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Jung JY, Ko KA, Strauss FJ, Lee JH, Kim JH, Lee JS. Patient-Centred Preferences for Autonomy and Information-Seeking Among Periodontal Patients in Dental Decision Making. J Clin Periodontol 2025. [PMID: 40237198 DOI: 10.1111/jcpe.14166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 03/05/2025] [Accepted: 03/31/2025] [Indexed: 04/18/2025]
Abstract
BACKGROUND AND AIM Managing periodontal disease often involves complex decisions involving multiple treatment options, and patient autonomy significantly influences this decision-making process. This study aimed to characterise the autonomy and information-seeking preferences among patients diagnosed with stage III/IV periodontitis, and to identify the factors influencing these preferences. MATERIALS AND METHODS The survey included 96 patients diagnosed with periodontal disease, all of whom underwent periodontal treatment or tooth extraction between May 2021 and February 2022. Participants completed a self-administered questionnaire incorporating the Autonomy Preference Index (API) to assess their decision-making and information-seeking preferences, along with demographic information, using a 5-point Likert scale. RESULTS Decision-making preferences were centrally distributed, with a score of 2.87 ± 0.47 (mean ± SD), indicating that most periodontal patients favoured a collaborative decision-making model. In contrast, information-seeking preferences were skewed, with a strong concentration towards the higher end of information preferences; the score was 4.55 ± 0.08. Lower age (p = 0.008) was associated with a preference for greater autonomy, while the financial burden (p = 0.034) was linked to reduced information-seeking preferences. Patients' autonomy remained relatively consistent across different periodontal clinical scenarios. CONCLUSION These findings suggest that periodontitis patients prefer to be well informed and share decision-making responsibilities with healthcare professionals after their diagnosis. Factors such as age and financial burden affect their autonomy, involvement and desire for information.
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Affiliation(s)
- Ji-Young Jung
- Department of Periodontology, Research Institute of Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
- Innovation Research and Support Center for Dental Science, Yonsei University Dental Hospital, Seoul, Republic of Korea
| | - Kyung-A Ko
- Department of Periodontology, Research Institute of Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
- Innovation Research and Support Center for Dental Science, Yonsei University Dental Hospital, Seoul, Republic of Korea
| | - Franz J Strauss
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
- Biomedical Sciences Institute, Faculty of Health Sciences, Universidad Autonoma de Chile, Santiago, Chile
| | - Jae-Hong Lee
- Department of Periodontology, College of Dentistry and Institute of Oral Bioscience, Jeonbuk National University, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jun-Hewk Kim
- Department of Dental Education, College of Dentistry, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Jung-Seok Lee
- Department of Periodontology, Research Institute of Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
- Innovation Research and Support Center for Dental Science, Yonsei University Dental Hospital, Seoul, Republic of Korea
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Yan C, Li Y, Ai J, Yang S. The Chinese version of the autonomy preference index for advanced cancer patients: a study on cultural adaptation based on cognitive interview. BMC Psychol 2025; 13:322. [PMID: 40176155 PMCID: PMC11967037 DOI: 10.1186/s40359-025-02391-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/15/2025] [Indexed: 04/04/2025] Open
Abstract
BACKGROUND The global cancer burden is becoming increasingly severe. In the context of patient-centred medicine, respecting patients' autonomy and preferences is of paramount importance. However, there is currently a lack of scientific tools in China to measure the autonomous preferences of advanced cancer patients. We aim to optimise assessment tools for patients' autonomous preferences and validate their effectiveness, thereby filling a gap in related research, in hopes of improving the quality of medical care in China. OBJECTIVES ① To assess the semantic clarity of entries of the Chinese Autonomy Preference Index (API) and determine whether patients can accurately comprehend their content. ② To validate the application effect of cognitive interviews in the translation of the scale into the Chinese culture and context. METHODS In March and April 2023, we selected 17 advanced cancer patients by convenience sampling in Zunyi, Guizhou, China, to participate in this study. We assessed their understanding of each item in the Chinese API scale through cognitive interviews and made the corresponding revisions to the scale items based on the interview results. RESULTS The respondents' understanding of various API entries after translation and adaptation was assessed. Based on the interview results, ambiguous entries were revised to create a refined Chinese version of the API. Ultimately, the API comprises two dimensions and 23 entries. The results of the first round of interviews revealed doubts or ambiguities in the semantic expression and understanding of 5 items, which were then revised following discussions by the research team. The second round of interviews confirmed that the interviewees could correctly understand the content of the entries without further modifications. CONCLUSIONS ① Cognitive interviews can address discrepancies in the understanding of scale items among the target population and mitigate measurement errors stemming from item content ambiguity. ② Targeted questionnaire revisions have improved the accuracy, reliability, and applicability of the Chinese version of the API questionnaire. The Chinese version of the Autonomy-Preference-Index offers clinical healthcare professionals an effective measurement tool to assess the autonomous preferences of advanced cancer patients.
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Affiliation(s)
- Chao Yan
- Nursing Department, Guizhou Aerospace Hospital, Guizhou Zunyi, 563000, China.
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Guizhou Zunyi, Guizhou, 563000, China.
| | - Yonghong Li
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Guizhou Zunyi, Guizhou, 563000, China.
| | - Ji Ai
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Guizhou Zunyi, Guizhou, 563000, China
| | - Shenghuan Yang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Guizhou Zunyi, Guizhou, 563000, China
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Plançon M, Ridley A, Lamore K, Tarot A, Burnod A, Blot F, Colombet I. Is shared decision making an aspect of palliative care integration? An observation of collaboration between oncologists and palliative care professionals. BMC Palliat Care 2024; 23:279. [PMID: 39639318 PMCID: PMC11622459 DOI: 10.1186/s12904-024-01608-y] [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: 09/11/2023] [Accepted: 11/29/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND Early palliative care interventions in oncology, as recommended by international oncology societies, promote patient understanding and support decision-making. At the same time, shared decision-making models are being developed to enhance patient participation as part of a new model of patient-physician relationship. For patients with palliative needs, this participation is essential and helps to avoid futile and aggressive treatments at the end of life. The aim of this study is to observe decision making during meetings between oncology and palliative care professionals, focusing particularly on the components of shared decision-making models, but also on the role played by palliative care professionals. METHODS We conducted a non-participant observation of multidisciplinary meetings and outpatient clinic activities in two Comprehensive Cancer Centres in France. Field notes were then coded using thematic content analysis. Deductive analysis was conducted using the observation grid developed from Elwyn's three-talk model. RESULTS Only a few elements of the different models of shared decision-making are apparent in the multidisciplinary meetings. Palliative care professionals emphasise the importance of involving patients and providing them with information about the advantages and disadvantages of different treatment options. However, patient involvement in decision-making remains difficult in daily practice. Decisions to discontinue oncological treatment are often driven by clinical and biological signs of terminal evolution rather than shared decision-making. CONCLUSIONS There are still cultural and organisational barriers to actual implementation of early integrated onco-palliative care. Promotion of shared decision making can be a strong lever of change which is frequently mobilised by palliative care teams.
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Affiliation(s)
- Morgane Plançon
- Palliative Care Mobile Unit, General Hospital, Valenciennes, France.
- Centre Hospitalier de Valenciennes, Avenue Désandrouin, Valenciennes, 59322, France.
| | - Ashley Ridley
- Departement of Pain and Palliative Care Unit, Necker-Enfants Malades Hospital, Paris, France
| | - Kristopher Lamore
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, F 59000, France
| | - Andréa Tarot
- Palliative Care Unit, University Hospital, Clermont-Ferrand, France
| | | | - François Blot
- Intensive Care Unit, Gustave Roussy Institute, Villejuif, France
| | - Isabelle Colombet
- Departement Recherche, Enseignement, Formation, Maison médicale Jeanne Garnier FR, Université Paris Cité, Paris, France
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Schindel D, Frick J, Gebert P, Grittner U, Letsch A, Schenk L. The effect of social care nurses on health related quality of life in patients with advanced cancer: A non-randomized, multicenter, controlled trial. Qual Life Res 2024; 33:3387-3399. [PMID: 39269581 PMCID: PMC11599374 DOI: 10.1007/s11136-024-03780-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2024] [Indexed: 09/15/2024]
Affiliation(s)
- Daniel Schindel
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Johann Frick
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Anne Letsch
- Department of Medicine II, Hematology and Oncology, University Hospital Schleswig-Holstein, Arnold- Heller-Straße 3, 24105, Kiel, Germany
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Liane Schenk
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Nizet P, Grivel C, Rabeau P, Pecout S, Evin A, Labarthe SP, Navas D, Feuillet F, Bourdon M, Huon JF. Patients' preferences in therapeutic decision-making in digestive oncology: a single centre cross-sectional observational study. Sci Rep 2023; 13:8534. [PMID: 37237043 PMCID: PMC10220004 DOI: 10.1038/s41598-023-35407-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Considering the preferences in Shared Decision Making (SDM) of patients with Digestive Cancer (DC) is crucial to ensure the quality of care. To date, there is limited information on preferences in SDM of patients with DC. The objectives of this study were to describe digestive cancer patients' preference for involvement in therapeutic decision-making and to identify variables associated with these preferences. An observational prospective study in a French university cancer center has been conducted. Patients completed two questionnaires to qualify and quantify their preference for involvement in therapeutic decision-making: the Control Preference Scale (CPS) and the Autonomy Preference Index (API), which is composed of the Decision Making (DM) score and the Information Seeking (IS) score. Associations between these scores and socio-demographic data, disease-related data, coping strategies (Brief-COPE), physical (QLQ-C30) and psychological (HADS) quality of life were tested. One-hundred fifteen patients returned the questionnaires. The majority of patients reported a passive (49.1%) or a collaborative (43.0%) CPS status. The mean DM score was 39.4 Variables associated with decision-making preferences were occupational status and time since diagnosis. The identification of variables associated with patients' preferences for involvement in decision-making can help make clinicians aware of patients' needs and wishes. However, it can only be determined by interviewing the patient individually.
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Affiliation(s)
- Pierre Nizet
- Nantes Université, CHU Nantes, Pharmacie, 44000, Nantes, France.
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes Université, Université de Tours, Nantes, France.
| | | | - Pauline Rabeau
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes Université, Université de Tours, Nantes, France
| | - Solange Pecout
- Nantes Université, CHU Nantes, Institut Des Maladies De l'Appareil Digestif, 44000, Nantes, France
| | - Adrien Evin
- Nantes Université, CHU Nantes, Service de Soins Palliatifs et de Support, 44000, Nantes, France
| | - Sonia Prot Labarthe
- Nantes Université, CHU Nantes, Pharmacie, 44000, Nantes, France
- Université Paris Cité, INSERM, ECEVE, 75010, Paris, France
| | - Dominique Navas
- Nantes Université, CHU Nantes, Pharmacie, 44000, Nantes, France
| | - Fanny Feuillet
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes Université, Université de Tours, Nantes, France
| | - Marianne Bourdon
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes Université, Université de Tours, Nantes, France
- Institut de Cancérologie de l'Ouest, Nantes, Angers, France
| | - Jean-François Huon
- Nantes Université, CHU Nantes, Pharmacie, 44000, Nantes, France
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes Université, Université de Tours, Nantes, France
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van der Waal MS, Seghers N, Welsing PMJ, van Huis LH, Emmelot-Vonk MH, Hamaker ME. A meta-analysis on the role older adults with cancer favour in treatment decision making. J Geriatr Oncol 2023; 14:101383. [PMID: 36243627 DOI: 10.1016/j.jgo.2022.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION In the complex setting of oncological treatment decision making, balancing professional guidance while respecting patient involvement can be a challenge. We set out to assess the role adults with cancer favour in treatment decision making (TDM), including differences across age groups and change over time. MATERIALS AND METHODS A systematic search was performed in MEDLINE and Embase, for studies on role preference of (older) adults with cancer in oncological treatment decision making. A meta-analysis was conducted based on Control Preference Scale (CPS) data, a questionnaire on patient role preference in TDM. RESULTS This meta-analysis includes 33 studies reporting CPS data comprising 17,197 adults with cancer. Mean age was 60.6 years old for studies that specified age (24 studies, 6155 patients). During the last decade, patients' role preference shifted towards significantly more active involvement in TDM (p = 0.006). No age-dependent subgroup differences have been identified; both younger and older adults, defined as, respectively, below and above 65 years old, favour active involvement in treatment decision making. DISCUSSION Over time, adults with cancer have shifted towards more active role preference in treatment decision making. In current cancer care, a large majority prefers taking an active role, irrespective of age.
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Affiliation(s)
- Maike S van der Waal
- Department of Geriatric Medicine, Universitair Medisch Centrum Utrecht, the Netherlands
| | - Nelleke Seghers
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht/Zeist/Doorn, the Netherlands
| | - Paco M J Welsing
- Julius Center Research Program Methodology, Universitair Medisch Centrum Utrecht, the Netherlands
| | - Lieke H van Huis
- Department of Internal Medicine, Diakonessenhuis, Utrecht/Zeist/Doorn, the Netherlands
| | | | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht/Zeist/Doorn, the Netherlands.
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Lima AMN, da Silva Martins MMF, Ferreira MSM, Fernandes CS, Schoeller SD, Parola VSO. From the challenge of assessing autonomy to the instruments used in practice: A scoping review. Porto Biomed J 2022; 7:e153. [PMID: 36186121 PMCID: PMC9521790 DOI: 10.1097/j.pbj.0000000000000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/26/2021] [Indexed: 11/26/2022] Open
Abstract
Autonomy is one of the essential components to live a quality life. Monitoring this autonomy is, in effect, essential, to allow the nurses to conceive, implement and evaluate interventions aimed at its promotion or even maintenance. For this reason, this scoping review aims to map the evidence to identify and analyze the instruments used to assess the person's autonomy, which emerges from scientific production. Methods Scoping review based on the recommended principles by the Joanna Briggs Institute. The research was realized in the databases: Scopus (excluding MEDLINE), CINAHL complete (via EBSCO, Excluding MEDLINE), and MEDLINE (via PubMed). Two independent reviewers evaluated the articles' pertinence for the study's investigation, the extraction, and synthesis of articles. Results After the analysis, according to the inclusion criteria established, 34 articles were selected, allude to 7 different instruments to assess autonomy. Conclusions The need for further development at this level is highlighted, namely through the construction and validation of more comprehensive instruments, integrating the different components of the concept of autonomy.
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Affiliation(s)
- Andreia Maria Novo Lima
- Abel Salazar Institute of Biomedical Sciences, Higher School of Health Fernando Pessoa, CINTESIS; Polytechnic Institute of Viana do Castelo, UICISA:E; Parola, Higher School of Health Fernando Pessoa, Porto, Portugal. Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Portugal. Portugal Centre for Evidence-Based Practice: A Joanna Briggs Institute Centre of Excellence
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Frick J, Gebert P, Grittner U, Letsch A, Schindel D, Schenk L. Identifying and handling unbalanced baseline characteristics in a non-randomized, controlled, multicenter social care nurse intervention study for patients in advanced stages of cancer. BMC Cancer 2022; 22:560. [PMID: 35585571 PMCID: PMC9118792 DOI: 10.1186/s12885-022-09646-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/06/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Given the psychosocial burdens patients in advanced stages of cancer face, innovative care concepts are needed. At the same time, such vulnerable patient groups are difficult to reach for participation in intervention studies and randomized patient inclusion may not be feasible. This article aims to identify systematic biases respectively selection effects occurring during the recruitment phase and to discuss their potential causes based on a non-randomized, multicenter intervention study with patients in advanced stages of cancer. METHODS Patients diagnosed with at least one of 16 predefined cancers were recruited at four hospitals in three German cities. The effect of social care nurses' continuous involvement in acute oncology wards was measured by health-related quality of life (EORTC QLQ-C30), information and participation preferences, decisional conflicts, doctor-patient communication, health literacy and symptom perception. Absolute standardized mean difference was calculated as a standardized effect size to test baseline characteristics balance between the intervention and control groups. RESULTS The study enrolled 362 patients, 150 in the intervention and 212 in the control group. Except for gender, both groups differed in relevant socio-demographic characteristics, e.g. regarding age and educational background. With respect to the distribution of diagnoses, the intervention group showed a higher symptom burden than the control group. Moreover, the control group reported better quality of life at baseline compared to the intervention group (52.6 points (SD 21.7); 47.8 points (SD 22.0), ASMD = 0.218, p = 0.044). CONCLUSION Overall, the intervention group showed more social and health vulnerability than the control group. Among other factors, the wide range of diagnoses included and structural variation between the recruiting clinics increased the risk for bias. We recommend a close, continuous monitoring of relevant social and health-related characteristics during the recruitment phase as well as the use of appropriate statistical analysis strategies for adjustment, such as propensity score methods. TRIAL REGISTRATION German Clinical Trials Register (DRKS-ID: DRKS00013640 ); registered on 29th December 2017.
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Affiliation(s)
- Johann Frick
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Pimrapat Gebert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Ulrike Grittner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Anne Letsch
- Department of Medicine II, Hematology and Oncology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Comprehensive Cancer Center, Charitéplatz 1, 10117, Berlin, Germany
| | - Daniel Schindel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany.
| | - Liane Schenk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
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