The relation between dyadic coping and relationship satisfaction in couples dealing with haematological cancer.

Couples' ability to cope with cancer is significantly associated with how satisfied they are with their relationship. However, little evidence specific to haemato-oncological patients exists. The objective of this study was to examine how dyadic coping (DC) affects relationship satisfaction among couples facing haematological cancer. Furthermore, we tested complex interactions between distress, disease-related and socio-demographic factors. In a multicentre study, 327 patients (haemato-oncological cancer; mean age: 57 years, 63% male) and their partners responded to surveys examining their relationship satisfaction, DC and distress. The Actor-Partner-Interdependence-Model (APIM) and moderator analyses were used to assess interactions between these concepts. In the APIM, positive DC was significantly related to greater levels of relationship satisfaction, and negative DC was related to lower levels of relationship satisfaction (all p < .001). The partners' distress was significantly related to lower levels of relationship satisfaction of the partners (p < .05). Furthermore, distress, age and relationship duration had significant moderating effects on the association between DC and relationship satisfaction (p < .05). Our results enable describing patient and partner as an interactional unit in which positive DC supports a satisfying relationship. They imply that strengthening positive DC in a couple facing haematological cancer can contribute to them having a well-functioning and sustaining relationship.

Efficacy of short-term psychodynamic psychotherapy (STPP) with depressed breast cancer patients: results of a randomized controlled multicenter trial.

BACKGROUND: There is a lack of trials of psychodynamic treatments of depression in breast cancer patients. The purpose of this trial was to determine the efficacy of short-term psychodynamic psychotherapy (STPP) in non-metastatic breast cancer patients diagnosed with depression, one of the most frequent mental comorbidities of breast cancer. PATIENTS AND METHODS: In a multicenter prospective trial, 157 breast cancer patients with comorbid depression were randomized to either individual STPP (intervention group, N=78) or 'treatment as usual' (control group, TAU, N=79). As our primary outcome measure, we hypothesized a higher rate of remission defined as no diagnosis of depression (Structured Clinical Interview for DSM-IV) and reduction in depression score by at least 2 points (Hospital Anxiety and Depression Scale, HADS-D) in STPP versus TAU at treatment termination. Secondary outcomes mainly refer to quality of life (QoL). RESULTS: In the intention to treat (ITT) analysis, 44% of the STPP group achieved highly significantly more remission than TAU (23%). STPP treatment (OR=7.64; P<0.001) was the strongest predictor for remission post-treatment; time was also significant (OR=0.96; P<0.05). A high effect favoring STPP (d=0.82) was observed for the HADS-D score post-treatment (secondary outcome). Regarding further secondary outcomes (QoL), analyses of covariance yielded main effects for group (favoring STPP with an effect size of at least d=0.5) for global QoL, role, emotional and social functioning, pain, treatment side-effects, breast symptoms and upset by hair loss. CONCLUSIONS: STPP is an effective treatment of a broad range of depressive conditions in breast cancer patients improving depression and functional QoL. Findings are limited by the drop-out rate (∼1/3) and delayed post-treatment assessments. Future trials may consider stepped-care approaches, tailored to patients' needs and requirements in the acute treatment phase.

[Patient involvement in medical decision making--an overview on patient preferences and impacting factors]. / Beteiligung von Patienten an medizinischen Entscheidungen--ein Überblick zu Patientenpräferenzen und Einflussfaktoren.

The involvement of patients in medical treatment decisions has been intensively discussed for several years. The present review article is concerned with the patient participation in medical decision making mainly in the field of oncology. Also discussed are methodological aspects of the measurement of patient involvement and the theoretical approach of shared decision -making. The preference to be involved in decisions is expressed from 16-50% of the patients and depends on socio-demographic and disease-related variables. Positive impact of patient participation is observed essentially as short-term effects and for psychosocial outcome criteria. Further research should consider the methodological aspects and focus on dyadic concepts and various dimensions of patient involvement. It is also important to focus on evaluation of the decision and on the possible (long time) effects in terms of recovery, progression of disease, psychosocial consequences and economic impact.

[Patient satisfaction in oncological aftercare--differential results of gender aspects in doctor-patient dyads]. / Patientenzufriedenheit in der onkologischen Nachsorge--differentielle Befunde zur Geschlechtsspezifik in Arzt-Patient-Dyaden.

OBJECTIVE: The aim of this study was to explore the role of gender of the physician and gender of the patient in explaining differences in patient satisfaction. MATERIAL AND METHODS: Overall, 1,130 patients were assigned to one of 4 possible physician-patient sex dyads and were interviewed with a questionnaire about their patient satisfaction. RESULTS: Female patients in a dyad with a female physician were most satisfied with the overall judgment of practice visit and the inclusion of life situation in comparison to all other dyads. Male patients in a dyad with a male physician were least satisfied. CONCLUSION: In the future, the specific role of patient-physician dyads has to be considered more in the assessment of subdimensions of patient satisfaction.

Patient participation in the medical decision-making process in haemato-oncology--a qualitative study.

Cancer patients are showing increased interest in shared decision-making. Patients with haematological illnesses, however, express considerably less desire for shared decision-making as compared with other oncological patient groups. The goal of the current project was to identify the reasons for the lower desire for shared decision-making among patients with haematological illness. We conducted qualitative, semi-structured interviews with 11 haematological patients (39-70 years old) after the beginning of therapy concerning the course and evaluation of medical shared decision-making. The patients were often overwhelmed by the complexity of the illness and the therapy and did not want to assume any responsibility in medical decision-making. They reported a great deal of distress and very traditional paternalistic role expectations with regards to their health care providers, which limited the patients' ability to partake in the decision-making process. In contrast to the socio-cultural support for many other oncological diseases, haematological diseases are not as well supported, e.g. there is a lack of self-help materials, systematic provision of information and support groups for patients, which may be related to a lower empowerment of this patient population. Results show the limits of patient participation in the context of highly complicated medical conditions. In addition to already researched preferences of the physicians and patients for shared decision-making, future research should pay greater attention to the process and other variables relevant to this aspect of the doctor-patient relationship.

Participation of haemato-oncological patients in medical decision making and their confidence in decisions.

Increasingly more clinical care and research acknowledge the patients' interest in participating in medical decision making. However, for haematological patients, there are as yet only modest findings. The current study explores patients' perceptions of their role in the medical decision-making process in a sample of 117 haematological patients. The majority of patients surveyed (63.9%) took a passive role in the medical decision-making process, which is a significantly greater proportion compared with individuals suffering from solid cancers. Despite passive majority, most of the participants reported a positive evaluation of the decision-making process. Importantly, patients' evaluations were significantly more negative either if patients were treated as inpatients (vs. outpatients), or if they experienced no control over the decision (vs. collaboration with the doctor, or deciding autonomously). The results and limitations of the study are discussed.

[Patients after prostatectomy. Psychiatric comorbidity, need for psychooncological treatment and quality of life]. / Patienten nach Prostatektomie. Psychische Begleiterkrankungen, Behandlungsbedarf und Lebensqualität.

BACKGROUND: Prostate carcinoma patients (PCP) with mental disorders suffer frequently from a decreased quality of life (QOL) and often need psychooncological treatment (PTN). To meet that need, the extent of treatment required should be determined and a reliable identification routine implemented. METHODS: A total of 103 PCP were interviewed with a validated instrument (SCID) during urological inpatient treatment to assess mental disorders of PTN, and questionnaires were administered to examine QOL (QLQ-C30) and mental stress (HADS); 17 doctors and 23 nurses assessed their patients' PTN. RESULTS: Twenty percent of the patients had a PTN which was identified by doctors and nurses in 50% of the cases and by HADS in up to 84%. Even 1 year after treatment, the QOL of patients with PTN was diminished, while patients without recovered remarkably better. CONCLUSION: Patients with PTN should be detected as a matter of routine, e.g., using the HADS, and treated early.

Children and Employment - Resource or Stressors after Breast Cancer?

Introduction: Breast cancer patients suffer clinically relevant levels of psychological stress because of their disease. Various factors can affect the level of stress experienced. This study aimed to investigate the relationship between the level of psychological stress and employment and children, including time since diagnosis. Material and Methods: A randomised clinical study was done of 724 breast cancer patients aged between 18 and 65 years; all were in the curative stage of disease and had been diagnosed 0-12 months previously. Patients were investigated for their levels of psychological stress (anxiety and depression) using the Hospital Anxiety and Depression Scale (HADS). The relationship between anxiety and depression and the variables "employment", "parenthood" and "time since diagnosis" were investigated, using univariate and multivariate analysis. Results: Patients with a longer time since diagnosis (4-12 months) were found to have lower levels of anxiety (6.28) compared to patients who had been diagnosed only 0-3 months previously (7.24; p < 0.01). There was no unambiguous relation between parenthood and anxiety. The age of the children was crucial. Even when results were controlled for patient age, the anxiety levels of women with children below the age of 16 years were significantly higher (7.84) compared to patients without children (6.42) or patients whose children were older than 16 years (6.87; p = 0.04). Women who were not employed had significantly higher levels of depression compared to all other participants in the study (p = 0.02). No reciprocal effects were found between investigated variables. Conclusion: We found a differentiated relationship between the variables "time since diagnosis", "employment" and "children" and the level of psychological stress experienced by breast cancer patients. When determining the level of psychological stress in the 1st year after diagnosis, particular attention should be paid to patients who are not employed and patients with children below the age of 16 years.

[Significance of the identification of hereditary cancer for routine oncological diagnosis]. / Bedeutung der Identifikation von hereditären Tumorerkrankungen in der onkologischen Routinediagnostik.

Genetic factors are likely to be the primary determinants of the cancer seen in around 5 - 10 % of all cancer patients. More than 20 inherited cancer syndromes are now known. For many of these cases molecular genetic diagnostic may be accomplished. Within the scope of genetic counselling and testing, which can validate the genetic background of cancer, the interdisciplinary cooperation of Primary Care Physicians (PCP) and human geneticists is necessary. The results of our empirical study on risk identification in familial cancer suggest that PCP in the acute care inform cancer patients only to a little extent about the possible genetic background of their disease. PCP also very rarely initiate genetic counselling and testing, which would be desirable for preventive reasons.