Informed consent for total knee arthroplasty: exploration of patient`s information acquisition and decision-making processes-a qualitative study.

BACKGROUND: Total knee arthroplasty (TKA) is an option for the treatment of knee osteoarthritis (OA). Patients have high expectations regarding the benefits of the actual operation. Patients can seek a second opinion on the indication for TKA. In a study, less than half of recommended TKAs were confirmed by the second opinion and conservative treatments are not fully utilized. Informed consent forms that are used in Germany usually do not meet the requirements to support informed decision-making. Our aim was to describe the process from the diagnosis of knee OA through the decision-making process to the informed consent process for TKA, and to understand when, how, and by whom decisions are made. Moreover, we wanted to describe patients' information needs and preferences about knee OA and its treatment, including TKA, and find out what information is provided. We also wanted to find out what information was important for decision-making and identify barriers and facilitators for the optimal use of evidence-based informed consent forms in practice. METHODS: We chose a qualitative approach and conducted semi-structured interviews with patients who were going to receive, have received, or have declined TKA, and with general practitioners (GP), office-based as well as orthopaedists and anaesthesiologists in clinics who obtain informed consent. The interviews were audio-recorded, transcribed and analysed using qualitative content analysis. RESULTS: We conducted interviews with 13 patients, three GPs, four office-based orthopaedists and seven doctors in clinics who had obtained informed consent. Information needs were modelled on subjective disease theory and information conveyed by the doctors. Patients in this sample predominantly made their decisions without having received sufficient information. Trust in doctors and experiences seemed to be more relevant in this sample than fact-based information. Office-based (GPs, orthopaedists) and orthopaedists in clinics had different understandings of their roles and expectations in terms of providing information. CONCLUSIONS: We were able to identify structural barriers and assumptions that hinder the implementation of evidence-based informed consent forms.

Are Nurse-Led Patient Consultations and Nurse-Led Dose Adjustments of Permanent Medication Acceptable for Patients with Diabetes Mellitus and Hypertension in General Practice? - Results of a Focus Group Study.

Purpose: Practice nurse (PN)-led patient consultations and PN-led dosage adjustments of permanent medication are uncommon and not well studied in general practice (GP) in Germany. We investigated the perspectives of patients with common chronic diseases in Germany, diabetes mellitus (DM) type 2 and/or arterial hypertension (AT), on PN-led patient consultations and dosage adjustments of permanent medications in GP. Patients and Methods: In this exploratory qualitative study, online focus groups were conducted using a semi-structured interview guide. Patients were recruited from collaborating GPs according to a predefined sampling plan. Patients were eligible for this study if they had DM or AT treated by their GP, were on at least one permanent medication and were aged 18 years or older. Focus group transcripts were analyzed using thematic analyses. Results: Analyses of two focus groups, involving a total of 17 patients, revealed four main themes: (1) openness to the PN-led care and perceived benefits, eg because of patients' confidence in PNs' skills, or patients' impression that PN-led care would better meet their needs and increase their compliance. Some patients had (2) reservations and perceived risks, especially for PN-led medication changes eg feeling that medication adjustments were a GP's issue. Patients identified (3) reasons for encounters where they were likely to accept PN-led consultation and medication advice, eg management of DM, AT and thyroid disease. Patients also saw several important general requirements for the implementation of PN-led care in German general practice (4). Conclusion: There is a potential for openness towards PN-led consultation and PN-led medication adjustment for permanent medication in patients with DM or AT. This study is the first qualitative study to investigate PN-led consultations and medication advice in German general practice. If the implementation of PN-led care is planned, our findings add the patients' perspectives of acceptable reasons for encounter for PN-led care and their general requirements.

Pushing occupational rehabilitation - implementation of a therapy diary in the outpatient aftercare of psychosomatic rehabilitation may promote the occupational reintegration process: a survey of therapists and patients.

BACKGROUND: Treatment results achieved after fulfilling an inpatient psychosomatic rehabilitation are often not permanent. Additional participation in outpatient rehabilitation aftercare may reduce the risk of recurrent disorders and support a successful reentry to working life. A therapy diary should accompany the aftercare and bring about the self-reflection process of psychosomatic rehabilitates, which could reduce recurrent disease progressions and support the recovery process as a whole. The study focuses on the evaluation of the effectiveness and implementation potentialities of a therapy diary in outpatient rehabilitation aftercare. METHODS: In a qualitative study, seven therapists for outpatient rehabilitation aftercare in Central Germany and eleven outpatient psychosomatic rehabilitation patients were interrogated using partially standardized, guideline-based expert interviews. The data evaluation is based on the Qualitative Content Analysis according to Mayring. RESULTS: The results show that an accompanying use of a therapy diary during the outpatient rehabilitation aftercare enables an intense commitment through own thoughts and feelings. By writing down thoughts, emotions, dysfunctional behaviors in problematic situations, great successes are experienced. Through this initiated self-reflection process, the rehabilitant gains a better knowledge of one's behavior in dealing with oneself and the environment and thereby, whenever necessary, learns to create new ways of acting. CONCLUSIONS: The voluntary use of the therapy diary in the outpatient rehabilitation aftercare could assist the therapy process and henceforward the recovery of the rehabilitants, and also increase the prospect of successful occupational rehabilitation.

[Are Especially Patients with Borderline Personality Disorder Stigmatised by Psychiatric Nurses?] / Werden besonders Patienten mit einer Persönlichkeitsstörung vom Borderline-Typ durch das psychiatrische Pflegepersonal stigmatisiert?

OBJECTIVE: Borderline Personality Disorder (BPD) appears to be the most stigmatized diagnosis among personality disorders. This study aims to assess attitudes of psychiatric nurses towards patients with BPD compared to patients with depressive disorder. METHOD: 37 psychiatric nurses were randomized to an experimental between-subject design, in form of two questionnaires with different vignettes. The vignettes examined main outcomes such as negative attitudes, social distance and emotional reactions. RESULTS: Significant moderate to large differences in terms of social distance (p = 0.033, d = -0.736) and single emotional reactions towards patients with BPD (p = 0.017, d = 0.82), e. g. "I have compassion with her" were found. CONCLUSION: Patients with BPD have a substantial need for support. Quality and standards of inpatient care of patients with a BPS disorder can only guaranteed by giving adequate information about the causes of the disorder and professional treatment of the patients. Personnel must be trained to be able to cope with the specifics of the symptoms in BPD patients.

Patient Satisfaction as a Moderator of Risky Alcohol Consumers' Attitude Towards Screening and Brief Intervention: A Cross Sectional Survey.

AIMS: Although shown to be effective, General Practitioners (GPs) tend to refuse the implementation of Screening and Brief Intervention (SBI). Their expectation of negative response by patients seems to contrast with the positive attitude towards SBI of these patients. This discrepancy may be resolved by regarding moderators such as drinking status and patient satisfaction. We hypothesized that the attitude towards SBI will be more positive for abstainers or low-level consumers in comparison to high risk consumers especially in case of low patient satisfaction. METHODS: Ten GP offices in Germany received the questionnaires for a recruitment maximum of 30 patients each. Patient satisfaction was measured by the Koelner Questionnaire of Patient Satisfaction and drinking status was evaluated using the AUDIT-C. To assess the SBI attitude a pretested 8-item Likert scale was used. RESULTS: Questionnaires of 257 patients could be analyzed. Almost a third of patients were risky consumers (N = 78, 29.9%). They showed a more negative attitude towards SBI (M = 3.99, SD = 0.71) than abstainers or low-level consumers (M = 4.20, SD = 0.55). The main analysis revealed main effects for alcohol consumption, F(1, 252) = 4.31, P < 0.05, and patient satisfaction, F(1, 252) = 22.15, P < 0.001, as well as an interaction effect, F(1, 252) = 5.01, P < 0.05, showing that the SBI attitude of risky consumers was more negative than the SBI attitude of abstainers or low-level consumers only in case of low satisfaction. CONCLUSIONS: Risky consumers show a more positive attitude towards SBI when they are satisfied with their GP. Our results thus suggest the use of a supportive consultation style for the intervention of risky consumers. SHORT SUMMARY: SBI attitude of general practice patients depends on their drinking status: abstainers or low-level consumers revealed a more positive attitude towards SBI than risky consumers. This effect is moderated by the patient's satisfaction. Risky consumers show a more positive attitude towards SBI if they are satisfied with their GP.

Methamphetamine use in Central Germany: protocol for a qualitative study exploring requirements and challenges in healthcare from the professionals' perspective.

INTRODUCTION: The synthetic drug methamphetamine with its high addiction potential is associated with substantial adverse health effects. In Germany, especially Central Germany, the increase in the consumption of methamphetamine has exceeded that of other illegal drugs. The treatment system and service providers are facing new challenges due to this rise in consumption. This qualitative study will explore the demand created by the increasing healthcare needs of methamphetamine-addicted persons in Central Germany, and the difficulty of rehabilitating addicted people. METHODS AND ANALYSIS: The collection of empirical data will take place in a consecutive, two-stage process. In the first part of data collection, the experiences and perspectives of 40 professionals from numerous healthcare sectors for methamphetamine-addicted persons will be explored with the help of semistructured face-to-face interviews and probed by the research team. These findings will be discussed in 2 focus groups consisting of the participants of the face-to-face interviews; these group discussions comprise the second part of the data collection process. The interviews will be audio recorded, transcribed, and then subjected to qualitative content analysis. ETHICS AND DISSEMINATION: All interviewees will receive comprehensive written information about the study, and sign a declaration of consent prior to the interview. The study will comply rigorously with data protection legislation. The research team has obtained the approval of the Ethical Review Committee at the Martin Luther University Halle-Wittenberg, Germany. The results of the study will be published in high-quality, peer-reviewed international journals, presented at several congresses and used to design follow-up research projects. TRIAL REGISTRATION NUMBER: VfD_METH_MD_15_003600.

[General practitioners' commitment to treating excessive alcohol consumption: A question of role security in treating affected patients?]. / Hausärztliche Bereitschaft zur Intervention bei zu hohem Alkoholkonsum: Eine Frage der Sicherheit im Umgang mit betroffenen Patienten?

Only a few general practitioners (GPs) are committed to screen their patients for alcohol consumption and, in case of excessive alcohol consumption conduct by a brief intervention according to WHO recommendations. Apart from inadequate compensation and work load, another barrier identified by the GPs was their uncertainty about how to deal with affected patients. Most German universities presently spend no more than 90minutes lecture time on addiction medicine teaching. Our research aims to investigate the question whether medical studies and advanced medical education increases the role security of medical students and physicians and their commitment to implementing alcohol screening and brief intervention. Moreover, we will explore whether lack of therapeutic commitment can be related to lack of role security. Questionnaires were administered to pre-clinical and clinical medical students as well as senior house officers. Role security and therapeutic commitment of students and senior house officers were assessed using the Alcohol and Alcohol Problems Questionnaire (SAAPPQ) subscales "Role Security" and "Therapeutic Commitment". Analysis was based on 367 questionnaires. As expected, senior house officers reported more Role Security than clinical medical students who showed a higher level of Role Security than pre-clinical medical students. No differences could be found for Therapeutic Commitment. An association between Role Security and Therapeutic Commitment was only revealed for clinical medical students. Medical studies and advanced medical education can increase students' and senior house officers' Role Security to treat patients with excessive alcohol consumption, but not Therapeutic Commitment. Moreover, no association between Role Security and Therapeutic Commitment could be found for senior house officers. Hence, it may be assumed that educational activities aiming to increase Role Security do not promote the development of motivational aspects such as Therapeutic Commitment to the management of patients with excessive alcohol intake.