Diethard Tauschel

Identifying and predicting subgroups of information needs among cancer patients: an initial study using latent class analysis

PurposeUnderstanding how the information needs of cancer patients (CaPts) vary is important because met information needs affect health outcomes and CaPts’ satisfaction. The goals of the study were to identify subgroups of CaPts based on self-reported cancer- and treatment-related information needs and to determine whether subgroups could be predicted on the basis of selected sociodemographic, clinical and clinician–patient relationship variables.MethodsThree hundred twenty-three CaPts participated in a survey using the “Cancer Patients Information Needs” scale, which is a new tool for measuring cancer-related information needs. The number of information need subgroups and need profiles within each subgroup was identified using latent class analysis (LCA). Multinomial logistic regression was applied to predict class membership.ResultsLCA identified a model of five subgroups exhibiting differences in type and extent of CaPts’ unmet information needs: a subgroup with “no unmet needs” (31.4% of the sample), two subgroups with “high level of psychosocial unmet information needs” (27.0% and 12.0%), a subgroup with “high level of purely medical unmet information needs” (16.0%) and a subgroup with “high level of medical and psychosocial unmet information needs” (13.6%). An assessment of sociodemographic and clinical characteristics revealed that younger CaPts and CaPts’ requiring psychological support seem to belong to subgroups with a higher level of unmet information needs. However, the most significant predictor for the subgroups with unmet information needs is a good clinician–patient relationship, i.e. subjective perception of high level of trust in and caring attention from nurses together with high degree of physician empathy seems to be predictive for inclusion in the subgroup with no unmet information needs.ConclusionsThe results of our study can be used by oncology nurses and physicians to increase their awareness of the complexity and heterogeneity of information needs among CaPts and of clinically significant subgroups of CaPts. Moreover, regression analyses indicate the following association: Nurses and physicians seem to be able to reduce CaPts’ unmet information needs by establishing a relationship with the patient, which is trusting, caring and empathic.

Physician empathy: Definition, outcome-relevance and its measurement in patient care and medical education

Objective: The present study gives a brief introduction into the definition of physician empathy (PE) and its influence on patients’ health outcomes. Furthermore we present assessment instruments to measure PE from the perspective of the patient and medical student. The latter topic will be explored in detail as we conducted a pilot study on the German versions of two self-assessment instruments of empathy, which are mostly used in medical education research, namely the “Jefferson Scale of Physician Empathy, Student Version” (JSPE-S) and the “Interpersonal Reactivity Index” (IRI). Methods: We first present an overview of the current empirical and theoretical literature on the definition and outcome-relevance of PE. Additionally, we conducted basic psychometric analyses of the German versions of the JSPE-S and the IRI. Data for this analyses is based on a cross-sectional pilot-survey in N=44 medical students and N=63 students of other disciplines from the University of Cologne. Results: PE includes the understanding of the patient as well as verbal and non-verbal communication, which should result in a helpful therapeutic action of the physician. Patients’ health outcomes in different healthcare settings can be improved considerably from a high quality empathic encounter with their clinician. Basic psychometric results of the German JSPE-S and IRI measures show first promising results. Conclusion: PE as an essential and outcome-relevant element in the patient-physician relationship requires more consideration in the education of medical students and, thus, in medical education research. The German versions of the JSPE-S and IRI measures seem to be promising means to evaluate these education aims and to conduct medical education research on empathy.

Can final year medical students significantly contribute to patient care A pilot study about the perception of patients and clinical staff

Background: Active participation of medical students in patient care has been shown to be important for professional development of learners. Not much is known about the impact of active student participation (ASP) to the quality of patient care. Aims: We established a Clinical Education Ward (CEW) for the final year medical students caring for patients under structured clinical supervision. This study investigates the views of both patients and clinical staff on the impact of ASP on patient care. Methods: The Picker Inpatient Questionnaire (PIQ) was used to survey all the patients admitted to the CEW during the pilot phase. Results concerning the general quality of health care and the patient–physician relationship (PPR) were compared to two matched pair control groups: patients of the same department (CG1) and of internal wards in Germany (CG2). In addition, quantitative and qualitative data were collected from patients and clinical staff members to specify the impact of students on patient care. Results: Out of 111 patients, 64 responded. The PIQ results revealed very minor problems in the assessment of the overall general quality of care and in PPR at the CEW, while significant improvements existed when compared to CG2. Furthermore, 79% of the patients and 95% of the staff members recorded a positive impact of ASP. Qualitative data illustrated and complemented these results. Chances and challenges in programs with high participation of students in clinical care are discussed. Conclusion: ASP may not only be useful for learners but also offers chances and benefits for patient care.

Integrative medical education: Educational strategies and preliminary evaluation of the Integrated Curriculum for Anthroposophic Medicine (ICURAM)

OBJECTIVES the development and preliminary evaluation of a new medical program aimed at educating students in patient-centered integrative care and developing appropriate educational strategies. METHODS The Integrated Curriculum for Anthroposophic Medicine (ICURAM) was developed with modules on anthroposophic medicine integrated into the full 6 years of the regular medical curriculum. The educational strategy is the ESPRI(2)T approach, combining Exploratory learning, Supported participation, Patient-based learning, Reflective practice, Integrated learning, an Integrative approach and Team-based learning. The student participation, assessed based on the number of credit points earned per year (ctp/year) through the ICURAM (1 ctp=30 h workload), served as a preliminary indicator of student interest. RESULTS Of the 412 55%medical students participated in the program: 16% full participation (≥ 4 ctp/year), 18% partial participation (1-3.99 ctp/year) and 22% occasional participation (0.25-0.99 ctp/year). The amount of additional workload taken on by students was between 7.8h/year for occasional participants, 33 h/year for partial participants and 84 h/year for full participants. CONCLUSION More than half of medical students were willing to invest a significant amount of additional time in the optional program. PRACTICE IMPLICATIONS An integrative medical curriculum with a student-centered educational strategy seems to be of interest to most medical students.

Medical Education in Complementary and Alternative Medicine (CAM): A European Perspective

As use of complementary and alternative medicine (CAM) is becoming increasingly popular among patients, we need to take a new look at how we are educating our future doctors. Opinions on integration of CAM courses into the main curriculum at medical faculties differ. In this chapter, we would like to discuss various aspects of this issue. Starting with the question of why CAM should be taught at medical schools, in the first section, we briefly outline the current usage of CAM among patients and then look at CAM from the physician’s point of view. How do physicians view the increasing popularity of CAM among patients and how do they deal with it? Do physicians integrate CAM into their regular practice? Do they wish for more training on CAM topics? We then go on to describe the current situation of CAM education in Europe. This section includes reports on how CAM is viewed at universities or medical faculties as well as a paragraph about possible reasons for the slow progress in integrating CAM into medical curricula in Europe. In the next section, we look at the content that should be taught and possible ways of integrating it into the medical curriculum. The final section describes the “Integrated Curriculum for Anthroposophic Medicine” (ICURAM) at the University of Witten/Herdecke in Germany as an example of successful integration of CAM into the medical education of students at a German university.