Flourishing, Mental Health Professionals and the Role of Normative Dialogue

This paper explores the dilemma faced by mental healthcare professionals in balancing treatment of mental disorders with promoting patient well-being and flourishing. With growing calls for a more explicit focus on patient flourishing in mental healthcare, we address two inter-related challenges: the lack of consensus on defining positive mental health and flourishing, and how professionals should respond to patients with controversial views on what is good for them. We discuss the relationship dynamics between healthcare providers and patients, proposing that 'liberal' approaches can provide a pragmatic framework to address disagreements about well-being in the context of flourishing-oriented mental healthcare. We acknowledge the criticisms of these approaches, including the potential for unintended paternalism and distrust. To mitigate these risks, we conclude by suggesting a mechanism to minimize the likelihood of unintended paternalism and foster patient trust.

The CREATION Health Assessment Tool for Patients (CHAT-P): Development & Psychometric Testing

The CREATION Model is a whole-person wellness model facilitating patient-provider partnerships for health promotion. CREATION is an acronym that represents eight whole-person health principles: Choice, Rest, Environment-Interpersonal Relationships, Activity, Trust, Outlook, and Nutrition, all focusing on the relationship between individual choice and physical, psychological, social, and spiritual health. This study develops and tests the psychometric properties of the CREATION Health Assessment Tool for Patients (CHAT-P). A 125-item-bank using a 5-point Likert scale with 1 to 5 rating was generated through focus-groups of clinicians, patients, and healthcare leaders. An expert panel assessed content adequacy, reducing items to 82. Patient survey data (n = 599) from 15 inpatient medical units were randomly divided into two datasets. Exploratory Factor Analysis applied to Dataset 1 resulted in a 7-factor (Choice/Rest/Environment-Interpersonal Relationships/Activity/Trust/Outlook/Nutrition) and 28-item tool with factor loading 0.47-0.86. The model structure was confirmed by Structural Equation Modeling on Dataset 2 with goodness-of-fit test results: X²/df = 2.41 < 5.0, RMSEA = 0.05 < 0.08, GFI = 0.91 and AGFI = 0.90. Cronbach's Alpha = 0.83 showed satisfactory reliability. The final CHAT-P totals ranged from 28-140 (higher scores indicating better health/well-being). When assessing the effectiveness of educational/behavioral interventions, this tool can measure the improvement of a patient's overall mind-body-spirit well-being or measure well-being for individual CREATION principle(s). It fills that gap and facilitates healthcare providers' ability to assess and plan interventions to support holistic well-being.

[Surgery in the balance between humanity, ethics and economics]

BACKGROUND

The economic pressure in the healthcare system has noticeably increased in the past few years. The manifestation of an "economization in medicine" development raises questions about the compatibility of physicians' duties and economic incentives in the healthcare system.

OBJECTIVE

Against this background the article analyzes areas of conflict in the German healthcare system and surgery in particular. The main questions focus on: what lines of conflict can arise between ethical duties and economic requirements and what possibilities for conflict resolution can provide orientation on the macrolevel and microlevel?

MATERIAL AND METHODS

The article is based on the analysis of normative regulations, guidelines and statements from the self-administrative institutions and multidisciplinary literature from medicine, medical ethics and health economics. Core issues in the conflict area between "humanity-ethics-economics" are structured and recommendations for action are derived.

RESULTS AND DISCUSSION

Superordinate regulatory framework conditions and their subsequent incentives must not conflict with the ethical principles of medical care, especially the primary orientation to patient welfare. Institutional and individual healthcare providers have a responsibility towards patients first and only secondarily for an economically appropriate spending of public resources. The provision of medical care for people must enable an adequate livelihood. Institutional maximization of profits is to be avoided, especially concerning financial investors. In the corona pandemic, economic disincentives are becoming apparent and necessitate readjustments. Possible recommendations for action are the empowerment of the medical profession and management to engage in a qualified exchange.

Patient-reported outcomes (PROs) after total extraperitoneal hernia repair (TEP)

Background

Patient-reported outcomes (PROs) such as quality of life (QoL), patient satisfaction, and work impairment, are arguably the most important outcomes of any medical treatment. In 2011, Staerkle and Villiger developed the Core Outcome Measurements Index (COMI) to standardise PROs and PRO measurement for inguinal hernia patients, in an attempt to increase inter-study comparability. The aim of this study is to prospectively evaluate the short- and long-term postoperative QoL, function, patient well-being, pain, and social/work disability, after total extraperitoneal (TEP) inguinal hernia repair and to provide the first clinical experience with the COMI-hernia questionnaire.

Methods

Between January 2013 and December 2014, all patients ≥18 years that were scheduled for elective uni- or bilateral TEP in a regional hospital were approached to participate in this study. Measurements were taken preoperatively, and 6 weeks and 1 year postoperatively.

Results

One hundred and twenty patients (113 men, 7 women), mean age 59 years (SD ±12), completed the follow-up of 1 year. Ninety-seven percent of the population reported that the operation improved their complaints. QoL, function, well-being, and pain all improved after 6 weeks and 1 year after surgery. Patients experienced more social and work-related limitations 6 weeks after surgery compared to baseline measurements, though this improved to normal 1 year postoperatively. The incidence of chronic pain was 14% (VAS ≥ 2), which had a negative impact on the patients' sense of well-being.

Conclusion

Patients recovered well after TEP repair with a good quality of life and fast restore of function. Patient well-being was lower than expected due to a 14% incidence of chronic pain. The COMI-hernia scale provided reasonable insight into the patients' experience, though it was difficult to interpret for both patient and physician.