Assessing somatic, psychosocial, and spiritual distress of patients with advanced cancer: development of the Advanced Cancer Patients' Distress Scale.

OBJECTIVE: For adequate distress assessment in palliative care, we developed a screening evaluation tool. METHODS: Proven methods of scale construction led to a 53-item pilot form of the Advanced Cancer Patients' Distress Scale (ACPDS). We used Hornheide Questionnaire (HQ), Palliative Outcome Scale (POS), and Minimal Documentation System (MIDOS) for validation. Advanced cancer patients (N = 168) from 3 centers for palliative medicine (aged 23-89, 51% female) filled out the questionnaire. RESULTS: With a principal component analysis (PCA), we extracted 5 distress scales (emotional reactions/physical restrictions, communication deficits, negative social reactions, pain, and gastrointestinal symptoms). Internal consistencies varied between medium (.52) and very good (.88). Positive validity scores were found. CONCLUSIONS: Using the ACPDS may help to identify needs for palliative care interventions and enhance the quality of palliative care.

[Depersonalization-derealization in the psychosomatic outpatient and consultation-liaison service]. / Depersonalisation-derealisation im psychosomatischen Ambulanz- und Konsildienst.

OBJECTIVES: First, to determine the prevalence of symptoms of depersonalization (DP) and derealization (DR) in psychosomatic consultation-liaison patients and psychosomatic outpatients; second, to examine how DP-DR contributes to differences among patients with respect to the spectrum of other diagnoses, disease severity, history of psychotherapeutic outpatient treatment and psychiatric/psychosomatic inpatient treatments as well as to self-rated distress. METHODS: The sample comprises n=825 patients. In order to analyze the effects of DP-DR, the sample was divided into three subgroups of DP-DR severity: patients without symptoms of DP-DR, patients with mild DP-DR, and patients with clinical significant DP-DR. RESULTS: 34.8% patients had no symptoms of DP-DR, 48.2% mild DP-DR, and 17.0% scored clinical significant DP-DR. The severity of DP-DR was associated with other indicators of self- and observer-rated disease severity as well as with greater psychosomatic and psychiatric health care use. However, after adjustment for indicators of disease severity, the significant association between the use of psychotherapeutic outpatient treatment and psychiatric or psychosomatic inpatient treatment in the medical history disappeared. CONCLUSIONS: Symptoms of DP-DR are very common in psychosomatic patients. They represent an indicator of disease severity, which however is paradoxically not associated with increased use of psychotherapeutic health care.

[Consultation-liaison and outpatient services of a psychosomatic university hospital: patient referral, reasons for presentation, recommendations]. / Konsiliar-Liaisondienst und Ambulanz einer Psychosomatischen Universitätsklinik: Patientenzuweisung, Anlass der Vorstellung, Empfehlungen.

OBJECTIVES: While psychosomatic clinics in German hospitals in general provide consultation-liaison and outpatient services, up to now no direct comparisons of the two systems of care have been made. METHODS: Based on a comparison of 750 CL patients and 617 outpatients from a university hospital during the course of one year, differences between the two patient populations were recorded for referral, reasons for presentation, and psychotherapeutic recommendations. RESULTS: Compared to outpatients (43 years), the average age of CL-patients was higher (50 years); the proportion of men was higher, and level of education was lower. Adjustment disorders and psychological factors in somatic disorders were more frequently diagnosed (versus more somatoform, affective and anxiety disorders in outpatients). CL patients had fewer experiences with psychotherapy and were overall less distressed than outpatients. More frequently they were recommended basic psychosomatic care or psychiatric outpatient treatment and less outpatient psychotherapy. CONCLUSIONS: Implications for concepts of care are discussed. A uniform basic documentation for the two fields of care seem to make sense.