The relationship between need satisfaction and motivation is well established within self‐determination theory (SDT). However, less is known about the affective mechanism that underlies this relationship. In this study, we extend SDT by focusing on the exact role of affect in the need satisfaction–motivation relationship. To this end, we conducted a daily diary study (N = 72) and an experience sampling study (N = 37) in which we tested the mediating role of positive and negative affect in the relationship between satisfaction of the autonomy, competence, and relatedness need on the one hand and autonomous motivation on the other hand. Moreover, alternative models were tested. The results of both studies demonstrated that affect did mediate the need satisfaction–intrinsic motivation relationship. Implications for theory and practice are discussed. Practitioner points Organizations can influence the intrinsic motivation of employees by changing working conditions to fulfil employees' needs. Organizations can influence intrinsic motivation by changing the appraisals of working conditions.

Five years after stroke, mean HRQoL of stroke survivors showed large variability and was more than ½ SD below population norm. Forty percent had a HRQoL level below, 52% on, and 8% above population norm. The variability could only partially be explained by the variables considered in this study. Longitudinal studies are needed to increase our understanding of the size and determinants of the impact of stroke on the HRQoL of long-term stroke survivors. Implications for rehabilitation The current European concept of stroke rehabilitation is focused on the acute and sub-acute rehabilitation phase, i.e., in the first months after stroke. The results of this study show that at five years after stroke, the mean level of HRQoL of stroke survivors remains below the healthy population level. This finding shows the need for continuation of rehabilitation in the chronic phase. At five years after stroke, higher patients' levels of depression, anxiety and disability were associated with lower scores for HRQoL. This finding implicates that chronic rehabilitation programs should be multi-faceted in order to increase long-term survivors' psychosocial outcomes.

These results indicate that the Distress Barometer, which is convenient for both patients and doctors, can be used as an acceptable, brief and sufficiently accurate method for detecting distress in cancer patients.

Purpose: This study evaluates how patterns of psychosocial referral of patients with elevated distress differ in a 'systematic screening for distress' condition versus a 'usual practice' condition in ambulatory oncology practice.Methods: The psychosocial referral process in a 2-week usual practice (N = 278) condition was compared with a 2-week 'using the Distress Barometer as a screening instrument' (N = 304) condition in an outpatient clinic with seven consulting oncologists.Results: Out of all distressed patients in the usual practice condition, only 5.5% of patients detected with distress were actually referred to psychosocial counselling, compared with 69.1% of patients detected with distress in the condition with systematic screening using the Distress Barometer. Only 3.7% of patients detected with distress in the usual practice condition finally accepted this referral, compared with 27.6% of patients detected with distress in the screening condition.Conclusions: Using the Distress Barometer as a self-report screening instrument prior to oncological consultation optimises detection of elevated distress in patients, and this results in a higher number of performed and accepted referrals, but cannot by itself guarantee actual psychosocial referral or acceptance of referral. There is not only a problem of poor detection of distress in cancer patients but also a need for better decision-making and communication between oncologists and patients about this issue.

Background: Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question. Case presentation: A woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions. Case management: The decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor). Case outcome: The patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise. Conclusion: This case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients.

BackgroundIn case of untreatable suffering at the end of life, palliative sedation may be chosen to assure comfort by reducing the patient’s level of consciousness. An important question here is whether such sedated patients are completely free of pain. Because these patients cannot communicate anymore, caregivers have to rely on observation to assess the patient’s comfort. Recently however, more sophisticated techniques from the neurosciences have shown that sometimes consciousness and pain are undetectable with these traditional behavioral methods. The aim of this study is to better understand how unconscious palliative sedated patients experience the last days of their life and to find out if they are really free of pain.MethodsIn this study we will observe 40 patients starting with initiation of palliative sedation until death. Assessment of comfort based on behavioral observations will be related with the results from a NeuroSense monitor, an EEG-based monitor used for evaluation of the adequacy of anesthesia and sedation in the operating room and an ECG-based Analgesia Nociception Index (ANI) monitor, which informs about comfort or discomfort condition, based on the parasympathetic tone. An innovative and challenging aspect of this study is its qualitative approach; “objective” and “subjective” data will be linked to achieve a holistic understanding of the study topic. The following data will be collected: assessment of pain/comfort by the patients themselves (if possible) by scoring a Visual Analogue Scale (VAS); brain function monitoring; monitoring of parasympathetic tone; caregivers’ assessment (pain, awareness, communication); relatives’ perception of the quality of the dying process; assessment by 2 trained investigators using observational scales; video and audio registration.DiscussionMeasuring pain and awareness in non-communicative dying patients is both technically and ethically challenging. ANI and EEG have shown to be promising technologies to detect pain that otherwise cannot be detected with the “traditional” methods. Although these technologies have the potential to provide objective quantifiable indicators for distress and awareness in non-communicative patients, strikingly they have not yet been used to check whether the current assessments for non-communicative patients are reliable.Trial registrationThe study is registered on ClinicalTrials.gov (Identifier: NCT03273244; registration date: 7.9.2017).

Despite the fact that studies on self-determination theory have traditionally disregarded the explicit role of emotions in the motivation eliciting process, research attention for the affective antecedents of motivation is growing. We add to this emerging research field by testing the moderating role of emotion differentiation –individual differences in the extent to which people can differentiate between specific emotions– on the relationship between twelve specific emotions and intrinsic motivation. To this end, we conducted a daily diary study (N = 72) and an experience sampling study (N = 34). Results showed that the relationship between enthusiasm, cheerfulness, optimism, contentedness, gloominess, miserableness, uneasiness (in both studies 1 and 2), calmness, relaxation, tenseness, depression, worry (only in Study 1) on one hand and intrinsic motivation on the other hand was moderated by positive emotion differentiation for the positive emotions and by negative emotion differentiation for the negative emotions. Altogether, these findings suggest that for people who are unable to distinguish between different specific positive emotions the relationship between those specific positive emotions and intrinsic motivation is stronger, whereas the relationship between specific negative emotions and intrinsic motivation is weaker for people who are able to distinguish between the different specific negative emotions. Theoretical and practical implications are discussed.

(measurement of) quality of life, subjective well-being, life satisfaction, happiness, relativity biases,