Prophylactic Acupuncture Treatment during Chemotherapy in Patients with Breast Cancer – Results of a Qualitative Study nested in a Randomized Pragmatic Trial

Background: In a randomized controlled trial, compared with standard care alone in breast cancer, acupuncture as a prophylactic treatment did not show better quality of life or fewer side effects of chemotherapy (NCT01727362 [clinicaltrials.gov]). The aim of the qualitative part of this mixed methods study was to better understand the subjective perspectives of the patients regarding quality of life during chemotherapy and the perceived effects of acupuncture. Methods: In a nested retrospective qualitative study, semi-structured telephone interviews were conducted with 5 responders and 5 non-responders (defined by the outcome of the primary parameter FACT-B) who were randomly selected from both study arms. The interviews were digitally recorded, pseudonymized, transcribed, and then deductively and inductively analyzed according to Qualitative Content Analysis using MAXQDA® software. Results: A total of 20 patients were included in the qualitative part of the study. In both groups, most women stated that their quality of life was surprisingly better than what they had expected before starting the chemotherapy. All patients of the acupuncture group experienced the acupuncture treatments as relaxing and beneficial, mentioning a friendly setting, and empathic attitude of the therapist. Most of these patients stated that the acupuncture treatment reduced chemotherapy-induced side effects. The patients reported that acupuncture was supportive for coping with the disease in a salutogenic way. For all patients, finding strategies to cope with life-threatening cancer and the side effects of chemotherapy was essential, for example, keeping a positive attitude toward life, selecting social contacts, and staying active as much as possible. Conclusions: Patients in the acupuncture group reported positive effects on psychological and physical well-being after receiving the study intervention. For all patients, having coping strategies for cancer seemed to be more important than reducing side effects. Therefore, further studies should focus more on coping strategies and reducing acute side effects

Perceived outcomes of spiritual healing: results from a prospective case series

BACKGROUND: The aims of this pilot study were to observe perceived outcomes of spiritual healing in Germany. PATIENTS AND METHODS: In this prospective case study, we performed qualitative interviews with clients and healers about perceived outcomes of spiritual healing treatments. A directed qualitative content analysis was used. In addition, we applied questionnaires (WHOQOL-BREF, General Self-Efficacy Scale, Sense of Coherence 13, SpREUK-15, intensity of complaints on visual analogue scale) at baseline and after week 1, month 2 and month 6 which were analysed descriptively. RESULTS: Seven healers and 7 clients participated, 42 interviews were analysed. In the interviews, the clients described positive body sensations, greater relaxation and well-being as short-term effects of healing treatments. Perceived longer-term effects were related to making significant life changes, creating new meanings, activating resources and improving social relationships. Patients in pain described a reduction of pain intensity. In the questionnaires, the clients reported improvements in quality of life and self-efficacy, to a smaller extent improvements of intensity of complaints and sense of coherence. CONCLUSION: The results from this pilot study could be useful to choose outcomes of future prospective studies with a larger sample: qualitative assessments combined with global and broad quantitative outcomes such as quality of life, self-efficacy and intensity of complaints could be applied

Wahrgenommene Effekte spirituellen Heilens: Ergebnisse einer prospektiven Fallserie

Background: The aims of this pilot study were to observe perceived outcomes of spiritual healing in Germany. Patients and Methods: In this prospective case study, we performed qualitative interviews with clients and healers about perceived outcomes of spiritual healing treatments. A directed qualitative content analysis was used. In addition, we applied questionnaires (WHOQOL-BREF, General Self-Efficacy Scale, Sense of Coherence 13, SpREUK-15, intensity of complaints on visual analogue scale) at baseline and after week 1, month 2 and month 6 which were analysed descriptively. Results: Seven healers and 7 clients participated, 42 interviews were analysed. In the interviews, the clients described positive body sensations, greater relaxation and well-being as short-term effects of healing treatments. Perceived longer-term effects were related to making significant life changes, creating new meanings, activating resources and improving social relationships. Patients in pain described a reduction of pain intensity. In the questionnaires, the clients reported improvements in quality of life and self-efficacy, to a smaller extent improvements of intensity of complaints and sense of coherence. Conclusion: The results from this pilot study could be useful to choose outcomes of future prospective studies with a larger sample: qualitative assessments combined with global and broad quantitative outcomes such as quality of life, self-efficacy and intensity of complaints could be applied.Hintergrund: Ziel dieser Pilotstudie war es, subjektiv wahrgenommene Effekte des spirituellen Heilens quali­tativ und quantitativ zu erfassen. Patienten und Metho­den: In dieser prospektiven Pilotstudie wurden über 6 Monate qualitative Interviews mit Klienten und Heilern über wahrgenommene Effekte spiritueller Heilbehandlungen geführt und auf Basis einer qualitativen Inhaltsanalyse ausgewertet. Ergebnisse wurden zusätzlich mit Fragebögen (WHOQOL-BREF, General Self-Efficacy Scale, Sense of Coherence 13, SpREUK-15, Beschwerdeintensität auf visueller Analogskala) zu Studienbeginn und nach der Woche 1, Monat 2 und Monat 6 erfasst. Ergebnisse: Sieben Heiler und 7 Klienten nahmen an dieser Studie teil, 42 ­Interviews wurden analysiert. Klienten beschrieben als kurzfristige Effekte der Heilbehandlungen positive Körperempfindungen, mehr Entspannung und Wohlbefinden. Die längerfristig wahrgenommenen Effekte standen im Zusammenhang mit signifikanten Veränderungen des Lebens, neuen Deutungen, Ressourcenaktivierung und der Verbesserung sozialer Beziehungen durch die Klien­ten. Klienten mit Schmerzen beschrieben eine Verringe­rung der Schmerzintensität. In den Fragebögen zeigten sich Verbesserungen der Lebensqualität und der Selbstwirksamkeit, zu einem geringeren Ausmaß Verbesserungen der Beschwerdeintensität und des Kohärenzgefühls. Schlussfolgerung: Die Ergebnisse dieser Pilotstudie könnten nützlich sein, um Endpunkte für künftige pros­pektive Studien mit einem größeren Stichprobenumfang zu wählen: qualitative Analysen in Kombination mit Fragebögen, die globale und umfassende Aspekte wie Lebensqualität, Selbstwirksamkeit und Intensität der ­Beschwerden erfassen, sind unserer Ansicht nach am besten geeignet

The Therapeutic Process in Spiritual Healing: Qualitative Results of a Prospective Case Series

Introduction: The aim of this study was to explore the therapeutic process between contemporary spiritual healers and their clients in Germany. Methods: This prospective observational case study was supported by questionnaires and semi-structured interviews with clients and healers from the first encounter through a period of 6 months. The qualitative analysis is based on a directed content analysis with focus in this article on the results relating to the therapeutic process. Results: Seven healers and seven clients were included, and 22 interviews with healers and 20 interviews with clients were conducted. The first treatment session was perceived as laying a foundation for the therapeutic process and the relationship, which was seen as crucial for healing to take place. Healers perceived the therapeutic process as highly individualized and multi-layered, with the perceived effects of spiritual healing sessions layered upon each other. The capacities to connect and to trust were seen as key elements of the healing process. Trust and connection operate multidimensionally: to oneself, to others, and to a transcendent or spiritual source. Clients’ spiritual attitudes were regarded as fundamental resources. Conclusion: The therapeutic process between spiritual healers and their clients was understood as a dynamic and individual activity, building up on a trustful relationship from the first encounter

Descriptive Cost-Effectiveness Analysis of a Counseling and Coordination Model in Psychosocial Care. Integration of Health Care and Social Rehabilitation

Introduction: A psychosocial outreach clinic was established to offer counseling and coordination of healthcare and complementary services for persons with psychosocial and mental problems. The cost-effectiveness of these services was measured based on a pre-post comparison. Methods: A prospective observational study was conducted with clients of the outreach clinic. Data on resource consumption and quality of life were collected at baseline and follow-up after 3, 6, and 12 months using the Client Sociodemographic and Service Receipt Inventory to assess service utilization, and the 12-Item Short Form Health Survey to assess quality of life. The objective of the present analysis was to estimate the relation between monetary expenditure and QALYs (quality-adjusted life-years), before and after the outreach clinic was established, descriptively. The analysis was constructed from payer’s perspective and was supplemented by a sensitivity analysis. Results: A total of 85 participants were included. Total annual expenditures before the intervention were 5,832 € per client for all service segments. During the 12-months study duration expenditures decreased to 4,350 € including the costs associated with outreach clinic services. QALYs for the 12-month study period were 0.6618 and increased about 0.0568 compared to the period before. Discussion: Despite methodological limitations due to small sample size, a pre-post comparison and the retrospective cost data collection, this study suggests acceptability of the outreach clinic as cost-effective. Conclusion: The activities of the outreach clinic as an integrated care model seem to be cost-effective regarding the relation between monetary expenditures and clients’ quality of life

Experiences and Perceived Effects of Rosary Praying: A Qualitative Study

The aim of this study is to explore experiences and perceived effects of the Rosary on issues around health and well-being, as well as on spirituality and religiosity. A qualitative study was conducted interviewing ten Roman Catholic German adults who regularly practiced the Rosary prayer. As a result of using a tangible prayer cord and from the rhythmic repetition of prayers, the participants described experiencing stability, peace and a contemplative connection with the Divine, with Mary as a guide and mediator before God. Praying the Rosary was described as helpful in coping with critical life events and in fostering an attitude of acceptance, humbleness and devotion

Learning to Establish a Therapeutic Doctor-Patient Communication: German and Israeli Medical Students Experiencing Integrative Medicine’s Skills

The doctors’ clinical time collides with the increasing of the use of telecare technologies in our digital era, reducing the actual doctor-patient interaction and the potential to engage with therapeutic doctor-patient communication. In our qualitative study, we followed a collaborative German-Israeli project that trained medical students to use complementary and integrative medicine (CIM) methods in order to improve doctor-patient communication. Interviews with the participants and participatory observation revealed the ways the mentors taught CIM methods, the meaning of therapuitic doctor-patient communication and how the students learned and implemented these skills in different ways. Our findings show that students expand their communication channels and skills, notice their own somatic-sensory states, and engage with somatic knowledge in different interactions. Our findings correspond with, and signify the intercorporeal space of doctor-patient interaction in the way in which doctors’ and patients’ soma-sensual aspects are interact, influence each another, and enable therapeutic communication

Users' Experiences with Psychosocial Counselling Services in a Community Mental Health Centre

OBJECTIVE: Analysis of users experiences with a low-threshold psychosocial counselling and case management service across separate sectors (e. g., outpatient, inpatient) and legal provisions (e. g., V and XII Books of Social Code). METHODS: Nine semi-structured interviews were conducted and analysed using content analysis. RESULTS: Several aspects of the users' experiences with counselling services have contributed towards their satisfaction with the service. The importance of short waiting times and the on-call telephone service as well as sufficient time taken for consultations, the availability of outreach counselling and the quality of the relationship with the counsellor were all highlighted. Potential for improvement was seen in the visibility of the service in the community. CONCLUSION: The investigated counselling and case management service can help to provide a low-threshold crisis intervention and could place users in more custom-fit community integration services.ZIEL: Analyse der Erfahrungen von Nutzern einer innovativen, rechtskreisübergreifenden psychosozialen Beratungsstelle. METHODE: Neun Einzelinterviews wurden qualitativ-inhaltsanalytisch ausgewertet. ERGEBNISSE: Das Angebot stärkte psychosoziale Ressourcen und die Autonomie der Nutzer. Positiv wurde die aufsuchende Beratung bewertet, kritisiert wurde die begrenzte Sichtbarkeit des Angebots. SCHLUSSFOLGERUNGEN: Eine rechtskreisübergreifende Beratungsstelle kann Hilfesuchende in Krisen auffangen und passgenau gemeindepsychiatrische oder psychosoziale Angebote vermitteln

Self-care strategies for medical students: an uncontrolled mixed-methods evaluation of a mind-body-medicine group course

Background High stress during medical education and its detrimental effects on student health is well documented. This exploratory evaluation study assesses a 10-week Mind-Body-Medicine student course, created to promote student self-care at Charité Universitätsmedizin Berlin, Germany. Methods During 2012–2019, uncontrolled quantitative and qualitative data were gathered from 112 student participants. Outcomes including changes in perceived stress (PSS), mindfulness (FMI/MAAS), self-reflection (GRAS), self-efficacy (GSE), empathy (SPF), and health-related quality of life (SF-12) were measured between the first (T0) and last sessions (T1). Qualitative data were obtained in focus groups at course completion and triangulated with quantitative data. Results Quantitative outcomes showed decreases in perceived stress and increased self-efficacy, mindfulness, self-reflection, and empathy. In focus groups, students reported greater abilities to self-regulate stressful experiences, personal growth and new insights into integrative medicine. Triangulation grounded these effects of MBM practice in its social context, creating an interdependent dynamic between experiences of self and others. Conclusion After completing an MBM course, students reported reduced perceived stress, increased self-efficacy, mindfulness, empathy and positive engagement with integrative concepts of doctor–patient relationships. Further research with larger randomized confirmatory studies is needed to validate these benefits

Interagency Cooperation in a Community Mental Health Centre - A Qualitative Study about the Stakeholders' Experiences

OBJECTIVE This study explores the conditions for the stakeholders' cooperation in an integrative care model for people with psychosocial problems. METHODS Expert interviews on various community mental health care providers were led and content analyzed. RESULTS Joint objectives and conceptually comparable financing models were found to be essential for cooperation across mental health and social integration services. CONCLUSIONS Implementation of intersectoral financing for both clinical and social integration services can promote interagency cooperation.ZIEL Untersucht werden die Kooperationsbedingungen der beteiligten Akteure in einem Modellprojekt zur Koordination von SGB V- und XII-Leistungen. METHODE Interviews mit gemeindepsychiatrischen Akteuren aus der Modellregion und qualitativ-inhaltsanalytischer Auswertung. ERGEBNISSE Ähnliche Steuerungsziele und Vergütungsmodelle sind Voraussetzungen rechtskreisübergreifender Zusammenarbeit. Gemeindeferne Versorgung sowie (infra-)strukturelle Defizite wirken sich hinderlich aus. SCHLUSSFOLGERUNGEN Die Implementierung sektorenübergreifender Finanzierung für Behandlungs- als auch Eingliederungsleistungen sind ein erster Schritt in Richtung rechtskreisübergreifender Kooperation