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Maiwald P, Weis J, Kurlemann U, Dresch C, Rademaker AL, Valentini J, Joos S, Heidt V, Bartsch HH. Barriers to utilisation of cancer rehabilitation from the expert's view: A cross-sectional survey. Eur J Cancer Care (Engl) 2021; 31:e13522. [PMID: 34637572 DOI: 10.1111/ecc.13522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/19/2021] [Accepted: 09/24/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The goal of this study was to investigate barriers to utilisation of cancer rehabilitation by querying a large sample of various professionals in health care with a comprehensive set of barriers. METHODS We developed a questionnaire comprising 55 barriers to utilisation of cancer rehabilitation and administered it to four different types of medical, care and social work experts involved in the referral to cancer rehabilitation. An exploratory factor analysis was conducted and the extracted factors were ranked by mean values. Additionally, ANOVAs were calculated to test for group differences. RESULTS Our sample (N = 606) consisted of 249 physicians, 194 social workers, 105 nurses and 55 psychologists in Germany. We identified seven barrier-dimensions: low appreciation of rehabilitation by professionals, insufficient coordination, insufficient application procedure, rehabilitation requirements not met, patients' unfulfilled demands, patients' social responsibilities and patients' coping style, with the latter being rated as the most obstructive thereof. Furthermore, we found statistically significant group differences for six of these factors with small- to medium-sized effects. CONCLUSION Our results support previous publications implicating the patients' coping style as a barrier. We furthermore found evidence for barriers relating to processes and organisational issues, thereby expanding on the scope of patient-oriented publications. Suggestions for improving patients' health services accessibility are made.
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Affiliation(s)
- Phillip Maiwald
- Tumor Biology Center, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Joachim Weis
- Tumor Biology Center, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Endowment Professorship for Self-Help Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ulrich Kurlemann
- German Professional Association for Social Work in Health Care e.V. (DVSG), Münster University Hospital, Münster, Germany
| | - Carolin Dresch
- Tumor Biology Center, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Research Methods Department, University of Education Freiburg, Freiburg im Breisgau, Germany
| | - Anna Lena Rademaker
- Faculty of Social Sciences, Bielefeld University of Applied Sciences (FH Bielefeld), German Professional Association for Social Work in Health Care e.V. (DVSG), Bielefeld, Germany
| | - Jan Valentini
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Vitali Heidt
- Scientific Institute of Office-Based Hematologists and Oncologists (WINHO), Cologne, Germany
| | - Hans Helge Bartsch
- Tumor Biology Center, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
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Scherer-Trame S, Jansen L, Arndt V, Chang-Claude J, Hoffmeister M, Brenner H. Inpatient rehabilitation therapy among colorectal cancer patients - utilization and association with prognosis: a cohort study. Acta Oncol 2021; 60:1000-1010. [PMID: 34137351 DOI: 10.1080/0284186x.2021.1940274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Inpatient rehabilitation therapy (IRT) is commonly offered to cancer patients during or after cancer treatment in Germany. However, little is known about utilization and long-term effects of this offer in colorectal cancer (CRC) patients. We aimed to assess IRT utilization, determinants of utilization and the association between IRT and survival in CRC patients. MATERIALS AND METHODS CRC patients diagnosed in 2005-2014 recruited in the population-based DACHS study in South West Germany were included. Determinants of IRT utilization were assessed by multivariable logistic regression. Hazard ratios (HRs) of the association of IRT with overall and disease-specific survival were estimated by adjusted Cox proportional hazards models. Modified landmark approach was applied to avoid immortal time biased results. RESULTS Among the included CRC patients (n = 3704), 43.6% underwent IRT. Patients who did not live in a relationship with a partner, worked as employee and who reported higher levels of physical activity were more likely to undergo IRT. Patients were less likely to undergo IRT if they had private health insurance, were diagnosed with cancer stage IV, received no or laparoscopic cancer surgery or were treated in a hospital with medium vs. high surgical volume. The median follow-up time was 4.4 years (post-landmark). Utilization of IRT was associated with better overall (HR 0.81, 95% confidence interval 0.72-0.92) and disease-specific survival (HR 0.72, 95% confidence interval 0.61-0.85). CONCLUSION Almost every other CRC patient underwent IRT. Next to clinical characteristics, identified social and lifestyle characteristics seemed to play an essential role in the decision-making. Use of IRT was associated with better overall and disease-specific survival.
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Affiliation(s)
- Sophie Scherer-Trame
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Epidemiological Cancer Registry Baden-Würrtemberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Arndt
- Epidemiological Cancer Registry Baden-Würrtemberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Clinical Epidemiology and Aging Research, Unit of Cancer Survivorship, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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Fach EM, Markert J, Spanier K, Bethge M, Schlumbohm A, Richter M. [Social Inequalities in Access to and Utilization of Medical Rehabilitation - Results of the Third German Sociomedical Panel of Employees (GSPE-III)]. REHABILITATION 2021; 60:310-319. [PMID: 33873216 DOI: 10.1055/a-1343-5586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM OF THE STUDY The influence of social status on health is well documented. Preliminary research provides initial evidence for social inequalities in rehabilitation care. Our study examines the role of social inequalities with respect to access and utilisation of medical rehabilitation services by analysing a risk cohort of the German Statutory Pension Insurance Scheme (Deutsche Rentenversicherung Bund). METHODS Data for the analysis consists of questionnaire data from the first two waves of the Third German Socio-medical Panel of Employees (GSPE-III) and administrative data of participants (2013-2016). This risk cohort comprises 40-54-year-old employees receiving sickness benefits in 2012. Using logistic regression models, the application for medical rehabilitation, its approval and rejection, possible opposition proceedings and its subsequent utilisation were analysed. The social status was measured by an index as well as by the single dimension of education. The analyses were carried out separately by gender. Age, employment status and subjective health status were considered as covariates. RESULTS A total of 2.376 insured employees, 1.092 men and 1.284 women, were included in the analysis. 639 (26.9%) submitted at least one application for medical rehabilitation. The chance of submitting an application was higher for men with low socioeconomic status (OR=1.8; 95%-CI=1.3-2.5) or lower (OR=1.9; 95%-CI=1.3-2.8) and medium education (OR=1.5; 95%-CI=1.1-2.2) in relation to the high status or education group. For women, low education (OR=1.6; 95%-CI=1.1-2.5) raised the chances of an application. When adjusted for health status and current employment situation, all significant differences disappeared. Regarding approval and utilisation, there were no significant differences between socioeconomic status groups, but women with a medium level of education were significantly more likely to have their application approved on the basis of an opposition proceeding (OR=3.0; 95%-CI=1.1-8.2) than women with a high level of education. CONCLUSION The analyses provided no evidence of a socially unequal access to or utilization of medical rehabilitation. However, insured persons with a low social status more frequently applied for rehabilitation, especially because of their poorer subjective health. Further research is needed to ensure that this meets the objective needs of this status group.
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Affiliation(s)
- Eva-Maria Fach
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg
| | - Jenny Markert
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg
| | - Katja Spanier
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck
| | - Matthias Bethge
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck
| | - Anna Schlumbohm
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité - Universitätsmedizin Berlin
| | - Matthias Richter
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg
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Noeres D, Sperlich S, Röbbel L, Safieddine B, Deuker JU, Hillemanns P, Ismaéel F, Moser A, Noeding KH, Noesselt T, Pape J, Park-Simon TW, Peschel S, Seifert W, Siggelkow W, Thoma M, Uleer C, Geyer S. [Predictors of the Utilization and Waiting Period Before Starting an Oncological Rehabilitation after Breast Cancer]. REHABILITATION 2021; 60:86-94. [PMID: 33858017 DOI: 10.1055/a-1361-4028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This study explores the sociodemographic, medical and work-related factors leading to a participation in an in-house rehabilitation measure after primary treatment for breast cancer. METHODS The prospective multi-center study is based on a written survey with employed breast cancer patients who were recruited at 11 breast cancer centers in Lower Saxony, Germany. Predictors of participation were examined by logistic regression, predictors of the time period before starting the rehabilitation by linear regression. RESULTS 409 patients returned their questionnaires at all three time-points. Response rates were 80,1% 3 weeks after surgery (t0), 95,2% 6 months after surgery (t1) and 89,9% one year after surgery (t2). Altogether, 294 patients (72%) participated in the rehabilitation measure. Respondents, 90% of whom participated in rehabilitation before returning to work, began their rehabilitation on average 21 weeks after primary surgery. They showed an increased probability of participation if they had indicated the need to clarify their job situation (OR=2,74, p<0,01), or if their answers displayed a detrimental relation between effort and reward at work (OR=3,89, p<0,05). At the same time, higher age, a higher level of school education (OR=4,23) and reduced physical health (OR=0,94, p<0,01) increased the chance for breast cancer patients to take part in oncological rehabilitation. The starting point of rehabilitation was only predictable by medical treatments: adjuvant chemotherapy (β=0,492, p≤0,001), additional surgery (β=0,112, p<0,05), and radiation therapy within the second half year after primary surgery (β=0,20; p<0,001) led to a postponement. CONCLUSION This study shows that an increased need of breast cancer patients for medical and socio-psychological support leads to their participation in an in-house rehabilitation and thus underlines the necessity of these institutions. Women with an impaired psychological health should be given extra attention.
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Affiliation(s)
- Dorothee Noeres
- Forschungs- und Lehreinheit Medizinische Soziologie, Med. Hochschule Hannover
| | - Stefanie Sperlich
- Forschungs- und Lehreinheit Medizinische Soziologie, Med. Hochschule Hannover
| | - Lena Röbbel
- Forschungs- und Lehreinheit Medizinische Soziologie, Med. Hochschule Hannover
| | - Batoul Safieddine
- Forschungs- und Lehreinheit Medizinische Soziologie, Med. Hochschule Hannover
| | | | - Peter Hillemanns
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover
| | | | | | | | | | | | | | | | | | | | | | - Christoph Uleer
- Gynäkologische Praxis Frauenärzte am Bahnhofsplatz, Hildesheim
| | - Siegfried Geyer
- Forschungs- und Lehreinheit Medizinische Soziologie, Med. Hochschule Hannover
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Weis J, Dresch C, Bartsch HH, Kurlemann U, Maiwald P, Rademaker AL, Valentini J, Joos S, Heidt V. Barrieren der Antragstellung in der Onkologischen Rehabilitation: Eine bundesweite Expertenstudie. DIE REHABILITATION 2021; 60:95-101. [DOI: 10.1055/a-1361-4050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Ziel der Studie Aus Perspektive verschiedener Expertengruppen, die in der Versorgung onkologisch Erkrankter tätig sind, werden Barrieren bei der Antragstellung zu onkologischen Rehabilitationsmaßnahmen identifiziert. Darauf aufbauend werden Handlungsempfehlungen zur Optimierung abgeleitet. Die Studie wurde von der Deutschen Rentenversicherung Bund (DRV) gefördert.
Methodik Auf Basis einer Interviewstudie (N=61) wurde ein Fragebogeninstrument mit 55 Items zu möglichen Barrieren im Antragstellungsprozess konzipiert und online eingesetzt. Teilnehmer mit mehr als 33% fehlenden Werten wurden von den Analysen ausgeschlossen. Mittelwertanalysen wurden zur Identifikation der bedeutsamsten Relevanz angewendet. Um übergeordnete Dimensionen zu identifizieren, wurde eine exploratorische Faktorenanalyse durchgeführt.
Ergebnisse Insgesamt wurden 606 Experten aus dem onkologischen Bereich in die Auswertung eingeschlossen. Darunter waren 249 Ärzte, 194 Sozialarbeiter, 105 Pflegefachkräfte / Medizinische Fachangestellte, 55 Psychologen / Psychoonkologen und 3 sonstige Berufsgruppen. Die befragten Experten waren im Mittel 51 Jahre alt (SD=10,4) und seit 17 Jahren (SD=9,8) im onkologischen Bereich tätig. Die Barrieren konnten folgenden 7 faktoranalytisch bestimmten Inhaltsbereichen zugeordnet werden: Krankheitsverarbeitung, Antragsverfahren, Rehafähigkeit, Koordination, soziale Verpflichtungen, Patientenwünsche und Stellenwert der Reha. Die Experten gaben an, dass insbesondere der Wunsch des Patienten nach Normalität, die zu starre Frist für die Anschlussrehabilitation (AHB) und das für Patienten mit Migrationshintergrund schlecht verständliche Antragsverfahren einer Antragstellung entgegenstehen kann. Außerdem wurde darauf hingewiesen, dass die Vermittlung von multimorbiden Patienten in die Rehabilitationseinrichtungen schwierig sei.
Schlussfolgerung Aus der Expertenstudie können folgende Handlungsempfehlungen für einen erleichterten Rehabilitationszugang abgeleitet werden: Optimierung der Koordination zwischen verschiedenen Expertengruppen; Einrichtungen und mit den Kostenträgern, Flexibilisierung der AHB-Frist, Vereinfachung der Antragstellung, Bereitstellung von Anträgen / Informationsmaterialien in weiteren Sprachen, Ausrichtung der Reha-Kliniken auf spezifische Patientengruppen.
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Affiliation(s)
- Joachim Weis
- Stiftungsprofessur Selbsthilfeforschung, Medizinische Fakultät, Universität Freiburg
| | | | | | - Ulrich Kurlemann
- Deutsche Vereinigung für Soziale Arbeit im Gesundheitswesen e. V. (DVSG), Berlin, Universitätsklinikum Münster
| | - Phillip Maiwald
- Klinik für onkologische Rehabilitation, Universitätsklinikum Freiburg
| | - Anna Lena Rademaker
- Deutsche Vereinigung für Soziale Arbeit im Gesundheitswesen e. V. (DVSG), Berlin, Fachhochschule Bielefeld
| | - Jan Valentini
- Institut für Allgemeinmedizin & Interprofessionelle Versorgung, Universitätsklinikum Tübingen
| | - Stefanie Joos
- Institut für Allgemeinmedizin & Interprofessionelle Versorgung, Universitätsklinikum Tübingen
| | - Vitali Heidt
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO), Köln
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Dresch C, Bartsch HH, Kurlemann U, Maiwald P, Rademaker A, Valentini J, Joos S, Heidt V, Weis J. [Barriers in the Application Process for Oncological Rehabilitation: Results of a Qualitative Expert Survey]. REHABILITATION 2020; 60:235-242. [PMID: 33152777 DOI: 10.1055/a-1248-4979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE In this study, which was funded by the German Federal Pension Fund (DRV), barriers in the application process for oncological rehabilitation services were examined from the perspective of various expert groups. METHODS In an exploratory multicentre qualitative cross-sectional study 61 semi-structured interviews with experts working in oncological care were conducted: Physicians (n=26), social workers (n=22), psychologists/psycho-oncologists (n=6), nurses/medical assistants (n=5), administrative staff of the DRV (n=2). In guided interviews the participants were asked about their experiences with rehabilitation applications as well as their estimations and evaluations regarding possible reasons for non-utilisation. The evaluation of the interviews was computerized and based on the qualitative content analysis by Mayring. RESULTS The respondents had an average age of 52.51 years (SD=10.06; min=25, max=71) and were working in the consultation or treatment of oncological patients for an average of 19.26 years (SD=10.15; min=1, max=42). In total, 854 statements were coded and assigned to the following three main categories: expert-related, system-related and patient-related barriers. In the first main category, scepticism about the benefits of rehabilitation services and an insufficiently met need for information on the part of experts became the focus of attention. In the main category of system-related barriers, aspects were mentioned that addressed the application procedure, the low availability of, for example, outpatient rehabilitation services and the absence of a functioning referral system. The main category of patient-related barriers included psychosocial factors such as subcategories on the topic of coping with the disease which include the patient's desire to come home, experience everyday life again and the fear of being confronted with the disease. CONCLUSION The exploratory study revealed potential barriers in the application process for oncological rehabilitation services from an expert perspective. In particular, the findings form the basis for a multi-dimensional assessment instrument that can be used to analyze the barriers in a standardised way and to derive individual recommendations for action.
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Affiliation(s)
| | | | - Ulrich Kurlemann
- Deutsche Vereinigung für Soziale Arbeit im Gesundheitswesen e.V. (DVSG), Berlin, Universitätsklinikum Münster
| | - Phillip Maiwald
- Klinik für onkologische Rehabilitation, Universitätsklinikum Freiburg
| | - AnnaLena Rademaker
- Deutsche Vereinigung für Soziale Arbeit im Gesundheitswesen e.V. (DVSG), Berlin, Fachhochschule Bielefeld
| | - Jan Valentini
- Institut für Allgemeinmedizin & Interprofessionelle Versorgung, Universitätsklinikum Tübingen
| | - Stefanie Joos
- Institut für Allgemeinmedizin & Interprofessionelle Versorgung, Universitätsklinikum Tübingen
| | - Vitali Heidt
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO), Köln
| | - Joachim Weis
- Stiftungsprofessur Selbsthilfeforschung, Universitätsklinikum Freiburg
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