Adding spontaneity to organizations - what hospice volunteers contribute to everyday life in German inpatient hospice and palliative care units: a qualitative study.

BACKGROUND: Volunteers have always been integral to hospice and palliative care. However, their roles have been left relatively undefined and broad. AIM: This study aims to examine the role of hospice volunteers in German inpatient hospice and palliative care. The question we seek to answer is: What do hospice volunteers contribute to everyday life in inpatient hospice and palliative care units? METHODS: We undertook a multicenter, on-site qualitative interview study, utilizing problem-centered interviews with 16 volunteers from five inpatient hospice units and one hospital palliative care unit. Interviews were analyzed using grounded theory. RESULTS: Analysis of the interviews revealed three typical characteristics of how hospice volunteers' describe their own role: (1) performing small acts of kindness, (2) creating a family-like atmosphere, (3) expecting emotional experiences. A common theme across all categories is the emphasis on spontaneous actions and personal experiences. The process of dying becomes an experience interpreted by volunteers as enriching, as a gift, as a "teacher". CONCLUSION: Granting hospice volunteers freedom to act spontaneously and intuitively benefits hospice and palliative care delivery. Organizations should leave sufficient room for spontaneity in order to involve volunteers effectively. Open and unstandardized roles facilitate dynamic work practices.

"Do you Really Believe that There is Something More?" - The Offer of Transcendental Communication by Pastoral Care Workers in German Hospices and Palliative Care Units: A Qualitative Study.

BACKGROUND: Palliative Care also encompasses the dimension of spiritual pain. Pastoral care workers and chaplains are specialists in the provision of spiritual care. Decreasing religious affiliation and increasing spiritual diversification in modern societies raise the question of the function of pastoral care. AIM: The goal of this study is to answer the question of what pastoral care workers can offer to dying residents in hospices and palliative care units. DESIGN: A qualitative interview study was designed to explore the specific perspective of pastoral care workers in a multidisciplinary environment. The study is based on differentiation theory which is particularly well adjusted to reveal differences in perspectives in so called 'holistic' care settings. The reporting follows the COREQ guidelines. SETTING: Problem centered interviews were conducted at five hospices and two palliative care units. RESULTS: Eight pastoral care workers were interviewed (5 Catholic, 3 Protestant, mean age of 58 years). The analysis of the interviews revealed three major themes: (A) Self-positioning in relation to the organization, (B) Offering conversations to patients and relatives, (C) Performing religious rituals. Minor themes were: mediating conflicts between patients, relatives and staff, sensing moods in silence with patients and organizing workshops for staff. CONCLUSION: In modern hospice care, pastoral care workers routinely address the problem of making death more tangible and of answering the unanswerable question of what comes afterwards. Through this, they support dying residents in hospices and palliative care units in dealing with the inexplicability of death.

The diversity of opinion among general practitioners regarding the threat and measures against COVID-19 - Cross-sectional survey.

BACKGROUND: After the 'first wave' in spring 2020, opinions regarding the threat and measures against COVID-19 seemed to vary among German general practitioners (GPs). OBJECTIVES: To systematically investigate opinions and to identify subgroups of GPs sharing similar views. METHODS: A questionnaire was sent to all 210 practices accredited for undergraduate teaching of family medicine at the Medical Faculty of the Technical University of Munich. Questions addressed personal opinions regarding risks, dilemmas, restrictions and their relaxation associated with COVID-19, and personal fears, symptoms of depression and anxiety. Patterns of strong opinions ('archetypes') were identified using archetypal analysis, a statistical method seeking extremal points in the multidimensional data. RESULTS: One hundred and sixty-one GPs sent back a questionnaire (response rate 77%); 143 (68%) with complete data for all 38 relevant variables could be included in the analysis. We identified four archetypes with subgroups of GPs tending in the direction of these archetypes: a small group of 'Sceptics' (n = 12/8%) considering threats of COVID-19 as overrated and measures taken as exaggerated; 'Hardliners' (n = 34/24%) considering threats high and supporting strong measures; 'Balancers' (n = 77/54%) who also rated the threats high but were more critical about potentially impairing the quality of life of elderly people and children; and 'Anxious' GPs (n = 20/14%) tending to report more fear, depressive and anxiety symptoms. CONCLUSION: Among the participants in this survey, opinions regarding the threat and the measures taken against COVID-19 during the 'first wave' in Germany in spring 2020 varied greatly.

[Narrative patterns in asthma and the challenge to accept the need for patient education]. / Erzählmuster bei Asthma bronchiale ­ über die Herausforderung, Schulungen dann zu wollen, wenn man soll.

BACKGROUND: The benefits of patient education in bronchial asthma in terms of reducing hospitalization and incapacity to work are well documented. However, only about a quarter of patients take advantage of training offers. Therefore, this qualitative study with asthma patients examines how to sharpen the motivation to participate in training programs. METHODS: In order to investigate narrative patterns of chronic illness in asthma patients, we conducted 14 problem-centered narrative (telephone) interviews. The collected data were evaluated in accordance with system-theoretical analysis. This methodology allows for the interviews to be examined for their narrative patterns. The central question was how the patients we interviewed succeeded in constructing normality in the interviews. RESULTS: From the analysis of the interviews, we were able to develop four types of narrative patterns: the chronic illness as a crisis (1), as a passion (2), as an odyssey (3), and as homeostasis (4). Within these forms of narration, the transition from normal to pathological is told in a specific and exemplary manner. The results of our study can be seen as a contribution to the dynamization and differentiation of trajectories of chronic disease. DISCUSSION: We identified significant differences in the experienced trajectories of the disease. Patients are dealing with chronic disease in different styles, which have individual "pressure points" where motivation for adherence is created in the first place. The results show that the patient's knowledge structures unfolding in the narrative patterns should not be viewed as health illiteracy. CONCLUSION: These typologies of the normal and the pathological do not only provide a key to understanding the life-world (Lebenswelt) of chronically ill people, but also to the question of what motivates chronically ill patients to participate in patient trainings. This in-depth understanding could help us to improve motivational discussions with these patients.

How Young German General Practitioners View and Use Complementary and Alternative Medicine: A Qualitative Study.

BACKGROUND: Qualitative and quantitative surveys show that many German general practitioners (GPs) use complementary and alternative medicine (CAM) in their daily work. However, participants in such studies were mostly experienced GPs. OBJECTIVE: The aim of this study was to investigate systematically how young GPs view CAM and to what extent and how they use CAM treatments. METHODS: Thirteen young physicians in specialist training for general practice as well as GPs who had completed their specialist training within the last 2 years participated in problem-oriented interviews. Interviews were evaluated by qualitative content analysis. RESULTS: The attitudes of participants towards CAM in general and towards specific CAM modalities varied strongly, but doubts regarding a firm evidence base and specific effects over placebo were expressed frequently. Nevertheless, participants were generally open to herbal medicines and all seemed to use them more or less regularly in clinical practice. Other CAM treatments seemed to be used infrequently. Participants used CAM often for minor illnesses; largely as a first low-intensity therapeutic trial to avoid potentially harmful conventional treatments; and to comply with patient preferences. CONCLUSIONS: Compared to more experienced GPs, the participants in our study tended to be more critical towards CAM. Apart from herbal medicines, CAM treatments were used rarely.

How German general practitioners justify their provision of complementary and alternative medicine - a qualitative study.

BACKGROUND: Many German general practitioners (GPs) use complementary and alternative medicine (CAM) in their daily work although most CAM procedures are controversial from an academic point of view. OBJECTIVE: We aimed to investigate how GPs justify their use of CAM. METHODS: We performed semi-structured, individual face-to-face interviews with 20 purposively sampled, experienced GPs providing primary care within the framework of the German statutory health insurance system. A grounded theory approach was used for data analysis. RESULTS: All GPs participating in this study used at least some CAM in their clinical practice. Participants did not have any major conflicts when justifying their use of CAM therapies. Important arguments justifying CAM provision were: using it as a supplementary tool to conventional medicine; the feeling that evidence and science leave many problems in primary care unanswered; a strong focus on helping the individual patient, justifying the use of procedures not based on science for therapeutic and communicative purposes; a strong belief in one's own clinical experience; and appreciation of placebo effects. In general, participants preferred CAM therapies which seemed at least somewhat plausible to them and which they could provide in an authentic manner. CONCLUSIONS: Our results suggest that many German GPs integrate CAM treatments in their routine primary care work without perceiving any major internal conflicts with professional ideals.

[How do young general practitioners experience the transition to general practice? A qualitative study]. / Wie erleben junge Allgemeinärzt*innen den Übergang in die hausärztliche Praxis? Eine qualitative Studie.

BACKGROUND: Although the role of general practice has been strengthened in recent years, undergraduate teaching at medical schools and the clinical phase of specialist training remain dominated by specialized care of seriously ill people in hospitals. It is to be assumed that young doctors' views on medical care are strongly shaped by this clinical focus. OBJECTIVE: To investigate how young general practitioners (GPs) perceive transition from medical school and hospital work to general practice. METHODS: In a qualitative study, a total of 13 physicians in specialist training for general practice as well as general practitioners who had completed their specialist examination up to two years ago participated in problem-oriented interviews. The interviews were analyzed using content analysis. RESULTS: The significant differences between hospital-based and primary care practice initially came as quite a shock to the study participants. Key differences and challenges compared to working in a hospital included: 1) the totally different type of patients or complaints they faced; 2) learning that in many situations one can and should bide one's time ("wait-and-see" approach); 3) ruling out avoidable dangerous developments in patients reliably and coping with the corresponding residual risk; 4) the discovery that sometimes it makes sense not to make a diagnosis; 5) that the doctor-patient relationship should be more cooperative in general practice; and 6) that GPs are often under pressure to act although there is no clear need for taking action or no clear treatment option from a medical and scientific point of view. CONCLUSIONS: Our findings confirm that young doctors' initial views on medical care are strongly shaped by the clinical focus of medical schools and hospital work. Working in general practice is perceived as being very different from working in a hospital.

On the edges of medicine - a qualitative study on the function of complementary, alternative, and non-specific therapies in handling therapeutically indeterminate situations.

BACKGROUND: In routine practice, general practitioners (GPs) see many patients for whom treatment might not be necessary, or evidence-based treatments are not available, yet often a treatment is prescribed. We denote such situations as therapeutically indeterminate. We aimed to investigate 1) whether therapeutically indeterminate situations play a role in the accounts of GPs in their practical work; 2) the role of complementary and alternative medicine (CAM) modalities or non-specific therapies, and of other strategies used in handling therapeutically indeterminate situations; and 3) factors associated with preferences for specific strategies. METHODS: We performed semi-structured, individual face-to-face interviews with 20 purposively sampled, experienced GPs from Bavaria, Germany. A grounded theory approach was used for data analysis. RESULTS: Participants reported that therapeutically indeterminate situations recur often in their daily practice. Professionally legitimate strategies such as empathetic consultations without providing a treatment intervention did not seem to suffice for coping with all of these situations. CAM treatments were used frequently, but motives varied. While some participants were convinced that these treatments were active and effective, others were uncertain or had doubts and used them as a relational tool, as a non-specific treatment or as a beneficial placebo. Conventional drugs were also used in a non-specific manner or despite doubts regarding the risk-benefit ratio. The extent to which GPs felt responsible for offering solutions in therapeutically indeterminate situations seemed to influence their preference for specific strategies. CONCLUSION: Our results demonstrate the important role of CAM and the somewhat smaller role of non-specific therapies for German general practitioners in dealing with therapeutically indeterminate situations. The concept of therapeutically indeterminate situations may be helpful in better understanding why many general practitioners treat patients in situations where treatment does not appear to be clearly indicated.

Egocentrism in sub-clinical depression.

Depression is marked by rigid thinking and the inability to generate different and more positive views on the self. The current study conceptualises this a perspective-taking deficit, which is defined as a deficit in the ability to overcome one's egocentrism. Previous research has demonstrated that individuals with depression are impaired in Theory of Mind reasoning and empathy - two social cognitions that involve cognitive and affective perspective-taking. Here, it was investigated whether these deficits generalise to visuo-spatial perspective-taking. To test this, a convenience sample (N = 268; n = 62 high depressive symptoms; n = 206 healthy control participants) completed a test-battery including measures of cognitive and visuo-spatial perspective-taking and closely matched cognitive and visuo-spatial control tasks. The results showed that individuals exhibiting high levels of depressive symptoms were specifically impaired on both perspective-taking tasks but performed equally well on the control tasks. Interventions to combat rigid thinking in depression are discussed.

Are target-shooters more aggressive than the general population?

Although psychological research shows that guns are aggressive cues, proponents of liberal gun control argue that people rather than guns are to blame for gun-related violence. For instance, athletic target-shooters might classify guns as athletic rather than aggressive stimuli and thus should not be more aggressive than the general population. The present work investigated aggression and emotion-regulation in target-shooters. A longitudinal study found that initial self-reported aggression in target-shooters was higher than in the general population and further increased over 1 year. Additionally, the sample exhibited deficient emotion-regulation strategies, and this was related to self-reported aggression. In contrast, their implicit self-construct became more peaceful over time but was unrelated to all other measures. Two further cross-sectional experiments explored the causal impact of athletic target-shooting and other athletic activities (shooting a basketball) on aggression. Target-shooters and basketball players were tested before and after their regular team practice and aggressive thoughts and feelings were measured. Target-shooting but not basketball practice activated aggressive and anxiety-related thought more strongly than positive thought. Future research avenues, implications for the indirect measurement of aggression, and possible interventions to decrease aggression in target-shooters are discussed. Aggr. Behav. 43:3-13, 2017. © 2016 Wiley Periodicals, Inc.

[Dealing with uncertainty--the hypermodernity of general practice]. / Umgang mit Unbestimmtheit--zur Hypermodernität des Hausarztes.

The general practitioner is fundamentally dealing with uncertainty. On the one hand, we want to demonstrate that uncertainty cannot simply be stipulated as a matter of fact. Instead, we will show that this uncertainty is a performative effect of the primary care setting. On the other hand, we want to point out that the general practitioner's ability to bear uncertainty is a genuinely hypermodern way of productively dealing with uncertainty.