Thomas Krattenmacher

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.

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.

Evidenzbasierte Behandlungselemente in der Rehabilitation von Patienten mit Depression – Eine Literaturübersicht

BACKGROUND In recent years, the importance of guidelines has increased continuously. This development also occurs in the field of rehabilitative health care, where process guidelines are being designed for various indicational groups to ensure quality standards and improvements. AIM The primary goal of this paper is to collect and evaluate the evidence for various treatment options for depressive disorders in order to establish a basis for the current development of a process guideline for the rehabilitation of patients with depressive disorders. METHOD In order to identify evidence based treatment elements, first a comprehensive investigation of national and international guidelines was conducted. Thirteen selected guidelines were then assessed with regard to aspects of methodological quality and evidence-based treatment elements. In a further step, literature searches were conducted for residual treatment elements, which were identified on the basis of the Classification of Therapeutic Services (KTL) 2007. For the literature search, a hierarchical approach was chosen: At first, meta-analyses and systematic reviews were viewed. In case when there was still a lack of evidence for specific, potentially relevant treatment elements, the search was expanded to the level of primary studies. All selected reviews and primary studies then underwent a standardized assessment especially regarding methodological quality and evidence grades were allocated to treatments. RESULTS Thereby, the following treatment elements with an adequate level of evidence were identified: Psychotherapeutic interventions, marital/couples/family therapy and counselling, inclusion of family members, psycho education and exercise, problem solving therapy, guided self-help, and behavioural activation treatments. On the basis of this complementary literature search, various other evident interventions could be identified within the following areas: relaxation techniques, improvement of social competence, occupational therapy, art therapies (music, movement/dance therapies), body-oriented therapies and massage therapy. CONCLUSION In summary, using this hierarchical approach, it was possible to assign different levels of evidence to the various treatment elements for depression. Based on the results of this literature search, a next step in the development of a process guideline for the rehabilitative treatment of patients with depression will be the integration of experts in the field of rehabilitation.

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

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.