Enhanced self-efficacy after a self-management programme in pituitary disease: a randomized controlled trial

Andela, Cornelie D.; Repping-Wuts, Han; Stikkelbroeck, Nike M. M. L.; Pronk, Mathilde C.; Tiemensma, Jitske; Hermus, A.R.M.M.; Kaptein, Adrian A.; Pereira, Alberto M.; Kamminga, Noëlle G. A.; Biermasz, Nienke R.

doi:10.1530/eje-16-1015

Cited by 38 publications

(30 citation statements)

References 40 publications

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“…Although much remains to be elucidated, it is likely that impairment in HRQoL in patients treated for a prolactinoma is caused by an interplay of symptoms of hyperprolactinemia, side effects of medical therapy, and possibly consequences of hypopituitarism [5]. Moreover, psychosocial interventions such as self-management and educational programs have proven beneficial for pituitary patients' HRQoL [42][43][44]. Although these interventions will require financial investment, the relation between HRQoL and healthcare utilization and costs found in NFA and prolactinoma patients suggests that these interventions may not only improve HRQoL but may 1 3…”

Section: Discussionmentioning

confidence: 99%

Healthcare utilization and costs among prolactinoma patients: a cross-sectional study and analysis of determinants

et al. 2020

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Purpose Prolactinomas are the most prevalent functioning pituitary adenomas. They affect gonadal function as well as health-related quality of life (HRQoL). This study aimed to report healthcare utilization and costs, including their determinants, for prolactinoma patients. Methods Cross-sectional study of 116 adult prolactinoma patients in chronic care in a Dutch tertiary referral center. Patients completed four validated questionnaires, assessing healthcare utilization and costs over the previous 12 months (Medical Consumption Questionnaire), disease bother and needs (Leiden Bother and Needs Questionnaire Pituitary), HRQoL (Short Form-36), and self-reported health status (EuroQol 5D). Regression analyses were used to assess associations between disease-related characteristics and healthcare utilization and costs. Results Mean age was 52.0 years (SD 13.7) and median follow-up was 15.0 years (IQR 7.6–26.1). Patients visited the endocrinologist (86.2%), general practitioner (37.9%), and ophthalmologist (25.0%) most frequently. Psychological care was used by 12.9% of patients and 5% were admitted to hospital. Mean annual healthcare costs were €1928 (SD 3319), mainly for pituitary-specific medication (37.6% of total costs), hospitalization (19.4%) and specialist care (16.1%). Determinants for higher healthcare utilization and costs were greater disease bother and needs for support, lower HRQoL, elevated prolactin, and longer disease duration, while tumor size, hypopituitarism and adrenal insufficiency were not significantly associated with healthcare utilization and costs. Conclusion Healthcare utilization and costs of prolactinoma patients are related to patient-reported HRQoL, bother by disease and needs for support. Therefore, addressing patients’ HRQoL and needs is a way forward to improve efficiency of care and patients’ health status.

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Section: Discussionmentioning

confidence: 99%

Healthcare utilization and costs among prolactinoma patients: a cross-sectional study and analysis of determinants

et al. 2020

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“…This makes patient-reported outcome measures (PROMS) a promising tool to gain better insight into the patient’s condition and when to consider interventions to reduce healthcare utilization and costs and to optimize care trajectories. Further investigation towards optimal strategies supporting this hypothesis is necessary, perhaps through self-management interventions [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Healthcare utilization and costs among patients with non-functioning pituitary adenomas

et al. 2019

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Purpose Non-functioning pituitary adenomas (NFPA) have a substantial impact on patients’ health status, yet research on the extent of healthcare utilization and costs among these patients is scarce. The objective was to determine healthcare usage, associated costs, and their determinants among patients treated for an NFPA. Methods In a cross-sectional study, 167 patients treated for an NFPA completed four validated questionnaires. Annual healthcare utilization and associated costs were assessed through the medical consumption questionnaire (MTA iMCQ). In addition, the Leiden Bother and Needs Questionnaire for pituitary patients (LBNQ-Pituitary), Short Form-36 (SF-36), and EuroQol (EQ-5D) were administered. Furthermore, age, sex, endocrine status, treatment, and duration of follow-up were extracted from the medical records. Associations were analyzed using logistic/linear regression. Results Annual healthcare utilization included: consultation of an endocrinologist (95% of patients), neurosurgeon (14%), and/or ophthalmologist (58%). Fourteen percent of patients had ≥1 hospitalization(s) and 11% ≥1 emergency room visit(s). Mean overall annual healthcare costs were € 3040 (SD 6498), highest expenditures included medication (31%), inpatient care (28%), and specialist care (17%). Factors associated with higher healthcare utilization and costs were greater self-perceived disease bother and need for support, worse mental and physical health status, younger age, and living alone. Conclusion Healthcare usage and costs among patients treated for an NFPA are substantial and were associated with self-perceived health status, disease bother, and healthcare needs rather than endocrine status, treatment, or duration of follow-up. These findings suggest that targeted interventions addressing disease bother and unmet needs in the chronic phase are needed.

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“…Interestingly, a specific educational programme for patients with CS resulted in improved physical activity, healthier lifestyle, better sleep patterns and reduced pain, that subsequently contributed to an improved QoL [80]. In another interesting study, promising results were observed when a self‐management intervention, with a focus on the social and psychological issues, was applied in patients with pituitary diseases, including CD, and their partners [81].…”

Section: Quality Of Lifementioning

confidence: 99%

Psychiatric and neurocognitive consequences of endogenous hypercortisolism

et al. 2020

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Psychiatric and neurocognitive symptoms due to hypercortisolism were already described by Harvey Cushing in his original paper on patients with Cushing's syndrome (CS). Nowadays, it is well known that psychiatric and cognitive complaints are two of the most common, and most distressing, symptoms in patients with CS. Psychiatric symptoms are indeed a major clinical manifestation of CS. The most commonly observed psychiatric conditions are depression and anxiety, whilst mania and psychosis are less common. Several domains of cognitive function are impaired at diagnosis, including episodic and working memory, executive function and attention. Following treatment, onefourth of the patients still experience depressed mood, and the cognitive impairments are only partially restored. Consequently, quality of life in patients with CS is severely and persistently affected. Neuroimaging studies have also illustrated the deleterious effects of hypercortisolism on the brain by demonstrating reduced grey matter volumes and cortical thickness, altered restingstate functional responses and during cognitive tasks, as well as widespread reduced white matter integrity, especially in structures important for cognitive function and emotional processing, both before and after successful abrogation of hypercortisolism. In this paper, we summarize the current knowledge on the psychiatric and neurocognitive consequences of hypercortisolism in patients with CS, both before, and after successful treatment. In addition, we review the structural and functional brain abnormalities associated with hypercortisolism and discuss the influence of these factors on quality of life.

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Enhanced self-efficacy after a self-management programme in pituitary disease: a randomized controlled trial

Abstract: This first study evaluating the effects of a SMI targeting psychosocial issues in patients with pituitary disease and their partners demonstrated promising positive results. Future research should focus on the refinement and implementation of this SMI into clinical practice.

Cited by 38 publications

References 40 publications

Healthcare utilization and costs among prolactinoma patients: a cross-sectional study and analysis of determinants

Healthcare utilization and costs among prolactinoma patients: a cross-sectional study and analysis of determinants

Healthcare utilization and costs among patients with non-functioning pituitary adenomas

Psychiatric and neurocognitive consequences of endogenous hypercortisolism

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