Heide Götze

Hospital anxiety and depression scale cutoff scores for cancer patients in acute care.

The aim of this study was to determine optimal cutoff scores for the Hospital Anxiety and Depression Scale (HADS) when used in evaluating cancer patients in acute care. A total of 689 cancer patients were assessed during their first days of in-patient treatment, using the structured clinical interview for DSM and the HADS. Statistical analysis was performed using ROC curves. A total of 222 patients (32%) had a mental disorder. The area under the curve was the best in the total scale of the HADS, namely 0.73. With a score of ⩾13, it is possible to detect 76% of the cases with a specificity of .60, whereas 95% of the cases can be detected with a score of ⩾6 (specificity 0.21). With scores of ⩾16 and ⩾22, recommended by the test authors for primary care, only 59 and 30% of the comorbid cancer patients are indicated. Lower HADS cutoff scores when preferable when evaluating cancer patients than are recommended for use in primary care. When using HADS in clinical practice and epidemiological studies, it is important to decide whether, for the task at hand, high detection rates of affected patients or low misclassification rates are more important.

Quality of care and emotional support from the inpatient cancer patient’s perspective

BackgroundPatient satisfaction and emotional support are crucial elements of cancer care. Little is known, however, about which areas of care are important from the patient’s perspective and the roles emotional distress and support play in this context.MethodsMulticenter prospective study was conducted (n = 396 cancer patients; t1 = after admission to hospital, t2 = before discharge). Quality of care was measured with the quality of care from the patient’s perspective questionnaire, and emotional distress was measured with the hospital anxiety and depression scale. Additional questions regarding emotional support wished (at t1) and provided (at t2) were administered.ResultsThe patients reported that the domains of care most important to them were as follows: respect and commitment of the physicians, information before procedures, care equipment, and medical care. The areas where improvements are most obviously needed were nutrition, participation, clarity about who is responsible for personal care, and having the possibility of speaking in private with nurses and psycho-oncologists. Fifty-six percent of the patients were highly emotionally distressed, 84% wanted support from physicians, 76% from nurses, 33% from psychologists, and 7% from a pastor.ConclusionEmotional support is a crucial part of patient satisfaction and should be provided by several members of the oncological team, especially the patients’ physicians. In turn, it is crucial that medical professionals be equipped with good communication skills.

Psychological distress in cancer patients with underage children: gender-specific differences.

Findings on gender differences in the psychological distress of cancer patients have been inconsistent. The objectives of the current study were to examine whether being a parent differentially modulates anxiety and depression in men and women and to compare whether psychological distress differs in male and female patients with and without children.

Quality of life of parents diagnosed with cancer: change over time and influencing factors

Suffering from cancer while having parental responsibilities can amplify the psychosocial strain that the disease puts on the individual as well as on the whole family system. Our longitudinal study examines changes in the quality of life of cancer patients in relation to parenthood. The quality of life of cancer patients is assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30-item version during the initial treatment period (T1) and compared to the quality of life 2 years later (T2). Two groups of patients are compared: those who have children below the age of 18 years (n= 41) and those who do not have children (n= 28). Shortly after being diagnosed with cancer (T1), both groups report a similarly low quality of life. Two years later (T2), individuals with children below the age of 18 report better quality of life on the majority of the dimensions assessed. However, variance analysis did not show that this is an independent effect of parenthood. In fact, having a partner and being female proved to impact the quality of life. These findings support the existing body of research on the influence of social support and gender on quality of life. The resulting limitations and suggestions on how to overcome them in further research are discussed.

Ambulante Palliativversorgung von Tumorpatienten im Raum Leipzig

BACKGROUND In many model regions of Germany, palliative home care can be improved for cancer patients over longer periods so that most of these patients could die at home. However, there is a shortage of ambulatory care for dying patients in regions without special agreements for this type of care. METHODS The aim of the study was to identify beneficial as well as impedimentary factors of outpatient palliative care. Therefore we interviewed 91 tumour patients and collected medical, psychosocial and sociodemographic data with standardized questionnaires. RESULTS Nearly half of the patients (43%) had moderate to strong pain during domestic care and felt depressed (44%) and anxious (26%). Home hospice services, social workers, and psychologists were rarely involved in home care. Ambulatory home care was often interrupted because of hospital stays. CONCLUSION Palliative symptom control in outpatients should be performed by qualified and interdisciplinary palliative-care teams, so that patients can receive more psychosocial support and hospital stays can be prevented.

Predictors of quality of life of cancer patients, their children, and partners

The objective of this study is to assess the quality of life (QOL) of cancer patients and their family members over 1‐year period post therapy.

Gestaltungskurs für Krebspatienten in der ambulanten Nachsorge

Hintergrund: Künstlerische Therapien gewinnen auch in der psychosozialen Onkologie zunehmend an Bedeutung. Schwerpunkte der Kunsttherapien für Krebspatienten liegen im Akutbereich und der Rehabilitation, wobei sich die Angebote im Ansatz und Setting unterscheiden. Die hier vorgestellte Studie hatte das Ziel, den Einfluss einer kunstpädagogischen Intervention auf die psychischen Belastungen und die Krankheitsverarbeitung von Tumorpatienten in der ambulanten Nachsorge abzubilden. Patienten und Methodik: Eine künstlerische Intervention für den ambulanten psychoonkologischen Bereich wurde in einer prospektiven Pilotstudie evaluiert. Messzeitpunkte waren unmittelbar vor (t1) und nach (t2) dem Kurs. Mithilfe quantitativer Messverfahren erfolgte die Erhebung der psychischen Belastetheit (HADS) der Teilnehmer sowie der Krankheitsverarbeitung (TSK). Ergebnisse: Die Ängstlichkeit der Teilnehmer (n = 18) war nach Beendigung des Kurses von 11,06 auf 9,33 gesunken und damit signifikant geringer als zu Kursbeginn (p < 0,04). Gegenüber einer repräsentativen Vergleichsstichprobe von Tumorpatienten (n = 48; M = 5,51) war die Ängstlichkeit jedoch zu beiden Messzeitpunkten deutlich höher ausgeprägt (p < 0,01). Die Depressivität der Kursteilnehmer veränderte sich nicht statistisch signifikant (t1 = 6,94, t2 = 6,22; p < 0,32). Auch gegenüber der Vergleichsgruppe (M = 5,24) waren keine signifikanten Unterschiede feststellbar (t1: p < 0,066, t2: p < 0,519). Die Teilnehmer selbst schätzten ihre psychische Belastung nach Kursende geringer ein als zu Kursbeginn (t1 = 3,1, t2 = 2,7; p < 0,021). Die Auswertung ergab keine Veränderungen in der Krankheitsverarbeitung. Schlussfolgerungen: Auch Tumorpatienten, die sich in der ambulanten Nachsorge befinden, sind psychisch überdurchschnittlich stark belastet. Dies spricht für die Einführung psychoonkologischer Angebote in der Nachsorge. Künstlerische Interventionen können hierbei einen wichtigen Beitrag für das seelische Wohlbefinden onkologischer Patienten leisten.

Gestaltungskurs für onkologische Patienten in der ambulanten Nachsorge

Zusammenfassung. Hintergrund: Fur krebskranke Menschen bieten Kunsttherapien die Moglichkeit, mit sich und der Umwelt in Dialog zu treten, das heist kunstlerisches Tatigsein eroffnet neue Ausdrucksmoglichkeiten. Fragestellung: Unbekannt ist, ob die Wirkungen von Kunsttherapien, die wahrend der stationaren onkologischen Behandlung und in Rehabilitationskliniken erreicht wurden, auch wahrend der ambulanten Nachsorge erzielt werden konnen und wie ein solches Angebot gestaltet sein sollte. Stichprobe und Methodik: In unserer Abteilung wurde ein Gestaltungskurs fur den ambulanten psychoonkologischen Bereich entwickelt. Mittels qualitativer Leitfadeninterviews wurde erhoben, welche Erwartungen onkologische PatientInnen an den Kurs haben und welche Wirkungen sie ihm Anschluss an die Intervention beschreiben. Ergebnisse: Aus den insgesamt 240 Aussagen der TeilnehmerInnen bezuglich der Wirkungen wurden folgende funf Bedeutungsbereiche extrahiert: Personliches Wachstum, Emotionale Stabilisierung, Krankheitsverarbeitung, Erweiterung der Ausdrucksmoglichkeit und Kommunikation. Im Vordergrund steht hierbei das personliche Wachstum (v. a. Selbstreflexion, Schaffung personlicher Freiraume), was ¾ der KursteilnehmerInnen als Kurswirkung angaben. Die Kategorien Emotionale Stabilisierung, Kommunikation und Krankheitsverarbeitung sind fur ca. die Halfte der KursteilnehmerInnen wesentlich. Diskussion: Unsere Ergebnisse zeigen, dass kunsttherapeutische Interventionen auch in der ambulanten psychosozialen Nachsorge einen entscheidenden Beitrag fur das psychische Wohlbefinden und die Unterstutzung der Krankheitsverarbeitung von onkologischen Patienten leisten konnen. Schlusselworter: Kunsttherapie, Onkologie, Wirkung, qualitative Forschung, ambulante Nachsorge Art therapies for cancer patients in ambulant aftercare – Participants views of expectations and effects

Partner von Krebspatientinnen mit minderjährigen Kindern – Psychische Belastung im Vergleich zur Allgemeinbevölkerung und zur krebskranken Partnerin

The psychological distress of men with underage children, whose female partners have cancer, was examined using the Hospital Anxiety and Depression Scale (HADS). The sample (N=141) was compared with the partners who have cancer and a comparison group of men from the general population (N=154). The male partners of cancer patients were psychological strongly distressed. About half of the partners showed increased scores in anxiety and one third of the partners had a high level of depression. There was a high correlation within the couple. The male partners of cancer patients were significantly more distressed than the comparison group of men with underage children from the general population. It is very important to assess psychosocial support needs of partners of cancer patients and to provide adequate options of possible psychosocial treatment.

A non-randomised trial of an art therapy intervention for patients with haematological malignancies to support post-traumatic growth

The aim of this study was to determine the effect of art therapy on post-traumatic growth in patients with haematological malignancies in a non-randomised trial (n = 36, intervention group; n = 129, control group). Art therapy was administered over a period of 22 weeks in small groups. Post-traumatic growth was measured with the Stress-Related Growth Scale. After controlling for the effect of potential confounders, no difference in post-traumatic growth was observed between the intervention and control groups after 22 weeks. There was no evidence for an effect of weekly group sessions with art therapy on post-traumatic growth in patients with haematological malignancies.