the record review process of the Dutch Adverse Event study, which we aimed to improve by the involvement of two independent physician reviewers per record instead of one including a consensus procedure in case of disagreement. The inter-rater agreement within pairs of physicians (independent review between p...

Diagnostic error is an important error type since diagnostic adverse events are regularly judged as being preventable and the consequences are considered to be severe. Existing research often focuses on either diagnostic adverse events or on the errors in diagnostic reasoning. Whether and when an incorrect diagnostic process results in adverse outc...

To describe the existence of policy statements on euthanasia and physician-assisted suicide (EAS) and practice guidelines for all medical end-of-life decisions in Dutch health care institutions in 2005, whether the existence of practice guidelines is related to characteristics of institutions, and to compare the existence of policies in 2005 and 19...

This study investigated the impact of a visit from a consulting physician on the patient and the relatives during the euthanasia procedure in The Netherlands. Data on experiences with the consultant's visit were collected from 86 relatives and 3,614 general practitioners, who described their most recent request for euthanasia or physician-assisted...

Up to now, costs attributable to adverse events (AEs) and preventable AEs in the Netherlands were unknown. We assessed the total direct medical costs associated with AEs and preventable AEs in Dutch hospitals to gain insight in opportunities for cost savings. Trained nurses and physicians retrospectively reviewed 7,926 patient records in 21 hospita...

To examine what pain and adjuvant medication is prescribed in palliative care patients at home in The Netherlands. In a nationwide, representative, prospective study in general practice in The Netherlands, prescribed medication was registered in 95 general practices with a listed population of 374 070 patients. The GPs identified those who received...

In many different countries the Hospital Survey on Patient Safety Culture (HSOPS) is used to assess the safety culture in hospitals. Accordingly, the questionnaire has been translated into Dutch for application in the Netherlands. The aim of this study was to examine the underlying dimensions and psychometric properties of the questionnaire in Dutc...

Different research groups sometimes carry out comparable studies. Combining the data can make it possible to address additional research questions, particularly for small observational studies such as those frequently seen in palliative care research. We present a systematic approach to pool individual subject data from observational studies that a...

Cancer patients have generally requested for euthanasia and assisted suicide (EAS) more frequently than others. However, different terminal cancers are accompanied by different clinical courses. This study seeks to explore the relationship, if any, between EAS requesters and cancer types, as relates to the provision of end-of-life care in the Nethe...

This study is aimed at enhancing understanding prenatal screening decision making through testing a hypothesized decision model based on decision theory and health behavior theory. We obtained questionnaires from 1,666 pregnant women who were offered prenatal screening for Down's syndrome. Path analysis (using LISREL) resulted in a final model with...

In 2007, a patient safety programme was started to reduce hospital mortality in the Netherlands. The hospital standardized mortality ratio (HSMR) seems to be a promising indicator for monitoring the reduction of hospital mortality within hospitals. It is questionable, however, whether the HSMR can be used to compare the performance of hospitals. It...

A growing number of institutions offer health checks to the public. These preventive checks have to comply with the Dutch 'Wet op het Bevolkingsonderzoek' (Population Screening Act), in order to protect citizens from harmful investigations and the detection of diseases for which there is no cure. However, for some of the investigations it is not cl...

Allereerst wil ik aangeven dat ik zeer vereerd ben dat ik de derde Henk Leenen-lezing heb mogen uitspreken. Vereerd omdat Henk een origineel denker was en grondlegger van het gezondheidsrecht. Maar ook vereerd omdat hij mijn promotor was en daarna een persoonlijke vriend is geworden.

Quality of life (QoL) is considered to be an indispensable outcome measure of curative and palliative treatment. However, QoL research often yields findings that raise questions about what QoL measurement instruments actually assess and how the scores should be interpreted. To investigate how patients interpret and respond to questions on the EORTC...

Caring for terminally ill patients is a meaningful task, however the patient's suffering can be a considerable burden and cause of frustration. The aim of this study is to describe the experiences of general practitioners (GPs) in The Netherlands in dealing with a request for euthanasia from a terminally ill patient. The data, collected through in-...

This study aims to find out whether offering prenatal screening for Down syndrome and neural tube defects influences pregnant women's attitudes toward having a screening test. Methods: Women were randomised into a group that was offered prenatal screening and a group that was not offered screening (controls). Both groups completed questionnaires be...

Borgsteede SD, Deliens L, Francke AL, Stalman WAB, Willems DL, Van Eijk JThM, Van der Wal G. Definiëring van de patiëntenpopulatie: een probleem bij het onderzoek naar palliatieve zorg. Huisarts Wet 2008;51(2):85-9. Inleiding In het onderzoek naar palliatieve zorg ontbreekt een duidelijke definitie van patiëntenpopulaties en zijn er geen criteria...

Parents' reported ambivalence toward large-scale vaccination programs for childhood diseases may be related to their perception of the risks of side-effects or safety of vaccination and the risk of contracting the disease. The aim of this study is to evaluate parents' perceptions of their child's risk contracting a Meningococcal C infection and par...

Medical students develop interest in a specialty career during medical school based on knowledge and clinical experience of different specialties. How valid this knowledge is and how this knowledge relates to the development of preference for a specialty is not known. We studied their "subjective" knowledge of a specialty (students' reported knowle...

To investigate the occurrence and predictors of interdisciplinary cooperation of GPs with other caregivers in palliative care at home. In a prospective study among 96 general practices, the GPs involved identified all dying patients during the study period of 12 months. The GPs received an additional post-mortem questionnaire for each patient who d...

In The Netherlands, approximately 12% of medical graduates spend their professional life in public health, but it is the authors' belief that few of them become interested in such a career during medical school. The aim of this study was to investigate students' development of interest in a career in a public health specialty during medical school....

To assess decline and improvement in functional characteristics, cognition and restraint use after a lower respiratory tract infection (LRI) and describe variation by dementia severity. Two prospective cohort studies. Nursing homes in the Netherlands and in Missouri, USA. 227 Dutch and 396 Missouri nursing home residents with dementia and LRI who w...

This study was carried out to investigate the usefulness of the SEIQoL-DW to elicit information about response shifts in palliative patients. The instrument measures individual quality of life and allows respondents to choose, rate and weight important areas of life (cues). We explored patients' reconceptualizations (ie, change in cues) and their v...

Debates over legalisation of physician-assisted suicide (PAS) or euthanasia often warn of a "slippery slope", predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over...

Appendix DCs of all countries. This additional file presents the death certificate forms used to certify deaths (at the time of the study) in Belgium, Denmark, Italy, The Netherlands, Sweden, Norway, England and Wales, and Scotland.

To obtain insight into the career choice of recently graduated physicians and the factors that influence this choice. Descriptive. Questionnaires were sent to 1091 physicians who graduated from the VU University in Amsterdam or the University Utrecht between 1 July 1999 and 30 June 2002. Graduates were asked to provide the following information: cu...

Long waiting times for elective surgery pose a threat to the quality of care. Our study aimed to assess (i) the physical symptoms and disabilities patients experience during the wait, (ii) the perceived improvements after surgery and (iii) whether problems increase during the wait or longer waits affect postoperative outcomes. A cross-sectional que...

Although lower respiratory tract infections (LRI) cause considerable morbidity and mortality among nursing home residents with dementia, the effects of care and treatment are largely unknown. Few large prospective studies have been conducted. We pooled data from two large prospective cohort studies in 61 Dutch nursing homes and 36 nursing homes in...

Van den Berg M, Timmermans DRM, Ten Kate LP, Van Vugt JMG, Van der Wal G. Nemen zwangere vrouwen geïnformeerde beslissingen over prenatale screening? Huisarts Wet 2007;50(9):410-5. Inleiding Zwangere vrouwen moeten een geïnformeerde keuze kunnen maken over eventuele deelname aan prenatale screening. Een geïnformeerde keuze is gebaseerd op voldoend...

Introduction: Prenatal screening should enable pregnant women to make informed choices. An informed decision is defined as one based on sufficient, relevant information and consistent with the decision-maker's values. This study aims to assess not only the extent to which pregnant women make informed choices about prenatal screening but also the ps...

Most people with an incurable disease prefer to stay and die at home, cared for by their general practitioner (GP). This paper aims at describing the prevalence of symptoms in patients receiving palliative care at home. Within the framework of a nation wide survey of general practice in the Netherlands, GPs received a questionnaire for all patients...

To examine long-term mortality and its determinants in nursing home residents with dementia diagnosed with a lower respiratory tract infection (LRI). US (Missouri) nursing home residents (541) and Dutch residents (403) with dementia who were treated with antibiotics for an LRI. Prospective studies of nursing home-acquired LRI in the US (Missouri) a...

Objective. To report the results of the fourth national study into the practice of euthanasia, physician-assisted suicide, and other medical decisions around the end of life in the Netherlands in 2005, after the Dutch law regulating the ending of life by a physician at the request of a patient and physician-assisted suicide had come into effect in...

We compared the results of two recent studies on end-of-life decisions (ELDs) for neonates and infants in Belgium (Flanders) and The Netherlands. Questionnaires were sent to physicians who reported the death of a child under the age of 1 (Belgium: n = 292, response 87%; Netherlands: n = 249, response 84%). The questionnaires included structured que...

Response shift has gained increasing attention in the measurement of health-related quality of life (QoL) as it may explain counter-intuitive findings as a result of adaptation to deteriorating health. To search for response shift type explanations to account for counter-intuitive findings in QoL measurement. Qualitative investigation of the respon...

In 2002, an act regulating the ending of life by a physician at the request of a patient with unbearable suffering came into effect in the Netherlands. In 2005, we performed a follow-up study of euthanasia, physician-assisted suicide, and other end-of-life practices. We mailed questionnaires to physicians attending 6860 deaths that were identified...

It is generally recognised that choices concerning treatment or screening should be people's own, autonomous decisions. However, in the context of genetic counselling, many studies found that counsellors deviate from nondirectiveness, or that subjective norm influences behaviour. The present study aimed to investigate whether prenatal counsellors (...

The prioritisation of patients on waiting lists is ascribed high potential for diminishing the consequences of waiting times for elective surgery. However, consistent evidence is lacking about which factors determine patient priority and it is unclear whether different stakeholders have different opinions on this issue. This study, conducted in the...

Public opinion and professional organisations dominate the euthanasia debate, and there is a need to understand the opinions of people confronted with euthanasia. The aim of this study was to investigate whether patients and their GPs talk about euthanasia, and if so, how they communicate about this. Qualitative, semi-structured interviews were hel...

Object of the study: Euthanasia continues to be an issue of moral debate in end of life care. As the general practitioner has a central role in performing and co-ordinating en-of-life home care in the Netherlands, he is regulartly confronted with patients requesting (information on) euthanasia. The research question of this paper is: how do general...

A statutory disciplinary system for health care psychologists in the Netherlands was introduced in 1998. To provide an indication of the contribution of this system to monitoring the quality of health care psychology all complaints dealt with in the period 1999-2002 were studied. Questionnaires were sent to all 388 members of the disciplinary board...

To describe differences in the treatment of pneumonia and in the association of treatment with prognosis in Dutch and American nursing home patients with late-stage dementia. Design. Prospective studies in The Netherlands and the American state of Missouri. In 61 Dutch nursing homes and 36 in Missouri, severely demented patients with pneumonia were...