Is there a need for a clear advice? A retrospective comparative analysis of ethics consultations with and without recommendations in a maximum-care university hospital.

BACKGROUND: The theory and practice of ethics consultations (ECs) in health care are still characterized by many controversies, including, for example, the practice of giving recommendations. These controversies are complicated by an astonishing lack of evidence in the whole field. It is not clear how often a recommendation is issued in ethics consultations and when and why this step is taken. Especially in a facilitation model in which giving recommendations is optional, more data would be helpful to evaluate daily practice, ensure that this practice is in line with the overarching goals of this approach and support the development of standards. METHODS: We analyzed all consultations requested from an EC service working under a facilitation approach at a maximum-care university hospital in Germany over a period of more than 10 years. Our aim was to better understand why-and under what circumstances-some consultation requests result in a recommendation, whereas others can be sufficiently addressed solely by facilitated meetings. We especially wanted to know when and why clients felt the need for clear advice from the EC service while in other cases they did not. We compared ethics consultations in terms of the differences between cases with and without recommendations issued by the ethics consultants using χ2 difference tests and Welch's t-test. RESULTS: A total of 243 ECs were carried out between September 2008 and December 2019. In approximately half of the cases, a recommendation was given. All recommendations were issued upon the request of clients. When physicians asked for an EC, the consultation was significantly more likely to result in a recommendation than when the EC was requested by any other party. ECs in cases on wards with ethics rounds resulted in comparably fewer recommendations than those in wards without ethics rounds. When interpersonal conflicts were part of the problem or relatives were present in the meeting, clients less frequently asked for a recommendation. CONCLUSION: From the client's point of view, there does not seem to be only one "right" way to provide ethics consultations, but rather several. While facilitated meetings are obviously appreciated by clients, there also seem to be situations in which a recommendation is desired (especially by physicians). Further empirical and theoretical research is needed to validate our single-center results and re-evaluate the role of recommendations in ethics consultations.

Antecedents, outcomes and measurement of work related-cognition in non-work time: A multistudy report using the work-related rumination questionnaire in two languages.

According to the perseverative cognition hypothesis, prolonged activation for example, via work-related rumination impairs recovery and thereby poses a risk to employee health. The extent to which gender, age, occupation or longitudinal stress exposure may alter work-related rumination is an ongoing debate. Whether group or longitudinal comparisons of work-related rumination are valid, however, has never been tested. In this multistudy report, we therefore investigated measurement invariance of the widely used Work-Related Rumination Questionnaire (WRRQ) across gender, age, occupation, and longitudinal measurements by performing secondary analyses of preexisting data on work-related rumination. We examined the psychometric properties of WRRQ measurements in two languages and expand knowledge about the nomological network of affective rumination, problem-solving pondering and detachment in relation to individual employee characteristics (e.g., personality, work engagement, commitment), job stressors (e.g., work intensity, decision latitude, social relations with colleagues and supervisors) and employee health outcomes (e.g., wellbeing, irritation, somatic symptoms). Multigroup confirmatory factor analyses showed partial scalar invariance of English and German WRRQ measurements and full scalar invariance across gender, age, occupation and over the period of 1 week (Study 1, n = 2,207). Correlation analyses supported criterion, convergent and discriminant validity of WRRQ measurements (Study 2, n = 4,002). These findings represent a prerequisite for comparisons of work-related cognition across groups and further the understanding of the antecedents and outcomes of different types of work-related cognition.

Sustainable return to work after depression - A comparative study among occupational physicians and affected employees.

Introduction: The number of sick days taken from work due to depression is steadily rising. A successful return to work (RTW) is essential for sustainable reintegration. This study aims to identify factors to optimize RTW and to investigate approaches for sustainable RTW (sRTW) after depressive episodes. Methods: Semi-structured expert interviews with senior occupational physicians (OPs, N = 5) served to develop two surveys among OPs (N = 180) and employees after depressive episode (N = 192). Predictors of RTW rating, workplace-based RTW interventions and sRTW interventions were analyzed using multiple hierarchical regression, chi-square difference and t-tests. Results: For OPs, employee training on mental illness prevention was found to be the strongest predictor of overall RTW rating, whereas understanding and appreciation in conversations and stigmatization were strongest predictors of overall RTW rating by the employees. Compared to the employees, OPs reported significantly more availability of workplace-based interventions. To prevent relapse, the employees prioritized sufficient time and financial security during the RTW process more than OPs. Conclusions: The study identified facilitating and hindering factors that can inform further research and practice to improve RTW after depressive episodes. To redress the awareness gap about the availability of workplace-based interventions, regular contact between OPs and employees is crucial. Several factors were considered to be of varying importance for relapse prevention by the two groups. Multiple perceptions and needs ought to be taken into account during RTW.

The relevance of pharmacological neuroenhancement for stress and resilience-A multistudy report.

Background: Pharmacological neuroenhancement (PNE) is discussed as coping strategy in academic and work-related contexts. Depending on the definition of PNE and sample population, different prevalence rates for various groups have been reported. In the three parts of the study, prevalence rates for work and student populations in Germany are detected and the reasons for PNE and possible causal associations between PNE, stress and resilience are investigated. Methods: In part 1 of the study, 152 occupational physicians (OPs) were surveyed about prevalence rates and reasons for PNE. In part 2 of the study, 1,077 German students reported on their PNE behavior. 704 students were then longitudinally considered to draw conclusions on causal associations between PNE, stress, and resilience. Results: The OPs' estimated prevalence rate of 10.9% in a working population is higher than the prevalence rate of 5.4% for prescription and illicit substances found in the student sample in part 2 of the study. The reason suspected by OPs to be most important for PNE with prescription drugs were performance pressure and long working hours. Using soft enhancers, such as caffeine, is most common with a prevalence rate of 76.8% in the student sample. Stress predicts a higher (ß = 0.179, p < 0.001) and resilience a lower use of PNE (ß = -0.13, p = 0.001). Resilience predicts a lower (ß = -0.35, p < 0.001) and PNE a higher level of stress (ß = 0.11, p < 0.001). Conclusion: OPs suspect a prevalence rate of 10.9% among the working population, while we found a prevalence rate of 5.4% among students. Caffeine is the most used substance for PNE, while the use of prescription and illicit substances remains low. Higher levels of stress and lower levels of resilience result in a higher use of PNE. Universities should therefore include the promotion of resilience and methods for dealing with study stress in health programs to reduce PNE.

A short scale for measuring attitudes towards the doctor-patient relationship: psychometric properties and measurement invariance of the German Patient-Practitioner-Orientation Scale (PPOS-D6).

BACKGROUND: The Patient-Practitioner Orientation Scale (PPOS) was originally developed to compare doctor's and patient's consensus regarding patient centeredness. Research assumed PPOS measurements to be comparable across different groups of participants, however, without assessing the actual validity of this assumption. In this study, we investigate the psychometric properties and measurement invariance of a short version of the German translation of the PPOS. METHODS: Based on a cross-sectional survey of N = 332 medical students, we present a short version of the German Patient-Practitioner-Orientation Scale (PPOS-D6) and examine its psychometric properties as well as measurement invariance across participants with varying levels of medical experience and gender using multigroup confirmatory factor analyses. RESULTS: Results indicate that PPOS-D6 provides valid and reliable measurements of patient-centeredness that are invariant across participants with different medical experience. Preliminary results also suggest invariance across gender. CONCLUSION: PPOS-D6 is a suitable and efficient measure to compare group-specific attitudes towards the doctor-patient interaction. Additional research on convergent and discriminant validity and divergent study samples is advised.