TY - JOUR A1 - Gerlich, Christian A1 - Schuler, Michael A1 - Jelitte, Matthias A1 - Neuderth, Silke A1 - Flentje, Michael A1 - Graefen, Markus A1 - Krüger, Alexander A1 - Mehnert, Anja A1 - Faller, Hermann T1 - Prostate cancer patients’ quality of life assessments across the primary treatment trajectory: true change or response shift? JF - Acta oncologica N2 - 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. Y1 - 2016 U6 - https://doi.org/10.3109/0284186X.2015.1136749 VL - 55 IS - 7 SP - 814 EP - 820 PB - Taylor&Francis Online ER - TY - JOUR A1 - Heß, Verena A1 - Meng, Karin A1 - Schulte, Thomas A1 - Neuderth, Silke A1 - Bengel, Jürgen A1 - Faller, Hermann A1 - Schuler, Michael T1 - Prevalence and predictors of cancer patients' unexpressed needs in the admission interview of inpatient rehabilitation JF - Psycho-Oncology N2 - 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. Y1 - 2020 U6 - https://doi.org/10.1002/pon.5450 SN - 1057-9249 VL - 29 IS - 10 SP - 1549 EP - 1556 PB - Wiley ER - TY - JOUR A1 - Heß, Verena A1 - Meng, Karin A1 - Schulte, Thomas A1 - Neuderth, Silke A1 - Bengel, Jürgen A1 - Jentschke, Elisabeth A1 - Zoll, Mario A1 - Faller, Hermann A1 - Schuler, Michael T1 - Unexpressed psychosocial needs in cancer patients at the beginning of inpatient rehabilitation JF - Journal of psychosocial oncology N2 - 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. Y1 - 2021 U6 - https://doi.org/10.1080/07347332.2020.1819931 VL - 39 IS - 2 SP - 173 EP - 188 PB - Taylor & Francis Online ER - TY - JOUR A1 - Heß, Verena A1 - Meng, Karin A1 - Schulte, Thomas A1 - Neuderth, Silke A1 - Bengel, Jürgen A1 - Faller, Hermann A1 - Schuler, Michael T1 - Decreased mental health, quality of life, and utilization of professional help in cancer patients with unexpressed needs: A longitudinal analysis JF - Psycho-Oncology N2 - 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. Y1 - 2022 U6 - https://doi.org/10.1002/pon.5856 VL - 31 IS - 5 SP - 725 EP - 734 PB - Wiley Online Library Open Access ER - TY - JOUR A1 - Seekatz, Bettina A1 - Jentschke, Elisabeth A1 - Lukasczik, Matthias A1 - Neuderth, Silke A1 - Schuler, Michael A1 - Orschot, von, Birgitt T1 - Identifikation nicht heilbarer Krebspatienten mit Palliativbedarf durch Screening JF - Der Onkologe N2 - Hintergrund Nach der S3-Leitlinie Palliativmedizin sollen bei Patienten mit nicht heilbaren Krebserkrankungen, unabhängig von der Durchführung einer tumorspezifischen Therapie, u. a. regelmäßig Symptome und Bedürfnisse erhoben werden. Zum Screening bieten sich palliativmedizinische Selbsteinschätzungsbögen wie z. B. die Edmonton Symptom Assessment Scale (ESAS) an, die in Kanada im Rahmen einer Qualitätsoffensive 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 für 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 mäßiger oder starker Ausprägung (ESAS-Itemwert ≥4) und benötigten damit ein genaueres klinisches Assessment und ggf. eine Intervention. Am häufigsten wurden Einschränkungen des Allgemeinbefindens, Erschöpfung und Müdigkeit, Appetitverlust oder Dyspnoe berichtet. Mindestens ein stark ausgeprägtes Symptom (ESASr-Wert ≥7) mit Interventionsbedarf zeigten 40,4 % aller Patienten. Schlussfolgerungen Ein hoher Anteil der Patienten berichtete über relevante Symptombelastung. Inwieweit klinisches Assessment und ggf. Interventionen durch die primär behandelnden Teams (allgemeine Palliativversorgung) übernommen werden können und zu welchen Zeitpunkt die Spezialisten einbezogen werden sollten, muss weiter diskutiert werden. N2 - Background The German S3 guideline on palliative care requires that symptoms and needs of patients with incurable cancerous diseases should be regularly assessed, irrespective of the tumor-specific treatment. Self-report questionnaires for palliative medicine are available for screening, such as the Edmonton Symptom Assessment Scale (ESAS), which is used in oncology centers in Canada in the context of a quality management initiative. Aims and method Implemention of the ESAS as a screening method for patients with metastases in lung cancer centers, colorectal cancer centers, in centers for neuro-oncological cancer and in the skin cancer center at the Mainfranken Comprehensive Cancer Center. Results From a total of 839 patient sceened, 79.6 % patients reported at least 1 out of 10 symptoms with moderate or severe intensity (ESAS item score ≥4), which indicates the need for a more detailed clinical assessment or intervention. The most prevalent symptoms were impairment of general well-being, fatigue and exhaustion, loss of appetite and dyspnea. Of the patients 40.4 % showed at least 1 symptom with severe intensity (ESAS score ≥7) with an ensuing need for an intervention. Conclusions A large proportion of patients reported a significant symptom burden. It should be further discussed whether clinical assessment and subsequent interventions can be provided by general palliative care teams and at what stage the inclusion of specialized teams is necessary. Access provided by DEAL DE / Springer Compact Clearingstelle Uni Freiburg _ Y1 - 2016 U6 - https://doi.org/10.1007/s00761-016-0122-5 VL - 22 IS - 11 SP - 870 EP - 877 PB - Springer Medizin ER - TY - JOUR A1 - Schuler, Michael A1 - Lukasczik, Matthias A1 - Laterveer, Hans A1 - Weilbach, Franz A1 - Presl, F. A1 - Presl, Margarete A1 - Knörzer, Jürgen A1 - Neuderth, Silke T1 - Formative Evaluation der „MBO® Kompakt-Neurowoche“ – Eine intensivierte berufsbezogene Behandlungsmaßnahme für neurologische Patienten JF - Die Rehabilitation N2 - Ziel der Studie: Die MBO® Kompakt-Neurowoche wird nach ärztlicher Zuweisung als 7-tägige berufsorientierte Reha-Maßnahme im Anschluss an eine reguläre neurologische Rehabilitation durchgeführt. Zugang, Durchführung und Outcomes werden formativ evaluiert. Methode: Prä-Post-Patientenbefragung zu fünf Zeitpunkten: Beginn reguläre Reha (T0), Beginn (T1), Ende (T2), 6 Monate (T3) und 12 Monate (T4) nach der MBOR-Maßnahme. Ergebnisse: Die N=252 Maßnahmenteilnehmer (75% Männer, 48±10 Jahre) weisen eine höhere berufsbezogene Behandlungsmotivation und eine günstigere subjektive Erwerbsprognose auf als Nichtteilnehmer (N=215). Zu T4 sind 76% (sehr) zufrieden mit der Maßnahme. Besonders hilfreich werden Angebote zur Verbesserung/Testung von Leistungsfähigkeit und Gedächtnis erlebt. Optimierungspotenzial wird in der Erarbeitung beruflicher Alternativen gesehen. Schlussfolgerungen: Die Teilnehmer haben berufliche Problemlagen bei gleichzeitig hoher Behandlungsmotivation. Die Maßnahme wird als hilfreich für die Rückkehr an den Arbeitsplatz und die Bewältigung von Arbeitsplatzproblemen angesehen. N2 - Objectives: The MBO® Kompakt-Neurowoche is offered as a work-related medical rehabilitation measure (based on allocation by a physician) following a regular neurological rehabilitation program with a duration of 7 days. Program access, process, and outcomes were examined in terms of a formative evaluation. Method: Pre-post-questionnaire data from 5 data points were used: start of regular rehabilitation (T0); start of work-related rehabilitation (T1); end of work-related rehabilitation (T2); 6-months follow-up (T3); 12-months follow-up (T4). Results: N=252 patients (75% male, 48±10 years) were included. Participants report a higher work-related treatment motivation and a more positive subjective return-to-work prognosis as compared to nonparticipants (N=215). At T4, 76% are (very) satisfied with the program. Patients rate therapy elements focusing on the assessment and improvement of work-related capacity and memory as especially useful. Assistance in developing job-related alternatives should be optimized. Conclusions: Patients participating in the work-related program report both vocational problems and a high motivation to deal with these problems during rehabilitation. The program is rated as useful with regard to return to work and the management of workplace issues. Y1 - 2016 U6 - https://doi.org/10.1055/s-0042-116582 IS - 55 SP - 312 EP - 318 PB - Georg Thieme Verlag KG CY - Stuttgart; New York ER - TY - JOUR A1 - Neuderth, Silke A1 - Schwartz, Betje A1 - Gerlich, Christian A1 - Schuler, Michael A1 - Markus, Miriam A1 - Bethge, Matthias T1 - Work-related medical rehabilitation in patients with musculoskeletal disorders: the protocol of a propensity score matched effectiveness study (EVA-WMR, DRKS00009780) JF - BMC Public Health N2 - 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). Y1 - 2016 U6 - https://doi.org/10.1186/s12889-016-3437-7 PB - BMC ER - TY - JOUR A1 - Seekatz, Bettina A1 - Lukasczik, Matthias A1 - Löhr, Mario A1 - Ehrmann, Katja A1 - Schuler, Michael A1 - Keßler, Almuth F. A1 - Neuderth, Silke A1 - Ernestus, Ralf-Ingo A1 - Oorschot, Birgitt, von T1 - 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 JF - Supportive care in cancer N2 - 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 _ Y1 - 2017 U6 - https://doi.org/10.1007/s00520-017-3687-7 VL - 25 IS - 9 SP - 2761 EP - 2770 PB - Springer CY - Berlin Heidelberg ER - TY - JOUR A1 - Fleischmann, Carolin A1 - Henking, Tanja A1 - Schuler, Michael A1 - Neuderth, Silke T1 - Was wissen Fachkräfte im Gesundheitswesen über Vorsorgedokumente? T1 - What do health care professionals know about advance directives? JF - DMW - Deutsche Medizinische Wochenschrift N2 - Einleitung Vorsorgedokumente sind bedeutsame Instrumente zur Wahrung der Autonomie bei einwilligungsunfähigen Patientinnen und Patienten und werden von vielen Gesundheitsfachkräften in ihrer beruflichen Praxis als hilfreich angesehen. Ihr Wissen zu den Dokumenten ist jedoch unbekannt. Fehlvorstellungen können Entscheidungen am Lebensende ungünstig beeinflussen. Diese Studie erfasst das Wissen von Gesundheitsfachkräften zu Vorsorgedokumenten sowie relevante Korrelate. Methoden Im Jahr 2021 erfolgte eine Befragung von Gesundheitsfachkräften verschiedener Berufsgruppen in Würzburg 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 geprüft. Ergebnisse Es nahmen 363 Gesundheitsfachkräfte aus unterschiedlichen Versorgungssettings teil, u.a. Ärzte, Sozialarbeiter, Pflegefachkräfte und Rettungsdienstpersonal. 77,5% arbeiteten in der Patientenversorgung, wovon 39,8% täglich bis mehrfach pro Monat Entscheidungen auf Basis einer Patientenverfügung trafen. Hohe Quoten inkorrekter Antworten im Wissenstest belegen Wissenslücken zu Entscheidungen bei einwilligungsunfähigen Patienten; im Mittel wurden 18 von 30 Punkten erreicht. Signifikant bessere Ergebnisse im Wissenstest hatten Ärzte, männliche Gesundheitsfachkräfte und Befragte mit mehr persönlicher Erfahrung mit Vorsorgedokumenten. Diskussion Die Gesundheitsfachkräfte 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 ärztlicher Berufsgruppen mehr Beachtung finden. N2 - Background Advance directives are important to preserve the autonomy of patients for future situations in which they are uncapable of expressing their will. They are considered helpful by many healthcare professionals in their professional practice. However, their knowledge on these documents is not well known. Misconceptions can adversely affect decisions at the end of life. This study examines healthcare professionals' knowledge of advance directives and relevant correlates. Methods In 2021 healthcare professionals from various professions and institutions in Wuerzburg were surveyed using a standardized questionnaire on previous experiences with, advice on and use of advance directives, as well as an objective knowledge test containing 30 questions. Apart from the descriptive analysis of single questions out of the knowledge test, various parameters were screened for their influence on knowledge level. Results 363 healthcare professionals from different care settings participated in the study, including physicians, social workers, nurses and emergency services personnel. 77.5% work in patient care, of which 39.8% make decisions based on living wills daily to several times a month. High rates of incorrect answers in the knowledge test show lack in knowledge about decisions concerning patients who are unable to give consent; an average of 18 out of 30 points was achieved. Physicians, male healthcare professionals and respondents with more personal experience regarding advance directives had significantly better results in the knowledge test. Conclusion Healthcare professionals have ethically and practically relevant knowledge deficits and a high need for further training on advance directives. Advance directives play an important role in maintaining patient autonomy and should receive more attention in training and further education equally involving non-medical professional groups. Y1 - 2023 U6 - https://doi.org/10.1055/a-2062-8761 VL - 148 IS - 14 SP - e76 EP - e86 PB - Thieme ER -