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Kusch M, Labouvie H, Schiewer V, Talalaev N, Cwik JC, Bussmann S, Vaganian L, Gerlach AL, Dresen A, Cecon N, Salm S, Krieger T, Pfaff H, Lemmen C, Derendorf L, Stock S, Samel C, Hagemeier A, Hellmich M, Leicher B, Hültenschmidt G, Swoboda J, Haas P, Arning A, Göttel A, Schwickerath K, Graeven U, Houwaart S, Kerek-Bodden H, Krebs S, Muth C, Hecker C, Reiser M, Mauch C, Benner J, Schmidt G, Karlowsky C, Vimalanandan G, Matyschik L, Galonska L, Francke A, Osborne K, Nestle U, Bäumer M, Schmitz K, Wolf J, Hallek M. Integrated, cross-sectoral psycho-oncology (isPO): a new form of care for newly diagnosed cancer patients in Germany. BMC Health Serv Res 2022; 22:543. [PMID: 35459202 PMCID: PMC9034572 DOI: 10.1186/s12913-022-07782-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background The annual incidence of new cancer cases has been increasing worldwide for many years, and is likely to continue to rise. In Germany, the number of new cancer cases is expected to increase by 20% until 2030. Half of all cancer patients experience significant emotional and psychosocial distress along the continuum of their disease, treatment, and aftercare, and also as long-term survivors. Consequently, in many countries, psycho-oncological programs have been developed to address this added burden at both the individual and population level. These programs promote the active engagement of patients in their cancer therapy, aftercare and survivorship planning and aim to improve the patients' quality of life. In Germany, the “new form of care isPO” (“nFC-isPO”; integrated, cross-sectoral psycho-oncology/integrierte, sektorenübergreifende Psycho-Onkologie) is currently being developed, implemented and evaluated. This approach strives to accomplish the goals devised in the National Cancer Plan by providing psycho-oncological care to all cancer patients according to their individual healthcare needs. The term “new form of care" is defined by the Innovation Fund (IF) of Germany's Federal Joint Committee as “a structured and legally binding cooperation between different professional groups and/or institutions in medical and non-medical care”. The nFC-isPO is part of the isPO project funded by the IF. It is implemented in four local cancer centres and is currently undergoing a continuous quality improvement process. As part of the isPO project the nFC-isPO is being evaluated by an independent institution: the Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Germany. The four-year isPO project was selected by the IF to be eligible for funding because it meets the requirements of the federal government's National Cancer Plan (NCP), in particular, the “further development of the oncological care structures and quality assurance" in the psycho-oncological domain. An independent evaluation is required by the IF to verify if the new form of care leads to an improvement in cross-sectoral care and to explore its potential for permanent integration into the German health care system. Methods The nFC-isPO consists of six components: a concept of care (C1), care pathways (C2), a psycho-oncological care network (C3), a care process organization plan (C4), an IT-supported documentation and assistance system (C5) and a quality management system (C6). The two components concept of care (C1) and care pathways (C2) represent the isPO clinical care program, according to which the individual cancer patients are offered psycho-oncological services within a period of 12 months after program enrolment following the diagnosis of cancer. The remaining components (C3-C6) represent the formal-administrative aspects of the nFC-isPO that are intended to meet the legally binding requirements of patient care in the German health care system. With the aim of systematic development of the nFC-isPO while at the same time enabling the external evaluators to examine its quality, effectiveness and efficiency under conditions of routine care, the project partners took into consideration approaches from translational psycho-oncology, practice-based health care research and program theory. In order to develop a structured, population-based isPO care program, reference was made to a specific program theory, to the stepped-care approach, and also to evidence-based guideline recommendations. Results The basic version, nFC-isPO, was created over the first year after the start of the isPO project in October 2017, and has since been subject to a continuous quality improvement process. In 2019, the nFC-isPO was implemented at four local psycho-oncological care networks in the federal state North Rhine-Westphalia, in Germany. The legal basis of the implementation is a contract for "special care" with the German statutory health insurance funds according to state law (§ 140a SCB V; Social Code Book V for the statutory health insurance funds). Besides the accompanying external evaluation by the IMVR, the nFC-isPO is subjected to quarterly internal and cross-network quality assurance and improvement measures (internal evaluation) in order to ensure continuous quality improvement process. These quality management measures are developed and tested in the isPO project and are to be retained in order to ensure the sustainability of the quality of nFC-isPO for later dissemination into the German health care system. Discussion Demands on quality, effectiveness and cost-effectiveness of in the German health care system are increasing, whereas financial resources are declining, especially for psychosocial services. At the same time, knowledge about evidence-based screening, assessment and intervention in cancer patients and about the provision of psychosocial oncological services is growing continuously. Due to the legal framework of the statutory health insurance in Germany, it has taken years to put sound psycho-oncological findings from research into practice. Ensuring the adequate and sustainable financing of a needs-oriented, psycho-oncological care approach for all newly diagnosed cancer patients, as required by the NCP, may still require many additional years. The aim of the isPO project is to develop a new form of psycho-oncological care for the individual and the population suffering from cancer, and to provide those responsible for German health policy with a sound basis for decision-making on the timely dissemination of psycho-oncological services in the German health care system. Trial registration The study was pre-registered at the German Clinical Trials Register (https://www.drks.de/DRKS00015326) under the following trial registration number: DRKS00015326; Date of registration: October 30, 2018.
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Affiliation(s)
- Michael Kusch
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany.
| | - Hildegard Labouvie
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Vera Schiewer
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Natalie Talalaev
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Jan C Cwik
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Sonja Bussmann
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Lusine Vaganian
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Alexander L Gerlach
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Antje Dresen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Natalia Cecon
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Sandra Salm
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Theresia Krieger
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Holger Pfaff
- University of Cologne, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Clarissa Lemmen
- Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Lisa Derendorf
- Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Christina Samel
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Anna Hagemeier
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Bernd Leicher
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Gregor Hültenschmidt
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Jessica Swoboda
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Peter Haas
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Anna Arning
- Krebsgesellschaft Nordrhein-Westfalen E.V, Düsseldorf, Germany
| | - Andrea Göttel
- Krebsgesellschaft Nordrhein-Westfalen E.V, Düsseldorf, Germany
| | | | - Ullrich Graeven
- Krebsgesellschaft Nordrhein-Westfalen E.V, Düsseldorf, Germany
| | - Stefanie Houwaart
- House of the Cancer Patient Support Associations of Germany, Bonn, Germany
| | - Hedy Kerek-Bodden
- House of the Cancer Patient Support Associations of Germany, Bonn, Germany
| | - Steffen Krebs
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Christiana Muth
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | | | - Marcel Reiser
- PIOH Köln - Praxis Internistischer Onkologie Und Hämatologie, Cologne, Germany
| | - Cornelia Mauch
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | | | | | | | | | | | | | | | | | | | | | | | - Jürgen Wolf
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
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Schomberg J, Teismann T, Bussmann S, Vaganian L, Gerlach AL, Cwik JC. The significance of the Interpersonal-Psychological Theory of Suicide in an oncological context-A scoping review. Eur J Cancer Care (Engl) 2020; 30:e13330. [PMID: 32959421 DOI: 10.1111/ecc.13330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/09/2020] [Accepted: 08/07/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Since individuals afflicted with cancer are at an elevated risk of dying by suicide, understanding suicide-related ideation and behaviours is critical in identifying vulnerable patients. The interpersonal theory of suicide (IPTS) provides a framework to research risk factors for suicide and has been validated in different samples. The aim of this scoping review is to study literature related to IPTS and cancer patients. METHODS This scoping review was registered with the OPEN Science Framework (osf.io/92465). The databases PsycINFO, Web of Science, PubMed and PubMed Central were searched. Eligible research needed to use a minimum of one psychometric element to measure at least one of the factors of the IPTS in individuals with cancer. RESULTS Ninety-six studies were identified and screened. Eligible research included individuals with cancer and the use of at least one measurement of at least one of the factors of the IPTS. Overall, four articles met the inclusion criteria and three studies found significant associations of components of the IPTS and suicidal ideation/behaviour. CONCLUSION While these initial findings support the notion that the IPTS is relevant for individuals with cancer as well, a direct validation of the IPTS in cancer patients is needed.
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Affiliation(s)
- Jan Schomberg
- Department of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Northrhine-Westphalia, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-University of Bochum, Bochum, Northrhine-Westphalia, Germany
| | - Sonja Bussmann
- Department of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Northrhine-Westphalia, Germany
| | - Lusine Vaganian
- Department of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Northrhine-Westphalia, Germany
| | - Alexander L Gerlach
- Department of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Northrhine-Westphalia, Germany
| | - Jan C Cwik
- Department of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Northrhine-Westphalia, Germany
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Vaganian L, Bussmann S, Gerlach AL, Kusch M, Labouvie H, Cwik JC. Critical consideration of assessment methods for clinically significant changes of mental distress after psycho-oncological interventions. Int J Methods Psychiatr Res 2020; 29:e1821. [PMID: 32090408 PMCID: PMC7301279 DOI: 10.1002/mpr.1821] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/19/2019] [Accepted: 01/29/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Considering the heterogeneity of cancer entities and the associated disease progression, personalized care of patients is increasingly emphasized in psycho-oncology. This individualization makes the use of measurements of individual clinically significant change important when studying the efficacy and effectiveness of psycho-oncological care. Two conceptualizations for the measurement of clinical significance are critically contrasted in this study: the Reliable Change Index (RCI) and the Minimal Important Difference (MID) method. METHODS In total, 2,121 cancer patients participated in the study and a subsample of 708 patients was reassessed about 4 months later. Psychological distress was measured using the Hospital Anxiety and Depression Scale. We evaluated two measures of clinical significance (RCI, MID) by comparing the respective numbers of improved, unimproved, and deteriorated patients. RESULTS Individually significant changes were observed with both methods; however, determined rates of improvement differed substantially: MID (66.67%) and RCI (48.23%). Most importantly, according to MID, 17.93% of patients were identified as being improved, although their respective improvements were not statistically significant and thus unreliable. CONCLUSIONS The benefits of RCI outweigh MID, and therefore, the RCI is recommended as a measure to assess change.
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Affiliation(s)
- Lusine Vaganian
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Sonja Bussmann
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Alexander L Gerlach
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Michael Kusch
- Department of Internal Medicine, Section: Clinical Psycho-Oncology, Working Group Psycho-Oncological Health Services Research, University Hospital of Cologne, Cologne, Germany
| | - Hildegard Labouvie
- Department of Internal Medicine, Section: Clinical Psycho-Oncology, Working Group Psycho-Oncological Health Services Research, University Hospital of Cologne, Cologne, Germany
| | - Jan C Cwik
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
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Jenniches I, Lemmen C, Cwik JC, Kusch M, Labouvie H, Scholten N, Gerlach A, Stock S, Samel C, Hagemeier A, Hellmich M, Haas P, Hallek M, Pfaff H, Dresen A. Evaluation of a complex integrated, cross-sectoral psycho-oncological care program (isPO): a mixed-methods study protocol. BMJ Open 2020; 10:e034141. [PMID: 32156765 PMCID: PMC7064131 DOI: 10.1136/bmjopen-2019-034141] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION International standards of care require the complete integration of psycho-oncological care into biomedical cancer treatment. The structured integrated, cross-sectoral psycho-oncological programme 'isPO' is aiming to ensure a provision of care in inpatient and outpatient settings according to a stepped-care approach. Up to now, psycho-oncological care is missing regulated and standardised processes to demonstrate the effectiveness. This study protocol describes the process and outcome evaluation that is conducted, along with the isPO study. The programme evaluation is aiming to proof effectiveness, explain potential discrepancies between expected and observed outcomes. Additionally, provide insight into the implementation process, as well as contextual factors that might promote or inhibit the dissemination and implementation of the stepped care programme will be gained. In addition to these measures, a cost-consequence analysis will provide further evidence aimed at integrating psycho-oncological care into primary healthcare. METHODS AND ANALYSIS The evaluation concept is based on a tripartite strategy consisting of a prospective, formative and summative evaluation. To capture all determinants, a concurrent mixed-method design is applied comprising qualitative (interviews and focus groups) and quantitative (standardised questionnaires) surveys of patients and healthcare providers. In addition, analysis of the psycho-oncological care data (isPO care data) and statutory health insurance claims data will be conducted. Primary and secondary data will complement one another (data linkage) to obtain a more comprehensive picture of the effectiveness and implementation of the complex intervention within the isPO study. ETHICS AND DISSEMINATION The study has been approved by the ethics committee of the Medical Faculty of the University of Cologne. For all collected data, the relevant national and European data protection regulations will be considered. All personal identifiers (eg, name, date of birth) will be pseudonymised. Dissemination strategies include annual reports as well as quality workshops for the organisations, the presentation of results in publications and on conferences, and public relations. TRIAL REGISTRATION NUMBER DRKS00015326; Pre-results.
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Affiliation(s)
- Imke Jenniches
- IMVR - Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Clarissa Lemmen
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Germany
| | | | - Michael Kusch
- Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Hildegard Labouvie
- Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Nadine Scholten
- IMVR - Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | | | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Germany
| | - Christina Samel
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Anna Hagemeier
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Peter Haas
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Michael Hallek
- Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Holger Pfaff
- IMVR - Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Antje Dresen
- IMVR - Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
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