Cancer research has made great progress in the recent years. With the increasing number of options in diagnosis and therapy the implementation of tumorboards (TUBs) has become standard procedure in ...the treatment of cancer patients. Adherence tests on tumor board decisions are intended to enable quality assurance and enhancement for work in tumor boards in order to continuously optimize treatment options for cancer patients.
Subject of this study was the adherence of the recommendations made in three of 14 tumorboards, which take place weekly in the Center for Integrated Oncology (CIO) at the University Hospital Bonn. In total, therapy recommendations of 3815 patient cases were checked on their implementation. A classification into four groups has been made according to the degree of implementation. A second classification followed regarding the reasons for differences between the recommendation and the therapy which the patient actually received.
The study showed that 80.1% of all recommendations in the three TUBs were implemented. 8.3% of all recommendations showed a deviance. Most important reasons for the deviances were patient wish (36.5%), patient death (26%) and doctoral decision, due to the patient's comorbidities or side effects of the treatment (24.1%).Interestingly, deviance in all three tumor boards in total significantly decreased over time.
Aim of the study was to clarify the use of tumor boards and find approaches to make them more efficient. Based on the results efficiency might be optimized by increased consideration of patients` preferences, improved presentation of patient-related data, more detailed documentation and further structuring of the tumor board meetings.
Purpose
Within families affected by parental cancer, open communication impacts the well-being of parents and their children; however, limited research exists on communication patterns in these ...families. This sub-study addresses this through the Family-SCOUT study, a multicenter, prospective, interventional, and non-randomized investigation with intervention (IG) and control group (CG). The purpose of this sub-study was to identify and compare the differences in communication patterns between the IG and CG as part of the process evaluation. The research question was addressed in both groups: What communication patterns do healthy parents perceive within their families?
Methods
Using a qualitative approach, the study involved interviewing healthy parents as surrogates for their families. The interviews were audio-recorded, transcribed, and coded using a template analysis. The resulting data were analyzed at the group level.
Results
Twenty-three interviews were conducted in the IG and 27 interviews in the CG. The analysis of themes centered on communication patterns as seen in the family structure. Both groups exhibited instances of open communication about fears and wishes as well as the use of child-friendly language when discussing cancer. Notable differences were observed: challenges in open communication with children were sorely reported in CG interviews, and “the illness is discussed when necessary” was sorely described in IG interviews.
Conclusion
This study underscores the need to address and encourage open communication within families with parental cancer.
German and Turkish-speaking patients were recruited for a chronic heart failure management program. So far little is known about the special needs and characteristics of Turkish-speaking patients ...with chronic heart failure; therefore, the aim of this study was to examine sociodemographic and illness-related differences between German and Turkish-speaking patients with chronic heart failure.
German and Turkish-speaking patients suffering from chronic heart failure and insured with the AOK Rheinland/Hamburg or the BARMER GEK health insurance companies and living in Cologne, Germany, were enrolled. Recruitment took place in hospitals, private practices and at information events. Components of the program were coordination of a guideline-oriented medical care, telemonitoring (e.g., blood pressure, electrocardiogram, and weight), a 24-h information hotline, attendance by German and Turkish-speaking nurses and a patient education program. Data were collected by standardized interviews in German or Turkish language. Data were analyzed with descriptive measures and tested for significance differences using Pearson's χ
-test and the t‑test.
A total of 465 patients (average age 71 years, 55 % male and 33 % Turkish-speaking) were enrolled in the care program during the study period. Significant differences between German and Turkish-speaking patients were found for age, education, employment status, comorbidities, risk perception, knowledge on heart failure and fear of loss of independence.
The response rate could be achieved with the help of specific measures for patient enrollment by Turkish-speaking integration nurses. The differences between German and Turkish-speaking patients should in future be taken into account in the care of people with chronic heart failure.
Zusammenfassung
Hintergrund
Im Rahmen einer Projektförderung konnten zielgruppenspezifische Rekrutierungsbemühungen zu einem vermehrten Einschluss von türkischsprachigen Patienten in ein ...strukturiertes Herzinsuffizienz-Versorgungsmodell führen. Bislang lagen kaum Erkenntnisse über diese Patientengruppe vor. Die vorliegende Arbeit vergleicht daher soziodemographische und krankheitsbezogene Unterschiede zwischen deutsch- und türkischsprachigen Patienten mit chronischer Herzinsuffizienz.
Methode
Deutsch- und türkischsprachige Patienten der AOK Rheinland/Hamburg oder der BARMER GEK mit der Diagnose einer chronischen Herzinsuffizienz aus dem Kölner Raum wurden in die Studie eingeschlossen. Die Patienten wurden in Krankenhäusern, Praxen sowie im Rahmen von Informationsveranstaltungen rekrutiert. Das Versorgungsmodell beinhaltete die Koordination und Leitlinienbasierung der ärztlichen Versorgung, ein Telemonitoring (Waage, Blutdruckmessung, EKG), einen 24-stündigen Informationsservice, eine Betreuung durch deutsch- und türkischsprachige Pflegekräfte sowie ein Patientenschulungsprogramm. Die Daten wurden in deutschen bzw. türkischen standardisierten Interviews erhoben, deskriptiv ausgewertet und mittels Pearson-Chi-Quadrat-Tests und T‑Tests auf signifikante Unterschiede getestet.
Ergebnisse
465 Patienten (mittleres Alter: 71 Jahre; 55 % Männer, 33 % türkischsprachig) wurden im Projektzeitraum in das Versorgungsmodell eingeschrieben. Signifikante Unterschiede zwischen deutsch- und türkischsprachigen Teilnehmenden zeigen sich in Bezug auf das Alter, die Schulbildung, den Beruf, die Begleiterkrankungen, die Bedrohung durch die Erkrankung, die Angst vor einem möglichen Autonomieverlust und das Krankheitswissen.
Diskussion
Der erfolgreiche Einschluss von türkischsprachigen Patientinnen und Patienten ist insbesondere durch den Einsatz von türkischsprachigen Integrationsschwestern möglich geworden. Die Unterschiede zwischen deutsch- und türkischsprachigen Betroffenen sollten zukünftig in der Versorgung von Menschen mit chronischer Herzinsuffizienz berücksichtigt werden.
Goals of work
Cancer patients often experience distress. However, the majority of newly diagnosed patients gradually adapt to the crisis. When symptoms of distress and anxiety persist over months, ...patients require psychosocial support. The aim of the present study was to determine the proportion of cancer patients who indicate the need for psychosocial support and to identify sociodemographic, psychological and illness-related factors predicting the need for psychosocial support in a German sample.
Materials and methods
The cross-sectional retrospective study was administered to 710 cancer patients who had been inpatients at the University Hospital of Cologne. The response rate was 49.5%. Patients suffering from bronchial, oesophageal, colorectal, breast, prostate and skin cancer participated in the study. The severity of depressive symptoms was assessed using the German version of the Major Depression Inventory. The level of anxiety was assessed with the state subscale of the German version of the State-Trait Anxiety Inventory. To measure the functional aspects of health-related quality of life, the scales “physical functioning”, “role functioning”, “emotional functioning”, “cognitive functioning” and “role functioning” of the European Organisation for Research and Treatment of Cancer QLQ-C30 Questionnaire (EORTC QLQ-C30) were used.
Main results
Of the cancer patients, 18.9% indicate an unmet need for psychosocial support and 9.5% are actually using psychosocial services. In a multiple logistic regression, significant indicators of the need for psychosocial support are gender
p
= 0.014; standardised effect coefficient (sc) = 1.615 and emotional functioning (
p
< 0.001; sc = 1.533). The estimated model has a specificity of 92.2% and a sensitivity of 54.0%.
Conclusion
Almost a third of the cancer patient population indicates an unmet need for psychosocial support or is actually using psychosocial services. Emotional functioning is a central predictor of the requirement for psychosocial support. Women are emotionally more affected than men and need more psychosocial support. The prognostic validity of the severity of depression and anxiety is limited.
This study aimed (1) to analyze patients' perceived shared decision-making (SDM) experiences over 4 weeks between patients participating or not in multidisciplinary tumor conferences (MTCs) and (2) ...to analyze the association of patients' active participation in and organizational variables of MTCs with patients' perceived SDM experience directly after MTC.
From the N=317 patients, this observational study included patient surveys, observations, and audio transcripts from MTCs with (N=82) and without (N=145) patient participation in six breast and gynecologic cancer centers. We performed t tests for within- and between-group comparisons and linear regression with "patients' perceived SDM experiences in MTC" as the dependent variable.
Patients' perceived SDM experiences increased at 4 weeks after MTC (p<0.001) with lower perceived SDM experiences for participating versus nonparticipating patients (p<0.001). Linear regression showed that the organizational variable "round table seating arrangement" was significantly associated with higher perceived SDM experiences compared with a theater or U-shape arrangement (beta=-0.38, p=0.043; beta=-0.69, p=0.010) directly after MTC.
Results provide first insights into patients' perceived SDM experiences in MTCs. SDM in MTCs is associated with organizational variables of MTCs. A round table seating arrangement in MTCs with patient participation seems important for patients' perceived SDM experiences. The relatively low perceived SDM experiences of participating patients directly after MTC indicates room for improvement, eg concerning patient-centered communication.
Healthcare providers decide on recommendations for further treatment of patients with cancer in multidisciplinary tumor boards (MTBs). As such, communicative processes during MTBs are assumed to ...influence decision-making and, thereby, treatment planning. The aim of this exploratory study is to gain insights into decision-making during MTBs.
Case discussions from MTBs in breast cancer centers in North Rhine-Westphalia, Germany, were observed and audiotaped. The transcripts of the audio recordings were analyzed by procedures of conversation analysis.
Based on 38 case discussions from 15 MTBs in four breast cancer centers, an action scheme for decision-making in MTBs in breast cancer care was developed. In addition, the conversational practices used by the participants during interactions were analyzed.
Analysis indicated that conventions in MTBs were observed during individual phases of decision-making but not for the entire process. Although exchanging multidisciplinary knowledge is an essential aspect of MTBs, this exchange does not always seem to occur in practice. The extent to which recommendations are derived from consensus during MTBs remains unclear. Thus, the study suggests developing standards for communication during MTBs to optimize decision-making and, thus, the quality of recommendation.
•ESMO Clinical Practice Guideline with key recommendations for communication and support of cancer patients and caregivers.•The guideline discusses training in communication of oncology clinicians ...and research on communication in cancer care.•Practical recommendations aim to support oncology clinicians in their communication with patients and caregivers.•Figures summarising the responsibilities of the clinician, the oncology team and the health care institution are provided.
Cancer patients with minor children but also their families suffer from significant psychological distress and comorbidity. Protective factors predicting successful coping are well known. ...Corresponding systematic interventions are rare and limited by access barriers. We developed a comprehensive family-centered intervention for cancer patients with at least one dependent minor.
Family-SCOUT represents a multicentric, prospective, interventional, and controlled study for families with parental cancer and their minor children. In the intervention group (IG), all family members were addressed using a care and case management approach for nine months. Families in the control group (CG) received standard of care. Participating parents were asked to complete the Hospital-Anxiety-Depression-Scale (HADS) questionnaire at enrolment (T0) and after 9 months (T2). The primary outcome was a clinically relevant reduction of distress in at least one parent per family, measured as minimal important difference (MID) of ≥1.6 in the HADS total score. The percentage of families achieving MID is compared between the IG and CG by exact Fisher’s test, followed by multivariate confounder analyses.
T0-questionnaire of at least one parent was available for 424 of 472 participating families, T2-questionnaire after 9 months was available for 331 families (IG n = 175, CG n = 156). At baseline, both parents showed high levels of distress (HADS total: sick parents IG: 18.7 ± 8.1; CG: 16.0 ± 7.2; healthy partners: IG: 19.1 ± 7.9; CG: 15.2 ± 7.7). The intervention was associated with a significant reduction in parental distress in the IG (MID 70.4% in at least one parent) compared with the CG (MID 55.8%; P = 0.008). Adjustment for group differences from specific confounders retained significance (P = 0.047). Bias from other confounders cannot be excluded.
Parental cancer leads to a high psychosocial burden in affected families. Significant distress reduction can be achieved through an optimized and structured care approach directed at the family level such as family-SCOUT.
•Care and case management for families with parental cancer and underage children such as family-SCOUT is feasible.•Can be implemented in an outreach setting centered on a comprehensive cancer center.•Is significantly associated with a meaningful reduction of psychosocial distress at the parent level.
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