Cancer patients' preferences for quantity or quality of life: German translation and validation of the quality and quantity questionnaire

Background: Decision-making with patients with incurable cancer often requires trade-offs between quality and length of life. The ‘Quality and Quantity Questionnaire' (QQ) is an English-language measure of patients' preference for length or quality of life. The aim of this study was to translate and validate this questionnaire. Materials and Methods: 1 new item was formulated to improve the ‘Quality of life' scale. Construct validity including exploratory factor analysis, convergent and discriminant validity, and reliability was determined in n = 194 patients. Results: The acceptability of the questionnaire among patients was high. The item-non-response rate was very low (2.5-4%). The 2 QQ scales ‘Quality of life' (QL) and ‘Length of life' (LL) had good and acceptable internal consistency (Cronbach's = 0.71 for LL and 0.59 for QL). Convergent validity was shown by significant correlation of the QL subscale with the CCAT (Cancer Communication Assessment Tool) subscale ‘Limitation of treatment' (r = 0.37, p < 0.01) and the LL scale with the CCAT subscale ‘Continuing treatment' (r = 0.24, p = 0.00). Conclusion: The German version of ‘QQ' has satisfactory psychometric properties for measuring patients' preferences for LL or QL. It can be used in all research fields that should be informed by patients' preferences: shared decision-making, palliative care, and health services

Assessing patient-caregiver communication in cancer—a psychometric validation of the Cancer Communication Assessment Tool (CCAT-PF) in a German sample

Purpose: The recently introduced Cancer Communication Assessment Tool (CCAT-PF) measures congruence in patient-caregiver communication and was initially validated in lung cancer patients. Contributing to a greater proportion of the variance in the conflict scores, primary caregivers were hypothesized to experience greater stress. For a detailed understanding of conflicting communication patterns of cancer-affected families, our study aimed for psychometric validation of the CCAT-PF in a sample covering heterogeneous tumor entities. Methods: Subsequent to a cross-sectional survey of 189 pairs of cancer patients (31% gastrointestinal, 34% lung, and 35% urological) and their caregivers' exploratory factor analysis with principal component condensation and varimax rotation was conducted (response rate, 74.2%). Reliability and construct validity were assessed calculating Cronbach's α and Pearson correlation coefficients for CCAT-P and CCAT-F scales and related constructs, respectively. Results: Cancer-related communication according to the CCAT-PF can be subdivided into four factors including the scales Disclosure, Limitation of treatment, Family involvement in treatment decisions, and Continuing treatment. Reliability ranged from α = .51-.68. The Disclosure scale, describing poor cancer-related communication of the patient, was correlated with patient's distress (QSC-R10: r = .30, p < .0001), unmet needs in several areas (SCNS-SF-34: r = .25-.32, p < .001), and negatively with social/family well-being (FACT: r = −0.31, p < .0001). Higher scores on the scale were significantly associated with considerable decrements in emotional well-being especially for caregivers perceiving patients' disclosure as problematic. Conclusions: The Disclosure scale originating from the CCAT-PF emerged as a short, valid, and reliable stand-alone instrument for identifying conflicting communication in patient-caregiver-dyads at risk

Assessing patient-caregiver communication in cancer—a psychometric validation of the Cancer Communication Assessment Tool (CCAT-PF) in a German sample

Purpose: The recently introduced Cancer Communication Assessment Tool (CCAT-PF) measures congruence in patient-caregiver communication and was initially validated in lung cancer patients. Contributing to a greater proportion of the variance in the conflict scores, primary caregivers were hypothesized to experience greater stress. For a detailed understanding of conflicting communication patterns of cancer-affected families, our study aimed for psychometric validation of the CCAT-PF in a sample covering heterogeneous tumor entities. Methods: Subsequent to a cross-sectional survey of 189 pairs of cancer patients (31% gastrointestinal, 34% lung, and 35% urological) and their caregivers' exploratory factor analysis with principal component condensation and varimax rotation was conducted (response rate, 74.2%). Reliability and construct validity were assessed calculating Cronbach's α and Pearson correlation coefficients for CCAT-P and CCAT-F scales and related constructs, respectively. Results: Cancer-related communication according to the CCAT-PF can be subdivided into four factors including the scales Disclosure, Limitation of treatment, Family involvement in treatment decisions, and Continuing treatment. Reliability ranged from α = .51-.68. The Disclosure scale, describing poor cancer-related communication of the patient, was correlated with patient's distress (QSC-R10: r = .30, p < .0001), unmet needs in several areas (SCNS-SF-34: r = .25-.32, p < .001), and negatively with social/family well-being (FACT: r = −0.31, p < .0001). Higher scores on the scale were significantly associated with considerable decrements in emotional well-being especially for caregivers perceiving patients' disclosure as problematic. Conclusions: The Disclosure scale originating from the CCAT-PF emerged as a short, valid, and reliable stand-alone instrument for identifying conflicting communication in patient-caregiver-dyads at risk

Online sexual solicitation by adults and peers – Results from a population based German sample

Prevalence of Internet use among adolescents is high, but little is known about the online sexual activities of German adolescents. This study aimed to describe the 12-month prevalence of German adolescents' online sexual experiences with a focus on Online Sexual Solicitation (OSS, subjectively negative online sexual experiences with a peer or any sexual online experience, positive or negative, with an adult). A sample of male and female adolescents aged 14-17 (N = 2238) was recruited using online survey panel. The sample was representative for gender and education. Subjects completed an online survey reporting their online sexual activities (i.e., sexual conversation, exchanging pictures, and cybersex) with peers (14-17 y.) and/or adults (>= 18 y.). Findings illustrated that 51.3% (n = 1148) of adolescents had experienced online sexual activity, which mostly involved peers (n = 969; 84.4%). In contrast, 23.2% (n = 519) of the adolescents experienced OSS with 2.6% (n = 57) reporting subjectively negative online sexual interactions with peers and 22.2% (n = 490) reporting online sexual interactions with adults, of which 10.4% (n = 51) were perceived as negative. The findings suggest that adolescents frequently engage in sexual interactions on the Internet with only a relatively small number perceiving such contacts as exploitative. In addition, females and adolescents with incomplete family situation, foreign nationality, higher education, homo- or bisexual orientation, and those without perceived social support reported OSS significantly more often

Accessibility, Availability, and Potential Benefits of Psycho‐Oncology Services: The Perspective of Community‐Based Physicians Providing Cancer Survivorship Care

Background. As persons of trust, community-based physicians providing survivorship care (e.g., general practitioners [GPs]) often serve as the primary contacts for cancer survivors disclosing distress. From the perspective of physicians providing survivorship care for cancer patients, this study explores (a) the accessibility, availability, and potential benefits of psychooncology services; (b) whether physicians themselves provide psychosocial support; and (c) predictors for impeded referrals of survivors to services. Methods. In a cross-sectional survey, all GPs and community-based specialists in a defined region were interviewed. In addition to descriptive analyses, categorical data were investigated by applying chi-square tests. Predictors for impeded referrals were explored through logistic regression. Results. Of 683 responding physicians, the vast majority stated that survivors benefit from psycho-oncology services (96.8%), but the physicians also articulated that insufficient coverage of psycho-oncology services (90.9%) was often accompanied by impeded referrals (77.7%). A substantial proportion (14.9%) of physicians did not offer any psychosocial support. The odds of physicians in rural areas reporting impeded referrals were 1.91 times greater than the odds of physicians in large urban areas making a similar report (95% confidence interval [1.07, 3.40]). Conclusion. Most community-based physicians providing survivorship care regard psycho-oncology services as highly beneficial. However, a large number of physicians report tremendous difficulty referring patients. Focusing on those physicians not providing any psychosocial support, health policy approaches should specifically (a) raise awareness of the role of physicians as persons of trust for survivors, (b) highlight the effectiveness of psycho-oncology services, and (c) encourage a proactive attitude toward the assessment of unmet needs and the initiation of comprehensive care

Psychoonkologische Versorgung in Stadt und Land

Background. The diagnosis of cancer is frequently accompanied by significant psychosocial distress not only for patients but also for their caregivers. Psycho-oncological services are nowadays implemented in routine oncological care to address such needs; however, little is known about utilization of psychosocial support by patients and caregivers outside of cancer centers. Objective. The aim of the study was to establish whether there is sufficient coverage and adequate use of psycho-oncological services in cancer survivors living in rural areas. Additionally, we were interested in the number of caregivers who received any form of psycho-oncological care. Methods. In a cross-sectional survey we estimated psychosocial stress and use of psycho-oncological services in mainly rural cancer patients, which we recruited in primary care practices. We used the distress thermometer (DT) and the short form of the Patient Health Questionnaire (PHQ-4) as well as a checklist on utilization of psychosocial and other support facilities. A total of 585 cancer patients and 488 caregivers provided data. Results. Approximately 2 years after diagnosis 48% of the patients experienced increased levels of distress and approximately 25% expressed signs of depression and/or anxiety disorders. Caregivers showed comparable levels of psychological burden. Large differences 22% versus 6%) were found between patients and caregivers with respect to utilization of psycho-oncological resources. Conclusion. Financial and work-related support was provided in more than half of the patients; however, the level of emotional support was poor, in particular with respect to caregivers needs. Public awareness on available resources should be strengthened