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1.
BMC Womens Health ; 22(1): 285, 2022 07 09.
Artículo en Inglés | MEDLINE | ID: mdl-35810270

RESUMEN

BACKGROUND: A considerable proportion of cervical cancer diagnoses in high-income countries are due to lack of timely follow-up of an abnormal screening result. We estimated colposcopy non-attendance, examined the potential factors associated and described non-attendance reasons in a population-based screening study. METHODS: Data from the MARZY prospective cohort study were analysed. Co-test screen-positive women (atypical squamous cells of undetermined significance or worse [ASC-US+] or high-risk human papillomavirus [hrHPV] positive) aged 30 to 65 years were referred to colposcopy within two screening rounds (3-year interval). Women were surveyed for sociodemographic, HPV-related and other data, and interviewed for non-attendance reasons. Logistic regression was used to examine potential associations with colposcopy attendance. RESULTS: At baseline, 2,627 women were screened (screen-positive = 8.7%), and 2,093 again at follow-up (screen-positive = 5.1%; median 2.7 years later). All screen-positives were referred to colposcopy, however 28.9% did not attend despite active recall. Among co-test positives (ASC-US+ and hrHPV) and only hrHPV positives, 19.6% were non-attendees. Half of only ASC-US+ screenees attended colposcopy. Middle age (adjusted odds ratio [aOR] = 1.55, 95% CI 1.02, 4.96) and hrHPV positive result (aOR = 3.04, 95% CI 1.49, 7.22) were associated with attendance. Non-attendance was associated with having ≥ 3 children (aOR = 0.32, 95% CI 0.10, 0.86). Major reasons for non-attendance were lack of time, barriers such as travel time, need for childcare arrangements and the advice against colposcopy given by the gynaecologist who conducted screening. CONCLUSIONS: Follow-up rates of abnormal screening results needs improvement. A systematic recall system integrating enhanced communication and addressing follow-up barriers may improve screening effectiveness.


Asunto(s)
Células Escamosas Atípicas del Cuello del Útero , Infecciones por Papillomavirus , Displasia del Cuello del Útero , Neoplasias del Cuello Uterino , Niño , Estudios de Cohortes , Colposcopía , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Persona de Mediana Edad , Papillomaviridae , Infecciones por Papillomavirus/diagnóstico , Embarazo , Estudios Prospectivos , Frotis Vaginal , Displasia del Cuello del Útero/diagnóstico
2.
Eur Spine J ; 30(8): 2360-2367, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34089353

RESUMEN

PURPOSE: Meeting the information needs of patients adequately is of high importance in informed consent consultations in surgery. However, information needs often remain unmet in the informed consent consultation. The aim of this study was to assess anxiety and pain in relation to the patients' information needs fulfillment perioperatively. METHODS: We applied a question prompt list (QPL) for patients undergoing spine surgery (SN-QPL) before (t1) and a question answering list (SN-QAL) after (t2) the informed consent consultation. The patients additionally completed the "State-Trait Anxiety Operation Inventory" (STOA, cognitive and affective scale) at t1, as well as a pain numerical rating scale (NRS) at t2 and postoperative (t3). We analyzed (1) the association between anxiety, information needs and pain and (2) anxiety and pain scores regarding information needs fulfillment after the consent consultation. RESULTS: A total of n = 118 patients was included. Affective and cognitive state anxiety was only reduced postoperatively (affective p < .001, cognitive p < .05). The higher trait anxiety was, the more patients longed for information at t1-t3 (t1: r = .58/r = .74, each p < .001), (t2: r = .38/r = .49, each p < .001) and (t3: r = .29, p < .01/r = 34, p < .001). Higher grades of trait anxiety resulted in lower information needs fulfilment. Higher state anxiety levels were associated with higher pain levels. Information needs more often remained unfulfilled in high trait and state anxiety patients. CONCLUSION: Patients' anxiety was associated with (un)fulfilled information needs. Meeting information needs should be optimized in the process of surgeon-patient communication. Adapting the information to the patients' anxiety levels seem to be an effective way to reduce anxiety.


Asunto(s)
Ansiedad , Consentimiento Informado , Ansiedad/etiología , Humanos , Estudios Longitudinales , Dolor , Derivación y Consulta , Encuestas y Cuestionarios
3.
Support Care Cancer ; 27(8): 2809-2818, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30539313

RESUMEN

PURPOSE: Fatigue has found increasing attention as a debilitating and lasting condition of cancer patients. However, it has remained unclear to what degree long-term survivors of malignant melanoma suffer from fatigue. Therefore, this study aimed to determine fatigue and its link with quality of life, aftercare behavior, and mental and physical symptoms among melanoma survivors. METHODS: A register-based sample of 684 long-term survivors an average of 8.4 (SD = 1.72; range 5.67-12.17) years after diagnosis was compared to 2049 participants from a representative survey by the Multidimensional Fatigue Inventory. In a hierarchical linear regression, statistical predictors for fatigue were ascertained. RESULTS: Overall fatigue was not increased in melanoma survivors except for younger melanoma survivors under 40 years. As in the general population, fatigue increased with age, and it was higher in women compared to men. Fatigue was associated with decreased quality of life, reduced functioning, and increased physical and mental symptoms. Substantial predictors (30% explained variance) were higher age, additional chronic illness, self-blame, detrimental interactions and lack of social support, and also fear of recurrence. There was neither an effect of medical parameters (clinical stage, time since diagnosis) nor of participation in follow-up care. CONCLUSIONS: Fatigue needs to be taken seriously in the aftercare of melanoma survivors as it is associated with multiple functional and quality of life impairments and heightened distress. Reduction of fatigue in melanoma patients should address younger survivors (under 40 years) and older survivors (over 60 years) with additional chronic illness and focus on illness coping and social support.


Asunto(s)
Supervivientes de Cáncer/estadística & datos numéricos , Fatiga/epidemiología , Melanoma/epidemiología , Adaptación Psicológica , Adulto , Anciano , Anciano de 80 o más Años , Supervivientes de Cáncer/psicología , Estudios de Cohortes , Fatiga/etiología , Femenino , Humanos , Masculino , Melanoma/complicaciones , Melanoma/psicología , Persona de Mediana Edad , Calidad de Vida , Sistema de Registros , Factores de Riesgo , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/psicología , Apoyo Social , Encuestas y Cuestionarios , Melanoma Cutáneo Maligno
4.
BMC Public Health ; 18(1): 511, 2018 04 17.
Artículo en Inglés | MEDLINE | ID: mdl-29665805

RESUMEN

BACKGROUND: Social support is considered to be one of the most important resources for coping with cancer. However, social interactions may also be detrimental, e. g. disappointing or discouraging. The present study explored: 1. the extent of illness-specific positive aspects of social support and detrimental interactions in melanoma survivors, 2. their relationships to mental health characteristics (e. g. distress, quality of life, fatigue, coping processes, and dispositional optimism) and 3. Combinations of positive social support and detrimental interactions in relation to depression and anxiety. METHODS: Based on the cancer registry of Rhineland-Palatinate, Germany, melanoma patients diagnosed at least 5 years before the survey were contacted by their physicians. N = 689 melanoma patients filled out the Illness-specific Social Support Scale ISSS (German version) and standardised instruments measuring potential psychosocial determinants of social support. RESULTS: Using principal component analysis, the two factor structure of the ISSS could be reproduced with acceptable reliability; subscales were "Positive Support" (PS) and "Detrimental Interactions" (DI); Cronbach's α = .95/.72. PS was rated higher than DI. Multivariable linear regressions identified different associations with psychosocial determinants. Survivors living in a partnership and those actively seeking out support had a higher probability of receiving PS, but not DI. PS and DI interacted regarding their association with distress: Survivors reporting high DI but low PS were the most depressed and anxious. High DI was partly buffered by PS. When DI was low, high or low PS made no difference regarding distress. CONCLUSION: Psycho-oncologic interventions should take into account both positive and negative aspects of support in order to promote coping with the disease.


Asunto(s)
Supervivientes de Cáncer/psicología , Melanoma/psicología , Melanoma/terapia , Apoyo Social , Estrés Psicológico/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Supervivientes de Cáncer/estadística & datos numéricos , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Encuestas y Cuestionarios
5.
Z Psychosom Med Psychother ; 62(1): 5-19, 2016.
Artículo en Alemán | MEDLINE | ID: mdl-26906209

RESUMEN

ISSUE: In 2012 the German medical licensure regulations (Approbationsordnung) made teaching and assessing the conduction of medical consultations a mandatory part of medical education. A catalogue of learning objectives (LO) based on existing references was developed to assist medical schools in meeting this requirement. METHODS: A body of relevant material was compiled using literature research and surveying experts. Then, in a multiphase Delphi process, this was evaluated and condensed by an interdisciplinary working group in dialogue with external (clinical) experts. Competence levels and examples of clinical application were assigned to enhance implementation. The catalogue was revised by the medical faculties, professional associations and the BVMD. RESULTS: This learning catalogue comprised 116 learning objectives for the specific skills necessary to conducting medical consultations as well as exemplary application contexts. The catalogue proved to be practical in terms of developing curricula and networking at medical schools. DISCUSSION: This catalogue of learning objectives can serve as the basis for developing a sample communication curriculum for use by medical faculties.


Asunto(s)
Catálogos como Asunto , Educación Basada en Competencias/legislación & jurisprudencia , Educación Basada en Competencias/métodos , Educación Médica/legislación & jurisprudencia , Objetivos , Licencia Médica/legislación & jurisprudencia , Programas Nacionales de Salud/legislación & jurisprudencia , Medicina Psicosomática/educación , Medicina Psicosomática/legislación & jurisprudencia , Derivación y Consulta/legislación & jurisprudencia , Competencia Clínica/legislación & jurisprudencia , Curriculum , Alemania , Humanos
6.
BMJ Open ; 13(4): e066998, 2023 04 04.
Artículo en Inglés | MEDLINE | ID: mdl-37015787

RESUMEN

OBJECTIVES: To revise the 37-item Advanced Cancer Patients' Distress Scale (ACPDS) regarding its content, comprehensibility, applicability, and relevance by healthcare professionals (HCPs) and patients in order to enhance an existing instrument that is appropriate for the needs of patients with advanced cancer admitted to palliative care. DESIGN: A preliminary revision of items regarding psychometric indices and relevance to initially shorten the scale, complemented by cognitive interviews with patients combining think-aloud and verbal-probe techniques and an HCP focus group on the detected remaining items. Interviews and the focus group were audio-recorded, transcribed verbatim and analysed using MAXQDA. SETTING: The study took place at a German palliative care unit. PARTICIPANTS: 10 patients were interviewed (50% female) and 6 HCPs (3 physicians, 2 nurses and 1 psychologist) participated in the focus group. OUTCOME MEASURES: Comprehensibility, applicability, and relevance of the ACPDS were evaluated. RESULTS: Based on the psychometric revision, a reduced number of 17 items was discussed by the HCP focus group and within cognitive interviews with patients. For the rest of the analysis of the HCP focus group and the patient interview data, the introduction of the ACPDS was simplified and adapted to everyday language. As recommended by HCPs and patients, the example question was replaced. Nine items were reworded to boost clarity, openness, redundancy and mitigation. Three items were eliminated, and another three items were added. CONCLUSION: With this revised 17-item version of the ACPDS, we constructed an instrument that seems to be appropriate for the needs of patients with advanced cancer in a palliative care setting. In the next step, the shortened scale will be tested on psychometric data and validated by a large sample of inpatients on palliative care suffering from advanced cancer. TRIAL REGISTRATION NUMBER: DRKS ID: DRKS00022425.


Asunto(s)
Neoplasias , Cuidados Paliativos , Humanos , Femenino , Masculino , Encuestas y Cuestionarios , Cuidados Paliativos/métodos , Personal de Salud , Neoplasias/terapia , Neoplasias/psicología , Atención a la Salud , Alemania
7.
Artículo en Inglés | MEDLINE | ID: mdl-36834018

RESUMEN

An implementation of training units that provide evidence for improving students' communication skills in the dental curriculum is now more than ever of utmost importance. This study aimed to investigate how students assess their skills after communication training and whether this training also increased students' self-efficacy expectancy. A total of 32 male and 71 female students with a mean age of 25.6 ± 3.9 years participated in the study. Self-assessment of communication skills and self-efficacy expectancies were collected at two time points using Likert scales. Our study shows that the communication training, consisting of a practical exercise with actors and an online theory module, significantly improved the students' self-assessment of their communication skills and also improved some aspects of self-efficacy expectancy. These results indicate that, in addition to the practical and technical-theoretical training of students, communication training is essential in the dental curriculum. In summary, this study showed that a one-time practical exercise with actors together with an online theory module could improve both the self-assessment of communication competence and some aspects of self-efficacy expectancy, which demonstrates the importance of training communication skills alongside practical and technical-theoretical training.


Asunto(s)
Autoeficacia , Estudiantes de Odontología , Humanos , Masculino , Femenino , Adulto Joven , Adulto , Competencia Clínica , Comunicación , Curriculum
8.
Psychother Psychosom Med Psychol ; 61(11): 465-71, 2011 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-22081465

RESUMEN

In order to determine if first year medical students of a Medical Psychology and Medical Sociology course have adopted basic physician patient communication skills, we developed an appropriate Objective Structured Clinical Examination (OSCE). The parcours took place in a pretest condition (n=182) and in the following semester under test condition, now relevant for passing the course (n=181). Reliability of the OSCE reached a medium degree (α=0.55/0.50). Results of written examinations and OSCE scores were weakly correlated. The correlation between task competence and patient-centeredness was higher in the pretest than under test condition. Female students mostly achieved higher scores than male students. Nearly all of the students (92%/97%) were in favor of continuing this examination. Physician-patient communication is a process of high complexity, but it can be tested by OSCE. Relevance for passing the course seems to enhance the learning behaviour.


Asunto(s)
Estudiantes de Medicina , Adulto , Comunicación , Educación Médica , Evaluación Educacional , Femenino , Humanos , Masculino , Examen Físico , Relaciones Médico-Paciente , Psicometría , Adulto Joven
9.
Psychother Psychosom Med Psychol ; 61(12): 518-24, 2011 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-22161798

RESUMEN

Glioblastoma patients should be provided with a professional health care system that helps reduce their psychosocial burden. The aim of this study was to identify patients in need of psychosocial intervention. In addition, it was examined whether physicians' assessments adequately address the burden patients are under and their need for intervention. During their visit to one of two neurosurgery outpatient departments, n = 49 glioblastoma patients filled out the short version of the Hornheider questionnaire (HFK). Consulting physicians also rated their patients' burdens in a specially adapted version of the questionnaire (HFK-F). The results of the psychometric evaluation with both instruments were satisfactory. The majority of the patients (76 %) were identified as in need of psychosocial intervention. All of them were correctly categorized with the physicians' ratings. Physicians overestimated some aspects of the patients' burden, particularly in regard to their problems with relaxing and fear of living with the illness. The patients' ratings concerning the quality of the information physicians provided and their overall state of health only corresponded with the physicians' ratings in roughly half of the cases.


Asunto(s)
Glioblastoma/psicología , Glioblastoma/terapia , Apoyo Social , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Costo de Enfermedad , Femenino , Glioblastoma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Procedimientos Neuroquirúrgicos , Médicos , Psicometría , Encuestas y Cuestionarios , Adulto Joven
10.
GMS J Med Educ ; 38(3): Doc70, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33824906

RESUMEN

Objective: In the context of educating medical students, testing of competence in medical communication is carried out primarily with the Objective Structured Clinical Examination [1]. This makes it possible to assess practical performance, but it is resource-intensive and has a negative impact on test quality. The project "Digital test tool for measuring communication skills in medical studies" (digiRole) was funded by the BMBF (Federal Ministry of Education and Research) and its objective was to develop digital formats as electronic versions of an OSCE in order to test the communication competency of medical students. Such digital forms of examination should be cost-effective, be relevant to clinical practice and have high psychometric quality. In terms of content, the examination questions should incorporate factual and procedural knowledge as components of communication competency, although we assumed that procedural knowledge is more relevant than facutal knowledge to OSCE performance. This article describes the development and testing of a video-based, communication-related e-examination that is relevant to passing the test, which is the first milestone of the overall project. Methodology: We produced videos and related exam questions in the form of a situational judgement test [2] related to medical psychology and medical sociology, based on the educational content of a preclinical course on doctor-patient communication at the Mainz University Medical Center. In the summer semester of 2018, 226 students sat for this video-based single-choice e-examination (VSE). In the winter semester of 2018/2019, a different cohort of 192 students participated in the VSE as well as a tried-and-tested communication OSCE with five stations [3]. Results: The internal consistencies for the VSE in the summer semester of 2018 were α=.55, in the winter semester 2018/19 with α=.62 and for the OSCE with α=.60. There was a positive correlation between the performance of the students with the VSE and that with the OSCE (r=.21, p≤.01). Principal Axis Analyses did not reveal any dimensioning in terms of factual and procedural knowledge. In the evaluation, the majority of the students stated that the VSE was quite relevant to the practise of medical communication and were in favour of retaining this form of examination. Conclusion: The correlation between the VSE and the OSCE is relatively low, so that the VSE in this form is not a satisfactory predictor of an OSCE result. In terms of internal consistency, the VSE and the OSCE produced an almost identical result. It can also be assumed that the VSE can achieve a high degree of objectivity with the use of standardised video-based examinations as well as greater resource efficiency than OSCEs.


Asunto(s)
Competencia Clínica , Comunicación , Educación Médica , Evaluación Educacional , Estudiantes de Medicina , Educación Médica/métodos , Evaluación Educacional/métodos , Humanos , Examen Físico
11.
BMC Palliat Care ; 9: 16, 2010 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-20673326

RESUMEN

BACKGROUND: In order to tackle the deficits in the provision of palliative home care, profound structural changes in the outpatient sector were introduced by law in Germany in 2007. The EPACS study was carried out (Research Accompanying the Establishment of Hospice and Palliative Care Services in Rhineland-Palatinate, Germany) to document the quality of inpatient and outpatient end-of-life care in Rhineland-Palatinate, Germany, before the implementation of these changes. With this article we focus on the study design and methods of the EPACS-Study. We further report first results regarding several aspects of outpatient end-of-life care. METHODS: The cross-sectional survey was based on a random sample of 5000 inhabitants of Rhineland-Palatinate that had died from May 25 until August 24 of the year 2008. Relatives of these randomly drawn deceased persons were interviewed by means of a written survey. RESULTS: The overall response proportion considering only those questionnaires that actually were delivered (n = 3833) was 36.0%. Factors influencing participation were age, sex, and marital status. 355 (25.8%) deceased persons had used professional home care in the four weeks prior to their death, but only very few persons had used a specialised palliative home care service (n = 30; 8.5%). There was a clear gap between the need for specialised outpatient care and the actual utilisation of these services. CONCLUSIONS: Satisfaction with professional home care was relatively high, but physicians were rated less favourable than nurses. There were deficits especially with respect to physicians' communicative and supportive skills. Further analyses are necessary to provide more detailed information about quality of care in different care settings and for distinct groups. Predictors of good care, as well as obstacles to it, must be further investigated. In the long run, a follow-up survey must be conducted to compare quality of home care before and after the structural changes in Germany.

12.
GMS J Med Educ ; 37(7): Doc85, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33364364

RESUMEN

Objectives: The limitations in teaching resulting from the Covid-19 epidemic were the rational for transferring the course in Medical Psychology and Medical Sociology (doctor-patient communication) into an asynchronous e-learning course. For this purpose, ten exercises were developed to be downloaded by the students and the solutions returned to the course lecturer on a weekly basis. In addition, two students individually recorded via video one of eight doctor-patient exercise conversations, which were then evaluated by four other students and the respective lecturer. Methods: For evaluation, the students filled out an exercise and an effect-related questionnaire with 21 items. Results: The questionnaire was completed by n=203 (98%) students (59% female, 41% male). The video-based situation analyses (91%) helped most of them to become rather closely or very well acquainted with medical conversation practice. 76% rated the exercise "Enlightenment Conversation/SPIKES Protocol" as fairly helpful or very helpful in respect to the practicing concepts of medical conversation. When asked about the effects, most of them found the idea of patient orientation in medicine to be quite helpful or very helpful (83%). About a quarter of them (24%) stated that the online course could not, or only slightly, replace face-to-face teaching. This assessment was less pronounced among female students than among male students (Wilcoxon test p<.01). Conclusion: Our online course concept of physician-patient conversation found good overall response among pre-clinical medical students. However, the participants expressed different opinions about the extent to which the concept can replace face-to-face teaching.


Asunto(s)
COVID-19/epidemiología , Instrucción por Computador/métodos , Educación a Distancia/organización & administración , Educación de Pregrado en Medicina/organización & administración , Relaciones Médico-Paciente , Competencia Clínica , Comunicación , Escolaridad , Humanos , Pandemias , SARS-CoV-2 , Estudiantes de Medicina/psicología
13.
Z Psychosom Med Psychother ; 55(4): 365-81, 2009.
Artículo en Alemán | MEDLINE | ID: mdl-20229484

RESUMEN

OBJECTIVES: The increasing survival of cancer patients is the result of early detection, improved treatment, and demographic change. This poses urgent questions regarding the stresses and needs for care long-term survivors face. METHODS: A literature survey (PubMed, Scopus) was conducted based on all publications with a psychooncological background from 2004 to 2008 concerning long-term survivors. RESULTS: Of the 164 publications found, 74 referred to breast cancer; 62 % came from the United States and only 4 % from Germany. Although overall quality of life among long-term survivors appears to be good, considerable adverse somatic effects (long-term effects, late consequences, recidivism, second tumors) and mental effects (e.g., fear of recurrence) persist. Somatic and psychosocial determinants of long-term adjustment, health behaviour, health care needs and utilization, and the quality of life of next-to-kin have hardly been studied. The effects of psychotherapy on survival remain controversial. CONCLUSIONS: In light of the growing number of long-term surviving cancer patients, it is necessary to study their strains and needs for care under a lifespan perspective.


Asunto(s)
Neoplasias de la Mama/psicología , Trastornos Psicofisiológicos/psicología , Calidad de Vida/psicología , Sobrevivientes/psicología , Adaptación Psicológica , Adulto , Neoplasias de la Mama/mortalidad , Progresión de la Enfermedad , Femenino , Humanos , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/psicología , Neoplasias Primarias Secundarias/mortalidad , Neoplasias Primarias Secundarias/psicología , Pronóstico , Trastornos Psicofisiológicos/mortalidad , Rol del Enfermo
14.
Spine J ; 19(3): 523-531, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30172898

RESUMEN

BACKGROUND CONTEXT: Informed consent is mandatory before surgery and fundamental in the physician-patient interaction. However, communication is sometimes suboptimal. PURPOSE: The objective was to develop a question prompt list (QPL) for patients undergoing spine surgery (spinal neurosurgery-QPL, "SN-QPL") to encourage them to acquire information during the informed consent consultation (ICC) and assess patients' information needs. STUDY DESIGN/SETTING: We conducted a prospective uncontrolled single center study in order to develop a QPL for patients undergoing spine surgery. PATIENT SAMPLE: Patients inclusion criteria were as follows: (1) planned spinal surgery, (2) age 18 to 80 years, (3) legal capacity, (4) ability to understand and respond to questionnaires, and (5) informed consent. OUTCOME MEASURES: We applied the following self-report measures: the developed preliminary QPL with regard to surgery topics and assessment of patients' information needs. METHODS: First, we performed a literature review, patient interviews, and two expert rounds. Subsequently, we validated a preliminary SN-QPL including 37 items before and after ICC with regard to importance of items and fulfillment of information needs in 118 patients. A principal component analysis followed by varimax rotation revealed the final SN-QPL. RESULTS: For the final version of the SN-QPL, 27 items with following four reliable subscales were derived with satisfactory internal consistency: (1) scale SN-QPL-C, "complications and possible postoperative deficits" (n  =  8 items, Cronbach α = 0.88); (2) scale SN-QPL-P, "prognosis and follow-up" (n = 8 items, Cronbach α = 0.86); (3) scale SN-QPL-I, "preoperative inpatient stay and organizational issues" (n = 5 items, Cronbach α = 0.75); and (4) scale SN-QPL-S: "safety of the surgical procedure" (with n = 6 items, Cronbach α = 0.84). The most unmet information needs were found in SN-QPL-P. The item with the greatest unmet information needs was "How much professional experience does my surgeon have?" CONCLUSIONS: Our SN-QPL was well-accepted and perceived as helpful by patients awaiting spinal surgeries. It seems to address meaningful items and questions. It could therefore be useful in optimizing pre- and postoperative satisfaction. Further, our study identified many unaddressed questions warranting communication interventions.


Asunto(s)
Consentimiento Informado/normas , Procedimientos Neuroquirúrgicos/normas , Educación del Paciente como Asunto/métodos , Columna Vertebral/cirugía , Encuestas y Cuestionarios/normas , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Procedimientos Neuroquirúrgicos/legislación & jurisprudencia , Procedimientos Neuroquirúrgicos/psicología , Educación del Paciente como Asunto/normas , Derivación y Consulta/normas
15.
Clin Neurol Neurosurg ; 170: 1-6, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29709767

RESUMEN

OBJECTIVE: Not only tumor patients suffer enormously from their disease, also the caregivers are massively affected by the disease of their relatives. In this study, we investigate the psychological burden in caregivers of outpatient malignant brain tumor patients. PATIENTS AND METHODS: Fifty caregivers of patients with primary malignant brain tumors were included in our study. Study participants filled in a form with demographic details, a self-established questionnaire concerning general well-being and three established psychological questionnaires to assess anxiety, depression, stress and social support: The "Hospital Anxiety and Depression Scale" (HADS), the "Perceived Stress Scale" (PSS-10) and the "Social Support Questionnaire" (F-SozU). RESULTS: Caregivers of patients with primary malignant brain tumors showed in the HADS clinically relevant anxiety in 49% and depression in 20% of the cases. The stress level of the caregivers was increased (mean: 18 points) compared to the general population mean: 13 points), although they felt well supported by their social environment (mean: 4.25 points; general population 3.99 points). There was a significant positive correlation between anxiety and depression (p < 0.001). Female caregivers suffered significantly more from anxiety (p = 0.017) and stress (p = 0.012) than their male counterparts. No correlation was found between tumor grade, age of relatives and patients or the state of living together with the patient and anxiety or depression. CONCLUSIONS: Although the caregivers felt well supported by their social environment, stress, anxiety and depression are common phenomena in caregivers of patients with malignant brain tumors. Especially female ones have an increased risk for developing these comorbidities.


Asunto(s)
Neoplasias Encefálicas/psicología , Cuidadores/psicología , Costo de Enfermedad , Familia/psicología , Carencia Psicosocial , Apoyo Social , Adaptación Psicológica/fisiología , Adulto , Anciano , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estrés Psicológico/diagnóstico , Estrés Psicológico/epidemiología , Estrés Psicológico/psicología , Adulto Joven
16.
PLoS One ; 10(8): e0132754, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26296089

RESUMEN

Patients who have survived malignant melanoma for more than five years may lack the opportunity to talk about their burden. As a consequence their psychosocial care needs remain undetected and available supportive interventions may not be utilised. Therefore, the psychosocial burden of this patient group needs to be assessed using specific screening instruments. The aim of this study was to investigate the psychosocial burden of long-term melanoma survivors, their psychosocial care needs and the determinants of these needs. We wanted to find out if the use of professional support corresponds to the care needs defined by experts. Using the cancer registry of Rhineland-Palatinate, melanoma patients diagnosed at least 5 years before the survey were contacted by physicians. N = 689 former patients completed the Hornheide Questionnaire (short form HQ-S) to identify psychosocial support need (scale cut off ≥ 16 or item-based cut-off score) and the potential psychosocial determinants of these needs. Additionally, they were asked about their utilisation of the professional support system. More than one third (36%) of them was in need for professional psychosocial support. The highest burden scores concerned worry about tumour progression. Younger age (< 50), higher general fatigue, higher symptom burden, lower general health, negative social interactions and unfulfilled information needs were significant predictors of the need for psychosocial intervention. Related to the percentage of survivors identified as 'in need', the professional support system was underused. Further studies should investigate whether using the HQ-S to routinely identify burdened melanoma patients could lead to better fulfilment of their intervention needs, ultimately enhancing health-related quality of life.


Asunto(s)
Ansiedad/psicología , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Melanoma/psicología , Calidad de Vida/psicología , Sobrevivientes/psicología , Adulto , Anciano , Ansiedad/fisiopatología , Femenino , Mal Uso de los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Melanoma/fisiopatología , Persona de Mediana Edad , Neoplasias Cutáneas , Apoyo Social , Encuestas y Cuestionarios , Melanoma Cutáneo Maligno
17.
PLoS One ; 10(1): e0116440, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25615573

RESUMEN

AIM: The purpose of the study was to determine anxiety and depression, quality of life, and their determinants in long-term survivors of malignant melanoma. METHODS: In a state cancer registry a cohort of survivors of malignant melanoma was contacted via the physician registered. Of 1302 contactable patients, 689 (52.2%) completed a questionnaire including the Patient Health Questionnaire with generalized anxiety (GAD-7) and depression (PHQ-9) and the EORTC Quality of Life Questionnaire (EORTC QLQ 30). Based on multiple regression analysis, predictors of quality of life and distress were identified. Comparison data were assessed in two waves of representative face-to-face household surveys of the adult German population. RESULTS: An average of 8.4 (5.7 to 12.2) years after diagnosis, distress was higher in women compared to men and in middle adulthood (vs. older patients). Symptoms were higher in women than in men, and there was a decline of functioning and increase of symptoms across the age range of both genders. Compared to the general population, there were slightly increased depression and anxiety (only women), but no impaired global quality of life. Yet, survivors evidenced functional decline and more physical symptoms. Distress and reduced quality of life were consistently predicted by lack of social support, fear of recurrence, pessimism and self-blame. Distress was increased by a family history of melanoma, and additional mental and somatic diseases. CONCLUSION: Overall, long-term survivors have adjusted well achieving a global quality of life comparable to the general population. Yet, compromised functional dimensions, physical symptoms and distress indicate the need for integrating psychooncological screening into oncological follow-up, which might be guided by predictors such as family history or social support. Further prospective study is needed to determine the course of adaptation to the disease and corroborate the risk factors identified.


Asunto(s)
Ansiedad/etiología , Depresión/etiología , Melanoma/psicología , Calidad de Vida/psicología , Neoplasias Cutáneas/psicología , Sobrevivientes/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/epidemiología , Estudios de Cohortes , Depresión/epidemiología , Femenino , Alemania , Humanos , Masculino , Melanoma/complicaciones , Persona de Mediana Edad , Sistema de Registros , Autoinforme , Adulto Joven
18.
Eur J Obstet Gynecol Reprod Biol ; 170(1): 235-40, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23880600

RESUMEN

OBJECTIVE: To identify women's care needs concerning cancer screening and to develop an instrument suitable for measuring them--the Gynaecological Cancer Screening Care Needs Scale (GCSCNS). We hypothesized that it is possible: (a) to explore care needs and to develop reliable subscales of them, (b) to rank these needs in order of importance, and (c) to detect determinants of these needs (age, social status, marital status, health locus of control) and these need scores. STUDY DESIGN: A questionnaire was developed based on the relevant literature, interviews conducted with gynaecological patients, and a consultation with 18 experts. The questionnaire listed 58 items addressed to physicians which deal with information and support needs during gynaecological cancer screening. Subjects rated the importance of each item using a five-point scale (from 1=very important, to 5=not important). The questionnaire also asked for patients' demographic information and their locus of control. It was distributed to 1000 female patients in 10 gynaecological practices in 3 federal states of Germany as an exploratory multi-centric cross-sectional study. A total of 961 women completed the questionnaire. Descriptive statistics were used to analyze patients' demographic variables. With a principal component analysis (PCA, Varimax rotation), three care needs subscales were generated which then led to the GCSCNS scales. RESULTS: The dimensions of patients' care needs can be described on three subscales: "Need for Information" (GCSCNS-I), "Need for Respect and Empathy during the physical examination" (GCSCNS-RE), "Need for Caring and Availability of the doctor" (GCSCNS-CA). Internal consistencies varied between good and very good (Cronbach's alpha .80-.89). Data indicate that it is possible to rank the female care needs in order of importance and that they are dependent on age and social status, but not on marital status and locus of control regarding health and disease. CONCLUSION: Because there is no comparable research available on this topic, we developed an instrument for measuring female care needs related to gynaecological cancer screening. The results give gynaecologists the opportunity to better fulfil their patients' wishes and needs and perhaps increase participation in gynaecological cancer screening.


Asunto(s)
Atención a la Salud , Neoplasias de los Genitales Femeninos/diagnóstico , Tamizaje Masivo/psicología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Control Interno-Externo , Persona de Mediana Edad , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
19.
Am J Hosp Palliat Care ; 30(4): 339-46, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22833555

RESUMEN

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.


Asunto(s)
Actividades Cotidianas/psicología , Neoplasias/psicología , Cuidados Paliativos/psicología , Psicometría/instrumentación , Perfil de Impacto de Enfermedad , Enfermo Terminal/psicología , Adulto , Anciano , Anciano de 80 o más Años , Disnea/diagnóstico , Disnea/etiología , Disnea/psicología , Femenino , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/psicología , Alemania , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Dolor/diagnóstico , Dolor/etiología , Dolor/psicología , Cuidados Paliativos/normas , Cuidados Paliativos/estadística & datos numéricos , Reproducibilidad de los Resultados , Distribución por Sexo , Encuestas y Cuestionarios , Enfermo Terminal/estadística & datos numéricos , Adulto Joven
20.
J Pain Symptom Manage ; 44(4): 542-51, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22771131

RESUMEN

CONTEXT: The integration of family members in the dying process and the recognition of their special needs are important factors for the development of high-quality palliative care. OBJECTIVES: This study aimed to explore important needs and personal experiences of relatives at the end of life, and to detect differences in these needs and experiences for various care settings. METHODS: Our cross-sectional survey was based on a random sampling of 5000 inhabitants of Rhineland-Palatinate (Germany) who died between May 25 and August 24, 2008. Relatives of these randomly drawn deceased persons were interviewed by a written survey. RESULTS: A total of 1378 questionnaires were completed (response rate 36.0%), with 1337 eligible for our analyses; 81.5% of the bereaved totally/partially agreed that the information received from physicians was comprehensive and sufficient; 7.5% neither agreed nor disagreed; and 11.0% partially/totally disagreed. Of the respondents, 54.1% totally/partially agreed to having received emotional support by physicians, 14.2% neither agreed nor disagreed, and 31.7% partially/totally disagreed. Physicians in nursing homes and standard hospital wards were rated less favorably. Whereas the professionals' lack of time was strongly associated with the unfulfilled needs for emotional support, many relatives also lacked this type of care when physicians seemed to have enough time. CONCLUSION: The high rates of unfulfilled needs of relatives across all care settings and all types of diseases reinforce the necessity of a comprehensive palliative care approach. An increased awareness of the psychological vulnerability of caregivers should lead to dedicated efforts to improve deficits in the German health care system.


Asunto(s)
Aflicción , Muerte , Familia/psicología , Necesidades y Demandas de Servicios de Salud , Cuidados Paliativos/psicología , Cuidado Terminal/psicología , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
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