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BACKGROUND: Psychosocial care of cancer patients is an important aspect throughout the entire course of oncological treatment. Since 2015, psychosocial screening has been implemented in the outpatient clinics of the Skin Cancer Center in Freiburg. We present here a post hoc analysis in the context of a quality management program. QUESTION: Acceptance, psychosocial distress and desire for counseling were evaluated. Exploratively, we investigated which patient and disease characteristics are related to increased subjective distress. MATERIALS AND METHODS: In a full survey from 06/2015 to 12/2015, we evaluated acceptance, psychosocial distress by distress thermometer (DT), and desire for counseling. RESULTS: Of 753 patients, 345 (45.8%) participated in psychosocial screening and data from 310 (174 men, 136 women; 89.7% melanoma patients, mean time since initial diagnosis 4.7⯱ 3.9 years) could be analyzed. The mean burden on the DT was 2.97⯱ 2.83 (median 2, range 0-10). High distress (DT ≥â¯5) was reported by 84 patients (28.8%). Thirty-four patients (11%) indicated a desire for counseling, and 23 patients took up the counseling offer. The patient group with high distress was younger, more often under ongoing or recently completed systemic therapy, and had more often a desire for counseling. CONCLUSION: In addition to assessing psychosocial distress with validated screening instruments, the survey of the subjective desire for care represents an important parameter for the identification of patients in need of care. Young patients and patients with ongoing systemic therapy should be the focus of attention.
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Neoplasias Cutâneas , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/psicologia , Neoplasias Cutâneas/terapia , Neoplasias Cutâneas/diagnóstico , Idoso , Adulto , Angústia Psicológica , Estresse Psicológico/diagnóstico , Estresse Psicológico/terapia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Programas de Rastreamento , Aconselhamento , Alemanha , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Inquéritos e Questionários , Melanoma/psicologia , Melanoma/terapia , Melanoma/diagnóstico , Idoso de 80 Anos ou mais , Institutos de CâncerRESUMO
BACKGROUND: Communication skills are among the most important key qualifications of the medical profession. To what extent these can also be acquired online in medical education in otolaryngology is investigated in this study. OBJECTIVE: A voluntary online training for the teaching of communication skills was compared with a corresponding face-to-face format. The question of the extent to which acceptance of the two formats and students' self-assessment of their communicative skills differed was investigated. MATERIALS AND METHODS: In the online training, students were prepared for the topic asynchronously via a video. Thereafter, they were able to conduct consultations with simulation patients online and synchronously. The face-to-face training was comparable in structure and duration and took place in an earlier semester. The acceptance of both seminars was assessed by a questionnaire with 19 items on a five-point Likert scale. Self-assessment of communication skills was measured by a 10-cm visual analog scale pre/post with 16 items. RESULTS: Both formats achieved high acceptance with an average score (M) of 2.08 (standard deviation, SDâ¯= 0.54) for the online format and Mâ¯= 1.97 (SDâ¯= 0.48) for the face-to-face event. Students' self-assessments of communication skills showed a twofold increase in the online group (Mâ¯= 1.54, SDâ¯= 0.94) compared to the face-to-face group (Mâ¯= 0.75, SDâ¯= 0.87). CONCLUSION: This study shows that teaching communication skills in the online format was well accepted and resulted in significant changes in students' self-assessment of communication skills.
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Comunicação , Instrução por Computador , Currículo , Otolaringologia , Otolaringologia/educação , Alemanha , Instrução por Computador/métodos , Humanos , Educação a Distância/métodos , Avaliação Educacional , Masculino , Feminino , Relações Médico-PacienteRESUMO
BACKGROUND: Men make use of outpatient cancer counseling less commonly than women, even when they stand to benefit from it. METHODS: In a cluster-randomized trial (registered under DRKS00032181), we studied whether measures on multiple levels (information for referring physicians, public information, structural changes, offerings specifically for male patients) over a period of 12 months would be able to increase the percentage of men among patients seeking outpatient cancer counseling (primary endpoint, initial contact; secondary endpoint, all contacts). The intervention effect was quantified by the fitting of generalized linear mixed models to obtain an odds ratio, which was adjusted for cluster structure and for the percentages of first contacts and of all contacts during the 12 months before the start of the intervention. RESULTS: In 12 regions of Germany (6 each in the intervention arm and the control arm), 11 986 people had first contacts with outpatient cancer counseling, 6004 of them during the intervention phase. The percentage accounted for by men was 30.7% in the intervention arm and 25.7% in the control arm, corresponding to a statistically insignificant model-based adjusted odds ratio (OR) of 1.2 (95% confidence interval [1.0; 1.4], p = 0.08) for the primary endpoint. There were a total of 51 842 counseling sessions (both initial contacts and subsequent contacts), 26 651 of them in the intervention phase. The percentage of these that was accounted for by men was 27.6% in the intervention arm and 22.2% in the control arm; the adjusted OR for this secondary endpoint was 1.3 [1.1; 1.6], p = 0.01). CONCLUSION: The targeted implementation of malespecific measures on multiple levels can increase, by a small amount, the percentage of men among persons seeking outpatient cancer counseling.
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Neoplasias , Pacientes Ambulatoriais , Humanos , Masculino , Feminino , Aconselhamento , Alemanha/epidemiologia , Neoplasias/epidemiologia , Neoplasias/terapiaRESUMO
INTRODUCTION: After solid-organ transplantation (SOTx), recipients must adhere to a lifelong medical regimen, change their lifestyle and cope with physiological and psychosocial challenges. This requires active participation in their care and self-management abilities. The concept of self-management after SOTx has only been described regarding specific organs and focused on adherence to medical treatment. A comprehensive conceptualisation of self-management entailing all solid organs and beyond medical aspects does not exist. This might lead to unmet self-management support needs of SOTx recipients and hinder a more holistic and integrative approach in self-management support. Therefore, a better understanding of the concept of self-management after SOTx is needed to facilitate a comprehensive evidence base for healthcare providers and researchers. The purpose of this scoping review is to explore existing evidence on self-management in adults after SOTx. METHODS AND ANALYSIS: To identify relevant evidence, six electronic databases and three study registers will be searched, supplemented by handsearches, reference checking and expert recommendations. Screening and selection of available evidence will be carried out in a two-step process by two independent reviewers. International evidence published in English or German reporting on adults after heart, lung, liver, pancreas, kidney or small bowel transplantation will be considered. To meet inclusion criteria, articles have to focus on either: self-management, self-management support or recipients' or healthcare providers' perspectives of challenges and needs potentially addressable by self-management. Data extraction will be performed by two reviewers independently using a structured form. Data will be analysed descriptively and using content analysis procedures. Findings will be summarised narratively and presented in tabular format. ETHICS AND DISSEMINATION: The consultation and approval of an ethics committee is not required for this scoping review. Findings of the scoping review will be published in a peer-reviewed open-access journal and presented at conferences.
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Transplante de Órgãos , Autogestão , Humanos , Adulto , Projetos de Pesquisa , Literatura de Revisão como AssuntoRESUMO
Introduction: Cancer-affected patients experience high distress due to various burdens. One way to expand psycho-oncological support is through digital interventions. This protocol describes the development and structure of a web-based psycho-oncological intervention, the Make It Training optimized. This intervention is currently evaluated in the Reduct trial, a multicenter randomized controlled trial. Methods: The Make It Training optimized was developed in six steps: A patient need and demand assessment, development and acceptability analysis of a prototype, the formation of a patient advisory council, the revision of the training, implementation into a web app, and the development of a motivation and evaluation plan. Results: Through a process of establishing cancer-affected patients' needs, prototype testing, and patient involvement, the Make It Training optimized was developed by a multidisciplinary team and implemented in a web app. It consists of 16 interactive self-guided modules which can be completed within 16 weeks. Discussion: Intervention protocols can increase transparency and increase the likelihood of developing effective web-based interventions. This protocol describes the process and results of developing a patient-oriented intervention. Future research should focus on the further personalization of web-based psycho-oncological interventions and the potential benefits of combining multiple psychotherapeutic approaches.
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To improve the health status of teachers, there is a need for good and reliable instruments to continuously assess their mental health. The current study proposed the GHQ-12 questionnaire as an appropriate instrument for measuring the mental health of teachers. The GHQ-12 is a well-established screening instrument that has mostly been applied in non-teaching samples. In the current study, the psychometric properties of the questionnaire were analyzed using a large sample of German teachers (N = 3996). The data was collected yearly over an extended period of time (2012-2020). Results showed good to very good reliability, as well as high correspondence to burnout and life satisfaction scales. Principal axis factor analysis supported a two-factor structure: Factor 1 represents "depression/stress" and Factor 2 represents "loss of confidence". However, the mental health of the investigated teachers was worse than that of a representative sample in Germany. Consequently, this study highlighted the fact that the teaching profession is vulnerable to mental strain and underlined the importance of promoting prevention programs that could help to sustain and foster the mental health of teachers. In this context, the GHQ-12 could be proposed as a good and economic tool to assess and analyze mental health in German teachers. The presented norm could help practitioners and teachers to compare individual scores within a larger peer group.
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Saúde Mental , Professores Escolares , Alemanha , Psicometria , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Many patients with cancer experience severe psychological distress, but as a result of various barriers, few of them receive psycho-oncological support. E-mental health interventions try to overcome some of these barriers and the limitation of healthcare offers, enabling patients with cancer to better cope with psychological distress. In the proposed trial, we aim to assess the efficacy and cost-effectiveness of the manualised e-mental health intervention Make It Training- Mindfulness-Based and Skills-Based Distress Reduction in Oncology. Make It Training is a self-guided and web-based psycho-oncological intervention, which includes elements of cognitive behavioural therapy, mindfulness-based stress reduction and acceptance and commitment therapy. The training supports the patients over a period of 4 months. We expect the Make It Training to be superior to treatment as usual optimised (TAU-O) in terms of reducing distress after completing the intervention (T1, primary endpoint). METHODS AND ANALYSIS: The study comprises a multicentre, prospective, randomised controlled confirmatory interventional trial with two parallel arms. The proposed trial incorporates four distinct measurement time points: the baseline assessment before randomisation, a post-treatment assessment and 3 and 6 month follow-up assessments. We will include patients who have received a cancer diagnosis in the past 12 months, are in a curative treatment setting, are 18-65 years old, have given informed consent and experience high perceived psychological distress (Hospital Anxiety and Depression Scale ≥13) for at least 1 week. Patients will be randomised into two groups (Make It vs TAU-O). The aim is to allocate 600 patients with cancer and include 556 into the intention to treat analysis. The primary endpoint, distress, will be analysed using a baseline-adjusted ANCOVA for distress measurement once the intervention (T1) has been completed, with study arm as a binary factor, baseline as continuous measurement and study centre as an additional categorical covariate. ETHICS AND DISSEMINATION: The Ethics Committee of the Medical Faculty Essen has approved the study (21-10076-BO). Results will be published in peer-reviewed journals, conference presentations, the project website, and among self-help organisations. TRIAL REGISTRATION NUMBER: German Clinical Trial Register (DRKS); DRKS-ID: DRKS00025213.
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Terapia de Aceitação e Compromisso , Intervenção Baseada em Internet , Atenção Plena , Neoplasias , Adolescente , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Atenção Plena/métodos , Estudos Multicêntricos como Assunto , Neoplasias/terapia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto JovemRESUMO
OBJECTIVE: Aim of the study was to compare working and non-working patients over a period of 12 months regarding socio-demographic, cancer-specific and mental health parameters. METHODS: This study was conducted as part of a Germany-wide longitudinal survey among 1398 patients in 13 national Comprehensive Cancer Centers. The sample used for analysis consisted of n = 430 cancer patients younger than 65 years (age M = 52.4 years, SD = 8.1; 67.0% females). Socio-demographic, cancer-specific and mental health parameters (Depression: Patient Health Questionnaire, Anxiety: Generalized Anxiety Disorder Scale, Distress: Distress Thermometer) were assessed at baseline during hospitalization and at 12 months follow-up. RESULTS: 73.7% of all patients (n = 317) have returned to work after one year. While working and non-working patients did not differ in socio-demographic parameters, there were significant differences in the presence of metastases, tumor and treatment status. Mixed analysis of variances revealed significant interactions between working status and time for depression (p = 0.009), anxiety (p = 0.003) and distress (p = 0.007). Non-working patients reported higher levels of depression, anxiety and distress than working patients over time. A logistic regression showed significant associations between lower depression (p = 0.019), lower distress (p = 0.033) and the absence of a tumor (p = 0.015) with working status. CONCLUSIONS: The majority of cancer survivors returned to work. Non-working patients had higher levels of depression, anxiety and distress than working patients. After controlling for cancer-specific factors, mental health parameters were still independently associated with working status. Return to work can thus be associated with an improved mental health in cancer survivors. In order to establish causality, further research is necessary.
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Sobreviventes de Câncer , Neoplasias , Ansiedade/epidemiologia , Ansiedade/psicologia , Sobreviventes de Câncer/psicologia , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Neoplasias/psicologia , Neoplasias/terapia , Retorno ao Trabalho/psicologiaRESUMO
The curvature of lipid membranes plays a key role in many relevant biological processes such as membrane trafficking, vesicular budding and host-virus interactions. In vitro studies on the membrane curvature of simplified biomimetic models in the nanometer range are challenging, due to their complicated nanofabrication processes. In this work, we propose a simple and low-cost platform for curvature sensitive protein screening, prepared through scanning probe lithography (SPL) methods, where lipid bilayer patches of different compositions can be multiplexed onto substrate areas with tailored local curvature. The curvature is imposed by anchoring nanoparticles of the desired size to the substrate prior to lithography. As a proof of principle, we demonstrate that a positive curvature membrane sensitive protein derived from the BAR domain of Nadrin2 binds selectively to lipid patches patterned on substrate areas coated with 100 nm nanoparticles. The platform opens up a path for screening curvature-dependent protein-membrane interaction studies by providing a flexible and easy to prepare substrate with control over lipid composition and membrane curvature.
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Bicamadas Lipídicas , Fosfolipídeos , Membrana Celular , Proteínas de Membrana , MembranasRESUMO
AIM: The aim of the study is to look at the specific contribution of outpatient cancer counselling centers (OCCC) from the perspective of both the person seeking advice and the referring health care professionals. METHODS: Qualitative design by means of guideline-based face-to-face interviews with cancer patients/relatives and individual telephone interviews with referring health care professionals. RESULTS: A total of 43 persons seeking advice and 30 referring health care professionals were interviewed. With regard to the contents of counselling, psycho-oncological support and help for self-help in combination with social-legal information about additional support services are perceived as central features. In the group of referring physicians, however, there seems to be some uncertainty about what OCCCs (can) provide. CONCLUSION: On the one hand, the results point to a specific core of the services offered by OCCCs, and on the other hand to ambiguous perceptions on the part of the respondents. They may contribute to further sharpening the profile of OCCC and to clarifying their place in the health care system.
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Aconselhamento , Neoplasias , Atenção à Saúde , Pessoal de Saúde , Humanos , Neoplasias/terapia , Psico-OncologiaAssuntos
COVID-19 , Neoplasias , Humanos , Oncologia , Neoplasias/epidemiologia , Neoplasias/terapia , Pandemias , SARS-CoV-2RESUMO
Background: As a teaching method, feedback is an integral part of medical education. However, there is a lack of a uniform theoretical basis or generally recognized guidelines for its specific design. Against this background, the aim of this article is to discuss conceptual considerations and empirical findings regarding feedback using various practical examples. Procedure and conceptual considerations: Building on the results of a workshop of the Committee for Communicative and Social Competences of the Society for Medical Education (GMA), this article first explains central conceptual considerations and empirical results on the topic of feedback. A particular focus is on various variables that influence the effect of feedback. This includes the feedback source, the frequency of feedback, starting points of feedback, the connection between feedback and reflection as well as the motivation and meta-cognitive skills of the feedback recipient. Practical examples: The implementation of feedback in practice is illustrated using eight examples from the field of medical and dental education. They stem from various settings and the focus is on formative oral feedback. It will become evident that the focus is more on the givers of feedback than the recipients of feedback. Instructions for recipients of feedback on how to reflect on it is still the exception. Discussion: Many of the relevant aspects for the effect of feedback described in the literature are already taken into account in the practical examples discussed. In conclusion, seven recommendations are made for implementing feedback in practice.
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Educação Médica , Retroalimentação , Comunicação , Educação , Educação Médica/métodos , Educação Médica/normas , Docentes de Medicina , Humanos , Motivação , Ensino/normas , Ensino/estatística & dados numéricosRESUMO
Hydrogen bound in organic liquid hydrogen carriers (LOHC) such as dibenzyl-toluene enables simple and safe handling as well as long-term storage. This idea is particularly interesting in the context of the energy transition, where hydrogen is considered a key energy carrier. The LOHC technology serves as a storage between volatile energy and locally and timely independent consumption. Depending on the type of application, decisive specifications are placed on the hydrogen purity. In the product gas from dehydrogenation, however, concentrations of 100 to a few 1000 ppm can be found from low boiling substances, which partly originate from the production of the LOHC material, but also from the decomposition and evaporation of the LOHC molecules in the course of the enormous volume expansion due to hydrogen release. For the removal of undesired traces in the LOHC material, a pre-treatment and storage under protective gas is necessary. For purification, the use of Pd-based membranes might be useful, which makes these steps less important or even redundant. Heat supply and phase contacting of the liquid LOHC and catalyst is also crucial for the process. Within the contribution, the first results from a coupled microstructured system-consisting of a radial flow reactor unit and membrane separation unit-are shown. In a first step, the 5 µm thick PdAg-membrane was characterized and a high Sieverts exponent of 0.9 was determined, indicating adsorption/desorption driven permeation. It can be demonstrated that hydrogen is first released with high catalyst-related productivity in the reactor system and afterwards separated and purified. Within the framework of limited analytics, we found that by using a Pd-based membrane, a quality of 5.0 (99.999% purity) or higher can be achieved. Furthermore, it was found that after only 8 h, the membrane can lose up to 30% of its performance when exposed to the slightly contaminated product gas from the dehydrogenation process. However, the separation efficiency can almost completely be restored by the treatment with pure hydrogen.
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AIM: The aim of the present survey was to describe and evaluate experiences of German psychosocial cancer counselling centers with user surveys as a quality management measure. METHODS: Representatives of various psychosocial cancer counselling centers were asked to prepare an experience report on user surveys. Nine field reports were presented and discussed in summary by the working group "Cancer Counselling Centers" of the Working Group Psychooncology of the German Cancer Society (PSO). Special attention was paid to the short questionnaire KBS-N (Cancer Counselling Centre Questionnaire) recommended by the working group. RESULTS: All psychosocial cancer counselling centers reported positive experiences with user surveys, which, however, represent an effort in terms of personnel and logistics. In addition to the KBS-N, more detailed questionnaires were also used. The surveys were conducted either continuously or on a random basis over a limited period of time. Those seeking advice were usually asked at a defined time directly after the initial interviews or after the end of the counselling sequence. The response rate was higher (85-95%) when the questionnaire was handed out personally after the initial consultation than for postal delivery and return (47-89%). All counselling centers reported positive feedback on the counselling services provided. Isolated points of criticism were related in particular to organizational framework conditions. CONCLUSION: After weighing up the costs and benefits, an active follow-up survey of those seeking advice using the short questionnaire KBS-N appears to be a practicable quality assurance measure, at least over a limited period of time. More detailed user surveys require more effort and are therefore more suitable for use in research that go beyond quality assurance.
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Aconselhamento , Neoplasias , Aconselhamento/normas , Alemanha/epidemiologia , Humanos , Neoplasias/psicologia , Neoplasias/terapia , Encaminhamento e Consulta , Inquéritos e QuestionáriosRESUMO
Hydrogen production and storage in small and medium scale, and chemical heat storage from renewable energy, are of great interest nowadays. Micro-membrane reactors for reforming of methane, as well as for the dehydrogenation of liquid organic hydrogen carriers (LOHCs), have been developed. The systems consist of stacked plates with integrated palladium (Pd) membranes. As an alternative to rolled and electroless plated (Pd) membranes, the development of a cost-effective method for the fabrication of Pd membranes by suspension plasma spraying is presented.
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Liquid organic hydrogen carriers (LOHC) are able to store hydrogen stably and safely in liquid form. The carrier can be loaded or unloaded with hydrogen via catalytic reactions. However, the release reaction brings certain challenges. In addition to an enormous heat requirement, the released hydrogen is contaminated by traces of evaporated LOHC and by-products. Micro process engineering offers a promising approach to meet these challenges. In this paper, a micro-structured multi-stage reactor concept with an intermediate separation of hydrogen is presented for the application of perhydro-dibenzyltoluene dehydrogenation. Each reactor stage consists of a micro-structured radial flow reactor designed for multi-phase flow of LOHC and released hydrogen. The hydrogen is separated from the reactors' gas phase effluent via PdAg-membranes, which are integrated into a micro-structured environment. Separate experiments were carried out to describe the kinetics of the reaction and the separation ability of the membrane. A model was developed, which was fed with these data to demonstrate the influence of intermediate separation on the efficiency of LOHC dehydrogenation.
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Outpatient Psychotherapy for Children and Adolescents with Intellectual Disability The psychiatric morbidity risk for people with intellectual disability is considerably increased. Psychotherapy is considered as one possible treatment. Among experts the caresituation is described as substantial insufficient. This study investigated the perspective of psychotherapists for children and adolescents in the German state North Rhine-Westphalia regarding the care situation of outpatient psychotherapy for children and adolescents with intellectual disability. The participants received a questionnaire (a) about the care situation, (b) how they consider their training to treat these patients and (c) the possibility for free answers. In this cross-section study 185 licensed psychotherapists for children and adolescents filled out a semi-standardized online-questionnaire. The data were analyzed descriptively; free answers were categorized according to Mayring. Additionally, group differences were tested. (a) The psychotherapeutic supply situation for children and adolescents with intellectual disability was rated as insufficient. Clients with learning disability or minor intellectual disability are mainly treated. This group of people benefits from psychotherapy. (b) The training for treating these clients was rated as inadequate. (c) Qualitative analysis refers that request for psychotherapy is seen as difficult; cognitive orientated treatments need modification. The psychotherapeutic care situation for children and adolescents with intellectual disability appears insufficient. This topic should be part of the training curriculum for psychotherapists.
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Assistência Ambulatorial , Deficiência Intelectual/psicologia , Deficiência Intelectual/terapia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Psicoterapia/métodos , Adolescente , Atitude do Pessoal de Saúde , Criança , Competência Clínica , Diagnóstico Duplo (Psiquiatria) , Alemanha , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Deficiência Intelectual/diagnóstico , Transtornos Mentais/diagnóstico , Psicoterapia/educação , Inquéritos e Questionários , Resultado do TratamentoRESUMO
Fear of progression (FoP) is an appropriate, rational response to the real threat of cancer and its treatments. However, patients experiencing elevated, dysfunctional levels of FoP often feel severely distressed and are in need of treatment. We previously conducted a (partly-)randomized controlled study with cancer patients undergoing in-patient rehabilitation and showed that a brief, four-session cognitive-behavioral group therapy significantly reduced dysfunctional FoP. In this report, we describe the adaption of the cognitive-behavioral group therapy program for use with cancer out-patients. This group therapy program was conducted in the psycho-oncological out-patient department of a large university hospital. It comprises 6 group sessions lasting 90 min each. Because of the larger number of sessions there is more room for the use of exposure-based techniques. Imaginal exposure is used to confront the patient's cancer-related fears and worries. Patients are asked to vividly recount their worries and to think of what would be the worst that can happen (worst-case scenario exercise). In addition, interventions that focus the patient's ressources are applied. The completion of 3 group therapies in the pilot phase supported the feasibility of the program. Pre-post evaluation (n=10) revealed a significant decline of FoP (Fear of Progression Questionnaire, FoP-Q) from M=12,0 (SD=2,0) to M=10,3 (SD=1,7), p=0.029. This represents a large effect (Cohen's d=0.9). Three out of 14 participants (21%) quit treatment after 2 sessions. In sum, the results and our experiences show that this out-patient group therapy program is feasible and probably effective. However, it also shows that some patients regard confronting their cancer-related fears and worries as too stressful. High ambivalence with regard to exposure seems to increase the risk for premature termination. Thus, cancer patients should be thoroughly educated before starting exposure-based treatment of dysfunctional FoP.
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Terapia Cognitivo-Comportamental/métodos , Progressão da Doença , Medo/psicologia , Neoplasias/psicologia , Psicoterapia de Grupo/métodos , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: Increasingly, communicative competencies are becoming a permanent feature of training and assessment in German-speaking medical schools (n=43; Germany, Austria, Switzerland - "D-A-CH"). In support of further curricular development of communicative competencies, the survey by the "Communicative and Social Competencies" (KusK) committee of the German Society for Medical Education (GMA) systematically appraises the scope of and form in which teaching and assessment take place. METHODS: The iterative online questionnaire, developed in cooperation with KusK, comprises 70 questions regarding instruction (n=14), assessment (n=48), local conditions (n=5), with three fields for further remarks. Per location, two to three individuals who were familiar with the respective institute's curriculum were invited to take part in the survey. RESULTS: Thirty-nine medical schools (40 degree programmes) took part in the survey. Communicative competencies are taught in all of the programmes. Ten degree programmes have a longitudinal curriculum for communicative competencies; 25 programmes offer this in part. Sixteen of the 40 programmes use the Basler Consensus Statement for orientation. In over 80% of the degree programmes, communicative competencies are taught in the second and third year of studies. Almost all of the programmes work with simulated patients (n=38) and feedback (n=37). Exams are exclusively summative (n=11), exclusively formative (n=3), or both summative and formative (n=16) and usually take place in the fifth or sixth year of studies (n=22 and n=20). Apart from written examinations (n=15) and presentations (n=9), practical examinations are primarily administered (OSCE, n=31); WPA (n=8), usually with self-developed scales (OSCE, n=19). With regards to the examiners' training and the manner of results-reporting to the students, there is a high variance. CONCLUSIONS: Instruction in communicative competencies has been implemented at all 39 of the participating medical schools. For the most part, communicative competencies instruction in the D-A-C-H region takes place in small groups and is tested using the OSCE. The challenges for further curricular development lie in the expansion of feedback, the critical evaluation of appropriate assessment strategies, and in the quality assurance of exams.