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Seifart C, Koch M, Herzog S, Leppin N, Nagelschmidt K, Riera Knorrenschild J, Timmesfeld N, Denz R, Seifart U, Rief W, Von Blanckenburg P. Collaborative advance care planning in palliative care: a randomised controlled trial. BMJ Support Palliat Care 2024:spcare-2023-004175. [PMID: 38960600 DOI: 10.1136/spcare-2023-004175] [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: 01/12/2023] [Accepted: 06/04/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE An effective tool for establishing concordant end-of-life (EOL) care in patients with cancer is advance care planning (ACP). However, various barriers, including psychological obstacles, hamper the access to ACP. Therefore, a new conceptual model combining a psycho-oncological approach with structured ACP was developed. The effectiveness and efficiency of this new concept of collaborative ACP (col-ACP) is evaluated in the present randomised controlled trial in patients with palliative cancer. METHODS 277 patients with palliative cancer and their relatives were randomised into three groups (1) collaborative ACP (col-ACP) consisting of a psycho-oncological approach addressing barriers to EOL conversations followed by a standardised ACP procedure, (2) supportive intervention (active control) and (3) standard medical care. RESULTS Patients in the col-ACP group completed advance directives (p<0.01) and healthcare proxies (p<0.01) significantly more often. Additionally, they felt better planned ahead for their future treatment (p<0.01) and were significantly more confident that their relatives were aware of their treatment wishes (p=0.03). In fact, their goals of care were known and highly fulfilled. However, patients' and caregivers' quality of life, patients' stress, depression and peace did not differ between the groups. CONCLUSIONS The new, well-received, concept of col-ACP improves readiness and access to ACP and results in more consistent EOL care. Further, even if no direct influence on quality of life could be proven, it supports patients in planning their treatment, making autonomous decisions and regaining self-efficacy in the face of life-limiting cancer. Therefore, a closer interlocking and information exchange between psycho-oncological and ACP services seems to be reasonable. TRIAL REGISTRATION NUMBER NCT03387436.
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Affiliation(s)
- Carola Seifart
- Faculty of Medicine; Deans Office, Philipps-Universität Marburg, Marburg, Germany
| | - Martin Koch
- Faculty of Medicine, Department Haematology and Oncology, Dresden University Hospital, Dresden, Germany
| | - Svenja Herzog
- Central Hospital of the Detention Center Hamburg, Hamburg, Germany
| | - Nico Leppin
- Faculty of Psychology, Department Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Katharina Nagelschmidt
- Faculty of Psychology, Department of Clinical Psychology and Psychotherapy, Philipps-Universitat Marburg, Marburg, Germany
| | - Jorge Riera Knorrenschild
- Faculty od Medicine; Department of Internal Medicine, Div. Haematology and Oncology, Philipps-Universitat Marburg, Marburg, Germany
| | - Nina Timmesfeld
- Department of Medical Computer Science, Biometry and Epidemiology, Ruhr University Bochum, Bochum, Germany
| | - Robin Denz
- Department of Medical Computer Science, Biometry and Epidemiology, Ruhr University Bochum, Bochum, Germany
| | | | - Winfried Rief
- Faculty od Psychology, Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Pia Von Blanckenburg
- Faculty of Psychology, Clinical Psychology and Psycohtherapy, Philipps-Universität Marburg, Marburg, Germany
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Khemai C, Leão DLL, Janssen DJA, Schols JMGA, Meijers JMM. Interprofessional collaboration in palliative dementia care. J Interprof Care 2024; 38:675-694. [PMID: 38757957 DOI: 10.1080/13561820.2024.2345828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
Interprofessional collaboration (IPC) is essential for high-quality palliative care (PC) for persons with dementia. The aim of this scoping review was to identify IPC approaches in palliative dementia care and explore the elements constituting these approaches. We performed a search in PubMed, CINAHL, and PsychINFO using the Joanna Briggs Institute Reviewers' manual and PRISMA guidelines, and conducted content analysis of the included articles. In total, 28 articles were included, which described 16 IPC approaches in palliative dementia care. The content analysis revealed three overall elements of these approaches: 1) collaborative themes, 2) collaborative processes, and 3) resources facilitating collaboration. Frequently reported collaborative themes embraced pain management and providing care in the dying phase. These themes were addressed through intertwined collaborative processes including communication, coordination, assessing and monitoring, and reflecting and evaluating. To ensure optimal IPC in palliative dementia care, various resources were required, such as PC knowledge, skills to manage symptoms, skills to communicate with collaborators, and a facilitating environment. In conclusion, the identified IPC approaches in palliative dementia care involve diverse collaborating professionals who mainly manage symptoms, prepare for the dying phase and require material and immaterial resources to enable optimal IPC in palliative dementia care.
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Affiliation(s)
- C Khemai
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - D L L Leão
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - D J A Janssen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
- Department of Research and Development, Ciro, Horn, the Netherlands
| | - J M G A Schols
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - J M M Meijers
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
- Zuyderland Care, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
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Heipon CS, Brom L, van der Linden YM, Tange D, Reyners AKL, Raijmakers NJH. Characteristics of timely integration of palliative care into oncology hospital care for patients with incurable cancer: results of a Delphi Study. Support Care Cancer 2024; 32:324. [PMID: 38700723 DOI: 10.1007/s00520-024-08508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/15/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To identify elements of timely integration of palliative care (PC) into hospital oncology care from best practices. Thereafter, to assess the level of consensus among oncology and PC specialists and patient and relative representatives on the characteristics of timely integration of PC. METHODS A three-round modified Delphi study was conducted. The expert panel consisted of 83 healthcare professionals (HCPs) from 21 Dutch hospitals (43 physicians, 40 nurses), 6 patient and 2 relative representatives. In the first round, four elements of integrated PC were considered: (1) identification of potential PC needs, (2) advance care planning (ACP), (3) routine symptom monitoring and (4) involvement of the specialist palliative care team (SPCT). In subsequent rounds, the panellists assessed which characteristics were triggers for initiating an element. A priori consensus was set at ≥ 70%. RESULTS A total of 71 (78%) panellists completed the first questionnaire, 65 (71%) the second and 49 (54%) the third. Panellists agreed that all patients with incurable cancer should have their PC needs assessed (97%), symptoms monitored (91%) and ACP initiated (86%). The SPCT should be involved at the patient's request (86%) or when patients suffer from increased symptom burden on multiple dimensions (76%). Patients with a life expectancy of less than 3 months should be offered a consultation (71%). CONCLUSION The expert panel agreed that timely integration of PC into oncology is important for all patients with incurable cancer, using early identification, ACP and routine symptom monitoring. Involvement of the SPCT is particularly needed in patients with multidimensional symptom burden and in those nearing death.
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Affiliation(s)
- Carly S Heipon
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
| | - Linda Brom
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Yvette M van der Linden
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands
| | - Dorien Tange
- Dutch Federation of Cancer Patients Organisations, Utrecht, the Netherlands
| | - Anna K L Reyners
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Natasja J H Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
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Konno R, Inoue K, Matsushita Y, Hashimoto K, Wiechula R, To T, Schultz TJ. Barriers to Advance Care Planning in Older Adults With Dementia, Their Families and Healthcare Professionals: An Umbrella Review of Qualitative Evidence. Res Aging 2024; 46:339-358. [PMID: 38242164 DOI: 10.1177/01640275241227909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
This umbrella review aimed to examine and synthesize qualitative studies that explored the barriers and facilitators of advance care planning for persons with dementia, their families, and their healthcare professionals and caregivers. The modified umbrella review approach developed by the Joanna Briggs Institute was followed. Five major English databases were searched. Four reviews based on 38 primary qualitative studies were included. The methodological quality of the included reviews was moderate to high. The synthesis yielded 16 descriptive themes and five analytical themes: making the wishes/preferences of persons with dementia visible; constructive collaboration based on stakeholders having positive relationships; emotional chaos in facing end-of-life substitute decision-making; initiating the advance care planning process; and preparedness and commitment of healthcare providers to advance care planning. Comprehensive and workable strategies are required to overcome complex and interrelated barriers involving not only healthcare professionals but also organizational and systemic challenges.
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Affiliation(s)
- Rie Konno
- Faculty of Nursing, Hyogo Medical University, Kobe-shi, Japan
| | - Kumiyo Inoue
- School of Nursing, University of Tasmania, Hobart, TAS, Australia
| | | | | | - Richard Wiechula
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | - Timothy To
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Timothy J Schultz
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
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Götze K, Feddersen B, In der Schmitten J, Marckmann G. Advance Care Planning in Germany. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 180:127-132. [PMID: 37393112 DOI: 10.1016/j.zefq.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 04/29/2023] [Accepted: 05/10/2023] [Indexed: 07/03/2023]
Abstract
Advance Care Planning (ACP) defined as a comprehensive concept requiring a cultural change following implementation at the individual, institutional and regional level in order to achieve care consistency with care preferences when individuals are incapable of participating in critical decisions was first implemented in two regional projects (LIMITS and beizeiten begleiten, North Rhine Westphalia) in Germany in the 2000s. Based on the positive evaluation of beizeiten begleiten, legislation of 2015 (§ 132g, Social Code Book V) allows nursing homes and care homes for persons with disabilities to offer qualified ACP facilitation covered by the statutory health insurance. However, trainers for ACP facilitators need no specific qualification, and the training program for ACP facilitators is only broadly defined, which resulted in great heterogeneity of ACP facilitator qualifications. Furthermore, neither the institutional nor the regional implementation are sufficiently considered in this legislation, i.e. essential components of a successful implementation of ACP are missing. Nevertheless, a growing number of initiatives, research projects and a professional national society for ACP, engage in approaches to advance institutional and regional implementation, and to offer ACP to other target groups beyond the legal framework.
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Affiliation(s)
- Kornelia Götze
- Institute of General Practice, Center for Health and Society, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
| | - Berend Feddersen
- Department of Palliative Medicine, Ludwig Maximilians University, Munich University Hospital, Munich, Germany
| | - Jürgen In der Schmitten
- Institute of Family Medicine/General Practice, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Georg Marckmann
- Institute of Ethics, History and Theory of Medicine, Ludwig Maximilians University Munich, Munich, Germany
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Aaron SP, Musacchio C, Douglas SL. Understanding Factors That Predict Advance Directive Completion. Palliat Med Rep 2022; 3:220-224. [PMID: 36876293 PMCID: PMC9983130 DOI: 10.1089/pmr.2021.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 10/14/2022] Open
Abstract
Background Advance care planning was designed for the purpose of ensuring that patients receive care at end of life (EOL) that is congruent with their wishes, goals, and values. Despite the evidence of the negative impact of not having advance directives (ADs), only one-third of adults in the United States have written ADs. Determining the patient's goals of care in the setting of metastatic cancer is vital to the delivery of high-quality healthcare. Although much is known about barriers to AD completion (e.g., the uncertainty of the disease process and trajectory, readiness of patient and family to have these discussions, and patient-provider communication barriers), little is known about the role of both patient and caregiver factors influencing AD completion. Objective This study aimed to understand the relationship between patient and family caregiver demographic characteristics, and processes, and their influence on AD completion. Design This study was a cross-sectional descriptive correlational design and employed secondary data analysis. The sample was composed of 235 patients with metastatic cancer and their caregivers. Results A logistic regression analysis was performed to analyze the relationship between predictor variables and the criterion variable of AD completion. Out of the 12 predictor variables, only 2 variables (patient age and race) predicted AD completion. Of those two predictor variables, patient age made a greater and unique contribution to explaining AD completion, compared with patient race. Conclusion There is a need for further research on cancer patients with historical low AD completion.
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Affiliation(s)
- Siobhan P Aaron
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Christine Musacchio
- Ursuline College, The Breen School of Nursing and Health Professions, Pepper Pike, Ohio, USA
| | - Sara L Douglas
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
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Pedrosa Carrasco AJ, Koch M, Machacek T, Genz A, Herzog S, Riera Knorrenschild J, von Blanckenburg P, Seifart C. ' It was like taking an inner bath': A qualitative evaluation of a collaborative advance care planning-approach. Palliat Med 2021; 35:1897-1907. [PMID: 34479460 PMCID: PMC8637376 DOI: 10.1177/02692163211043209] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Impaired readiness may hinder purposeful advance care planning in cancer patients. To reduce barriers to participation in end-of-life decision-making, a collaborative intervention was developed combining a psycho-oncological approach of dignity-based and cognitive-behavioural interventions, followed by a standardised advance care planning-process. AIM To evaluate the novel collaborative advance care planning-approach by synthetising cancer patient and carer perspectives on communicational and relational effects. DESIGN As a sub-project of a mixed-methods evaluation study, we conducted an inductive content analysis of qualitative interviews with advanced cancer patients and caregivers to deeply explore the focused impact of a collaborative advance care planning-approach on communication and relationship dynamics. SETTING/PARTICIPANTS Twelve patients with advanced cancer and 13 carers who participated in a collaborative advance care planning-intervention. RESULTS The collaborative advance care planning-approach was consistently evaluated positively by participants. Transcriptions of the semi-structured interviews were coded, analysed and merged under three main themes concerning communicational and relationship dynamics: action readiness, content readiness and impact on future communication and relationship. CONCLUSIONS The novel intervention served to foster individual readiness - including action and content readiness - for advance care planning-discussions by addressing highly individualised barriers to participation, as well as specific end-of-life issues. In addition, societal readiness could be promoted. Although the brief psycho-oncological intervention could not fully meet the needs of all participants, it can be used to develop individual psychotherapeutic strategies to improve different facets of readiness. The collaborative advance care planning-approach might require more time and human resources, but could pioneer successful advance care planning.
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Affiliation(s)
| | - Martin Koch
- Study Group Ethics in Medicine, Philipps-University Marburg, Marburg, Germany.,Department of Medicine, Haematology Division, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Teresa Machacek
- Study Group Ethics in Medicine, Philipps-University Marburg, Marburg, Germany
| | - Anna Genz
- Study Group Ethics in Medicine, Philipps-University Marburg, Marburg, Germany
| | - Svenja Herzog
- Study Group Ethics in Medicine, Philipps-University Marburg, Marburg, Germany
| | - Jorge Riera Knorrenschild
- Department of Haematology, Oncology and Immunology, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Carola Seifart
- Study Group Ethics in Medicine, Philipps-University Marburg, Marburg, Germany
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Betker L, Nagelschmidt K, Leppin N, Knorrenschild JR, Volberg C, Berthold D, Sibelius U, Rief W, Barke A, von Blanckenburg P, Seifart C. The Difficulties in End-of-Life Discussions - Family Inventory (DEOLD-FI): Development and Initial Validation of a Self-Report Questionnaire in a Sample of Terminal Cancer Patients. J Pain Symptom Manage 2021; 62:e130-e138. [PMID: 33933622 DOI: 10.1016/j.jpainsymman.2021.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/21/2022]
Abstract
CONTEXT Open end-of-life communication is especially important within the patient-family unit of care and can positively affect their medical, psychological, and relational outcomes. Nevertheless, end-of-life discussions are often perceived as difficult and avoided. OBJECTIVES To develop and validate the Difficulties in End-of-Life Discussions - Family Inventory (DEOLD-FI) to allow a systematic assessment of reasons why people shy away from end-of-life discussions. METHODS Patients with advanced cancer were recruited and completed the DEOLD-FI and measures of avoidance of cancer communication, quality of life and distress, and the experienced difficulty as well as the occurrence of end-of-life discussions. Standard item analyses and an exploratory factor analysis were conducted. Construct validity was analysed through associations between the DEOLD-FI and the aforementioned measures. RESULTS Questionnaires were obtained from 112 participants (53% response rate; male 54%, mean age 64.9 years [range 33-94]). In the final 23-item version two factors were extracted: 'emotional burden due to end-of-life discussions' (α = 0.90) and "negative attitudes towards end-of-life discussions" (α = 0.91) explaining 69% of the variance (total scale α = 0.93). Construct validity was supported by its significant correlations with the reported difficulty in end-of-life discussions (r = 0.42) and avoidance of cancer communication (r = 0.40 to r = 0.46) and insignificant correlations with quality of life (r = -0.11), distress (r = 0.16), and physical well-being (r = 0.02). Those who had already engaged in end-of-life discussions showed significantly fewer communication barriers. CONCLUSION Results provide evidence that the DEOLD-FI is a valid and reliable instrument for the assessment of difficulties in end-of-life discussions. Benefits for clinical practice and research are discussed.
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Affiliation(s)
- Liv Betker
- Department of Clinical Psychology and Psychotherapy (L.B., K.N., N.L., W.R., P.V.B.), Philipps-University Marburg, Marburg, Germany.
| | - Katharina Nagelschmidt
- Department of Clinical Psychology and Psychotherapy (L.B., K.N., N.L., W.R., P.V.B.), Philipps-University Marburg, Marburg, Germany
| | - Nico Leppin
- Department of Clinical Psychology and Psychotherapy (L.B., K.N., N.L., W.R., P.V.B.), Philipps-University Marburg, Marburg, Germany
| | - Jorge Riera Knorrenschild
- Department of Internal Medicine, Division Haematology and Oncology (R.K.), University Hospital of Giessen and Marburg, Marburg Site, Germany
| | - Christian Volberg
- Faculty of Medicine, Deans Office, Research Group Medical Ethics (C.V., C.S.), Philipps-University Marburg, Marburg, Germany
| | - Daniel Berthold
- Department of Clinical Oncology and Palliative Care (D.B., U.S.), University Hospital of Giessen and Marburg, Giessen Site, Germany
| | - Ulf Sibelius
- Department of Clinical Oncology and Palliative Care (D.B., U.S.), University Hospital of Giessen and Marburg, Giessen Site, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy (L.B., K.N., N.L., W.R., P.V.B.), Philipps-University Marburg, Marburg, Germany
| | - Antonia Barke
- Department of Psychology (A.B.), Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy (L.B., K.N., N.L., W.R., P.V.B.), Philipps-University Marburg, Marburg, Germany
| | - Carola Seifart
- Faculty of Medicine, Deans Office, Research Group Medical Ethics (C.V., C.S.), Philipps-University Marburg, Marburg, Germany
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