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Metzner G, Horstmann S, Barth M, Giesler JM, Jünemann S, Kaier K, Schlett C, Schroeder N, Siebolds M, Sinss F, van Staa J, Glattacker M, Renner I. Evaluation of a cross-sectoral care intervention for families with psychosocial burden: a study protocol of a controlled trial. BMC Health Serv Res 2022; 22:475. [PMID: 35410201 PMCID: PMC8996544 DOI: 10.1186/s12913-022-07787-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Family risk factors, e.g. low socioeconomic status or parental mental health disorders, can affect children’s health and development. Thus, targeted preventive services for families with psychosocial burden are crucial. The German Early Childhood Intervention (ECI) program is a preventive approach that aims to strengthen parent’s resources by supportive services. However, research has revealed that only a proportion of the families considered to have substantial risk factors access the ECI program. To increase pediatricians’ skills in identifying risk factors, and to improve the cross-sectoral collaboration between relevant professionals and the referral of families to supportive services, the PATH-intervention (Pediatric Attention To Help) was developed. The PATH-intervention includes interprofessional quality circles and a one-day training program for the pediatricians. This study aims to evaluate this complex cross-sectoral care intervention for families with psychosocial burden. Methods Using a prospective quasi-experimental, controlled (matched-pair), longitudinal mixed-method design, we will compare families under treatment of pediatricians trained in the PATH-intervention with families under treatment of a control group of pediatricians. Participating families are asked to complete online-surveys. As a primary outcome, we will examine the use of supportive services of the ECI by burdened families. Secondary outcomes are the proportion of correctly identified families with psychosocial burden by the pediatricians, as well as information provision and motivation of the families to use the supportive services. Additionally, the cost-effectiveness ratio will be investigated. In the process evaluation, we will qualitatively explore the acceptance of the PATH-intervention of all involved stakeholders and the treatment fidelity of the trained pediatricians. Discussion This study will determine whether the PATH-intervention enables the pediatricians to identify and recommend supportive services to burdened families, as well as the families’ use of the supportive services of the ECI. Qualitative data will give insight into the acceptance of the intervention from the perspective of all stakeholders and the treatment fidelity. Results of this study could be the starting point for the broader implementation of the PATH-intervention as standard care. Trial registration German Clinical Trials Register (DRKS): DRKS00023461 (3rd December 2020); WHO UTN: U1111- 260-6575. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07787-9.
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Affiliation(s)
- Gloria Metzner
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Sabine Horstmann
- National Centre for Early Prevention, Federal Centre for Health Education, Maarweg 149-161, 50825, Köln, Germany
| | - Michael Barth
- Center for Pediatrics, Medical Center, University of Freiburg, Mathildenstraße 1, 79106, Freiburg, Germany
| | - Jürgen M Giesler
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
| | - Susanne Jünemann
- National Centre for Early Prevention, Federal Centre for Health Education, Maarweg 149-161, 50825, Köln, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Zinkmattenstr. 6a, 79108, Freiburg, Germany
| | - Christian Schlett
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
| | - Nora Schroeder
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
| | - Marcus Siebolds
- Department of Health Care, Catholic University of Applied Sciences, Wörthstraße 10, 50668, Köln, Germany
| | - Frank Sinss
- National Centre for Early Prevention, Federal Centre for Health Education, Maarweg 149-161, 50825, Köln, Germany
| | - Juliane van Staa
- National Centre for Early Prevention, Federal Centre for Health Education, Maarweg 149-161, 50825, Köln, Germany
| | - Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
| | - Ilona Renner
- National Centre for Early Prevention, Federal Centre for Health Education, Maarweg 149-161, 50825, Köln, Germany
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Giesler JM, Dederichs-Masius U, Glattacker M. [Changes in Somatic, Behavioral, and Psychosocial Outcomes during the Inpatient Rehabilitation of Patients with Metabolic Syndrome - A Longitudinal Study of the META-Program]. REHABILITATION 2021; 61:326-335. [PMID: 34768294 DOI: 10.1055/a-1647-6896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE This study analyzed whether clinical, behavioral and psychosocial outcomes changed in patients who participate in a five weeks inpatient rehabilitation program addressing the metabolic syndrome (META-program) and whether changes were maintained at a three months follow-up. METHODS At the beginning of the program, N=114 eligible patients consented to participate in the study. Behavioral and psychosocial outcomes were measured with standardized questionnaires at program entry, program completion and three months later. These outcome measures included eating behaviors, illness beliefs, health literacy and psychosocial health. Data analysis used t-tests for dependent samples and repeated measures ANOVAs for assessing change. RESULTS Most of the outcomes improved significantly across time with effect sizes frequently medium or larger. At program completion, this included, e. g., blood pressure, fasting blood glucose and blood lipids. Improvements in self-reported eating behaviors at three months included an increase in eating and eating-related health promoting behaviors in terms of a more flexible control of one's eating, sports, and compliance with nutrition recommendations. Illness beliefs also changed significantly: Symptom burden and concern decreased, while understanding of one's illness increased towards the end of the program. Similarly, facets of psychosocial health also improved towards program completion. At three months follow-up, some facets of psychosocial health like somatoform disorder and depression deteriorated again slightly. CONCLUSION The significant and in part marked changes of the included outcomes are in line with the goals the META-program attempts to achieve. Future research on programs like the one under study here should include longer follow-up intervals and should use designs that allow interpreting observed changes as effects of participating in the program. This also would allow determining how changes in outcomes can be stabilized or even be enhanced in the long term.
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Affiliation(s)
- Jürgen M Giesler
- Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
| | - Ute Dederichs-Masius
- Drei-Burgenklinik, Deutsche Rentenversicherung Rheinland-Pfalz, Bad Kreuznach, Deutschland
| | - Manuela Glattacker
- Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
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Giesler JM, Weis J. Patient competence in the context of cancer: its dimensions and their relationships with coping, coping self-efficacy, fear of progression, and depression. Support Care Cancer 2020; 29:2133-2143. [PMID: 32875374 PMCID: PMC7892518 DOI: 10.1007/s00520-020-05699-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/19/2020] [Indexed: 12/23/2022]
Abstract
Purpose Influenced in part by research on coping, patient empowerment and self-efficacy, and by patient self-help initiatives, the construct of patient competencies (PC) has been elaborated and later integrated into Germany’s National Cancer Plan. As a self-report measure of PC, the Patient Competence Questionnaire 57 (PCQ-57) has only rarely been evaluated psychometrically. Therefore, we aimed to re-examine its dimensionality and its relationships with related constructs and potential psychosocial cancer outcomes. Methods We surveyed 424 breast, colorectal, and prostate cancer patients from clinics for oncological rehabilitation and private oncology practices who completed the PCQ-57 and self-report measures of coping, coping self-efficacy, fear of progression, and depression. Patients’ PCQ-57 responses were submitted to principal axis factor analyses. Using the original scoring keys, we computed internal consistencies (Cronbach’s α) and Pearson correlations between all measures. Results Factor analyses suggested 5 of the 8 original PCQ-57 dimensions to replicate satisfactorily, their internal consistencies ranging from 0.74 to 0.88. The competency of managing distress correlated significantly, highly, and negatively with fear of progression and depression (|r’s| ≥ 0.43) and positively with coping self-efficacy (r = 0.58). Conclusion The results support the reliability and validity of 5 of the 8 original PCQ-57 scales while suggesting refinement of the others. The replicated scales may help identify patients in need of support for dealing with the multiple tasks of adjusting to cancer. Further research should clarify the conceptual and empirical relationships between PC, health literacy, and patient activation as well as potential effects of PC on psychosocial cancer outcomes. Electronic supplementary material The online version of this article (10.1007/s00520-020-05699-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jürgen M Giesler
- Section of Health Care Research and Rehabilitation Research, University of Freiburg Medical Center, Hugstetter Str. 49, D 79106, Freiburg, Germany.
| | - Joachim Weis
- Comprehensive Cancer Center, Department of Self-Help Research, University of Freiburg Medical Center, Freiburg, Germany
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Herschbach P, Britzelmeir I, Dinkel A, Giesler JM, Herkommer K, Nest A, Pichler T, Reichelt R, Tanzer-Küntzer S, Weis J, Marten-Mittag B. Distress in cancer patients: Who are the main groups at risk? Psychooncology 2020; 29:703-710. [PMID: 31876011 DOI: 10.1002/pon.5321] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Psychosocial distress is common in cancer patients and survivors and encompasses a broad range of concerns and psychological symptoms. The aim of the current study was to identify subgroups of respondents who experience a specific constellation of distress symptoms. METHODS This study uses data from a large data base (n = 21 680) of cancer patients from diverse settings who provided data in the Questionnaire on Distress in Cancer Patients-Short Form (QSC-R10). Cluster analysis was applied to identify subgroups with a distinct constellation of distress symptoms. RESULTS The results showed five distinct clusters: minimally distressed patients (46.6% of the sample), highly distressed patients (12.7%), mainly physically distressed patients (15.2%), mainly psychologically distressed patients (15.6%), and mainly socially distressed patients (9.9%). These groups differed with regard to age, sex, cancer site, treatment setting, and disease progression. CONCLUSION The results revealed large heterogeneity in the experience of distress. Distress clusters were associated with socio-demographic and clinical variables. These associations might aid a clinician to tailor interventions and to address specific types of distress.
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Affiliation(s)
- Peter Herschbach
- Comprehensive Cancer Center, Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | | | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Jürgen M Giesler
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center University of Freiburg, Freiburg, Germany
| | - Kathleen Herkommer
- Department of Urology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Alexandra Nest
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner University Children's Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | | | | | | | - Joachim Weis
- Comprehensive Cancer Center, Department of Self-Help Research, Faculty of Medicine and Medical Center University of Freiburg, Freiburg, Germany
| | - Birgitt Marten-Mittag
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
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Hempler I, Höhn C, Giesler JM, Farin E. [Development of a flexible rehabilitation concept for a neurological in-patient rehabilitation program after stroke]. Z Evid Fortbild Qual Gesundhwes 2019; 146:35-42. [PMID: 31558374 DOI: 10.1016/j.zefq.2019.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/06/2019] [Accepted: 08/14/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE OF THE STUDY The aim was to develop an evidence-based treatment concept which describes a standard of performance for stroke patients in neurological follow-up rehabilitation, contracted by a statutory health insurance agency. METHOD The treatment concept was developed in several steps: a) first of all, a systematic literature search for guidelines was conducted and an online discussion forum was established, followed by b) formation of an expert group, as well as c) two expert workshops, two working groups and several written follow-up surveys. The implementation of the concept was scientifically accompanied by project team members from the eight pilot facilities selected. RESULTS The treatment concept in its current version provides eleven modules, ten of which refer to the rehabilitation itself and one to the interface of acute care and rehabilitation. An innovative feature of this treatment concept is that the often contradictory demands for standardization and flexibility of individual cases according to the patients' needs are brought in line by freely selectable intensity standards. However, the commitment of a total minimum of therapy times is important. Since mid-March 2018, the treatment concept has been initially implemented in various pilot facilities occupied by the AOK Baden-Württemberg. CONCLUSION The evidence-based and consensus-based concept is characterized by being individually and flexibly applicable to the individual patient. In this way, it meets the given demands and fulfils the requirements of a heterogeneous group of patients. It is intended to incorporate the treatment concept into the routine healthcare services offered by the AOK Baden-Württemberg. In addition, the treatment concept will be the basis for the development of performance-based remuneration.
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Affiliation(s)
- Isabelle Hempler
- Sektion für Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland.
| | - Cindy Höhn
- Sektion für Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Jürgen M Giesler
- Sektion für Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Erik Farin
- Sektion für Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Meiss F, Loquai C, Weis J, Giesler JM, Reuter K, Nashan D. Psycho-oncological care of melanoma patients in certified skin cancer centers. J Dtsch Dermatol Ges 2019; 16:576-582. [PMID: 29750461 DOI: 10.1111/ddg.13521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/02/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The establishment und certification of skin cancer centers (SCCs) in compliance with requirements issued by the German Cancer Society play a key role for quality-assured treatment of skin cancer patients. These requirements also call for the implementation of a qualified psycho-oncology program. When planning the present study, we assumed site-specific differences in the way such programs were implemented at various SCCs. METHODS In 2014, we conducted a cross-sectional survey of all SCCs certified at the time (n = 43), in which these institutions were asked to provide information on the structural and process quality of their psycho-oncology programs. RESULTS Overall, 81.4 % of certified SCCs (n = 35) participated in the survey. Thirty-seven percent of SCCs directly employed personnel trained in psycho-oncology. Nearly all facilities offered information/counseling, crisis intervention, one-on-one discussions, and palliative/end-of-life care as part of their psycho-oncology program. Standardized screening tools were commonly used to evaluate patients' need for psycho-oncological support. Eighty-three percent of psycho-oncology programs primarily focused on inpatients. On average, 25.2 % of melanoma patients received psycho-oncological support. Ninety-seven percent of SCCs stated that the certification requirements had actually improved the psycho-oncological care of their patients. Seventy-one percent of SCCs reported to be satisfied with the implementation of the requirements. CONCLUSIONS The certification of institutions as SCCs has led to the implementation of personnel, structural, and content requirements relating to psycho-oncological care. The majority of SCCs surveyed reported to be satisfied with the quality of care thus achieved.
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Affiliation(s)
- Frank Meiss
- Department of Dermatology and Venereology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Joachim Weis
- Chair of Selfhelp Research, Comprehensive Cancer Center, University Medical Center Freiburg, Medical Faculty, University Freiburg, Freiburg, Germany
| | - Jürgen M Giesler
- Institute of Medical Biometry and Statistics, Section for Health Care Research and Rehabilitation Research, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Katrin Reuter
- Group Practice for Psychotherapy and Psychooncology (PPPO), Stadtstraße 11, Freiburg, Germany
| | - Dorothée Nashan
- Medical Center Dortmund, Department of Dermatology, Dortmund, Germany
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Giesler JM, Klindtworth K, Nebe A, Glattacker M. [Medical Rehabilitation in MS: Barriers to and Facilitators of its Utilization from the Patients' Perspective]. REHABILITATION 2019; 59:112-119. [PMID: 31408893 DOI: 10.1055/a-0965-0977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Although there is evidence on the efficacy of multi-disciplinary rehabilitation in the case of MS, use of inpatient rehabilitation by patients with MS in Germany is comparatively low. Therefore, it was the aim of this study to determine potential barriers and facilitators of inpatient rehabilitation use as perceived by patients with MS. METHODS Based on an extensive preliminary qualitative study a questionnaire was developed that addressed potential determinants of inpatient rehabilitation use by means of 45 items. Data were obtained mainly online from 590 patients with MS. Data analysis primarily included descriptive statistics. RESULTS Patients' expectations regarding rehabilitation in the case of MS strongly focus on structural components of a rehabilitation clinic's quality and on participating in treatment decisions in the rehab setting. Barriers to MS-rehabilitation use are perceived to exist in terms of insufficient information on the scope and process of rehabilitation, insufficient support from physicians with respect to applying for rehabilitation and a lack of clarity with respect to the criteria upon which applications will be decided. A smaller proportion of respondents also consider family- and vocation-related factors as barriers to making use of MS-rehabilitation. CONCLUSION Based on these findings, recommendations may be derived that may help reduce barriers to the use of inpatient rehabilitation by patients with MS. These include providing and improving information on the aims, interventions and effects of MS rehabilitation, information on how to apply for medical rehabilitation and the criteria on which applications are decided upon, as well as strengthening the role of the outpatient medical specialist.
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Affiliation(s)
- Jürgen M Giesler
- Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Katharina Klindtworth
- Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | | | - Manuela Glattacker
- Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
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Glattacker M, Giesler JM, Klindtworth K, Nebe A. Rehabilitation use in multiple sclerosis: Do illness representations matter? Brain Behav 2018; 8:e00953. [PMID: 30106225 PMCID: PMC5991568 DOI: 10.1002/brb3.953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/31/2018] [Accepted: 02/20/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Multidisciplinary rehabilitation improves illness outcomes and is recommended in clinical guidelines for multiple sclerosis (MS). However, many people with MS do not make use of rehabilitation. We do not know much about the barriers to the use of rehabilitation in MS, but in other patient groups, illness representations have proven to be predictors of service utilization. Therefore, the aim of our study was to explore whether, in patients with MS, illness representations are associated with self-reports of rehabilitation use in the past and the intention to use rehabilitation in the future, beyond sociodemographic and illness-related factors. MATERIALS AND METHODS Patients were recruited in a cross-sectional nationwide online survey in Germany. Hierarchical binary logistic regression analysis was used to analyze whether illness representations are associated with the use of rehabilitation in the past and the intention to use rehabilitation in the future, over and above socio-demographic and illness-related variables. RESULTS There were 590 patients, who had MS, participating in the study. Illness representations were correlated to both outcome variables beyond sociodemographic and illness-related factors: The probabilities of having the intention to use rehabilitation and of making using of rehabilitation were higher in patients who believed that their MS was controllable by treatment and perceived that their MS would have severe consequences. CONCLUSIONS Our data suggest that addressing patients' illness representations may facilitate the intention to use and the use of multimodal rehabilitation, contributing to better illness outcomes.
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Affiliation(s)
- Manuela Glattacker
- Section of Health Care Research and Rehabilitation ResearchMedical Center—University of FreiburgFaculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Jürgen M. Giesler
- Section of Health Care Research and Rehabilitation ResearchMedical Center—University of FreiburgFaculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Katharina Klindtworth
- Section of Health Care Research and Rehabilitation ResearchMedical Center—University of FreiburgFaculty of MedicineUniversity of FreiburgFreiburgGermany
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Meiss F, Loquai C, Weis J, Giesler JM, Reuter K, Nashan D. Psychoonkologische Versorgung von Melanompatienten in zertifizierten Hautkrebszentren. J Dtsch Dermatol Ges 2018; 16:577-584. [PMID: 29750470 DOI: 10.1111/ddg.13521_g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Frank Meiss
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg im Breisgau
| | - Carmen Loquai
- Hautklinik und Poliklinik, Universitätsmedizin Mainz, Mainz
| | - Joachim Weis
- Professur Selbsthilfeforschung, Comprehensive Cancer Center, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert Ludwigs Universität Freiburg im Breisgau
| | - Jürgen M Giesler
- Institut für Medizinische Biometrie und Statistik, Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg im Breisgau
| | - Katrin Reuter
- Praxengemeinschaft für Psychotherapie und Psychoonkologie (PPPO), Stadtstraße 11, Freiburg im Breisgau
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Giesler JM, Keller B, Repke T, Leonhart R, Weis J, Muckelbauer R, Rieckmann N, Müller-Nordhorn J, Lucius-Hoene G, Holmberg C. Effect of a Website That Presents Patients' Experiences on Self-Efficacy and Patient Competence of Colorectal Cancer Patients: Web-Based Randomized Controlled Trial. J Med Internet Res 2017; 19:e334. [PMID: 29030329 PMCID: PMC5660297 DOI: 10.2196/jmir.7639] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/29/2017] [Accepted: 07/14/2017] [Indexed: 12/19/2022] Open
Abstract
Background Patients often seek other patients’ experiences with the disease. The Internet provides a wide range of opportunities to share and learn about other people’s health and illness experiences via blogs or patient-initiated online discussion groups. There also exists a range of medical information devices that include experiential patient information. However, there are serious concerns about the use of such experiential information because narratives of others may be powerful and pervasive tools that may hinder informed decision making. The international research network DIPEx (Database of Individual Patients’ Experiences) aims to provide scientifically based online information on people’s experiences with health and illness to fulfill patients’ needs for experiential information, while ensuring that the presented information includes a wide variety of possible experiences. Objective The aim is to evaluate the colorectal cancer module of the German DIPEx website krankheitserfahrungen.de with regard to self-efficacy for coping with cancer and patient competence. Methods In 2015, a Web-based randomized controlled trial was conducted using a two-group between-subjects design and repeated measures. The study sample consisted of individuals who had been diagnosed with colorectal cancer within the past 3 years or who had metastasis or recurrent disease. Outcome measures included self-efficacy for coping with cancer and patient competence. Participants were randomly assigned to either an intervention group that had immediate access to the colorectal cancer module for 2 weeks or to a waiting list control group. Outcome criteria were measured at baseline before randomization and at 2 weeks and 6 weeks Results The study randomized 212 persons. On average, participants were 54 (SD 11.1) years old, 58.8% (124/211) were female, and 73.6% (156/212) had read or heard stories of other patients online before entering the study, thus excluding any influence of the colorectal cancer module on krankheitserfahrungen.de. No intervention effects were found at 2 and 6 weeks after baseline. Conclusions The results of this study do not support the hypothesis that the website studied may increase self-efficacy for coping with cancer or patient competencies such as self-regulation or managing emotional distress. Possible explanations may involve characteristics of the website itself, its use by participants, or methodological reasons. Future studies aimed at evaluating potential effects of websites providing patient experiences on the basis of methodological principles such as those of DIPEx might profit from extending the range of outcome measures, from including additional measures of website usage behavior and users’ motivation, and from expanding concepts, such as patient competency to include items that more directly reflect patients’ perceived effects of using such a website. Trial Registration Clinicaltrials.gov NCT02157454; https://clinicaltrials.gov/ct2/show/NCT02157454 (Archived by WebCite at http://www.webcitation.org/6syrvwXxi)
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Affiliation(s)
- Jürgen M Giesler
- Section of Health Services Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bettina Keller
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tim Repke
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Hasso-Plattner-Institute, Potsdam, Germany
| | - Rainer Leonhart
- Department of Psychology, University of Freiburg, Freiburg, Germany
| | - Joachim Weis
- Clinic for Oncological Rehabilitation, UKF Reha, Department of Psycho-Oncology, University Clinic Center, Freiburg, Germany
| | - Rebecca Muckelbauer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nina Rieckmann
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jacqueline Müller-Nordhorn
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Christine Holmberg
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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11
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Abstract
Rehabilitation for cancer patients aims at reducing the impact of disabling and limiting conditions resulting from cancer and its treatment in order to enable patients to regain social integration and participation. Given current trends in cancer incidence and survival along with progress in medical treatment, cancer rehabilitation is becoming increasingly important in contemporary health care. Although not without limitations, the International Classification of Functioning, Disability and Health (ICF) provides a valuable perspective for cancer rehabilitation in understanding impairments in functioning and activity as the result of an interaction between a health condition and contextual factors. The structure of cancer rehabilitation varies across countries as a function of their healthcare systems and social security legislations, although there is a broad consensus with respect to its principal goals. Cancer rehabilitation requires a careful assessment of the individual patient's rehabilitation needs and a multidisciplinary team of health professionals. A variety of rehabilitation interventions exist, including psycho-oncological and psycho-educational approaches. Research on the effectiveness of cancer rehabilitation provides evidence of improvements in relevant outcome parameters, but faces some methodological challenges as well.
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Affiliation(s)
- Joachim Weis
- Universitätsklinikum Freiburg Medizinische Fakultät, Klinik Für Onkologische Rehabilitation UKF Reha GGmbH, Albert-Ludwigs-Universität Freiburg, Breisacher Str. 117, Freiburg, 79106, Deutschland, Germany.
| | - Jürgen M Giesler
- Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Str. 49, Freiburg, 79106, Deutschland, Germany
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12
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Ernst J, Mehnert A, Weis J, Faust T, Giesler JM, Roick J. [Social counseling in outpatient cancer counseling centers : Offers and use by advice-seekers]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:1476-1483. [PMID: 27695938 DOI: 10.1007/s00103-016-2440-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Outpatient psychosocial cancer care has gained importance in recent years and psychosocial counselling services (PCS) offer a broad spectrum of counselling interventions. Yet there is no published research on PCS legal counselling services. This study investigated the range of issues addressed by legal counselling and their relationship with characteristics of advice seekers and counsellors. METHODS We analyzed the records of 21 PCS funded by the German Cancer Aid (DKH) including 5203 advice seekers (80 % patients, 20 % others including friends and family; age ∅ 54 years; 24 % male) in 20,947 counselling sessions. We calculated descriptive statistics and binary logistic regression analyses (legal counselling: yes/no). RESULTS Fifty-five percent of counselling seekers received legal counselling and 28 % approached the PCS exclusively for legal counselling. The proportion of people seeking legal advice ranged from 15 to 87 % between counselling centers. The most common topics during legal counselling were medical rehabilitation programs (57 %) and disability law (43 %). Counselling occurred in a single session in 68 % of cases and was mostly sought by older and unemployed persons with a recent diagnosis. Legal counselling made up 18 % of counselling time. Legal advice was mostly given by social workers (71 %). CONCLUSIONS Legal counselling is a major part of psychosocial care services. Our results reveal large differences between counselling centers. Further research on quality of care and efficacy of legal counseling is needed.
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Affiliation(s)
- Jochen Ernst
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Deutschland.
| | - Anja Mehnert
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Deutschland
| | - Joachim Weis
- Universitätsklinikum Freiburg, Klinik für Tumorbiologie, UKF Reha gGmbh Freiburg/Br., Freiburg, Deutschland
| | - Tanja Faust
- Universitätsklinikum Freiburg, Klinik für Tumorbiologie, UKF Reha gGmbh Freiburg/Br., Freiburg, Deutschland
| | - Jürgen M Giesler
- Universitätsklinikum Freiburg, Klinik für Tumorbiologie, UKF Reha gGmbh Freiburg/Br., Freiburg, Deutschland
| | - Julia Roick
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Deutschland
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13
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Kuhnt S, Mehnert A, Giesler JM, Faust T, Weis J, Ernst J. [The Development of Quality Standards for the Psychosocial Outpatient Care of Cancer Patients - Results of a Delphi Survey]. Gesundheitswesen 2016; 80:113-121. [PMID: 27077320 DOI: 10.1055/s-0042-100732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The psychosocial outpatient care of cancer patients and their families is a central element of oncological care. To date, the provision of care to this group is very heterogeneous in terms of the spectrum of services offered and quality of care. The aim of this study was to develop a multidimensional classification of quality standards for psychosocial outpatient cancer counseling. METHOD We conducted a study using the Delphi method. 97 experts from more than 10 different fields of action or institutional contexts (e. g. mental health care professionals, cancer societies, self-help groups) were included in 3 rounds of Delphi assessment. Finally, 134 single criteria within 9 quality areas (e. g. staff, range of services, documentation) were generated and evaluated for their relevance, clarity, comprehensiveness and level of obligation. RESULT A total of 119 individual criteria (88.8%) achieved consensus within the 3 Delphi rounds. Hereof, 94 were basic criteria (79%) and 25 optional criteria (21%). The highest number of individual criteria referred to the service spectrum (26 individual criteria), documentation (21) as well as staff and accessibility (16 each). Fifteen criteria (11.2%) achieved no consensus and were removed. CONCLUSION For the first time, criteria for assessing the quality of psychosocial outpatient cancer counseling with expert consensus are available, facilitating the evaluation of psychosocial outpatient cancer counseling.
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Affiliation(s)
- S Kuhnt
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig
| | - A Mehnert
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig
| | - J M Giesler
- Klinik für Tumorbiologie an der Albert-Ludwigs-Universität Freiburg, Institut für Reha-Forschung und Prävention, Freiburg
| | - T Faust
- Klinik für Tumorbiologie an der Albert-Ludwigs-Universität Freiburg, Institut für Reha-Forschung und Prävention, Freiburg
| | - J Weis
- Klinik für Tumorbiologie an der Albert-Ludwigs-Universität Freiburg, Institut für Reha-Forschung und Prävention, Freiburg
| | - J Ernst
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig
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14
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Eichhorn S, Kuhnt S, Giesler JM, Schreib M, Voelklin V, Brähler E, Ernst J, Mehnert A, Weis J. [Structural and process quality in outpatient psychosocial cancer counselling centres. evaluating a major funding programme of the "Deutsche Krebshilfe e.V."]. Gesundheitswesen 2014; 77:289-95. [PMID: 25268412 DOI: 10.1055/s-0034-1377030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND In 2007, the German Cancer Aid ("Deutsche Krebshilfe e.V.") initiated and funded a programme in 28 selected cancer counselling centres in Germany attempting to both promote and strengthen quality assured psychosocial cancer counselling as well as to ensure long-term financing. The accompanying evaluation programme aims to collect structural data of the institutions and to evaluate processes of quality assurance within the sample of cancer counselling centres. METHODS On the basis of structured research within scientific databases and internet, as well as with the support of experts, characteristics of structural quality of cancer counselling centres were identified. Structural data were collected using a self-developed questionnaire and a semi-structured interview during the on-site visitations of the institutions. RESULTS The results show homogeneity in some fields of structural quality such as individual psycho-oncological and social counselling, human resources, room facilities, quality assurance, diagnostics, documentation and public relations. Structural quality of the investigated centres appears more heterogeneous with regard to aspects such as availability and accessibility, barrier-free access, group support offers (counselling, sports, arts, etc.) as well as cooperation, financing and written mission statements. CONCLUSION The investigated cancer counselling centres ensure mainly good minimum standards according to structural quality of cancer counselling. There is potential for further optimisation including cooperation, quality assurance, room facilities and being differentiated in terms of conceptual content and working concepts. Further achievements on quality assured cancer counselling can use the presented data as a basis for describing minimum standards and obligatory quality criteria.
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Affiliation(s)
- S Eichhorn
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Sektion Psychosoziale Onkologie, Universität Leipzig, Leipzig
| | - S Kuhnt
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Sektion Psychosoziale Onkologie, Universität Leipzig, Leipzig
| | - J M Giesler
- Institut für Reha-Forschung und Prävention, Klinik für Tumorbiologie, Freiburg
| | - M Schreib
- Institut für Reha-Forschung und Prävention, Klinik für Tumorbiologie, Freiburg
| | - V Voelklin
- Institut für Reha-Forschung und Prävention, Klinik für Tumorbiologie, Freiburg
| | - E Brähler
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Sektion Psychosoziale Onkologie, Universität Leipzig, Leipzig
| | - J Ernst
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Sektion Psychosoziale Onkologie, Universität Leipzig, Leipzig
| | - A Mehnert
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Sektion Psychosoziale Onkologie, Universität Leipzig, Leipzig
| | - J Weis
- Institut für Reha-Forschung und Prävention, Klinik für Tumorbiologie, Freiburg
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15
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Ernst J, Eichhorn S, Kuhnt S, Giesler JM, Schreib M, Brähler E, Weis J. [Outpatient psychosocial counseling--results of a user-based cross-sectional study about patient reported needs and its consideration]. Psychother Psychosom Med Psychol 2014; 64:421-30. [PMID: 24864031 DOI: 10.1055/s-0034-1374604] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND This article presents results of a user-based cross-sectional study about patient reported needs and its consideration in the course of outpatient psychosocial counseling. In addition, patient satisfaction with consultations was evaluated. METHOD A sample of 1 930 cancer patients or family caregivers who consulted one of 26 psychosocial counseling units funded by German Cancer Aid completed a questionnaire sent by mail. RESULTS Younger and female patients/care-givers, and those with ovarian, pancreatic and cns tumours were more likely to seek counseling. Overall, patient reported needs were met to a high degree. The majority of the participants was very satisfied with different aspects of counseling. However, 16% of participants reported unmet needs and had suggestions for improvements primarily with regard to the counselor (4% of the participants) and time management (2% of the participants). In addition, 10% of the participants suggested optimizing the counseling location and setting as well as the accessibility, time scheduling and the work approach of the staff (1-5%). DISCUSSION Our findings represent a part of the core evaluation of psychosocial counseling for cancer patients. Overall, it can be highlighted that cancer patients are very satisfied with outpatient psychosocial counseling offers. However, few critical aspects could be identified from the clients' perspective. Our results are discussed in the context of methodological aspects of the study.
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Affiliation(s)
- Jochen Ernst
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Sektion Psychosoziale Onkologie, Universität Leipzig
| | - Svenja Eichhorn
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Sektion Psychosoziale Onkologie, Universität Leipzig
| | - Susanne Kuhnt
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Sektion Psychosoziale Onkologie, Universität Leipzig
| | | | - Melanie Schreib
- Klinik für Tumorbiologie, Albert-Ludwigs-Universität Freiburg
| | - Elmar Brähler
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Sektion Psychosoziale Onkologie, Universität Leipzig
| | - Joachim Weis
- Klinik für Tumorbiologie, Albert-Ludwigs-Universität Freiburg
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16
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Albrecht K, Droll H, Giesler JM, Nashan D, Meiss F, Reuter K. Self-efficacy for coping with cancer in melanoma patients: its association with physical fatigue and depression. Psychooncology 2013; 22:1972-8. [PMID: 23288588 DOI: 10.1002/pon.3238] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 11/27/2012] [Accepted: 11/27/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this study was to explore the impact of self-efficacy for coping with cancer (SECC) on physical fatigue and depressive symptoms in melanoma patients, in comparison with objective factors, such as treatment with interferon-alpha (IFN-α) and medical and sociodemographic variables. Current literature shows that psychological distress in melanoma patients is generally moderate, that they experience high quality of life, and that symptoms of depression and fatigue have been mostly associated with adjuvant IFN-α treatment METHODS A total of 175 melanoma patients, stages Ib-IIIc with and without low-dose IFN-α therapy, completed surveys on SECC, depression, and fatigue. Two hierarchical regression analyses were conducted to explore the predictive role of objective factors (first step: tumor stage, time since diagnosis, and current IFN-α treatment; second step: age and gender) in conjunction with the subjective factor of SECC (third step) on physical fatigue and depression. RESULTS Regression analysis revealed no significant effect of IFN-α treatment upon depression. Current IFN-α treatment was predictive of higher fatigue scores, however. The highest predictive effect by far was obtained for SECC, indicating higher fatigue and depression in patients with lower SECC. CONCLUSIONS The findings suggest that the treatment with IFN-α is mainly accompanied by physical fatigue in melanoma patients rather than by mood changes. Most notably, the potential influence of increased SECC on reducing both physical fatigue and depression is suggested by the data, indicating the importance of self-efficacy enhancing interventions in the psycho-oncological support of melanoma patients.
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Affiliation(s)
- Karoline Albrecht
- Department of Psychiatry and Psychotherapy, University Freiburg - Medical Center, Freiburg, Germany.
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17
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Abstract
OBJECTIVE Concepts of patient competence (PC) are being increasingly used, but seldom clearly defined in the context of shared medical treatment decision making and coping with cancer. The meaning of such concepts should therefore be clarified, and measures developed that permit the assessment of different facets of this patient characteristic. Consequently, this study attempted to contribute to the definition and measurement of PC. METHODS Employing literature reviews and qualitative interviews, we developed a working definition of PC in the context of cancer from which we designed a self-rating measure of this patient characteristic that was then tested for validity and reliability in a sample of N=536 patients with cancer. RESULTS Using factor analyses, we developed five problem- and three emotion-focused subscales that measure distinct facets of PC with satisfactory reliability. Additional analyses provide preliminary evidence of the instruments' validity. CONCLUSIONS This study represents an essential first step in developing a reliable self-rating measure of PC in the context of cancer. Although further refinement of this measure is clearly required, it provides a preliminary methodological basis for empirically investigating the determinants and potential health effects of PC.
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Affiliation(s)
- Jürgen M Giesler
- Tumor Biology Center, Psychosocial Department, Freiburg, Germany.
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18
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Weis J, Giesler JM. Subjective dimensions of patient competence: relationships with selected healthcare usage behaviors and general features of self-rated competence. Patient Educ Couns 2008; 73:511-518. [PMID: 18952394 DOI: 10.1016/j.pec.2008.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Revised: 06/04/2008] [Accepted: 07/04/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To introduce the concept of patient competence and provide additional information on the concurrent validity of a new self-rating measure of patient competence in the context of cancer employing healthcare usage behaviors and more general self-rated features of patient competence as criteria. METHODS Based on a multi-center sample of n=536 patients with cancer, bivariate correlations and multiple regressions were computed. RESULTS The competence subscale of striving for autonomous decisions emerged as significant, albeit weak predictor of having used professional psycho-social support (r=.31, beta=.28) and employing other complementary medicines (r=.28; B=.65) in relation to one's cancer. Problem-focused and emotion-focused competencies relate differently to different general features of self-rated competence like feeling informed and assertive or adapting well. CONCLUSION Additional support for the concurrent validity of the new self-rating measure of patient competence in the context of cancer has been found. Viewed in perspective, this measure may therefore provide a methodological basis to examine determinants and health effects of patient competence empirically. Nevertheless, further research on the conceptualization and measurement of patient competence appears necessary. PRACTICE IMPLICATIONS Having available measures of patients' specific competencies in the context of cancer will help identify their strength and weaknesses in dealing with life-threatening disease and enhance their coping resources.
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Affiliation(s)
- Joachim Weis
- Tumor Biology Center, Freiburg, Freiburg, Germany.
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Hildenbrand B, Sauer B, Kalis O, Stoll C, Freudenberg MA, Niedermann G, Giesler JM, Jüttner E, Peters JH, Häring B, Leo R, Unger C, Azemar M. Immunotherapy of patients with hormone-refractory prostate carcinoma pre-treated with interferon-gamma and vaccinated with autologous PSA-peptide loaded dendritic cells--a pilot study. Prostate 2007; 67:500-8. [PMID: 17262804 DOI: 10.1002/pros.20539] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE We conducted a pilot trial to assess the feasibility and tolerability of a prime/boost vaccine strategy using interferon-gamma (IFN-gamma) and autologous dendritic cells (DCs) pulsed with HLA-A2-specific prostate-specific antigen (PSA) peptides (PSA-1 [141-150]; PSA-2 [146-156]; PSA-3 [154-163]) for the treatment of 12 patients with hormone refractory prostate carcinoma. PATIENTS AND METHODS All patients were vaccinated four times with intracutaneously injected PSA-peptide loaded DCs after subcutaneous administration of IFN-gamma 2 hr before DC administration (50 microg/m(2) body surface). Objectives were safety, clinical benefit, clinical and biochemical response, quality of life, and immunological parameters. RESULTS The vaccination was well tolerated without any vaccination-associated adverse events. One partial and one mixed responder were identified, four patients showed stable diseases. Two patients had a decrease and four a slow-down velocity slope in the PSA serum level. All responders showed a positive DTH-response, but only two a slight increase in PSA-peptide specific T-lymphocytes. CONCLUSION The immunotherapy with IFN-gamma and PSA-peptide loaded DCs was feasible and well tolerated. The observed responses imply a potential antitumor activity.
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