Information needs of patients in spine surgery: development of a question prompt list to guide informed consent consultations.

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.

[The role of childhood stress in symptoms of social phobia and agoraphobia in adulthood]. / Kindheitsbelastungen und Symptome der Sozialen Phobie und Agoraphobie im Erwachsenenalter.

The role of childhood stress in symptoms of social phobia and agoraphobia in adulthood Objectives: Anxiety disorders are among themost prevalent mental disorders inmodern times. Childhood stress constitutes a risk factor for their occurrence in adulthood. METHODS: In a sample of 1000 Polish and German probands recruited via the internet, we studied the associations of nine childhood stress factors (physical abuse, periodic harsh physical punishment, threat of physical violence, sexual abuse, neglect, long-term absence of a parent, violence between parents, arguments between parents and financial hardship) with later agoraphobic and sociophobic symptoms. RESULTS: Especially neglect showed a strong association to both forms of phobic symptoms. Threat of physical violence aswell as periodic harsh physical punishment and threat of physical violence also showed an association to both forms of phobic symptoms. CONCLUSIONS: The study revealed plausible associations for both forms of anxiety and various childhood adversities, though the amounts of explained variances were generally small.

A questionnaire assessing women's care needs related to gynaecological cancer screening: development of the GCSCNS.

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.

[Assessment of communication skills with an OSCE among first year medical students]. / Überprüfung ärztlicher kommunikativer Kompetenz mittels einer OSCE bei Studierenden der Medizin im ersten Studienjahr.

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.

Job satisfaction and the work situation of physicians: a survey at a German university hospital.

OBJECTIVE: Job demands and workload of hospital physicians are increasing. The object of this survey was to examine the factors that constitute job satisfaction and to analyse physicians' work situation in the area of in-patient care. METHODOLOGY: 447 physicians at a German University Hospital received questionnaires with regard to work situation, job satisfaction and personal health. Data were analysed by MANOVA and multiple regression models. RESULTS: A first regression model explained 53% of the variance in satisfaction with "work and profession". Among the explanatory variables "superiors and hierarchy" showed the highest beta-weight (beta = -0.49). "Personal health" also determined job satisfaction, for female physicians stronger (beta = -0.31) than for male physicians (beta = -0.11). In a second regression model on satisfaction with "Financial situation" only 18% of the variance was explained, whereby "work condition on the ward", "personal health" and "collaboration between occupational groups" showed the highest beta-weights. DISCUSSION: Among resident physicians, work conditions, superiors, hierarchy, transparency and participation in decisions are very important variables for job satisfaction. Improvements in these aspects may improve job satisfaction and help to reduce physician shortage in hospitals.

[Work situation and job satisfaction in an university hospital: development of questionnaires for physicians and nurses]. / Arbeitssituation und Mitarbeiterzufriedenheit in einem Universitätsklinikum: Entwicklung von Messinstrumenten für ärztliches und pflegerisches Personal.

Aim of the present work was to develop scales for the description of the work situation of physicians and nurses. For this purpose a sample of n = 447 physicians and n = 920 nurses of an University Hospital filled out a new conception work situation questionnaire. Further on they got the subscales work and profession and financial situation of the Life Satisfaction Questionnaire (FLZ). After Principle Component Analysis and item analyses we could develop four work situation scales similar for both groups, the physicians and the nurses: 1. chief and hierarchy, 2. conflict ability of the team, 3. work conditions at the ward and 4. cooperation of the professions. The internal consistencies are medium to high with Cronbach's alpha = 0.80-0.90 for the physicians and alpha = 0.83-0.90 for the nurses. The Work Situation Questionnaire in it's forms for physicians (FAA) and for nurses (FAP) are high reliable scales. We also found positive validity indications.