Effectiveness of case management as a cross-sectoral healthcare provision for women with breast cancer.

OBJECTIVE: Case management (CM) programs are intended to improve care coordination for cancer patients. This quasi-experimental, controlled study evaluated whether such a program was effective in improving health-related quality of life and reducing the psychological distress of breast cancer patients. METHODS: For the study, 126 patients with CM and 118 patients with treatment as usual (TAU) were surveyed at baseline, a 6-month follow-up and a 12-month follow-up. Comparisons of the two groups with regard to quality of life (Short Form-8, European Organization for Research and Treatment of Cancer-11; primary outcome) and psychological distress (Hospital Anxiety and Depression Scale, distress thermometer; secondary outcome) were conducted. RESULTS: Univariate t-tests regarding the primary and secondary outcomes demonstrated improvements in the relevant outcomes at the 6-month and 12-month follow-ups for the intervention group as well as for the control group. An analysis of covariance revealed that the controls showed a higher level of physical quality of life at the 12-month follow-up than the other time points and no differences at 6 months after the baseline. CONCLUSIONS: The tested CM model did not improve the quality of life or psychological well-being of the patients beyond treatment as usual. Possible reasons include that the treatment was already of high standards in the control group or that there are possibly different impacts than found in the literature regarding different forms of organization in CM. The need for and the tailoring of this CM model as well as the transfer of CM to other oncological indications remain to be clarified. Copyright © 2016 John Wiley & Sons, Ltd.

Self-efficacy and fear of cancer progression during the year following diagnosis of breast cancer.

OBJECTIVE: The aim of this study was to investigate fear of disease progression (FoP) during the year following diagnosis of breast cancer and its association with general self-efficacy (SE). METHODS: In a prospective study, 118 breast cancer patients were recruited shortly after diagnosis disclosure (response rate: 54%) and at 1-year follow-up (follow-up rate: 90%). Participants completed self-report measures of general self-efficacy (General Self-Efficacy Scale) and fear of progression (short form of the Fear of Progression Questionnaire). RESULTS: Cross-sectional regression analysis revealed that high FoP is significantly associated with low SE, even when controlling for demographic and medical characteristics (total R² = 0.17). Having children and a relatively short time since diagnosis also significantly predicted higher FoP. Longitudinal analyses showed that FoP decreased significantly over time (p = 0.001; d = 0.25), but a significant decrease was only observed for patients with high initial FoP (p < 0.001; d = 0.74) and not for those with low initial FoP (p = 0.688; d = 0.08). SE was not a significant predictor of FoP at follow-up when controlling for initial FoP and other patient characteristics (incremental R² = 0.001; p = 0.674; total R² = 0.47). Overall, only initial FoP significantly predicted FoP at follow-up (p < 0.001; ß = 0.671). CONCLUSION: Findings that low SE is associated with high FoP can help to improve the treatment of dysfunctional fears in breast cancer patients. As FoP changes only slightly over time, treatment to enhance SE and reduce FoP should be initiated soon after disease disclosure.

[Rehabilitative elements for the treatment of patients with mental disorders: are they considered in the development of guidelines?]. / Rehabilitative Elemente bei der Behandlung von Menschen mit psychischen Störungen: Werden sie bei der Entwicklung von Leitlinien ausreichend berücksichtigt?

OBJECTIVE: In the context of the current discussion of integrating rehabilitative elements into the (acute) treatment of patients with mental disorders, it is investigated what rehabilitative elements actually are and whether these elements are considered in existing guidelines. METHODS/RESULTS: An expert-based consensus, especially results of expert ratings using a 46-item questionnaire (Delphi Technique; n = 16), shows that it is possible to specify rehabilitative elements, although there are still aspects which need further clarification. Analyses of current guidelines (using published guidelines for panic disorders) demonstrate that rehabilitative elements which are rated as important by the experts are only marginally mentioned in guidelines up to now. CONCLUSIONS: A considerable need for research exists for a further specification of rehabilitative elements and for the development of evidence based recommendations in the form of guidelines.

The development of guidelines for the treatment of patients with mental disorders under particular consideration of rehabilitative aspects.

Inpatient psychotherapeutic treatment is quite extensive in Germany. Three treatment systems (psychosomatic/psychotherapeutic healthcare, psychiatric/psychotherapeutic healthcare and rehabilitation of patients with mental disorders) exist relatively independently from one another. They show large areas of overlap, however, with regard to various criteria. This is due to the fact that, as opposed to many somatic illnesses, a clear distinction between acute-medical and rehabilitative elements cannot be made in the treatment of mental disorders.Systematic treatment recommendations in the form of guidelines could aid in determining the optimal treatment form for patients.The current development of guidelines for mental disorders will thus be presented and analyzed in this article. Particular focus will be placed on rehabilitative aspects. The presentation and analysis will take place using the example of guidelines written for panic disorders. Based on a national and international investigation of guidelines (internet, databases) 11 guidelines for panic disorder (2 German guidelines, 9 from English spoken countries; target group of 9 guidelines: general practitioners; recommendations concerning diagnostics /assessment and treatment) were analysed. The results demonstrate a considerable need for development as rehabilitative elements are only marginally mentioned in the guidelines up to now. Of the 16 rehabilitative elements being investigated, only two ("psycho education" and "pharmacotherapy of chronic illness in the long-term perspective") are considered more than once in the guidelines. Seven elements (e.g. "salutogenic aspects of the therapy/ measures for the maintenance of quality of life", "methods of long-term guidance") are not mentioned at all. Based on the results of the analyses performed, conclusions for the further development of guidelines will be presented for discussion.