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Wang H, Jia J, Fan Y, Chen H, Lou Y, Wang X, Huang X. Impact of inpatient self-efficacy and trust in physicians on inpatient satisfaction with medical services: the mediating role of patient participation in medical decision-making. Front Psychol 2024; 15:1364319. [PMID: 39282672 PMCID: PMC11392843 DOI: 10.3389/fpsyg.2024.1364319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024] Open
Abstract
Objective Patient satisfaction reflects the social benefits of hospitals and is an important indicator of hospital performance. This study explores the mechanism through which inpatients' trust in physicians, self-efficacy, and participation in medical decision-making impact their satisfaction with medical services. Methods A questionnaire was administered to 814 inpatients in 10 randomly selected tertiary hospitals and 10 randomly selected secondary hospitals in Hangzhou, China. A correlation analysis and hierarchical linear regression were conducted to analyze the factors influencing inpatient satisfaction. Results The outcome measures of trust in physicians and participation in medical decision-making behaviors had significant positive effects on inpatient satisfaction.Trust in physicians was shown to directly influence inpatient satisfaction, while inpatient participation in decision-making partially mediated this relationship. Inpatient participation in medical decision-making fully mediated the relationship between self-efficacy and inpatient satisfaction. Conclusion While inpatients were relatively satisfied, there is room for improvement. Healthcare providers should improve patient trust by actively listening to their needs and providing feedback, establishing effective communication mechanisms. Patient self-efficacy can be enhanced through health education, special lectures, and case sharing. Patients should also be encouraged to actively participate in medical decision-making. Practical implications Based on inpatient feedback during a preliminary survey, we refined this study's questionnaire to enhance its feasibility for future research. This article shares key findings for healthcare managers and providers, advising that patient satisfaction can be enhanced through trust, self-efficacy, and participation.
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Affiliation(s)
- Haixia Wang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Jie Jia
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yafeng Fan
- Nursing Laboratory, School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Hanlin Chen
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yi Lou
- Department of Scientific Research, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xiaohe Wang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Xianhong Huang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
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Fahmer N, Faller H, Wöckel A, Salmen J, Heuschmann PU, Meng K. Patients' perceived challenges, competencies, and supportive care needs during acute clinical treatment of breast or gynecological cancer. Psychooncology 2023; 32:682-691. [PMID: 36790934 DOI: 10.1002/pon.6112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/15/2022] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE This study aimed to examine challenges, competencies, and supportive care needs (SCN) of women with breast or gynecological cancer during acute cancer treatment and associations to other health-related variables. METHODS We surveyed 120 patients with breast or gynecological cancer at the end of acute cancer treatment, either directly after surgery or during adjuvant chemotherapy. We assessed challenges, subjective competencies, and SCN using a self-developed measure comprising 25 items referring to coping tasks assigned to six domains. In addition, patients' competencies and health literacy (HL) were assessed. RESULTS Most patients felt at least moderately challenged by coping tasks concerning psychological distress (e.g., dealing with fears and insecurities, 70.2%; coping with cancer diagnosis, 69.6%) and physical complaints (e.g., dealing with a reduced physical capacity, 56.6%). About 42.5%-71.4% of patients who evaluated coping tasks as highly challenging felt competent to deal with these challenges themselves. Less than half of patients reported SCN, mainly regarding psychological concerns. The extent of challenging coping tasks, patients' perceived ability to overcome challenges themselves, and SCN showed associations to patient competencies and HL. CONCLUSIONS SCN regarding psychological concerns and health behavior should be addressed in acute cancer care and rehabilitation programs. In addition, promoting HL might be essential in strengthening patients' subjective competencies related to various coping tasks.
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Affiliation(s)
- Natascha Fahmer
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Hermann Faller
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Jessica Salmen
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg, Würzburg, Germany.,Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Karin Meng
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
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Grapp M, Rosenberger F, Hemlein E, Klein E, Friederich HC, Maatouk I. Acceptability and Feasibility of a Guided Biopsychosocial Online Intervention for Cancer Patients Undergoing Chemotherapy. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:102-110. [PMID: 32557164 PMCID: PMC8816767 DOI: 10.1007/s13187-020-01792-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Chemotherapy is a physically and psychologically highly demanding treatment, and specific Internet-based interventions for cancer patients addressing both physical side effects and emotional distress during chemotherapy are scarce. This study examined the feasibility and acceptability of a guided biopsychosocial online intervention for cancer patients undergoing chemotherapy (OPaCT). A pre-post, within-participant comparison, mixed-methods research design was followed. Patients starting chemotherapy at the outpatient clinic of the National Center for Tumor Diseases in Heidelberg, Germany, were enrolled. Feasibility and acceptability were evaluated through intervention uptake, attrition, adherence and participant satisfaction. As secondary outcomes, PHQ-9, GAD-7, SCNS-SF34-G and CBI-B-D were administered. A total of N = 46 patients participated in the study (female 76.1%). The age of participants ranged from 29 to 70 years (M = 49.3, SD = 11.3). The most prevalent tumour diseases were breast (45.7%), pancreatic (19.6%), ovarian (13.1%) and prostate cancer (10.8%). A total of N = 37 patients (80.4%) completed the OPaCT intervention. Qualitative and quantitative data showed a high degree of participant satisfaction. Significant improvements in the SCNS-SF34 subscale 'psychological needs' were found. Study results demonstrate the feasibility and acceptability of the intervention. The results show that OPaCT can be implemented well, both in the treatment process and in participants' everyday lives. Although it is premature to make any determination regarding the efficacy of the intervention tested in this feasibility study, these results suggest that OPaCT has the potential to reduce unmet psychological care needs of patients undergoing chemotherapy.
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Affiliation(s)
- Miriam Grapp
- Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- Psycho-oncology Service, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Friederike Rosenberger
- Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Elena Hemlein
- Social Service, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Eva Klein
- Nursing Service, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Imad Maatouk
- Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- Psycho-oncology Service, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
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Giesler JM, Weis J, Caspari R, Dauelsberg T, Hoffmann W, Körber J, Bartsch HH. Patient competencies, coping self-efficacy, and coping: Do they change during oncological inpatient rehabilitation and beyond? Psychooncology 2021; 31:577-586. [PMID: 34676636 DOI: 10.1002/pon.5839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The construct of Patient Competencies (PCs) has been suggested to allow a more comprehensive understanding of cancer patients' abilities to confront emotion- and problem-focused coping tasks arising from the diagnosis, treatment and survivorship of cancer. While providing a reliable and valid measure of PCs, research thus far has not clarified whether PCs change across time and/or through intervention. This study asks whether PCs change during oncological inpatient rehabilitation and beyond. METHODS N = 377 breast, colorectal, and prostate cancer patients from clinics for oncological rehabilitation were included to complete self-report measures of PC, coping and self-efficacy for coping with cancer at the beginning and the end of rehabilitation and 9 months afterward. In order to determine differences between tumor diagnostic groups and changes across time 3 (tumor site) x 3 (time) repeated measures analyses of variance were computed. RESULTS Tumor diagnostic groups differed only marginally in PCs, coping self-efficacy and coping. The PCs of self-regulation and managing distress and coping self-efficacy improved slightly during rehabilitation but returned to initial levels at 9 months. Differential improvement was evident in the competencies of seeking information and interest in social services. Two of five coping behaviors decreased markedly from the end of rehabilitation to follow-up. CONCLUSIONS This study suggests that oncological inpatient rehabilitation may contribute to advancing PCs, albeit to a limited extent. Aside from addressing conceptual, diagnostic and measurement issues, future research should clarify which interventions may be most effective for advancing problem- and emotion-focused PCs.
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Affiliation(s)
- Juergen M Giesler
- Section of Health Services Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, University of Freiburg Medical Center, Freiburg, Germany
| | - Joachim Weis
- Department of Self-Help Research, Comprehensive Cancer Center, University of Freiburg Medical Center, Freiburg, Germany
| | - Reiner Caspari
- Niederrhein Center for Oncological Rehabilitation, Bad Neuenahr-Ahrweiler, Germany
| | - Timm Dauelsberg
- Center for Oncological Rehabilitation at the Tumor Biology Center, University of Freiburg Medical Center, Freiburg, Germany
| | - Wilfried Hoffmann
- Park Therme Center for Oncological Rehabilitation, Hamm-Kliniken GmbH, Badenweiler, Germany
| | - Jürgen Körber
- Nahetal Center for Oncological Rehabilitation, Hamm-Kliniken GmbH, Bad Kreuznach, Germany
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Giesler JM, Weis J. Patient competence in the context of cancer: its dimensions and their relationships with coping, coping self-efficacy, fear of progression, and depression. Support Care Cancer 2020; 29:2133-2143. [PMID: 32875374 PMCID: PMC7892518 DOI: 10.1007/s00520-020-05699-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/19/2020] [Indexed: 12/23/2022]
Abstract
Purpose Influenced in part by research on coping, patient empowerment and self-efficacy, and by patient self-help initiatives, the construct of patient competencies (PC) has been elaborated and later integrated into Germany’s National Cancer Plan. As a self-report measure of PC, the Patient Competence Questionnaire 57 (PCQ-57) has only rarely been evaluated psychometrically. Therefore, we aimed to re-examine its dimensionality and its relationships with related constructs and potential psychosocial cancer outcomes. Methods We surveyed 424 breast, colorectal, and prostate cancer patients from clinics for oncological rehabilitation and private oncology practices who completed the PCQ-57 and self-report measures of coping, coping self-efficacy, fear of progression, and depression. Patients’ PCQ-57 responses were submitted to principal axis factor analyses. Using the original scoring keys, we computed internal consistencies (Cronbach’s α) and Pearson correlations between all measures. Results Factor analyses suggested 5 of the 8 original PCQ-57 dimensions to replicate satisfactorily, their internal consistencies ranging from 0.74 to 0.88. The competency of managing distress correlated significantly, highly, and negatively with fear of progression and depression (|r’s| ≥ 0.43) and positively with coping self-efficacy (r = 0.58). Conclusion The results support the reliability and validity of 5 of the 8 original PCQ-57 scales while suggesting refinement of the others. The replicated scales may help identify patients in need of support for dealing with the multiple tasks of adjusting to cancer. Further research should clarify the conceptual and empirical relationships between PC, health literacy, and patient activation as well as potential effects of PC on psychosocial cancer outcomes. Electronic supplementary material The online version of this article (10.1007/s00520-020-05699-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jürgen M Giesler
- Section of Health Care Research and Rehabilitation Research, University of Freiburg Medical Center, Hugstetter Str. 49, D 79106, Freiburg, Germany.
| | - Joachim Weis
- Comprehensive Cancer Center, Department of Self-Help Research, University of Freiburg Medical Center, Freiburg, Germany
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Psychoeducational group intervention for breast cancer survivors: a non-randomized multi-center pilot study. Support Care Cancer 2019; 28:3033-3040. [DOI: 10.1007/s00520-019-05076-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
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[Development and validation of a questionnaire for patient competence in coping with cancer (PCQ)]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2019; 65:239-256. [PMID: 31476991 DOI: 10.13109/zptm.2019.65.3.239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Development and validation of a questionnaire for patient competence in coping with cancer (PCQ) Objectives: The aim of the study was the development and evaluation of the psychometric properties of a self-assessment questionnaire for resource-orientated coping with cancer (Patient Competence Questionnaire, PCQ). Methods: In 420 patients and members of cancer support-groups item selection and evaluation of item properties, reliability (Cronbach's Alpha), validity (convergent and divergent) and factorial structure were performed in two studies. Results: The final version of the PCQ (18 items) demonstrated a Cronbach's Alpha between 0.71 and 0.91 for five subscales identified with exploratory factor analysis (religious/spiritual coping, coping competence, healthy lifestyle, information seeking, adaptability) and 0.85 for the total score. The PCQ shows a high convergent validity (r = 0.46) with the Freiburg Questionnaire on Coping with Illness (FKV) and significant correlations with depression (r = -0.23), posttraumatic growth (r = 0.65) and religiosity (r = 0.59). Conclusions: First analyses underline that the PCQ can be regarded as a valid and reliable instrument for assessing patients' resources in dealing with cancer.
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Poss-Doering R, Kunz A, Pohlmann S, Hofmann H, Kiel M, Winkler EC, Ose D, Szecsenyi J. Utilizing a Prototype Patient-Controlled Electronic Health Record in Germany: Qualitative Analysis of User-Reported Perceptions and Perspectives. JMIR Form Res 2018; 2:e10411. [PMID: 30684411 PMCID: PMC6334712 DOI: 10.2196/10411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 01/26/2023] Open
Abstract
Background Personal electronic health records (PHR) are considered instrumental in improving health care quality and efficiency, enhancing communication between all parties involved and strengthening the patient’s role. Technical architectures, data privacy, and applicability issues have been discussed for many years. Nevertheless, nationwide implementation of a PHR is still pending in Germany despite legal regulations provided by the eHealth Act passed in 2015. Within the information technology for patient-oriented care project funded by the Federal Ministry of Education and Research (2012-2017), a Web-based personal electronic health record prototype (PEPA) was developed enabling patient-controlled information exchange across different care settings. Gastrointestinal cancer patients and general practitioners utilized PEPA during a 3-month trial period. Both patients and physicians authorized by them could view PEPA content online and upload or download files. Objective This paper aims to outline findings of the posttrial qualitative study carried out to evaluate user-reported experiences, perceptions, and perspectives, focusing on their interpretation of PEPA beyond technical usability and views on a future nationwide implementation. Methods Data were collected through semistructured guide-based interviews with 11 patients and 3 physicians (N=14). Participants were asked to share experiences, views of perceived implications, and perspectives towards nationwide implementation. Further data were generated through free-text fields in a subsequent study-specific patient questionnaire and researcher’s notes. Data were pseudonymized, audiotaped, and transcribed verbatim. Content analysis was performed through the Framework Analysis approach. All qualitative data were systemized by using MAXQDA Analytics PRO 12 (Rel.12.3.1). Additionally, participant characteristics were analyzed descriptively using IBM SPSS Statistics Version 24. Results Users interpreted PEPA as a central medium containing digital chronological health-related documentation that simplifies information sharing across care settings. While patients consider the implementation of PEPA in Germany in the near future, physicians are more hesitant. Both groups believe in PEPA’s concept, but share awareness of concerns about data privacy and older or impaired people’s abilities to manage online records. Patients perceive benefits for involvement in treatment processes and continuity of care but worry about financing and the implementation of functionally reduced versions. Physicians consider integration into primary systems critical for interoperability but anticipate technical challenges, as well as resistance from older patients and colleagues. They omit clear positioning regarding PEPA’s potential incremental value for health care organizations or the provider-patient relationship. Conclusions Digitalization in German health care will continue to bring change, both organizational and in the physician-patient relationship. Patients endorse and expect a nationwide PEPA implementation, anticipating various benefits. Decision makers and providers need to contribute to closing modernization gaps by committing to new concepts and by invigorating transformed roles.
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Affiliation(s)
- Regina Poss-Doering
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Aline Kunz
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Sabrina Pohlmann
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Helene Hofmann
- Ethics and Patient-Oriented Care, National Centre for Tumor Diseases, Heidelberg, Germany
| | - Marion Kiel
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Eva C Winkler
- Ethics and Patient-Oriented Care, National Centre for Tumor Diseases, Heidelberg, Germany
| | - Dominik Ose
- Division of Cancer Population Science, Department of Population Health Services, University of Utah, Salt Lake City, UT, United States
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Giesler JM, Keller B, Repke T, Leonhart R, Weis J, Muckelbauer R, Rieckmann N, Müller-Nordhorn J, Lucius-Hoene G, Holmberg C. Effect of a Website That Presents Patients' Experiences on Self-Efficacy and Patient Competence of Colorectal Cancer Patients: Web-Based Randomized Controlled Trial. J Med Internet Res 2017; 19:e334. [PMID: 29030329 PMCID: PMC5660297 DOI: 10.2196/jmir.7639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/29/2017] [Accepted: 07/14/2017] [Indexed: 12/19/2022] Open
Abstract
Background Patients often seek other patients’ experiences with the disease. The Internet provides a wide range of opportunities to share and learn about other people’s health and illness experiences via blogs or patient-initiated online discussion groups. There also exists a range of medical information devices that include experiential patient information. However, there are serious concerns about the use of such experiential information because narratives of others may be powerful and pervasive tools that may hinder informed decision making. The international research network DIPEx (Database of Individual Patients’ Experiences) aims to provide scientifically based online information on people’s experiences with health and illness to fulfill patients’ needs for experiential information, while ensuring that the presented information includes a wide variety of possible experiences. Objective The aim is to evaluate the colorectal cancer module of the German DIPEx website krankheitserfahrungen.de with regard to self-efficacy for coping with cancer and patient competence. Methods In 2015, a Web-based randomized controlled trial was conducted using a two-group between-subjects design and repeated measures. The study sample consisted of individuals who had been diagnosed with colorectal cancer within the past 3 years or who had metastasis or recurrent disease. Outcome measures included self-efficacy for coping with cancer and patient competence. Participants were randomly assigned to either an intervention group that had immediate access to the colorectal cancer module for 2 weeks or to a waiting list control group. Outcome criteria were measured at baseline before randomization and at 2 weeks and 6 weeks Results The study randomized 212 persons. On average, participants were 54 (SD 11.1) years old, 58.8% (124/211) were female, and 73.6% (156/212) had read or heard stories of other patients online before entering the study, thus excluding any influence of the colorectal cancer module on krankheitserfahrungen.de. No intervention effects were found at 2 and 6 weeks after baseline. Conclusions The results of this study do not support the hypothesis that the website studied may increase self-efficacy for coping with cancer or patient competencies such as self-regulation or managing emotional distress. Possible explanations may involve characteristics of the website itself, its use by participants, or methodological reasons. Future studies aimed at evaluating potential effects of websites providing patient experiences on the basis of methodological principles such as those of DIPEx might profit from extending the range of outcome measures, from including additional measures of website usage behavior and users’ motivation, and from expanding concepts, such as patient competency to include items that more directly reflect patients’ perceived effects of using such a website. Trial Registration Clinicaltrials.gov NCT02157454; https://clinicaltrials.gov/ct2/show/NCT02157454 (Archived by WebCite at http://www.webcitation.org/6syrvwXxi)
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Affiliation(s)
- Jürgen M Giesler
- Section of Health Services Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bettina Keller
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tim Repke
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Hasso-Plattner-Institute, Potsdam, Germany
| | - Rainer Leonhart
- Department of Psychology, University of Freiburg, Freiburg, Germany
| | - Joachim Weis
- Clinic for Oncological Rehabilitation, UKF Reha, Department of Psycho-Oncology, University Clinic Center, Freiburg, Germany
| | - Rebecca Muckelbauer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nina Rieckmann
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jacqueline Müller-Nordhorn
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Christine Holmberg
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Ose D, Kunz A, Pohlmann S, Hofmann H, Qreini M, Krisam J, Uhlmann L, Jacke C, Winkler EC, Salize HJ, Szecsenyi J. A Personal Electronic Health Record: Study Protocol of a Feasibility Study on Implementation in a Real-World Health Care Setting. JMIR Res Protoc 2017; 6:e33. [PMID: 28254735 PMCID: PMC5355628 DOI: 10.2196/resprot.6314] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/18/2016] [Accepted: 01/13/2017] [Indexed: 12/14/2022] Open
Abstract
Background A significant potential for patient empowerment is seen in concepts aiming to give patients access to their personal health information (PHI) and to share this PHI across different care settings and health systems. Personal health records (PHRs) and the availability of information through health information exchanges are considered to be key components of effective and efficient health care. With tethered PHRs, as often used in the United States, patients’ opportunities to manage their PHI are strongly restricted. Therefore, within the INFOPAT (information technology for patient oriented care) project (2012-2016) in Germany, funded by the Federal Ministry of Education and Research (BMBF), the development of a patient-controlled “personal electronic health record” (PEPA) was based on user requirements right from the beginning. Objective The overall objective of the study is to implement and evaluate a PEPA prototype for patients with colorectal cancer who are treated at the National Center for Tumor Diseases in Heidelberg. To achieve this aim, this study has 2 parts: a pre-implementation study (phase 1) and an implementation study (phase 2). The pre-implementation study will include a usability evaluation of the PEPA approach and the consideration of organizational preconditions for the implementation. With the implementation study, we will evaluate the process of implementation (eg, barriers or facilitators), the need for organizational change (eg, processes of communication), and the impact on outcomes (eg, self-efficacy, involvement in care). Methods The pre-implementation study is based on a mixed methods approach and comprises qualitative and quantitative element according to our research aim. We will use a think-aloud method for the usability analysis. Additionally, participants will be asked to evaluate their overall satisfaction based on a standardized questionnaire, the System Usability Scale. For the analysis of preconditions, we will conduct semistructured personal interviews with, for example, patients, medical assistants, and physicians. Within the implementation study the outcome evaluation is planned as a prospective, 3-month, open-label “before and after” trial. Additionally, for the analysis of processes and the need for organizational change, we will conduct interviews with the participants (eg, patients, general practitioners, physicians) of the before and after trial. Results This project is part of the INFOPAT project, which is funded (2012-2016) by the Federal Ministry of Education and Research (BMBF). The enrolment was completed in July 2016. Data analysis is currently under way and the first results are expected to be submitted for publication at end of 2017. Conclusions Existing approaches of PHRs aim to give patients access to their treatment data. With the PEPA approach and this study, we go a step further: patients have access to their PHI and they can give other persons (eg, their general practitioner) access. With this approach, new possibilities for professional collaboration and the engagement of patients can arise.
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Affiliation(s)
- Dominik Ose
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.,Health System Innovation and Research, Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Aline Kunz
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Sabrina Pohlmann
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Helene Hofmann
- Ethics and Patient-Oriented Care, National Centre for Tumor Diseases (NCT), Heidelberg, Germany
| | - Markus Qreini
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes Krisam
- Institute for Medical Biometry and Informatics, Department of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute for Medical Biometry and Informatics, Department of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Jacke
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Eva C Winkler
- Ethics and Patient-Oriented Care, National Centre for Tumor Diseases (NCT), Heidelberg, Germany
| | - Hans-Joachim Salize
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Developing and implementing a complex Complementary and Alternative (CAM) nursing intervention for breast and gynecologic cancer patients undergoing chemotherapy—report from the CONGO (complementary nursing in gynecologic oncology) study. Support Care Cancer 2015; 24:2341-2350. [DOI: 10.1007/s00520-015-3038-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 11/23/2015] [Indexed: 02/07/2023]
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Groen WG, Kuijpers W, Oldenburg HS, Wouters MW, Aaronson NK, van Harten WH. Empowerment of Cancer Survivors Through Information Technology: An Integrative Review. J Med Internet Res 2015; 17:e270. [PMID: 26614438 PMCID: PMC4704924 DOI: 10.2196/jmir.4818] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/28/2015] [Accepted: 10/26/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patient empowerment may be an effective approach to strengthen the role of cancer survivors and to reduce the burden on health care. However, it is not well conceptualized, notably in oncology. Furthermore, it is unclear to what extent information technology (IT) services can contribute to empowerment of cancer survivors. OBJECTIVE We aim to define the conceptual components of patient empowerment of chronic disease patients, especially cancer survivors, and to explore the contribution of existing and new IT services to promote empowerment. METHODS Electronic databases were searched to identify theoretical and empirical articles regarding empowerment. We extracted and synthesized conceptual components of patient empowerment (ie, attributes, antecedents, and consequences) according to the integrated review methodology. We identified recent IT services for cancer survivors by examining systematic reviews and a proposed inventory of new services, and we related their features and effects to the identified components of empowerment. RESULTS Based on 26 articles, we identified five main attributes of patient empowerment: (1) being autonomous and respected, (2) having knowledge, (3) having psychosocial and behavioral skills, (4) perceiving support from community, family, and friends, and (5) perceiving oneself to be useful. The latter two were specific for the cancer setting. Systematic reviews of IT services and our additional inventory helped us identify five main categories: (1) educational services, including electronic survivorship care plan services, (2) patient-to-patient services, (3) electronic patient-reported outcome (ePRO) services, (4) multicomponent services, and (5) portal services. Potential impact on empowerment included knowledge enhancement and, to a lesser extent, enhancing autonomy and skills. Newly developed services offer promising and exciting opportunities to empower cancer survivors, for instance, by providing tailored advice for supportive or follow-up care based on patients' input. CONCLUSIONS We identified five main components of empowerment and showed that IT services may especially contribute to empowerment by providing knowledge. The components of empowerment could be used to develop IT services for cancer survivors. It is important to take into account patients' needs, follow up on these needs, and create a service that is attractive and easy to use.
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Affiliation(s)
- Wim G Groen
- The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, Netherlands
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Klafke N, Mahler C, von Hagens C, Rochon J, Schneeweiss A, Müller A, Salize HJ, Joos S. A complex nursing intervention of complementary and alternative medicine (CAM) to increase quality of life in patients with breast and gynecologic cancer undergoing chemotherapy: study protocol for a partially randomized patient preference trial. Trials 2015; 16:51. [PMID: 25887713 PMCID: PMC4337273 DOI: 10.1186/s13063-014-0538-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 12/19/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is most adversely affected in cancer patients between diagnosis and the end of chemotherapy. The aim of the Complementary Nursing in Gynecologic Oncology (CONGO) study is to assess the effectiveness of a complex nursing care intervention of CAM to increase HRQoL in cancer patients undergoing chemotherapy. METHODS/DESIGN CONGO is a prospective partially randomized patient preference (PRPP) trial including adult women diagnosed with breast and gynecologic cancer starting a new chemotherapy regimen. Patients without strong preferences for CAM will be randomized to usual nursing care or complex nursing care; those patients with strong preferences will be allowed their choice. The intervention consists of three interacting and intertwined elements: CAM nursing intervention packet, counseling on CAM using a resource-oriented approach and evidence-based informational material on CAM. Primary outcome data on participants' HRQoL will be collected from baseline until the end of treatment and long-term follow-up using the EORTC-QLQ-C30. Secondary outcomes include nausea, fatigue, pain, anxiety/depression, social support, self-efficacy, patient competence, spiritual wellbeing, and satisfaction with care. Accompanying research on economic outcomes as well as a mixed-methods process evaluation will be conducted. A total of 590 patients (236 patients in the randomized part of the study and 354 patients in the observational part of the study) will be recruited in the two outpatient clinics. The first analysis step will be the intention-to-treat (ITT) analysis of the randomized part of the trial. A linear mixed model will be used to compare the continuous primary endpoint between the intervention and control arm of the randomized group. The observational part of the trial will be analyzed descriptively. External validity will be assessed by comparing randomized with nonrandomized patients. DISCUSSION Cancer patients are increasingly using CAM as supportive cancer care, however, a patient-centered model of care that includes CAM for the patient during chemotherapy still needs to be evaluated. This protocol has been designed to test if the effects of the intervention go beyond potential benefits in quality-of-life outcomes. TRIAL REGISTRATION German Clinical Trials Register (DRKS), DRKS00006056 (15 April 2014).
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Affiliation(s)
- Nadja Klafke
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstr. 2, D-69115, Heidelberg, Germany.
| | - Cornelia Mahler
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstr. 2, D-69115, Heidelberg, Germany.
| | - Cornelia von Hagens
- Department of Gynaecological Endocrinology and Reproductive Medicine, University Women's Hospital Heidelberg, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany.
| | - Justine Rochon
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, D-69120, Heidelberg, Germany.
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital, Im Neuenheimer Feld 460, D-69120, Heidelberg, Germany.
| | - Andreas Müller
- Community Hospital Karlsruhe, Moltkestraße 90, D-76133, Karlsruhe, Germany.
| | - Hans-Joachim Salize
- Central Institute of Mental Health, Mental Health Services Research Group, Medical Faculty Mannheim/Heidelberg University, Mannheim, D-68159, Germany.
| | - Stefanie Joos
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstr. 2, D-69115, Heidelberg, Germany. .,Institute of General Practice, University Hospital Tuebingen, Oesterbergstr. 9, D-72074, Tuebingen, Germany.
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Assessment of proximal outcomes of self-management programs: translation and psychometric evaluation of a German version of the Health Education Impact Questionnaire (heiQ™). Qual Life Res 2012; 22:1391-403. [PMID: 22987145 DOI: 10.1007/s11136-012-0268-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE This paper describes the translation, cultural adaption, and psychometric evaluation of a German version of the Health Education Impact Questionnaire (heiQ™), a widely used generic instrument assessing a wide range of proximal outcomes of self-management programs. METHODS The translation was carried out according to international standards and included forward and backward translations. Comprehensibility and content validity were tested using cognitive interviews with 10 rehabilitation inpatients. Psychometric properties were examined in rehabilitation inpatients (n = 1,202) with a range of chronic conditions. Factorial validity was assessed using confirmatory factor analysis; concurrent validity was explored by correlations with comparator scales. RESULTS The items of the German heiQ™ were well understood by rehabilitation inpatients. The structure of the eight heiQ™ scales was replicated after minor adjustment. heiQ™ scales had higher correlations with comparator scales with similar constructs, particularly mental health concepts than with physical health. Moreover, all heiQ™ scales differentiated between individuals across different levels of depression. CONCLUSION The German heiQ™ is comprehensible for German-speaking patients suffering from different types of chronic conditions; it assesses relevant outcomes of self-management programs in a reliable and valid manner. Further studies involving its practical application are warranted.
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Künstlerische Therapien in der Onkologie - wissenschaftlicher Kenntnisstand und Ergebnisse einer Studie. ACTA ACUST UNITED AC 2011. [DOI: 10.13109/muum.2011.32.3.206] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Weis J, Giesler JM. Subjective dimensions of patient competence: relationships with selected healthcare usage behaviors and general features of self-rated competence. PATIENT EDUCATION AND COUNSELING 2008; 73:511-518. [PMID: 18952394 DOI: 10.1016/j.pec.2008.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Revised: 06/04/2008] [Accepted: 07/04/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To introduce the concept of patient competence and provide additional information on the concurrent validity of a new self-rating measure of patient competence in the context of cancer employing healthcare usage behaviors and more general self-rated features of patient competence as criteria. METHODS Based on a multi-center sample of n=536 patients with cancer, bivariate correlations and multiple regressions were computed. RESULTS The competence subscale of striving for autonomous decisions emerged as significant, albeit weak predictor of having used professional psycho-social support (r=.31, beta=.28) and employing other complementary medicines (r=.28; B=.65) in relation to one's cancer. Problem-focused and emotion-focused competencies relate differently to different general features of self-rated competence like feeling informed and assertive or adapting well. CONCLUSION Additional support for the concurrent validity of the new self-rating measure of patient competence in the context of cancer has been found. Viewed in perspective, this measure may therefore provide a methodological basis to examine determinants and health effects of patient competence empirically. Nevertheless, further research on the conceptualization and measurement of patient competence appears necessary. PRACTICE IMPLICATIONS Having available measures of patients' specific competencies in the context of cancer will help identify their strength and weaknesses in dealing with life-threatening disease and enhance their coping resources.
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Affiliation(s)
- Joachim Weis
- Tumor Biology Center, Freiburg, Freiburg, Germany.
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