Preserving the integrity of personhood in people with advanced cancer: An in-depth qualitative study among patients, relatives, and care professionals.

BACKGROUND: Every advanced cancer diagnosis brings enormous challenges to patients and their relatives on numerous levels: be it physical, practical, social challenges, or on a more personal level. While specific aspects have been researched before, an overarching approach is lacking. AIM: To understand the lived experiences of people with advanced cancer, to identify gaps along the cancer care continuum, to identify potential opportunities for meaningful interventions and to develop a theoretical framework for practitioners and researchers. DESIGN: A qualitative study using in-depth interviews with patients, relatives, and care professionals. Interviews were transcribed verbatim and analysed using a conventional content analysis. SETTING/PARTICIPANTS: Fifty-four interviews with 17 patients from a university oncology department and palliative care service, 15 relatives and 22 care professionals from physicians to funeral directors. All interviewees were recruited by a German university hospital. RESULTS: We developed a novel model describing the diagnosis with advanced cancer as a highly disruptive experience that threatens to challenge the integrity of personhood in cancer patients through four areas: communication, knowledge, relationships, and confidence. We were able to identify factors leading to disintegration in these areas and factors supporting a restoration of integrity of personhood. CONCLUSIONS: The developed model provides a more thorough understanding of patients lived experiences. It can help to develop new interventions along the cancer care continuum to support patients in the complex challenges they face. These interventions should focus on supporting the integrity of personhood.

[COVID-19 and Its Potential for Disruption and Transformation in Public Health: Lessons Learned from the Perspective of Young Professionals]. / COVID-19 zwischen Disruption und Transformation der öffentlichen Gesundheit: Erste Lehren aus Perspektive des Nachwuchses.

The COVID-19 pandemic has both exposed and intensified various challenges for Public Health and the Public Health service (ÖGD) in Germany. However, it also offers a window of opportunity for effective long-term transformation of the country's Public Health system. Against this backdrop, an online survey was carried out among the members of the German Network of Young Professionals in Public Health (Nachwuchsnetzwerk Öffentliche Gesundheit (NÖG)) in October and November 2020. It sought to elicit members' experiences and views related to Public Health during the COVID-19 pandemic. The resulting preliminary "lessons learned" for the German Public Health context are presented in this article. Based on the results of the survey, recommendations were formulated which are intended to provide targeted and concrete advice for the strengthening and transformation of Public Health in Germany. The main issues that preoccupied the young professionals were the increased public and political attention to Public Health and the narrow focus on infectious disease control, the standing of Public Health in Germany and the strengths and weaknesses of Public Health structures and workforce. The recommendations are aimed at promoting long-term and holistic strengthening of Public Health, with the training of an interdisciplinary workforce of young professionals presenting a key focus.

Global Health as "umbrella term" - a qualitative study among Global Health teachers in German medical education.

BACKGROUND: The increasing impact of globalisation on healthcare demands new knowledge, skills and attitudes from healthcare professionals. One consequence of this is the rise of Global Health (GH) programs in health education all over the world. In Germany no consensus exists on what GH is and how it should be taught. This study used a grounded theory approach. We conducted eleven in-depth interviews with GH teachers in German medical education to ask them about their views on Global Health and the approaches they took in teaching these topics. Data collection and Analysis informed each other and followed an inductive approach. RESULTS: Our research identified three major questions: (1) What is GH? (2) What belongs to GH? (3) How can GH be taught? A central finding of our study is the understanding of GH as an umbrella term. We show how this understanding helps clarify the relation between GH and Public Health, International Health and Tropical medicine. At the core of GH we see the supraterritorial determinants of health. Surrounding the core, we describe a wide variety of topics that are a facultative, but not necessarily a compulsory part GH. One of the key characteristics of GH within all its aspects is its multidisciplinary nature. Based on this understanding we present models about the content of GH, how it can be taught and how GH teaching improves and strengthens overall medical education. CONCLUSIONS: This is to our knowledge the first study that conducts in-depth interviews with GH teachers to explore the practical understanding of GH in medical education. While the generalisability of our results needs to be subject of further research, the models presented can help shape the future discourse around GH and its integration into medical education.