Holger Pfaff | University of Cologne (original) (raw)
Papers by Holger Pfaff
Journal of Medical Systems, Jun 22, 2008
Gesundheitswesen, Sep 8, 2014
Palliative & Supportive Care, May 22, 2014
Objective:People feeling severely affected by multiple sclerosis (MS) comprise a heterogeneous gr... more Objective:People feeling severely affected by multiple sclerosis (MS) comprise a heterogeneous group, and this heterogeneity leads to very distinct needs and makes planning for needs difficult. To provide optimal care, it is important to identify specific needs in specific subgroups. Our objective was to identify the specific palliative care (PC) needs of patients who felt severely affected by the disease by analyzing their feeling (1) more or (2) less severely affected and their possible differences in expressed care needs.Method:A self-report questionnaire with 25 needs categories including 7 categories pertaining to care was applied to patients who felt severely affected by MS. An additional single question identified patients feeling more (≥7, median-split) and less (<7) severely affected. Differences were analyzed by chi-squared and Mann–Whitney U tests. The sample (N = 573) was composed of respondents who replied to an invitation by the German Multiple Sclerosis Society to participate in a survey on unmet needs of severely affected patients.Results:Of 573 patients (median age 51), 358 (62.48%) felt more severely affected. Compared to patients feeling less severely affected, they found the stress on their next of kin to be higher (p < 0.001), were in greater need of home visitation (p < 0.001), did not have permanent neurologists (p = 0.016), and felt that they visited them too rarely (p < 0.0001). They also needed more emotional support from their nursing care service (p = 0.006).Significance of results:A self-rating scale can identify two groups of patients with different care needs. These data may help shaping patient-centered support structures. Palliative care, with its multidisciplinary approach, might be one further option to meet the specific needs of patients and their relatives.
Journal of Cancer Education, Jan 21, 2017
In cancer care, where patients and their families experience significant emotional distress and p... more In cancer care, where patients and their families experience significant emotional distress and patients have to deal with complex medical information, patient centeredness is an important aspect of quality of care. The aim of this study is to examine the impact of patients' trust in their oncologists and patients' enablement on changes in health-related quality of life of colon cancer patients during follow-up care. We conducted a prospective study in a representative sample of private practices of German oncologists (N = 44). Patients (N = 131) filled out a standardized questionnaire prior to their first consultation (T0), directly after the first consultation (T1) and after two months (T2). Data were analyzed by structural equation modeling. Significant associations were found between trust in physician and changes in physical functioning between T1 and T2, and between trust in physician and patient enablement. Patient enablement is significantly associated with changes in physical functioning between T1 and T2. The results underline the importance of building a close and trustful patient-physician relationship in the oncology encounter. A central mechanism of the association between the quality of the relationship and health outcomes seems to be patient enablement. To enable patients to cope with their situation by making them understand their diagnosis, treatments, and side effects can impact healthrelated quality of life in physical domains.
Tobacco Induced Diseases, 2010
Supportive Care in Cancer, Sep 17, 2017
Purpose Palliative care (PC) involves many health care providers leading to a high complexity of ... more Purpose Palliative care (PC) involves many health care providers leading to a high complexity of structures that requires efficient coordination as provided by case management (CM). Our study aimed to evaluate the effects of CM newly implemented in a specialised palliative care unit by evaluating team members' tasks and time resources before (T0) and after implementation (T1). It was hypothesised that team members would be able to spend less time on organisational and administrative tasks and more time on patient care. Methods A prospective pre-post study design was used. Time distribution of different tasks at T0 and T1 was compared between three different professional groups: physicians, nursing staff and social work. To document their tasks and time required, a documentation form with several items for each profession was developed. Data was analysed using t tests for independent samples. Results After Bonferroni correction, a significant pre-post difference was found for the time spent on Bdischarge interview and discharge^as rated by the physicians (p < .001) with less time spent on this activity after CM implementation. The nursing staff had significantly more time for Bconversations with patients^(p < .001) after CM implementation. Moreover, they spent significantly less time on Bpatient-related requests/ advice by telephone^(p < .001) and Bdiscussions with relatives/participation in family discussions^at postassessment (p < .001). The social worker had significantly more time for Bpatient advice and support services(p = .013) after CM implementation. Conclusions Integrating CM can be time efficient and ensures team members to spend more time on their core tasks in patient care.
European journal of public health, Oct 20, 2017
7.15), prostate (RR 2.59), colon (RR 2.20) and lung (RR 2.01) cancer for males; cervix uteri (RR ... more 7.15), prostate (RR 2.59), colon (RR 2.20) and lung (RR 2.01) cancer for males; cervix uteri (RR 3.45), breast (RR 3.36), corpus uteri (RR 2.51), colon (RR 2.41) and lung (RR 2.16) cancer for females. There is a significant positive correlation between cancer mortality and urban population, population with higher education, lung cancer in women and negative correlation with unemployment rate. A strong positive correlation is found between breast cancer mortality and GDP, population with higher education and urban population. Mortality from cervical cancer is most affected by poverty and dropped out of education. Prostate cancer mortality is positively correlated with urban population, higher education and negatively correlated with number of people per GP.
Journal of Clinical Oncology, May 20, 2011
e19678 Background: The number of people with access to the Internet and who actually use it to ob... more e19678 Background: The number of people with access to the Internet and who actually use it to obtain health information is continuously on the rise. Gynecologists must, therefore, adapt their practice to these changing circumstances. However, there is still virtually no data available on the determinants of patient Internet use. This study aims to determine the percentage of breast cancer patients using the Internet for health information and to ascertain which socio-demographic and disease characteristics are associated with this use. METHODS The study population consisted of female patients with primary breast cancer who had undergone surgery in one of the breast centers in the German state of North Rhine-Westphalia between February and July of the years 2007 to 2010. Patients from the four cohorts were surveyed postoperatively by mail using the Cologne Patient Questionnaire for Breast Cancer (CPQ-BC). Of the patients who consented to participating in the survey (consent rate: 90 %), an average of 88 % responded to the questionnaire. The total sample size for the study in 2007 to 2010 was N = 14,923. Frequency and logistic regression analyses were used for statistical analysis. RESULTS Over the three years of the study, there was an increase in the percentage of breast cancer patients using the Internet to obtain information on their condition (2007: 30.9%; 2008: 32.7%; 2009: 34.3%; 2010: 37.2%). Significant differences were found in the correlations between the different age and social status groups and Internet use. Older patients, patients with lower levels of formal education, patients without a partner, and patients without private medical insurance are significantly less likely to search for health information online. CONCLUSIONS One-third of breast cancer patients in the sample use the Internet to obtain information on their condition, and this number is rising. Patient Internet use is associated with age, education, and insurance status in all four cohorts.
Supportive Care in Cancer, Jun 17, 2021
Objective This study investigated the prevalence, individual courses, and determinants of fear of... more Objective This study investigated the prevalence, individual courses, and determinants of fear of cancer recurrence (FoR) in long-term breast cancer survivors (BCSs) with and without recurrence. Methods A total of 184 breast cancer survivors were surveyed at four measurement time points: during hospitalization (T1), 10 weeks (T2), 40 weeks (T3), and 5-6 years (T4) after hospital discharge. Descriptive statistics, chi-square tests, and logistic regression were performed. Results Respondents were females and 57 years old, on average. At T1, T3, and T4, 54.8%, 31.6%, and 29.7% of BCSs, respectively, were classified as having dysfunctional levels of FoR. Dysfunctional FoR decreased from T1 to T3 (χ 2 (1) = 17.11, p = 0.000; N = 163) and remained stable afterwards. Eight subgroups of individual courses of FoR over time could be described: (1) constant functional FoR; (2) constant dysfunctional FoR;
Supportive Care in Cancer, Apr 12, 2011
Whilst much is known as to the met and unmet communication needs of prostate cancer patients, few... more Whilst much is known as to the met and unmet communication needs of prostate cancer patients, few studies have been conducted on the changes in communication between provider and patient over time. Therefore, the aim of our study is to examine (a) whether there are changes over time in the quality of psychosocial care in long-term treatment of localized prostate cancer and (b) whether those changes are associated with the treatment decision. HAROW is a prospective, observational study designed to collect clinical data and patient reported outcomes (PROs) of different treatment options (hormonal therapy, active surveillance, radiation, operation, watchful waiting) for newly diagnosed patients with localized prostate cancer under real conditions. At 6-month intervals, general clinical data, PROs (e.g. quality of life, quality of physician-patient interaction) and individual costs are documented. We analysed data of N = 1,216 patients at the time of initial diagnosis (T1) and after 6 months (T2). There is a significant decline in shared decision-making behaviour of physicians for the group of patients undergoing a prostatectomy and for the hormonal therapy group at the time of initial diagnosis and after 6 months. In terms of emotional support by physicians, there is a significant difference between the treatment groups at the time of initial diagnosis with patients undergoing a prostatectomy reporting significantly less support than the hormonal therapy group. Future research from both, the providers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; and the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perspective, will have to clarify if we can interpret our results as change in the communication behaviour once the treatment decision for prostatectomy or hormonal therapy is made.
Psychology Health & Medicine, Jun 2, 2020
This studyinvestigates the need for psycho-oncological care over the course of a breast cancer tr... more This studyinvestigates the need for psycho-oncological care over the course of a breast cancer treatment and possible associated factors to develop such a need. The PIAT-Study was a longitudinal postal survey study conducted in Germany (2013 to 2014) with breast cancer patients (BCPs). Patients received a questionnaire at three-time points (T1: few days after surgery, T2: after 10 weeks; T3: after 40 weeks). This study considers information about patients' needs for psychooncological care, their breast cancer disease, social support, anxiety, health literacy (HL) and sociodemographic information. Data were analysed with descriptive statistics and logistic regression modelling to estimate the association between a need for psycho-oncological treatment and patient characteristics. N = 927 breast cancer patients reported their psycho-oncological need. 35.2% of patients report at least at one measuring point to be in need for psycho-oncological care. In a multiple logistic regression, noticeable determinants for developing such a need are an inadequateHL(OR = 1.97), fear of progression (FoP) (OR = 2.08) and psychological comorbidities (OR = 8.15) as well as certain age groups. BCPs with a low HL, suffering from a dysfunctional level of FoP or mental disorders are more likely to develop a need for psycho-oncological care.
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 2009
ABSTRACT Safety culture is a multi-dimensional phenomenon. Safety culture of a healthcare organiz... more ABSTRACT Safety culture is a multi-dimensional phenomenon. Safety culture of a healthcare organization is high if it has a common stock in knowledge, values and symbols in regard to patients’ safety. The article intends to define safety culture in the first step and, in the second step, demonstrate the effects of safety culture. We present the model of safety behaviour and show how safety culture can affect behaviour and produce safe behaviour. In the third step we will look at the causes of safety culture and present the safety-culture-model. The main hypothesis of this model is that the safety culture of a healthcare organization strongly depends on its communication culture and its social capital. Finally, we will investigate how the safety culture of a healthcare organization can be improved. Based on the safety culture model six measures to improve safety culture will be presented.
BMC Health Services Research, Dec 1, 2018
Background: Return to work (RTW) is a key parameter of outcome quality that ensures social partic... more Background: Return to work (RTW) is a key parameter of outcome quality that ensures social participation. Therefore, this study analyses the sociodemographic and disease-related determinants of RTW among newly diagnosed breast cancer patients. Methods: In a prospective, multicentre cohort study, breast cancer patients were surveyed three times: directly after surgery, after 10 weeks, and after 40 weeks. Logistic regression analysis was applied to estimate the association of RTW at 40 weeks following discharge with sociodemographic and disease-related characteristics (n = 577). Results: The sociodemographic variables "entrance certificate at a university of applied science" compared to "university entrance certificate" (OR = 3.1, 95%-CI = 1.2-8.1), age group "55-59 years" compared to "18-44 years" (OR = 3.2, 95%-CI = 1.2-8.4) and "having children" (OR = 2.8, 95%-CI = 1.2-6.2) as well as the disease-related variables "rehabilitation" (OR = 0.5, 95%-CI = 0.3-0.9), self-rated health "good" and "excellent" compared to "bad" (OR = 2.7, 95%-CI = 1.4-5.5; OR = 11.6, 95%-CI = 4.2-31.8) and the UICC-classification "stage II" and "stage III/IV" in comparison to "stage 0/I" (OR = 0.5, 95%-CI = 0.3-0.8; OR = 0.2, 95%-CI = 0.1-0.5) significantly affect RTW among breast cancer patients (Nagelkerke's Pseudo-R 2 = 0.275). Conclusions: The findings show that significant differences in RTW exist between patient groups and suggest that RTW issues must be addressed more effectively before, during and after treatment. For future research on RTW in Germany, longitudinal studies with a follow-up of several years are necessary. Information and support deficits should be tackled by social services or breast care nurses.
BMC Cancer, Apr 8, 2019
Background: Decisions made in multidisciplinary tumor conferences (MTC) that consider patient pre... more Background: Decisions made in multidisciplinary tumor conferences (MTC) that consider patient preferences result in better patient outcomes. Furthermore, it has been shown that in some breast cancer centers in Germany, patients participate in MTCs and that participation is associated with sociodemographic and breast cancer centerrelated factors. Health literacy (HL) has been shown to be predictive for individual health behavior and is an important prerequisite for patient participation in healthcare. However, so far nothing is known about the association between HL and MTC patient participation. To close this gap in research, we analyzed which patient characteristics affect participation in MTCs and whether participation varies between breast cancer centers. Methods: In a prospective, multicenter cohort study, newly diagnosed breast cancer patients were surveyed directly after surgery (T1) as well as 10 weeks (T2) and 40 weeks (T3) after surgery. After descriptive analysis, t-tests were conducted, correlations for independent variables were run, and logistic multilevel regression analysis was applied to estimate the association between patient participation in MTCs at T1 and HL (HLS-EU-Q16 [1]), sociodemographic and disease-related characteristics (n = 863 patients) and the variation between breast cancer centers (n = 43 centers). Results: Descriptive results show that 6.8% of breast cancer patients took part in a MTC. The logistic multilevel regression model revealed that patients with an inadequately HL are less likely to participate in MTCs (OR = 0.31, 95%-CI = 0.1-0.9, Pseudo-R 2 = 0.06), and participation is dependent on the breast cancer center (ICC = 0.161). Conclusions: These findings are the first to show significant differences in HL and patient participation in MTCs in a large sample of breast cancer patients. In future research on patient participation in MTCs and HL, questions concerning the organization, communication and decision-making in MTCs with and without patient participation have to be addressed, and patient and provider perspectives must be equally considered.
Breast Cancer Research and Treatment, Feb 8, 2012
The objective of this study is to investigate health-related quality of life (HRQoL) in male brea... more The objective of this study is to investigate health-related quality of life (HRQoL) in male breast cancer patients. Data of 20,673 patients diagnosed with primary breast cancer (male: n = 84) who completed a questionnaire after discharge from hospital were analysed. HRQoL (SF-36), age, sex, education, native language, insurance status, and partnership status were measured. Cancer staging, treatment (partial mastectomy vs. radical mastectomy), and cancer site were indicated by the clinicians. The HRQoL scores of male breast cancer patients were compared with reference populations. Differences in HRQoL scores between men and women were compared using t tests and regression analysis. Compared to female breast cancer patients, male patients scored significantly higher on seven of eight subscales (physical functioning, role functioning-physical and emotional, bodily pain, vitality, social functioning, and mental health) in the regression analysis. Compared to the reference populations (general male population, men aged 61-70, and the cancer-affected population), male breast cancer patients scored lower on SF-36 subscales on average, with major differences in emotional and physical role functioning. The results suggest that male breast cancer patients may need early interventions that specifically target role functioning, which is severely impaired compared to the male reference population. Future research needs to assess HRQoL with cancer-specific questionnaires and longitudinal designs also focussing on male patients in breast centres.
BMC Psychiatry, Feb 9, 2022
Background: There is a significant number of long-term breast cancer survivors in Germany. Howeve... more Background: There is a significant number of long-term breast cancer survivors in Germany. However, research on the psychological challenges of cancer survivors is limited. This analysis describes prevalence, development and determinants of depression and anxiety 5 to 6 years after diagnosis and identifies predictors for an increase of anxiety and depression over time. Methods: Data from 164 women was collected by survey and tumour documentation during post-operative hospital stay, 40 weeks and 5 to 6 years after diagnosis. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale. Sankey-diagrams were created for visual presentation of prevalence over time. Logistic and linear regression models were calculated to identify determinants of anxiety and depression. Results: Respondents had higher levels of depression and anxiety 5 to 6 years than 40 weeks after the diagnosis. Lower vocational status and having children were associated with depression, surgery type was correlated with anxiety, and age, as well as comorbidities, were predictors for both anxiety and depression 5 to 6 years after diagnosis. An increase of depression over time was more likely when having children and comorbidities. An increase in anxiety was less likely after cancer recurrence. Conclusions: Findings highlight that anxiety and depression are relevant burdens for breast cancer survivors in Germany. Several sociodemographic and clinical predictors are identified. There is need for psychosocial support after acute treatment and in the long-term. Research on psychological burdens of long-term breast cancer survivors in the identified vulnerable groups is needed.
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, Apr 1, 2017
Please cite this article in press as: Ernstmann N, et al. Measuring attributes of health literate... more Please cite this article in press as: Ernstmann N, et al. Measuring attributes of health literate health care organizations from the patients' perspective: Development and validation of a questionnaire to assess health literacy-sensitive communication (HL-COM). Z. Evid.
Patient Education and Counseling, May 1, 2016
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service... more This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Journal of Nursing Care Quality, Oct 1, 2009
The purpose of the study was to examine the relationship between social capital and clinical risk... more The purpose of the study was to examine the relationship between social capital and clinical risk management in hospitals from nurses' perspective. The results of our investigation suggest that higher values of social capital are associated with better ratings in clinical risk management behavior. An established atmosphere of trust and a feeling of common values and convictions can help nurses integrate clinical risk management into their daily work.
Patient Education and Counseling, Aug 1, 2012
Eleven months after being interviewed in a study on unmet needs of severely affected multiple scl... more Eleven months after being interviewed in a study on unmet needs of severely affected multiple sclerosis patients, one participant died by assisted suicide. We reanalyzed the data to find out if our 15 study patients might have brought up the topic of death and dying during episodic interviews that had not primarily addressed this issue. Secondary analysis with regard to the thematic field of death and dying revealed that patients unsolicited brought up this issue within the following categories: "Passing over death and dying," "Death is not relevant to me," "We want to keep up the life challenge," "Death as an option," and "Wish to have the opportunity to address end of life issues." We conclude that the topic of death and dying is of importance to these patients, as they spontaneously mentioned it in multiple varieties. Health professionals should individually acknowledge patients' needs to address death and dying.
Journal of Medical Systems, Jun 22, 2008
Gesundheitswesen, Sep 8, 2014
Palliative & Supportive Care, May 22, 2014
Objective:People feeling severely affected by multiple sclerosis (MS) comprise a heterogeneous gr... more Objective:People feeling severely affected by multiple sclerosis (MS) comprise a heterogeneous group, and this heterogeneity leads to very distinct needs and makes planning for needs difficult. To provide optimal care, it is important to identify specific needs in specific subgroups. Our objective was to identify the specific palliative care (PC) needs of patients who felt severely affected by the disease by analyzing their feeling (1) more or (2) less severely affected and their possible differences in expressed care needs.Method:A self-report questionnaire with 25 needs categories including 7 categories pertaining to care was applied to patients who felt severely affected by MS. An additional single question identified patients feeling more (≥7, median-split) and less (<7) severely affected. Differences were analyzed by chi-squared and Mann–Whitney U tests. The sample (N = 573) was composed of respondents who replied to an invitation by the German Multiple Sclerosis Society to participate in a survey on unmet needs of severely affected patients.Results:Of 573 patients (median age 51), 358 (62.48%) felt more severely affected. Compared to patients feeling less severely affected, they found the stress on their next of kin to be higher (p < 0.001), were in greater need of home visitation (p < 0.001), did not have permanent neurologists (p = 0.016), and felt that they visited them too rarely (p < 0.0001). They also needed more emotional support from their nursing care service (p = 0.006).Significance of results:A self-rating scale can identify two groups of patients with different care needs. These data may help shaping patient-centered support structures. Palliative care, with its multidisciplinary approach, might be one further option to meet the specific needs of patients and their relatives.
Journal of Cancer Education, Jan 21, 2017
In cancer care, where patients and their families experience significant emotional distress and p... more In cancer care, where patients and their families experience significant emotional distress and patients have to deal with complex medical information, patient centeredness is an important aspect of quality of care. The aim of this study is to examine the impact of patients' trust in their oncologists and patients' enablement on changes in health-related quality of life of colon cancer patients during follow-up care. We conducted a prospective study in a representative sample of private practices of German oncologists (N = 44). Patients (N = 131) filled out a standardized questionnaire prior to their first consultation (T0), directly after the first consultation (T1) and after two months (T2). Data were analyzed by structural equation modeling. Significant associations were found between trust in physician and changes in physical functioning between T1 and T2, and between trust in physician and patient enablement. Patient enablement is significantly associated with changes in physical functioning between T1 and T2. The results underline the importance of building a close and trustful patient-physician relationship in the oncology encounter. A central mechanism of the association between the quality of the relationship and health outcomes seems to be patient enablement. To enable patients to cope with their situation by making them understand their diagnosis, treatments, and side effects can impact healthrelated quality of life in physical domains.
Tobacco Induced Diseases, 2010
Supportive Care in Cancer, Sep 17, 2017
Purpose Palliative care (PC) involves many health care providers leading to a high complexity of ... more Purpose Palliative care (PC) involves many health care providers leading to a high complexity of structures that requires efficient coordination as provided by case management (CM). Our study aimed to evaluate the effects of CM newly implemented in a specialised palliative care unit by evaluating team members' tasks and time resources before (T0) and after implementation (T1). It was hypothesised that team members would be able to spend less time on organisational and administrative tasks and more time on patient care. Methods A prospective pre-post study design was used. Time distribution of different tasks at T0 and T1 was compared between three different professional groups: physicians, nursing staff and social work. To document their tasks and time required, a documentation form with several items for each profession was developed. Data was analysed using t tests for independent samples. Results After Bonferroni correction, a significant pre-post difference was found for the time spent on Bdischarge interview and discharge^as rated by the physicians (p < .001) with less time spent on this activity after CM implementation. The nursing staff had significantly more time for Bconversations with patients^(p < .001) after CM implementation. Moreover, they spent significantly less time on Bpatient-related requests/ advice by telephone^(p < .001) and Bdiscussions with relatives/participation in family discussions^at postassessment (p < .001). The social worker had significantly more time for Bpatient advice and support services(p = .013) after CM implementation. Conclusions Integrating CM can be time efficient and ensures team members to spend more time on their core tasks in patient care.
European journal of public health, Oct 20, 2017
7.15), prostate (RR 2.59), colon (RR 2.20) and lung (RR 2.01) cancer for males; cervix uteri (RR ... more 7.15), prostate (RR 2.59), colon (RR 2.20) and lung (RR 2.01) cancer for males; cervix uteri (RR 3.45), breast (RR 3.36), corpus uteri (RR 2.51), colon (RR 2.41) and lung (RR 2.16) cancer for females. There is a significant positive correlation between cancer mortality and urban population, population with higher education, lung cancer in women and negative correlation with unemployment rate. A strong positive correlation is found between breast cancer mortality and GDP, population with higher education and urban population. Mortality from cervical cancer is most affected by poverty and dropped out of education. Prostate cancer mortality is positively correlated with urban population, higher education and negatively correlated with number of people per GP.
Journal of Clinical Oncology, May 20, 2011
e19678 Background: The number of people with access to the Internet and who actually use it to ob... more e19678 Background: The number of people with access to the Internet and who actually use it to obtain health information is continuously on the rise. Gynecologists must, therefore, adapt their practice to these changing circumstances. However, there is still virtually no data available on the determinants of patient Internet use. This study aims to determine the percentage of breast cancer patients using the Internet for health information and to ascertain which socio-demographic and disease characteristics are associated with this use. METHODS The study population consisted of female patients with primary breast cancer who had undergone surgery in one of the breast centers in the German state of North Rhine-Westphalia between February and July of the years 2007 to 2010. Patients from the four cohorts were surveyed postoperatively by mail using the Cologne Patient Questionnaire for Breast Cancer (CPQ-BC). Of the patients who consented to participating in the survey (consent rate: 90 %), an average of 88 % responded to the questionnaire. The total sample size for the study in 2007 to 2010 was N = 14,923. Frequency and logistic regression analyses were used for statistical analysis. RESULTS Over the three years of the study, there was an increase in the percentage of breast cancer patients using the Internet to obtain information on their condition (2007: 30.9%; 2008: 32.7%; 2009: 34.3%; 2010: 37.2%). Significant differences were found in the correlations between the different age and social status groups and Internet use. Older patients, patients with lower levels of formal education, patients without a partner, and patients without private medical insurance are significantly less likely to search for health information online. CONCLUSIONS One-third of breast cancer patients in the sample use the Internet to obtain information on their condition, and this number is rising. Patient Internet use is associated with age, education, and insurance status in all four cohorts.
Supportive Care in Cancer, Jun 17, 2021
Objective This study investigated the prevalence, individual courses, and determinants of fear of... more Objective This study investigated the prevalence, individual courses, and determinants of fear of cancer recurrence (FoR) in long-term breast cancer survivors (BCSs) with and without recurrence. Methods A total of 184 breast cancer survivors were surveyed at four measurement time points: during hospitalization (T1), 10 weeks (T2), 40 weeks (T3), and 5-6 years (T4) after hospital discharge. Descriptive statistics, chi-square tests, and logistic regression were performed. Results Respondents were females and 57 years old, on average. At T1, T3, and T4, 54.8%, 31.6%, and 29.7% of BCSs, respectively, were classified as having dysfunctional levels of FoR. Dysfunctional FoR decreased from T1 to T3 (χ 2 (1) = 17.11, p = 0.000; N = 163) and remained stable afterwards. Eight subgroups of individual courses of FoR over time could be described: (1) constant functional FoR; (2) constant dysfunctional FoR;
Supportive Care in Cancer, Apr 12, 2011
Whilst much is known as to the met and unmet communication needs of prostate cancer patients, few... more Whilst much is known as to the met and unmet communication needs of prostate cancer patients, few studies have been conducted on the changes in communication between provider and patient over time. Therefore, the aim of our study is to examine (a) whether there are changes over time in the quality of psychosocial care in long-term treatment of localized prostate cancer and (b) whether those changes are associated with the treatment decision. HAROW is a prospective, observational study designed to collect clinical data and patient reported outcomes (PROs) of different treatment options (hormonal therapy, active surveillance, radiation, operation, watchful waiting) for newly diagnosed patients with localized prostate cancer under real conditions. At 6-month intervals, general clinical data, PROs (e.g. quality of life, quality of physician-patient interaction) and individual costs are documented. We analysed data of N = 1,216 patients at the time of initial diagnosis (T1) and after 6 months (T2). There is a significant decline in shared decision-making behaviour of physicians for the group of patients undergoing a prostatectomy and for the hormonal therapy group at the time of initial diagnosis and after 6 months. In terms of emotional support by physicians, there is a significant difference between the treatment groups at the time of initial diagnosis with patients undergoing a prostatectomy reporting significantly less support than the hormonal therapy group. Future research from both, the providers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; and the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perspective, will have to clarify if we can interpret our results as change in the communication behaviour once the treatment decision for prostatectomy or hormonal therapy is made.
Psychology Health & Medicine, Jun 2, 2020
This studyinvestigates the need for psycho-oncological care over the course of a breast cancer tr... more This studyinvestigates the need for psycho-oncological care over the course of a breast cancer treatment and possible associated factors to develop such a need. The PIAT-Study was a longitudinal postal survey study conducted in Germany (2013 to 2014) with breast cancer patients (BCPs). Patients received a questionnaire at three-time points (T1: few days after surgery, T2: after 10 weeks; T3: after 40 weeks). This study considers information about patients' needs for psychooncological care, their breast cancer disease, social support, anxiety, health literacy (HL) and sociodemographic information. Data were analysed with descriptive statistics and logistic regression modelling to estimate the association between a need for psycho-oncological treatment and patient characteristics. N = 927 breast cancer patients reported their psycho-oncological need. 35.2% of patients report at least at one measuring point to be in need for psycho-oncological care. In a multiple logistic regression, noticeable determinants for developing such a need are an inadequateHL(OR = 1.97), fear of progression (FoP) (OR = 2.08) and psychological comorbidities (OR = 8.15) as well as certain age groups. BCPs with a low HL, suffering from a dysfunctional level of FoP or mental disorders are more likely to develop a need for psycho-oncological care.
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 2009
ABSTRACT Safety culture is a multi-dimensional phenomenon. Safety culture of a healthcare organiz... more ABSTRACT Safety culture is a multi-dimensional phenomenon. Safety culture of a healthcare organization is high if it has a common stock in knowledge, values and symbols in regard to patients’ safety. The article intends to define safety culture in the first step and, in the second step, demonstrate the effects of safety culture. We present the model of safety behaviour and show how safety culture can affect behaviour and produce safe behaviour. In the third step we will look at the causes of safety culture and present the safety-culture-model. The main hypothesis of this model is that the safety culture of a healthcare organization strongly depends on its communication culture and its social capital. Finally, we will investigate how the safety culture of a healthcare organization can be improved. Based on the safety culture model six measures to improve safety culture will be presented.
BMC Health Services Research, Dec 1, 2018
Background: Return to work (RTW) is a key parameter of outcome quality that ensures social partic... more Background: Return to work (RTW) is a key parameter of outcome quality that ensures social participation. Therefore, this study analyses the sociodemographic and disease-related determinants of RTW among newly diagnosed breast cancer patients. Methods: In a prospective, multicentre cohort study, breast cancer patients were surveyed three times: directly after surgery, after 10 weeks, and after 40 weeks. Logistic regression analysis was applied to estimate the association of RTW at 40 weeks following discharge with sociodemographic and disease-related characteristics (n = 577). Results: The sociodemographic variables "entrance certificate at a university of applied science" compared to "university entrance certificate" (OR = 3.1, 95%-CI = 1.2-8.1), age group "55-59 years" compared to "18-44 years" (OR = 3.2, 95%-CI = 1.2-8.4) and "having children" (OR = 2.8, 95%-CI = 1.2-6.2) as well as the disease-related variables "rehabilitation" (OR = 0.5, 95%-CI = 0.3-0.9), self-rated health "good" and "excellent" compared to "bad" (OR = 2.7, 95%-CI = 1.4-5.5; OR = 11.6, 95%-CI = 4.2-31.8) and the UICC-classification "stage II" and "stage III/IV" in comparison to "stage 0/I" (OR = 0.5, 95%-CI = 0.3-0.8; OR = 0.2, 95%-CI = 0.1-0.5) significantly affect RTW among breast cancer patients (Nagelkerke's Pseudo-R 2 = 0.275). Conclusions: The findings show that significant differences in RTW exist between patient groups and suggest that RTW issues must be addressed more effectively before, during and after treatment. For future research on RTW in Germany, longitudinal studies with a follow-up of several years are necessary. Information and support deficits should be tackled by social services or breast care nurses.
BMC Cancer, Apr 8, 2019
Background: Decisions made in multidisciplinary tumor conferences (MTC) that consider patient pre... more Background: Decisions made in multidisciplinary tumor conferences (MTC) that consider patient preferences result in better patient outcomes. Furthermore, it has been shown that in some breast cancer centers in Germany, patients participate in MTCs and that participation is associated with sociodemographic and breast cancer centerrelated factors. Health literacy (HL) has been shown to be predictive for individual health behavior and is an important prerequisite for patient participation in healthcare. However, so far nothing is known about the association between HL and MTC patient participation. To close this gap in research, we analyzed which patient characteristics affect participation in MTCs and whether participation varies between breast cancer centers. Methods: In a prospective, multicenter cohort study, newly diagnosed breast cancer patients were surveyed directly after surgery (T1) as well as 10 weeks (T2) and 40 weeks (T3) after surgery. After descriptive analysis, t-tests were conducted, correlations for independent variables were run, and logistic multilevel regression analysis was applied to estimate the association between patient participation in MTCs at T1 and HL (HLS-EU-Q16 [1]), sociodemographic and disease-related characteristics (n = 863 patients) and the variation between breast cancer centers (n = 43 centers). Results: Descriptive results show that 6.8% of breast cancer patients took part in a MTC. The logistic multilevel regression model revealed that patients with an inadequately HL are less likely to participate in MTCs (OR = 0.31, 95%-CI = 0.1-0.9, Pseudo-R 2 = 0.06), and participation is dependent on the breast cancer center (ICC = 0.161). Conclusions: These findings are the first to show significant differences in HL and patient participation in MTCs in a large sample of breast cancer patients. In future research on patient participation in MTCs and HL, questions concerning the organization, communication and decision-making in MTCs with and without patient participation have to be addressed, and patient and provider perspectives must be equally considered.
Breast Cancer Research and Treatment, Feb 8, 2012
The objective of this study is to investigate health-related quality of life (HRQoL) in male brea... more The objective of this study is to investigate health-related quality of life (HRQoL) in male breast cancer patients. Data of 20,673 patients diagnosed with primary breast cancer (male: n = 84) who completed a questionnaire after discharge from hospital were analysed. HRQoL (SF-36), age, sex, education, native language, insurance status, and partnership status were measured. Cancer staging, treatment (partial mastectomy vs. radical mastectomy), and cancer site were indicated by the clinicians. The HRQoL scores of male breast cancer patients were compared with reference populations. Differences in HRQoL scores between men and women were compared using t tests and regression analysis. Compared to female breast cancer patients, male patients scored significantly higher on seven of eight subscales (physical functioning, role functioning-physical and emotional, bodily pain, vitality, social functioning, and mental health) in the regression analysis. Compared to the reference populations (general male population, men aged 61-70, and the cancer-affected population), male breast cancer patients scored lower on SF-36 subscales on average, with major differences in emotional and physical role functioning. The results suggest that male breast cancer patients may need early interventions that specifically target role functioning, which is severely impaired compared to the male reference population. Future research needs to assess HRQoL with cancer-specific questionnaires and longitudinal designs also focussing on male patients in breast centres.
BMC Psychiatry, Feb 9, 2022
Background: There is a significant number of long-term breast cancer survivors in Germany. Howeve... more Background: There is a significant number of long-term breast cancer survivors in Germany. However, research on the psychological challenges of cancer survivors is limited. This analysis describes prevalence, development and determinants of depression and anxiety 5 to 6 years after diagnosis and identifies predictors for an increase of anxiety and depression over time. Methods: Data from 164 women was collected by survey and tumour documentation during post-operative hospital stay, 40 weeks and 5 to 6 years after diagnosis. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale. Sankey-diagrams were created for visual presentation of prevalence over time. Logistic and linear regression models were calculated to identify determinants of anxiety and depression. Results: Respondents had higher levels of depression and anxiety 5 to 6 years than 40 weeks after the diagnosis. Lower vocational status and having children were associated with depression, surgery type was correlated with anxiety, and age, as well as comorbidities, were predictors for both anxiety and depression 5 to 6 years after diagnosis. An increase of depression over time was more likely when having children and comorbidities. An increase in anxiety was less likely after cancer recurrence. Conclusions: Findings highlight that anxiety and depression are relevant burdens for breast cancer survivors in Germany. Several sociodemographic and clinical predictors are identified. There is need for psychosocial support after acute treatment and in the long-term. Research on psychological burdens of long-term breast cancer survivors in the identified vulnerable groups is needed.
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, Apr 1, 2017
Please cite this article in press as: Ernstmann N, et al. Measuring attributes of health literate... more Please cite this article in press as: Ernstmann N, et al. Measuring attributes of health literate health care organizations from the patients' perspective: Development and validation of a questionnaire to assess health literacy-sensitive communication (HL-COM). Z. Evid.
Patient Education and Counseling, May 1, 2016
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service... more This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Journal of Nursing Care Quality, Oct 1, 2009
The purpose of the study was to examine the relationship between social capital and clinical risk... more The purpose of the study was to examine the relationship between social capital and clinical risk management in hospitals from nurses' perspective. The results of our investigation suggest that higher values of social capital are associated with better ratings in clinical risk management behavior. An established atmosphere of trust and a feeling of common values and convictions can help nurses integrate clinical risk management into their daily work.
Patient Education and Counseling, Aug 1, 2012
Eleven months after being interviewed in a study on unmet needs of severely affected multiple scl... more Eleven months after being interviewed in a study on unmet needs of severely affected multiple sclerosis patients, one participant died by assisted suicide. We reanalyzed the data to find out if our 15 study patients might have brought up the topic of death and dying during episodic interviews that had not primarily addressed this issue. Secondary analysis with regard to the thematic field of death and dying revealed that patients unsolicited brought up this issue within the following categories: "Passing over death and dying," "Death is not relevant to me," "We want to keep up the life challenge," "Death as an option," and "Wish to have the opportunity to address end of life issues." We conclude that the topic of death and dying is of importance to these patients, as they spontaneously mentioned it in multiple varieties. Health professionals should individually acknowledge patients' needs to address death and dying.
Background: As the number of people with Internet access rises, so does the use of the Internet a... more Background: As the number of people with Internet access rises, so does the use of the Internet as a potentially valuable source for health information. Insight into patient use of this information and its correlates over time may reveal changes in the digital divide based on patient age and education. Existing research has focused on patient characteristics that predict Internet information use and research on treatment context is rare.
Objective: This study aims to (1) present data on the proportion of newly diagnosed breast cancer patients treated in German breast centers from 2007 to 2013 who used the Internet for information on their disease, (2) look into correlations between Internet utilization and sociodemographic characteristics and if these change over time, and (3) determine if use of Internet information varies with the hospitals in which the patients were initially treated.
Methods: Data about utilization of the Internet for breast cancer–specific health information was obtained in a postal survey of breast cancer patients that is conducted annually in Germany with a steady response rate of 87% of consenting patients. Data from the survey were combined with data obtained by hospital personnel (eg, cancer stage and type of surgery). Data from 27,491 patients from 7 consecutive annual surveys were analyzed for this paper using multilevel regression modeling to account for clustering of patients in specific hospitals.
Results: Breast cancer patients seeking disease-specific information on the Internet increased significantly from 26.96% (853/3164) in 2007 to 37.21% (1485/3991) in 2013. Similar patterns of demographic correlates were found for all 7 cohorts. Older patients (≥70 years) and patients with <10 years of formal education were less likely to use the Internet for information on topics related to their disease. Internet use was significantly higher among privately insured patients and patients living with a partner. Higher cancer stage and a foreign native language were associated with decreased use in the overall model. Type of surgery was not found to be associated with Internet use in the multivariable models. Intraclass correlation coefficients were small (0.00-0.03) suggesting only a small contribution of the hospital to the patients’ decision to use Internet information. There was no clear indication of a decreased digital divide based on age and education.
Conclusion: Use of the Internet for health information is on the rise among breast cancer patients. The strong age- and education-related differences raise the question of how relevant information can be adequately provided to all patients, especially to those with limited education, older age, and living without a partner.