In a prospective study, 133 married cancer patients and their spouses were interviewed within a month of diagnosis and administered three self-reports: The Brief Symptom Inventory (BSI) to assess psychological distress, the Impact of Events Scale (IES) to assess coping, and the Family Adaptability and Cohesion Scales (FACES III) to assess family relations. Patients and spouses were moderately distressed. The patient's psychological distress was explained by the level of intrusion, by the spouse's psychological distress and cohesion which had a protective effect (R2.41). The spouse's distress was explained by intrusion, gender and, to some extent, by the patient's distress (R2.41); but cohesion had no influence. Only half of the group (as couples) reached the last follow-up nearly 2 years later. A disassociation seems to have occurred; family relations, as well as partner's distress, did not have an influence on either the patient's or spouse's distress. The information gathered at the beginning of the study explained about 25% of the distress 2 years later of male patients and their wives, and that of female patients but not of their husbands.

Adaptation, Psychological↗

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Participation of oncological outpatients in psychosocial support.

In total, 132 cancer patients in four oncology outpatient clinics in Hamburg completed a questionnaire consisting of a newly designed instrument for measuring psychosocial support. In this questionnaire, patients were asked about their knowledge of institutions offering support, their previous participation in psychosocial support, the reasons for participation and their experience with and attitude towards it. A second section consisted of standardized instruments: the EORTC QLQ-C30 questionnaire (Aaronson), the Brief Symptom Inventory (Derogatis and Melisaratos), the List of Physical Complaints (von Zerssen and Koller) and the Impact of Event Scale (Horowitz). Descriptive and variance-analytical methods were used for the analysis of results. Most respondents were women (88%). The largest group (72%) had a history of breast cancer. A total of 28% of the patients in the sample had participated in psychosocial support, about 4% of these in self-help groups. Participants in psychosocial support did not differ from non-participants in gender, but they were significantly younger. They showed considerably higher scores in emotional and physical distress than non-participants, their attitude towards psychosocial support was more positive, and they had more knowledge about institutions offering support than non-participants. The main reasons listed for their participation in psychosocial support were mental distress, a desire to obtain help, and the wish to cope with the illness. The main reason for not participating was sufficient support from the family, friends or doctors.

Adult↗

PubMedDate not supplied

Psychological intervention in cancer patients: a randomized study.

We examined the long-term effects of a behavioral intervention on the psychological distress of patients recently diagnosed with localized cancer, who were being treated at Hadassah University Hospital. All 116 patients who met the inclusion criteria (49 men and 67 women) were randomized into an intervention group and a control group on a 3:1 basis. The intervention chosen was Progressive Muscle Relaxation with Guided Imagery, which is intended to decrease psychological distress and increase the patient's sense of internal control. The Brief Symptom Inventory (BSI) and the Impact of Events Scale (IES) were used to assess psychological distress within 1 month of diagnosis, 3 months later (shortly before starting intervention), and 6 months after the end of the intervention. At the final assessment, the effect of the behavioral intervention on psychological distress was positive. The effect was relatively modest but statistically significant when assessed in terms of the Global Severity Index (GSI) (a decrease of 2.3 points in the GSI of the treatment group as compared to an increase of 1.2 points in the GSI of the control group P=.005). Despite these moderately positive findings, we suggest that the results might be more meaningful if cancer patients are first screened for psychological distress to exclude those with a low distress level that does not justify intervention, and only then randomized for participation in the study.

Adaptation, Psychological↗

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[Outpatient and inpatient orthopaedic rehabilitation--results of a study comparing outcome and costs].

This article presents main results of a study comparing outcome and costs of various all-day outpatient and inpatient orthopaedic rehabilitation forms. The results were obtained within the scope of a comprehensive evaluation programme commissioned by the federation of health (VdAK) and pension insurance institutes (VDR). The purpose of this evaluation was to examine the quality of different types of various rehabilitation care. The outcome comparison comprises a longitudinal follow-up of various somatic, psychosocial und occupational reintegration parameters up to one year after rehabilitation as well as outcome assessments from the perspective of patients and physicians in rehabilitation centres and general practice. The costs are estimated on the basis of data from health and pension insurance funds. The results show extensive corresponding of results und assessments in the different forms of rehabilitation care for comparable patient groups. There are no indications of poorer care quality in outpatient rehabilitation, while economic analyses show better cost effectiveness in outpatient treatment by comparability of treatment, patients, and results. Results suggest that outpatient care, offered in the same quality as in the examined rehabilitation centres, is an alternative or complement to inpatient care at least for those patients, who can be treated in both the outpatient and inpatient setting.

Ambulatory Care↗

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[Subjective estimations of the treatment programmes offered in inpatient and outpatient orthopaedic rehabilitation].

The survey of psychosocial, somatic and economic outcomes is regarded as standard in establishing the effectiveness of various rehabilitative forms of medical care. Another important part is the patient's perspective for the subjective valuation of the entire measure or different facets of the rehabilitation measure. During a comparison of the effectiveness of different forms of care of orthopaedic rehabilitation (inpatient, outpatient in the hospital, outpatient) 1176 patients were questioned in writing at 4 different time points. The results concerning the general measurement of the satisfaction with the rehabilitation measure showed a high level and a high acceptance in all forms of medical care at the end of and after the measure. The result relating to the selection of the correct hospital for the specific troubles of the patient was positive as well. This can also be stated for the patients' estimation of the contacts between the doctors and the physiotherapists. At the end of measure, all the patients in every form of care viewed these contacts as being helpful. The outpatient offers were viewed a bit better by the patients concerning the contacts to doctors and physiotherapists. The extent of the care specific to the different occupational groups was estimated by almost all patients of all forms as being just about right. Additionally, the course organization and the work of the administration had a good evaluation - with slight advantages for the inpatient forms.

Ambulatory Care↗

PubMedDate not supplied

[Structural and procedural quality of different orthopaedic rehabilitation settings: A comparison].

In addition to outcome quality, the quality of structure and process is an essential parameter for health care. In the context of a study comparing the outcome and costs of inpatient and different outpatient rehabilitation settings, the structural and procedural quality of the participating rehabilitation facilities were examined as well. Data were collected using questionnaires, interviews, treatment plans and visitations of the rehabilitation facilities. The analyses show a great correspondence of structural and procedural quality between the different rehabilitation settings. Particularly the data gathered by questionnaires show few differences. Points of significant difference include the more extensive equipment and the more favorable personnel key with regard to physicians in the inpatient clinics and the outpatient settings within these clinics. The outpatient rehabilitation facilities outside of rehabilitation clinics are characterized by a stronger accentuation of functional therapy, in particular physiotherapy and sports therapy. Functional therapy is of greater importance in the self-concept of the outpatient rehabilitation facilities and is also applied there more often.

Ambulatory Care↗

PubMedDate not supplied

[Perspectives of outpatient rehabilitation in Germany--brief report of an international symposium, December 2001 in Hamburg].

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Ambulatory Care↗

PubMedDate not supplied

[Outpatient rehabilitation of alcohol dependent patients in a day clinic: initial results of a comparative follow-up study of day clinic and inpatient treatment].

This article describes the development of an outpatient concept for the day-clinic withdrawal treatment of alcohol dependent persons in a Hamburg institution for addiction aid. It reports the initial, selected results of a comparative follow-up study of patients discharged during the years 1998-2000, who either receive ambulatory treatment in the day clinic (n = 270) or inpatient treatment in the institution's special clinic (n = 462). Assessable questionnaires are available from 131 outpatients of the day-clinic treatment and 173 patients of the inpatient treatment form. The response rate - with reference to the group of those who were reachable - was 57.2 % for patients of the day clinic and 53.2 % for patients of the special clinic. The results of the study arrive at the conclusion that both treatment forms can be seen as thoroughly comparable with regard to primary outcome measurements (for example reduction of psychological stress, abstinence rates, reintegration into occupational life). Rehabilitants treated in the inpatient setting more frequently report that they had already contacted centres for further treatment and self-help groups during the rehabilitation phase, which however doesn't lead to a change of participation behaviour following the rehabilitation phase. This serves to confirm the assumption that an additional offer of a day-clinic service in the area of addiction rehabilitation provides a further, effective treatment concept that sensibly supplements the otherwise inpatient-oriented treatment landscape. The results indicate the quality of the work performed in the day clinic studied (as well as in the inpatient clinic) and should encourage the funding agencies and employees of other day clinic institutions in the field of addiction rehabilitation to participate in evaluation and quality assurance measures, thus continuing to bridge the gap between the (theoretical) state of knowledge concerning outpatient rehabilitation and the degree to which it can be successfully realized.

Adult↗