Überprüfung von Screening-Instrumenten zur Erfassung individueller psychosozialer Belastungen und Implementation eines psychoonkologischen Behandlungspfades in der gynäkologischen Onkologie

Die aktuelle S3-Leitlinie Psychoonkologie empfiehlt ein flächendeckendes wiederholtes Screening zur Erfassung von Distress bei Tumorpatienten. Evidenzbasierte Empfehlungen, welches Instrument zur psychoonkologischen Indikationsdiagnostik am geeignetsten ist, fehlen bislang. Im Zeitalter digitaler Dokumentationssysteme erscheint eine Umstellung von klassischen Papierfragebögen auf computerbasierte Befragungen sinnvoll. Dies ermöglicht eine sofortige automatisierte Auswertung und direkte Weiterleitung des Ergebnisses an den psychoonkologischen Dienst zur gestuften Intervention auf der Grundlage psychoonkologischer Behandlungspfade. In dieser randomisiert-kontrollierten Studie wurde N=206 Patientinnen mit Brustkrebs ein Fragebogen auf Papier oder in elektronischer Form vorgelegt. Die Akzeptanz des elektronischen Screenings war höher als die des konventionellen Papierfragebogens. Eine Verzerrung der Ergebnisse durch die Präsentationsform lag nicht vor. Der hier erstmals vorgenommene direkte Vergleich von fünf empfohlenen und häufig genutzten Screening-Instrumenten zeigte mittlere bis hohe korrelative Zusammenhänge – in der Indikationsstellung war die Übereinstimmung jedoch äußerst gering. Der subjektive Bedarf zeigte geringe Zusammenhänge mit den Belastungsmaßen und scheint einen eigenständigen Beitrag zur Belastungsmessung zu leisten. In weiterführenden Untersuchungen konnte gezeigt werden, dass Teile der Problemliste des Distress-Thermometers zur Integration weiterer Fachdienste in die Behandlungsplanung genutzt werden können. Die Umsetzbarkeit der entwickelten psychoonkologischen Behandlungspfade in der klinischen Routine erwies sich als gut. Es konnte jedoch nur eine geringe Übereinstimmung des Screenings mit der Psychoonkologischen Basisdokumentation gezeigt werden. Nachfolgestudien müssen klären, welches Instrument gemessen am derzeitigen Goldstandard am geeignetsten ist. Die Erhebung des subjektiven Bedarfs muss weiter überprüft werden. Ferner sollten interaktive Möglichkeiten computerbasierter Befragungen genutzt und die Empfehlung zurückgemeldet werden, um Patienten in die psychoonkologische Behandlungsplanung stärker einzubinden

Resilience as a Factor Influencing Psychological Distress Experience in Patients with Neuro-Oncological Disease

Cancer causes psychological distress. Approximately one-third of all patients with cancer suffer from distress requiring psycho-oncological treatment. Examining factors contributing to their distress can inform approaches to counteracting them. Among such factors, resilience is considered to be a psychological adaptive capacity resulting from complex genetic, epigenetic, psychological, and environmental influences. For that reason, we investigated resilience as a factor of psychological distress experience among patients with neuro-oncological disease. To assess distress among patients with neuro-oncological diseases, we performed electronic psycho-oncological screening in the Department of Neurosurgery at Tübingen University Hospital (n = 100) following tumor surgery (T0) using the Resilience Scale 13, the Hornheider Screening Instrument, the Patient Health Questionnaire-2, the Generalized Anxiety Disorder Scale-2, and the Distress Thermometer, all administered on tablets. Follow-up was done 6 months after (T1). The distress of patients with neuro-oncological disease decreased significantly after 6 months (p < 0.01). Most patients (87%) showed moderate to high resilience. Although significant correlations with distress are measurable at the T0 time point (ρ = −0.318 **, p < 0.01), no significant correlations were observed at T1. Thus, resilience seems to significantly impact distress in the acute phase of the neuro-oncological disease. For clinical practice, our findings suggest that resilience-focused screening can provide useful information about patients at risk of experiencing distress

Higher Acceptance of Videotelephonic Counseling Formats in Psychosomatic Medicine in Times of the COVID-19 Pandemic

Background: Due to the COVID-19 pandemic, the healthcare system in general and psychosomatics in particular were forced to change counseling-specific services and break up established structures. At the beginning of 2020, phone as well as videotelephonic counseling options had to be quickly established.Methods: Patients (n = 278) of the department of psychosomatic medicine and psychotherapy at the University Hospital Tübingen were asked to complete an ad hoc questionnaire to assess the acceptance of the counseling format following each counseling session (office, phone, video) in the period between July 2020 and February 2021.Results: Satisfaction and acceptance of the three counseling formats (office, phone, video) were rated (1–6) on average as “good” to “very good” in the three subgroups (1.5 ± 0.9). Likewise, the “therapeutic relationship” scored high in all three subgroups in terms of establishing a strong therapeutic relationship (4.4 ± 1.5). “Hurdles” were rated as low and tolerable (1.8 ± 1.3). The global assessment of therapeutic contact was significantly better in the video group compared to phone and office consultation (p < 0.05). Predictor analyses showed that there was an influence of age, but not gender, on the acceptance of digital counseling formats in the present sample [F(1, 277) = 4.50, p = 0.04].Discussion & Conclusion: Digital consultation formats were perceived by patients as promising addition to the classic face-to-face setting. Digital formats (phone, video) were not generally preferred to face-to-face counseling, but especially video counseling was accepted and perceived with great satisfaction and acceptance. Accordingly, the additional use of digital counseling formats, especially video-telephony, could be an opportunity to enrich the existing structures also after the pandemic

Acceptance of Psycho-Oncological Counseling Formats in a Cancer Counseling Center during the COVID-19 Pandemic: An Exploratory Care Study

Background: The COVID-19 pandemic made it necessary to change established structures of medical counseling services and quickly establish digital counseling formats to ensure continuity of care. In this context, we offered telephone and video-telephonic counseling in addition to traditional face-to-face counseling in the office. Methods: Patients (n = 100) of the Cancer Counseling Center, Tübingen, were asked to complete a questionnaire to assess the acceptance of the counseling format following each counseling session (office, telephone, and video) in the period between July 2020 and February 2021. The questionnaire included the subject areas of patient characterization, assessment of therapeutic contact, therapeutic relationship, and hurdles and was used in this exploratory care study. Results: The satisfaction and acceptance of the three counseling formats (office, telephone, and video) were rated as “good” to “very good” in the three subgroups (range 1–6, office M = 1.2, telephone M = 1.3, video M = 1.4). Likewise, the “therapeutic relationship” achieved high ratings in terms of establishment of a therapeutic relationship in all three subgroups (office M = 5.7, telephone M = 5.0, video M = 5.0). The type of contact (office and video counseling) achieved a significant main effect on the therapeutic relationship for items such as “I believe that counseling is helping me” (F(2,97) = 4.80, p = 0.01) and “I feel that I can rely on the counselor/therapist” (F(2,97) = 3.29, p = 0.04). The “hurdles” were rated as minor and tolerable (office M = 1.3, telephone M = 1.3, video M = 1.4). Predictor analyses showed that there was no effect of age and gender on the acceptance of digital counseling formats in the present sample. Discussion and Conclusion: On the basis of this survey, it can be concluded that digital counseling formats were perceived by patients as a promising addition to the classic face-to-face setting. In addition, it can be stated that the digital formats (telephone and video) were not generally preferred to face-to-face counseling, but that the innovative telecounseling was accepted and perceived with great satisfaction and acceptance. Accordingly, the additional use of digital counseling formats could be an opportunity to enrich and expand the existing presence structures also after the COVID-19 pandemic