@article{GerlichSchulerJelitteetal., author = {Gerlich, Christian and Schuler, Michael and Jelitte, Matthias and Neuderth, Silke and Flentje, Michael and Graefen, Markus and Kr{\"u}ger, Alexander and Mehnert, Anja and Faller, Hermann}, title = {Prostate cancer patients' quality of life assessments across the primary treatment trajectory: true change or response shift?}, series = {Acta oncologica}, volume = {55}, journal = {Acta oncologica}, number = {7}, publisher = {Taylor\&Francis Online}, doi = {10.3109/0284186X.2015.1136749}, pages = {814 -- 820}, abstract = {Background Self-report questionnaires are widely used to assess changes in quality of life (QoL) during the course of cancer treatment. However, comparing baseline scores to follow-up scores is only justified if patients' internal measurement standards have not changed over time, that is, no response shift occurred. We aimed to examine response shift in terms of reconceptualization, reprioritization and recalibration among prostate cancer patients. Material and methods We included 402 newly diagnosed patients (mean age 65 years) and assessed QoL at the beginning of cancer treatment and three months later. QoL was measured with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). We employed structural equation modeling testing measurement invariance between occasions to disentangle 'true' change and change in the measurement model (response shift). Results We found reprioritization effects for both the Physical Functioning and Role Functioning subscales of the EORTC QLQ-C30, indicating that both had gained importance for representing the latent construct of QoL at follow-up. These effects added to the worsening effect evident in the latent construct, thus rendering observed changes even more pronounced. In addition, we found recalibration effects for both the Emotional Functioning and Cognitive Functioning subscales indicating judgments becoming more lenient over time. These effects counteracted 'true' negative changes thus obscuring any substantial changes on the observed level. Conclusion Our results suggest that changes observed in some subscales of the EORTC QLQ-C30 should not be taken at face value as they may be affected by patients' changed measurement standards.}, language = {en} } @article{HessMengSchulteetal., author = {Heß, Verena and Meng, Karin and Schulte, Thomas and Neuderth, Silke and Bengel, J{\"u}rgen and Faller, Hermann and Schuler, Michael}, title = {Prevalence and predictors of cancer patients' unexpressed needs in the admission interview of inpatient rehabilitation}, series = {Psycho-Oncology}, volume = {29}, journal = {Psycho-Oncology}, number = {10}, publisher = {Wiley}, issn = {1057-9249}, doi = {10.1002/pon.5450}, pages = {1549 -- 1556}, abstract = {Objective: The admission interview in oncological inpatient rehabilitation might be a good opportunity to identify cancer patients' needs present after acute treatment. However, a relevant number of patients may not express their needs. In this study, we examined (a) the proportion of cancer patients with unexpressed needs, (b) topics of unexpressed needs and reasons for not expressing needs, (c) correlations of not expressing needs with several patient characteristics, and (d) predictors of not expressing needs. Methods: We enrolled 449 patients with breast, prostate, and colon cancer at beginning and end of inpatient rehabilitation. We obtained self-reports about unexpressed needs and health-related variables (quality of life, depression, anxiety, adjustment disorder, and health literacy). We estimated frequencies and conducted correlation and ordinal logistic regression analyses. Results: A quarter of patients stated they had "rather not" or "not at all" expressed all relevant needs. Patients mostly omitted fear of cancer recurrence. Most frequent reasons for not expressing needs were being focused on physical consequences of cancer, concerns emerging only later, and not knowing about the possibility of talking about distress. Not expressing needs was associated with several health-related outcomes, for example, emotional functioning, adjustment disorder, fear of progression, and health literacy. Depression measured at the beginning of rehabilitation showed only small correlations and is therefore not sufficient to identify patients with unexpressed needs. Conclusions: A relevant proportion of cancer patients reported unexpressed needs in the admission interview. This was associated with decreased mental health. Therefore, it seems necessary to support patients in expressing needs.}, language = {en} } @article{HessMengSchulteetal., author = {Heß, Verena and Meng, Karin and Schulte, Thomas and Neuderth, Silke and Bengel, J{\"u}rgen and Jentschke, Elisabeth and Zoll, Mario and Faller, Hermann and Schuler, Michael}, title = {Unexpressed psychosocial needs in cancer patients at the beginning of inpatient rehabilitation}, series = {Journal of psychosocial oncology}, volume = {39}, journal = {Journal of psychosocial oncology}, number = {2}, publisher = {Taylor \& Francis Online}, doi = {10.1080/07347332.2020.1819931}, pages = {173 -- 188}, abstract = {Cancer patients often need professional help to alleviate their psychosocial distress. However, not all patients express their needs. In this study, we explored possible barriers to patients' expressing needs, contents of needs difficult to express, and conditions facilitating expressing needs. Methods We conducted semi-structured interviews with 29 oncological inpatient rehabilitation patients, 7 members of self-help groups, and 10 health professionals. We analyzed data with structuring content analysis. Results Fear of stigmatization and difficulties in the physician-patient-relationship were the most critical expression barriers reported. Sexuality deemed to be one of the most challenging themes for patients. Changes in the physician's behavior and sufficient resources were mentioned as the main facilitating conditions. Our results indicate a wide diversity within the barriers and topics, but a general consistency between patients and health professionals. Conclusion This study provides evidence for the existence of a variety of barriers to cancer patients' expressing their needs. Practice Implications Health professionals should be aware of the different possible expression barriers to facilitate patient communication.}, language = {en} } @article{HessMengSchulteetal., author = {Heß, Verena and Meng, Karin and Schulte, Thomas and Neuderth, Silke and Bengel, J{\"u}rgen and Faller, Hermann and Schuler, Michael}, title = {Decreased mental health, quality of life, and utilization of professional help in cancer patients with unexpressed needs: A longitudinal analysis}, series = {Psycho-Oncology}, volume = {31}, journal = {Psycho-Oncology}, number = {5}, publisher = {Wiley Online Library Open Access}, doi = {10.1002/pon.5856}, pages = {725 -- 734}, abstract = {Background: Cancer patients' mental health and quality of life can be improved through professional support according to their needs. In previous analyses of the UNSAID study, we showed that a relevant proportion of cancer patients did not express their needs during the admission interview of inpatient rehabilitation. We now examine trajectories of mental health, quality of life, and utilization of professional help in cancer patients with unexpressed needs. Methods: We enrolled 449 patients with breast, prostate, and colon cancer at beginning (T0) and end (T1) of a 3-week inpatient rehabilitation and 3 (T2) and 9 (T3) months after discharge. We explored depression (PHQ-2), anxiety (GAD-2), emotional functioning (EORTC QLQ-C30), fear of progression (FoP-Q-SF), and global quality of life (EORTC QLQ-C30) using structuring equation models. Furthermore, we evaluated self-reports about expressing needs and utilization of professional help at follow-up. Results: Patients with unexpressed needs (24.3\%, n = 107) showed decreased mental health compared to other patients (e.g., depression: d T0 = 0.32, d T1-T3 = 0.39). They showed a significant decline in global quality of life at discharge and follow-up (d = 0.28). Furthermore, they had a higher need for support (Cramer's V T2 = 0.10, T3 = 0.15), talked less about their needs (Cramer's V T2 = 0.18), and made less use of different health care services at follow-up. Conclusion: Unexpressed needs in cancer patients may be a risk factor for decreased mental health, quality of life, and non-utilization of professional help in the long term. Further research should clarify causal relationships and focus on this specific group of patients to improve cancer care.}, language = {en} } @article{SeekatzJentschkeLukascziketal., author = {Seekatz, Bettina and Jentschke, Elisabeth and Lukasczik, Matthias and Neuderth, Silke and Schuler, Michael and Orschot, von, Birgitt}, title = {Identifikation nicht heilbarer Krebspatienten mit Palliativbedarf durch Screening}, series = {Der Onkologe}, volume = {22}, journal = {Der Onkologe}, number = {11}, publisher = {Springer Medizin}, doi = {10.1007/s00761-016-0122-5}, pages = {870 -- 877}, abstract = {Hintergrund Nach der S3-Leitlinie Palliativmedizin sollen bei Patienten mit nicht heilbaren Krebserkrankungen, unabh{\"a}ngig von der Durchf{\"u}hrung einer tumorspezifischen Therapie, u. a. regelm{\"a}ßig Symptome und Bed{\"u}rfnisse erhoben werden. Zum Screening bieten sich palliativmedizinische Selbsteinsch{\"a}tzungsb{\"o}gen wie z. B. die Edmonton Symptom Assessment Scale (ESAS) an, die in Kanada im Rahmen einer Qualit{\"a}tsoffensive in den Onkologischen Zentren eingesetzt wird. Ziel und Methode Ziel ist die Umsetzung des ESAS-Screenings bei metastasierten Patienten im Lungenkrebszentrum, im Darmkrebszentrum, im Zentrum f{\"u}r neuroonkologische Tumoren und im Hautkrebszentrum im Comprehensive Cancer Center (CCC) Mainfranken. Ergebnisse Von insgesamt 839 gescreenten Patienten berichteten 79,6 \% mindestens eines von 10 erfragten Symptomen in m{\"a}ßiger oder starker Auspr{\"a}gung (ESAS-Itemwert ≥4) und ben{\"o}tigten damit ein genaueres klinisches Assessment und ggf. eine Intervention. Am h{\"a}ufigsten wurden Einschr{\"a}nkungen des Allgemeinbefindens, Ersch{\"o}pfung und M{\"u}digkeit, Appetitverlust oder Dyspnoe berichtet. Mindestens ein stark ausgepr{\"a}gtes Symptom (ESASr-Wert ≥7) mit Interventionsbedarf zeigten 40,4 \% aller Patienten. Schlussfolgerungen Ein hoher Anteil der Patienten berichtete {\"u}ber relevante Symptombelastung. Inwieweit klinisches Assessment und ggf. Interventionen durch die prim{\"a}r behandelnden Teams (allgemeine Palliativversorgung) {\"u}bernommen werden k{\"o}nnen und zu welchen Zeitpunkt die Spezialisten einbezogen werden sollten, muss weiter diskutiert werden.}, language = {de} } @article{SchulerLukasczikLaterveeretal., author = {Schuler, Michael and Lukasczik, Matthias and Laterveer, Hans and Weilbach, Franz and Presl, F. and Presl, Margarete and Kn{\"o}rzer, J{\"u}rgen and Neuderth, Silke}, title = {Formative Evaluation der „MBO® Kompakt-Neurowoche" - Eine intensivierte berufsbezogene Behandlungsmaßnahme f{\"u}r neurologische Patienten}, series = {Die Rehabilitation}, journal = {Die Rehabilitation}, number = {55}, publisher = {Georg Thieme Verlag KG}, address = {Stuttgart; New York}, doi = {10.1055/s-0042-116582}, pages = {312 -- 318}, abstract = {Ziel der Studie: Die MBO® Kompakt-Neurowoche wird nach {\"a}rztlicher Zuweisung als 7-t{\"a}gige berufsorientierte Reha-Maßnahme im Anschluss an eine regul{\"a}re neurologische Rehabilitation durchgef{\"u}hrt. Zugang, Durchf{\"u}hrung und Outcomes werden formativ evaluiert. Methode: Pr{\"a}-Post-Patientenbefragung zu f{\"u}nf Zeitpunkten: Beginn regul{\"a}re Reha (T0), Beginn (T1), Ende (T2), 6 Monate (T3) und 12 Monate (T4) nach der MBOR-Maßnahme. Ergebnisse: Die N=252 Maßnahmenteilnehmer (75\% M{\"a}nner, 48±10 Jahre) weisen eine h{\"o}here berufsbezogene Behandlungsmotivation und eine g{\"u}nstigere subjektive Erwerbsprognose auf als Nichtteilnehmer (N=215). Zu T4 sind 76\% (sehr) zufrieden mit der Maßnahme. Besonders hilfreich werden Angebote zur Verbesserung/Testung von Leistungsf{\"a}higkeit und Ged{\"a}chtnis erlebt. Optimierungspotenzial wird in der Erarbeitung beruflicher Alternativen gesehen. Schlussfolgerungen: Die Teilnehmer haben berufliche Problemlagen bei gleichzeitig hoher Behandlungsmotivation. Die Maßnahme wird als hilfreich f{\"u}r die R{\"u}ckkehr an den Arbeitsplatz und die Bew{\"a}ltigung von Arbeitsplatzproblemen angesehen.}, language = {de} } @article{NeuderthSchwartzGerlichetal., author = {Neuderth, Silke and Schwartz, Betje and Gerlich, Christian and Schuler, Michael and Markus, Miriam and Bethge, Matthias}, title = {Work-related medical rehabilitation in patients with musculoskeletal disorders: the protocol of a propensity score matched effectiveness study (EVA-WMR, DRKS00009780)}, series = {BMC Public Health}, journal = {BMC Public Health}, publisher = {BMC}, doi = {10.1186/s12889-016-3437-7}, pages = {11}, abstract = {Background Musculoskeletal disorders are one of the most important causes of work disability. Various rehabilitation services and return-to-work programs have been developed in order to reduce sickness absence and increase sustainable return-to-work. As the effects of conventional medical rehabilitation programs on sickness absence duration were shown to be slight, work-related medical rehabilitation programs have been developed and tested. While such studies proved the efficacy of work-related medical rehabilitation compared with conventional medical rehabilitation in well-conducted randomized controlled trials, its effectiveness under real-life conditions has yet to be proved. Methods/Design The cohort study will be performed under real-life conditions with two parallel groups. Participants will receive either a conventional or a work-related medical rehabilitation program. Propensity score matching will be used to identify controls that are comparable to treated work-related medical rehabilitation patients. Over a period of three months, about 18,000 insured patients with permission to undergo a musculoskeletal rehabilitation program will be contacted. Of these, 15,000 will receive a conventional and 3,000 a work-related medical rehabilitation. We expect a participation rate of 40 \% at baseline. Patients will be aged 18 to 65 years and have chronic musculoskeletal disorders, usually back pain. The control group will receive a conventional medical rehabilitation program without any explicit focus on work, work ability and return to work in diagnostics and therapy. The intervention group will receive a work-related medical rehabilitation program that in addition to common rehabilitation treatments contains 11 to 25 h of work-related treatment modules. Follow-up data will be assessed three and ten months after patients' discharge from the rehabilitation center. Additionally, department characteristics will be assessed and administrative data records used. The primary outcomes are sick leave duration, stable return to work and subjective work ability. Secondary outcomes cover several dimensions of health, functioning and coping strategies. Discussion This study will determine the relative effectiveness of a complex, newly implemented work-related rehabilitation strategy for patients with musculoskeletal disorders. Trial registration German Clinical Trials Register (DRKS00009780, February 10, 2016).}, language = {en} } @article{SeekatzLukasczikLoehretal., author = {Seekatz, Bettina and Lukasczik, Matthias and L{\"o}hr, Mario and Ehrmann, Katja and Schuler, Michael and Keßler, Almuth F. and Neuderth, Silke and Ernestus, Ralf-Ingo and Oorschot, Birgitt, von}, title = {Screening for symptom burden and supportive needs of patients with glioblastoma and brain metastases and their caregivers in relation to their use of specialized palliative care}, series = {Supportive care in cancer}, volume = {25}, journal = {Supportive care in cancer}, number = {9}, publisher = {Springer}, address = {Berlin Heidelberg}, doi = {10.1007/s00520-017-3687-7}, pages = {2761 -- 2770}, abstract = {Purpose Patients with brain tumors have a high symptom burden and multiple supportive needs. Needs of caregivers are often unattended. This study aims to determine screening-based symptom burden and supportive needs of patients and caregivers with regard to the use of specialized palliative care (SPC). Methods Seventy-nine patients with glioblastoma and brain metastases and 46 caregivers were screened with standardized questionnaires following diagnosis and 2 months later. The screening assessed symptom burden, quality of life (QoL), distress, and supportive needs. Results The most relevant symptoms were drowsiness, tiredness, and low well-being (53-58\%). The most prevalent patient supportive needs were the need for information about available resources, the illness, and possible lifestyle changes (50-56\%). The most prevalent caregiver needs were information about the illness, lifestyle changes, and about available resources (56-74\%). Patients who received SCP and their caregivers had higher symptom burden and supportive needs than those without SPC. They reported moderate improvement in pain, distress, and QoL, while patients without SPC also improved their QoL, but had small to moderate deteriorations in pain, drowsiness, nauseas, well-being, and other problems. Distress of caregivers with SPC improved with moderate to large effect sizes but still was on a high level and remained stable for those without SPC. Conclusions Symptom burden and supportive needs were high, but even more caregivers than patients expressed high distress and supportive needs. SPC appears to reach the target group, both patients and caregivers with elevated symptom burden. Targeted interventions are needed to improve tiredness and drowsiness. Access provided by DEAL DE / Springer Compact Clearingstelle Uni Freiburg _}, language = {en} } @article{FleischmannHenkingSchuleretal., author = {Fleischmann, Carolin and Henking, Tanja and Schuler, Michael and Neuderth, Silke}, title = {Was wissen Fachkr{\"a}fte im Gesundheitswesen {\"u}ber Vorsorgedokumente?}, series = {DMW - Deutsche Medizinische Wochenschrift}, volume = {148}, journal = {DMW - Deutsche Medizinische Wochenschrift}, number = {14}, publisher = {Thieme}, doi = {10.1055/a-2062-8761}, pages = {e76 -- e86}, abstract = {Einleitung Vorsorgedokumente sind bedeutsame Instrumente zur Wahrung der Autonomie bei einwilligungsunf{\"a}higen Patientinnen und Patienten und werden von vielen Gesundheitsfachkr{\"a}ften in ihrer beruflichen Praxis als hilfreich angesehen. Ihr Wissen zu den Dokumenten ist jedoch unbekannt. Fehlvorstellungen k{\"o}nnen Entscheidungen am Lebensende ung{\"u}nstig beeinflussen. Diese Studie erfasst das Wissen von Gesundheitsfachkr{\"a}ften zu Vorsorgedokumenten sowie relevante Korrelate. Methoden Im Jahr 2021 erfolgte eine Befragung von Gesundheitsfachkr{\"a}ften verschiedener Berufsgruppen in W{\"u}rzburg mittels eines standardisierten Fragebogens, u.a. zu Vorerfahrungen mit, Beratung zu und Anwendung von Vorsorgedokumenten, sowie mittels eines objektiven Wissenstests mit 30 Fragen. Neben der deskriptiven Analyse der Wissensfragen wurde der Einfluss verschiedener Parameter auf den Wissensstand gepr{\"u}ft. Ergebnisse Es nahmen 363 Gesundheitsfachkr{\"a}fte aus unterschiedlichen Versorgungssettings teil, u.a. {\"A}rzte, Sozialarbeiter, Pflegefachkr{\"a}fte und Rettungsdienstpersonal. 77,5\% arbeiteten in der Patientenversorgung, wovon 39,8\% t{\"a}glich bis mehrfach pro Monat Entscheidungen auf Basis einer Patientenverf{\"u}gung trafen. Hohe Quoten inkorrekter Antworten im Wissenstest belegen Wissensl{\"u}cken zu Entscheidungen bei einwilligungsunf{\"a}higen Patienten; im Mittel wurden 18 von 30 Punkten erreicht. Signifikant bessere Ergebnisse im Wissenstest hatten {\"A}rzte, m{\"a}nnliche Gesundheitsfachkr{\"a}fte und Befragte mit mehr pers{\"o}nlicher Erfahrung mit Vorsorgedokumenten. Diskussion Die Gesundheitsfachkr{\"a}fte weisen ethisch und berufspraktisch relevante Wissensdefizite sowie einen hohen Fortbildungsbedarf zu Vorsorgedokumenten auf. Vorsorgedokumente nehmen bei der Wahrung der Patientenautonomie eine wichtige Rolle ein und sollten in der Aus- und Fortbildung unter Beteiligung nicht {\"a}rztlicher Berufsgruppen mehr Beachtung finden.}, language = {de} }