ABSTRACT
The case of the head of a psychoanalytic training institute for the psychotherapeutic treatment of children and young people who committed sexual violence against patients and training candidates between 1975 and 1993 was scientifically investigated in a current, qualitative study. The results point to persistent risk potential in the context of treating patients and training psychotherapists, which still require extensive preventive efforts. In particular, power relations, institutional pragmatics and emotional entanglements must be examined.
Subject(s)
Child Abuse , Sex Offenses , Child , Humans , Adolescent , Psychotherapy/methods , Qualitative ResearchABSTRACT
OBJECTIVE: The current study evaluates the long-term psychological impact of a decision aid intervention for surgical and systemic treatment in women with newly diagnosed breast cancer from a previous reported randomized, controlled trial (Vodermaier et al., 2009). METHODS: Patients (n = 111) were randomized into usual care, or a 20-min decision aid intervention plus an information brochure prior to consultation planning with the senior physician. The retention rate at 1 year was 88%. RESULTS: Linear mixed model analyses demonstrated that the intervention group experienced less decisional conflict (p = .047; d = .19), which was driven by perceptions of a more effective choice (p = .029; d = .20) over time. Subgroup analyses revealed that patients in the intervention group who participated in chemotherapy decision making showed better long-term body image outcomes (p = .009; d = .44), which were mediated by reduced depressive coping (p = .049). No effects emerged for anxiety and depressive symptoms, or for quality of life. Internal health locus of control moderated group effects on 'uncertainty with the decision' (p = .003). CONCLUSIONS: The study results provide novel evidence on the role of individual differences and the mechanisms behind decision aid effectiveness, and demonstrate the long-term impact of decision aid interventions on some indices of well-being.
Subject(s)
Adaptation, Psychological , Breast Neoplasms/diagnosis , Breast Neoplasms/psychology , Decision Making , Patient Education as Topic , Aged , Conflict, Psychological , Female , Humans , Internal-External Control , Linear Models , Middle Aged , Surveys and QuestionnairesABSTRACT
BACKGROUND: There is little knowledge as to whether the chronicity of a disease affects patients' desire for participation. AIM: To study whether participation preferences vary according to the type of disease. DESIGN, PARTICIPANTS AND METHODS: Data of 1,393 patients from six trials with different medical conditions (hypertension, depression, breast cancer, schizophrenia, multiple sclerosis, minor traumas) were pooled and analysed, using multiple regression analysis controlling for socio-demographic variables. RESULTS: Younger age, better education as well as female gender accounted for a small but statistically significantly greater desire to participate. Patients suffering from multiple sclerosis (MS) exhibited significantly higher participation preferences than the other diagnostic groups. There were no major differences between the other diagnostic groups. Age, gender, education and diagnosis explained only 14% of the variance. CONCLUSIONS: We found no clear differences between chronic and acute conditions. However, patients suffering from MS, a chronic condition, were clearly different from all other diagnostic groups. The reasons for this difference remain unclear. The predictive value of socio-demography and type of illness is low.
Subject(s)
Decision Making , Patient Participation/psychology , Patient Satisfaction , Physician-Patient Relations , Acute Disease , Adolescent , Adult , Age Distribution , Aged , Chronic Disease , Female , Humans , Male , Middle Aged , Regression Analysis , Sex DistributionABSTRACT
Following an overall view of the emotional situation of primary breast cancer patients and of studies exploring shared decision making in this setting we present the results of qualitative analyses about breaking bad news situations and interviews with this group of patients and describe both methods for implementing shared decision making in the treatment of primary breast cancer and an evaluation study. The main result was that most patients showed a lack of information about breast cancer and its therapy, which led to uncertainty. Another source of uncertainty was the lack of preoperative punch biopsy. Due to the so-called "diagnostic shock" patients felt under pressure to make a quick decision over their treatment. This perceived pressure can be effectively countered by a shared decision making approach. To investigate the options in breast cancer therapy, decision aids for diagnostic and therapeutic options have been developed focusing on the following treatment modalities: 1. breast conserving therapy and radiation versus radical mastectomy 2. chemotherapy plus endocrine therapy versus endocrine therapy alone 3. preoperative versus postoperative chemotherapy. The decision instruments in question were tested in N = 35 breast cancer patients and N = 36 nurses as a control group. The results of a questionnaire survey among both these groups revealed a very positive appraisal of the decision aids. Implementation in daily routine was favoured.
