Franziska Kühne

Job Satisfaction Among Primary Care Physicians: Results of a Survey

BACKGROUND A shortage of primary care physicians (PCPs) seems likely in Germany in the near future and already exists in some parts of the country. Many currently practicing PCPs will soon reach retirement age, and recruiting young physicians for family practice is difficult. The attractiveness of primary care for young physicians depends on the job satisfaction of currently practicing PCPs. We studied job satisfaction among PCPs in Lower Saxony, a large federal state in Germany. METHODS In 2009, we sent a standardized written questionnaire on overall job satisfaction and on particular aspects of medical practice to 3296 randomly chosen PCPs and internists in family practice in Lower Saxony (50% of the entire target population). RESULTS 1106 physicians (34%) responded; their mean age was 52, and 69% were men. 64% said they were satisfied or very satisfied with their job overall. There were particularly high rates of satisfaction with patient contact (91%) and working atmosphere (87% satisfied or very satisfied). In contrast, there were high rates of dissatisfaction with administrative tasks (75% dissatisfied or not at all satisfied). The results were more indifferent concerning payment and work life balance. Overall, younger PCPs and physicians just entering practice were more satisfied than their older colleagues who had been in practice longer. CONCLUSION PCPs are satisfied with their job overall. However, there is significant dissatisfaction with administrative tasks. Improvements in this area may contribute to making primary care more attractive to young physicians.

Children of cancer patients: Prevalence and predictors of emotional and behavioral problems

Children of patients with cancer are at increased risk for developing emotional and behavioral problems. This study explored the prevalence and predictors of emotional and behavioral problems in Children of cancer patients in a multisite research project.

Spezialisierte ambulante Palliativversorgung

BACKGROUND The aim was to explore the expectations of general practitioners (GPs) towards specialized outpatient palliative care (SAPV) focused on older patients in the last phase of life. METHODS A standardized postal survey was carried out with 1,962 GPs in Lower Saxony with an analysis of physician and practice-related factors. RESULTS The response rate was 46% (n=897) and SAPV was known to 68% of the participants (n=599) of whom 48% (n=288) assumed that SAPV will improve the healthcare for older patients in the last phase of life. The GPs favored advice by and collaborative patient care with SAPV teams. Younger and female GPs, and GPs who had been practicing for a shorter period or working in a group practice showed greater interest in collaboration than other colleagues. CONCLUSIONS The perception of patients in specialized palliative care with its current focus on cancer patients is different from the perception in general practice with its focus on geriatric and multimorbid patients. This may be a reason for the skepticism showed in this study whether SAPV will actually improve healthcare in the community. However, with respect to the concept and framework SAPV has the potential to fulfill GPs expectations and should be focused on counseling and collaborative services. The knowledge about physician and practice-related factors shaping GPs attitudes towards SAPV can be helpful to further implement SAPV into practice.

Parental palliative cancer: psychosocial adjustment and health-related quality of life in adolescents participating in a German family counselling service

BackgroundParental palliative disease is a family affair, however adolescents well-being and coping are still rarely considered. The objectives of this paper were a) to identify differences in psychosocial adjustment and health-related quality of life (HRQoL) among adolescents and young adults with parents suffering from palliative cancer or cancers in other disease stages, b) to relate psychosocial adjustment and health-related quality of life to adolescent coping, and c) to explore significant mediator and predictor variables.MethodsCross-sectional data were derived from a multi-site research study of families before child-centered counselling. N=86 adolescents and young adults were included, their mean age 13.78 years (sd 2.45), 56% being female. Performed analyses included ANCOVA, multiple linear regression, and mediation analysis.ResultsAdolescents with parents suffering from palliative cancers reported significantly less total psychosocial problems, and better overall HRQoL. There were no significant group differences regarding coping frequency and efficacy. Our set of coping items significantly mediated the effect of parental disease stage on psychosocial problems and HRQoL. Further, parental disease status and general family functioning predicted psychosocial problems (R2adj =.390) and HRQoL (R2adj =.239) best.ConclusionThe study indicates distress among adolescents throughout the entire parental disease process. Our analysis suggests that counselling services could offer supportive interventions which focus particularly on adolescent coping as well as family functioning.

There is still so much ahead of us-family functioning in families of palliative cancer patients.

Adopting a systems approach, parental cancer has its impact on patients, spouses, and dependent children. The purpose of the current study was to examine family functioning dependent on parental disease stage and on family member perspective in families of cancer patients with adolescent children. The cross-sectional study was conducted within a German multisite research project of families before their first child-centered counseling encounter. The sample comprised individuals nested within N = 169 families. Analyses performed included analysis of covariance (ANCOVA) and intraclass correlation. Open answers were analyzed following quantitative content analysis procedures. Between 15% and 36% of family members reported dysfunctional general functioning scores. Parents indicated more dysfunctional scores on the Family Assessment Device scale Roles, and adolescents more dysfunctional Communication scores. Regarding assessment of family functioning, there was higher agreement in families with parents in a palliative situation. For adolescents with parents in palliation, incidents because of the disease tend to become more dominant, and spending time with the family tends to become even more important. As our study pointed out, parental cancer, and especially parental palliative disease, is associated with both perceived critical and positive aspects in family functioning. Supporting families in these concerns as well as encouraging perceptions of positive aspects are important components of psycho-oncological interventions for families with dependent children.

Conceptual decomposition of complex health care interventions for evidence synthesis: a literature review.

Rationale, aims and objectives The clarity of pivotal concepts is an important prerequisite for the development, evaluation and exchange of scientific ideas. The term ‘complex intervention’ is increasingly used in the health care literature, although it often remains unclear what is actually meant by this concept. Therefore, our aim was to analyse the literature regarding definitions of the terms ‘complex intervention’ and ‘components’ of such interventions. Method To identify the methodological publications, systematic and snowballing techniques were combined for the literature search. Relevant units of meaning were extracted from 68 included publications. Afterwards, we deduced categories and related frequencies by inductive and quantitative content analysis techniques. Results Several types of complexity were distinguished in the literature. Most authors viewed complex interventions as multicomponent interventions that are characterized by interactions between the components themselves, with the context or as systemic interventions. Components of complex interventions were described in the publications as having the potential to causally influence outcomes, thus being essential for achieving an effect. Other definitions and inconsistencies among the definitions are highlighted and discussed. Conclusions From our synthesis, we derived definitions of the central health care-related concepts ‘complex intervention’ and ‘components’ of an intervention. Although we found numerous diverse definitions, they could be reduced to a defined number of core characteristics. These characteristics may facilitate communication regarding complex interventions and enable the deduction of methodological approaches for evidence synthesis.

Specialized outpatient palliative care. The expectations of general practitioners

BACKGROUND The aim was to explore the expectations of general practitioners (GPs) towards specialized outpatient palliative care (SAPV) focused on older patients in the last phase of life. METHODS A standardized postal survey was carried out with 1,962 GPs in Lower Saxony with an analysis of physician and practice-related factors. RESULTS The response rate was 46% (n=897) and SAPV was known to 68% of the participants (n=599) of whom 48% (n=288) assumed that SAPV will improve the healthcare for older patients in the last phase of life. The GPs favored advice by and collaborative patient care with SAPV teams. Younger and female GPs, and GPs who had been practicing for a shorter period or working in a group practice showed greater interest in collaboration than other colleagues. CONCLUSIONS The perception of patients in specialized palliative care with its current focus on cancer patients is different from the perception in general practice with its focus on geriatric and multimorbid patients. This may be a reason for the skepticism showed in this study whether SAPV will actually improve healthcare in the community. However, with respect to the concept and framework SAPV has the potential to fulfill GPs expectations and should be focused on counseling and collaborative services. The knowledge about physician and practice-related factors shaping GPs attitudes towards SAPV can be helpful to further implement SAPV into practice.

Elternschaft und Krebserkrankung: Dyadische Analyse von psychosozialer Belastung und gesundheitsbezogener Lebensqualität von krebskranken Eltern minderjähriger Kinder

The purpose of this study was the analysis of psychological distress and health-related quality of life (HRQoL) of parents with minor children during curative resp. palliative treatment.Cross-sectional design with a sample of N=89 parent dyads. Dyadic analysis of demographic, illness and family variables via mixed linear models.Patients and healthy partners indicated psychological distress on different subscales. Intradyadic correlations were small-moderate. Most important predictors of psychological distress and HRQoL were treatment stadium, gender, family functioning, and employment status.Dependent on demographic variables, psychooncological support was evident mainly for parents in palliative care and for families with dysfunctional functioning.tion und den Umgang damit nachhaltig beeinfl ussen. Wünsche für die Zukunft der Familie können aufseiten beider Partner durch eine Krebserkrankung nachhaltig erschüttert werden. In der Palliativphase kann sich Elternschaft auch auf das Treff en von Behandlungsentscheidungen auswirken, wie eine Studie zeigt, nach der Palliativpa tienten eher bereit waren, sich aggressiven Behandlungsformen auszusetzen und seltener ihren Willen hinsichtlich Behandlung und Betreuung formal hinterlegt hatten [ 4 ] . An Krebs erkrankten Eltern minderjähriger Kinder ist es wichtig, im Alltag so lange wie möglich eine gewisse Normalität aufrechtzuerhalten, das Wohlbefi nden der Kinder in den Mittelpunkt zu Einleitung ▼ Eine schwerwiegende körperliche Erkrankung stellt, zumal in der Palliativphase, für alle Familienmitglieder ein einschneidendes Lebensereignis dar und spiegelt sich in der psychischen Belastung von Patienten und deren Lebenspartnern wider [ 1 – 3 ] . Sind Patienten und deren Partner Eltern minderjähriger Kinder [ 4 ] und ist das Behandlungsziel palliativ [ 2 , 3 ] , so scheint dies mit einer stärkeren psychosozialen Belastung beider Partner einherzugehen. Neben der eigenen Bestürzung und Hilfl osigkeit kann die Angst vor dem Verlust des Partners und der Bewältigung der alleinigen Elternrolle das Erleben der SituaAutoren Franziska Kühne 2 , Thomas Krattenmacher 1 , Corinna Bergelt 2 , Anna-Lena Bierbaum 3 , Johanna Christine Ernst 2 , Hans-Henning Flechtner 4 , Monika Keller 5 , Kai v. Klitzing 6 , Georg Romer 1 , Birgit Möller 1

Effectiveness of metacognitive interventions for mental disorders in adults: a systematic review protocol (METACOG)

Introduction Whereas the efficacy of cognitive-behavioural therapy has been demonstrated for a variety of mental disorders, there is still need for improvement, especially regarding less prevalent or more severe disorders. Recently, metacognitive interventions have been developed and are now available for a variety of diagnoses. Still, a systematic review investigating the effectiveness of different metacognitive interventions for various mental disorders is missing. Methods and analysis Randomised controlled trials (RCTs), cross-over and cluster RCTs and non-randomised controlled trials on metacognitive interventions (ie, metacognitive therapy, metacognitive training, others) in adults with any mental disorder will be included. As comparators, another psychological or pharmacological treatment, a combined psychological and pharmacological treatment, treatment as usual or no active treatment are eligible. Outcomes refer to efficacy and acceptability of metacognitive interventions. Ethics and dissemination In light of the popularity of metacognitive interventions, the systematic review will provide researchers, clinicians and patients with substantial information on the intervention’s effectiveness across different mental disorders. Results will be published in peer-reviewed journals and disseminated through a patient workshop.

Minderjährige Kinder krebskranker Eltern

ZusammenfassungEine Krebserkrankung ist mit einer Reihe von medizinischen, psychischen, sozialen und existenziellen Stressoren verbunden. Eine solche Krisensituation hat Auswirkungen für das gesamte Familiensystem. So sind Patienten und Partner in ihren individuellen Rollen, aber auch als Eltern verstärkt gefordert. Außerdem wirkt sich eine elterliche Krebserkrankung auch auf das psychosoziale Befinden minderjähriger Kinder aus. Verschiedene Beratungsangebote wurden konzipiert, die Ängsten der Kinder einen Raum geben und Familienmitglieder besser miteinander ins Gespräch bringen sollen. Die empirische Absicherung der Zielerreichung, Wirksamkeit und Effizienz dieser Konzepte steht allerdings noch aus. Bei einem kleinen Teil der Kinder ist eine psychiatrische oder psychotherapeutische Behandlung indiziert. Exemplarisch wird ein von einem Teil der Autoren entwickeltes manualisiertes Interventionskonzept (COSIP-Beratung) in einer praxisnahen Kurzübersicht dargestellt.AbstractSuffering from cancer is associated with a number of medical, psychological, social and existential stressors and such a crisis affects the whole family system. Patients and their partners are challenged within their individual roles but also in their roles as parents. Moreover, parental cancer influences the psychosocial adjustment of dependent children. Several counseling concepts were developed to take children’s worries and anxieties into account and to facilitate communication among family members; however, empirical evidence of goal attainment, efficacy and effectiveness is still due for all of these concepts. For a small portion of children and adolescents, psychiatric or psychotherapeutic treatment is indicated. As an example, a short practical overview of a manualized intervention concept for families with a parent having cancer (COSIP Counseling) is given, which was developed by some of the authors.