[Subjective requirements for psychosomatic rehabilitation and their influence on patient satisfaction - "basic, performance and excitement factors" according to Kano]. / Subjektive Anforderungen an die psychosomatische Rehabilitation und ihr Einfluss auf die Patientenzufriedenheit - "Basis-, Leistungs- und Begeisterungsfaktoren" nach dem Kano-Modell.

OBJECTIVE: The main goal of this study was to identify different types of requirements which patients have during rehabilitation and their influence on patient satisfaction. METHODS: 276 patients in psychosomatic rehabilitation were investigated by an anonymous cross-sectional survey at the end of their inpatient stay. Patient satisfaction (instruments FPZ and ZUF-8), psychological distress (BSI) and health status (SF-12) were assessed by the questionnaire. In addition, personal minimal standards as well as positive and negative events during the rehabilitation were assessed and evaluated by a content analysis. RESULTS: Patient satisfaction showed significant correlations with depression (neg.), life satisfaction and health status. In the penalty-reward-contrast analysis, the rehabilitation outcome came out as a "performance factor", that means disappointed expectations led to dissatisfaction, exceeded expectations to satisfaction. The skills of the doctors seemed to be regarded as a "basic factor" by the patients, while psychosocial competence of the doctors appeared as an "excitement factor". Accordingly the patients in their free answers stressed the meaning of the kindness of the staff, but also parameters of accommodation (especially the single room was regarded as minimal standard). The comparison of the two methods of analysis (validated scales and content analysis of free answers) showed common as well as complimentary results. CONCLUSION: The three factors typology of satisfaction according to Kano were confirmed also in a clinical setting as an interesting approach. Obviously influencing factors to some degree have non-linear relationships with patient satisfaction. The finding that interpersonal aspects seem to be important for patient satisfaction speaks for social training of the staff as a central task of quality management.

Quality of life, coping, and mental health status after living kidney donation.

The main aim of the study was to explore well-being after donation. This retrospective, cross-sectional study of 161 living kidney donors (104 women; response rate 81.4%) who were aged between 32 and 80 years (x = 56.3; standard deviation = 10.9) included responses to standardized questionnaires concerning quality of life (QOL), coping, and mental health status. Most donors recovered fully from donation within 6 months (90.8%). Donor willingness to donate again (96.1%) was high. Their relationship to the recipient did not change (67.9%) or even improved (27.5%) in most cases. Donor QOL (as assessed by the Short-Form [SF]-36) did not differ from healthy norms. In 25% of donors, screening with the Hospital Anxiety and Depression Scale revealed anxious and/or depressive symptoms above the clinical cutoff score. Donor predominant coping style with their recipient's renal disease was "active problem-focused coping." The component scores of the SF-36 correlated positively with sociodemographic and self-reported medical parameters, coping, and mental health status. Although living kidney donation again proved to be a treatment without negative impact on donor QOL, the results underlined the importance of screening for donor mental health status and coping both in the evaluation process and after the procedure.

Quality of life, psychosocial strains and coping in parents of children with haemophilia.

Quality of life in parents of children suffering from haemophilia may be diminished by the illness burden experienced in daily life and by non-adaptive ways of coping. The aim of this study was to examine the relation between parents' quality of life, their perceived psychosocial strains and ways of coping, and to compare parents' outcome to other paediatric illness groups (juvenile idiopathic arthritis, type 1 diabetes). In a cross-sectional study, parents completed a questionnaire concerning quality of life, psychosocial strains, coping strategies and needs as well as sociodemographic and illness parameters. Study participants were recruited in an ambulant haemophilia centre. A total of 55 parents (32 mothers, 23 fathers; age = 39.6; SD = 8.6) of children suffering from haemophilia (age = 11.0; SD = 6.4) took part in the study. Comparison groups were parents of children with juvenile idiopathic arthritis (n = 161) and parents of children with type 1 diabetes (n = 69). Compared to parents from other paediatric illness groups, the parents of children with haemophilia experience less impact on their quality of life and lower psychosocial strains. Quality of life was predicted by the coping strategy 'improving marital relationship' (beta = 0.48) and by emotional strains and worries concerning future (beta = -0.43; explained variance 49%). Parents reported a pronounced need for further information on the comprehensive management of haemophilia. In the psychosocial care of families with a child suffering from -haemophilia, reducing psychosocial strains and strengthening adaptive coping strategies may be a preventive intervention for improving parents' quality of life.

Training for doctors and nurses to deal with bereaved relatives after a sudden death: evaluation of the European Donor Hospital Education Programme (EDHEP) in Germany.

The sudden death of a person is one of the most extreme and painful experiences for the relatives, and doctors require special communication skills to deal adequately with the bereaved. The Dutch European Donor Hospital Education Programme was developed to train doctors and nurses in talking to the bereaved relatives and to make the donation request. In Germany, the one-day workshop has been adapted to the German language, law, and clinical practice. The evaluation data of 75 workshops and experiences of 760 participants (doctors, nurses, and psychologists) are reported. The framework of, methods used, and issues dealt with in the workshop were clearly appreciated by the great majority of the participants. Criticisms and suggestions were directed mainly at the duration of the workshop. One third of the participants pleaded for a 2-day workshop, two thirds for a refresher course half a year later. The main effects reported were that two thirds of the participants rated that relatives could be helped, talked with, and cared for in a better way. The workshop participants also reported that they themselves were better able to cope with the situation and were more inclined to take on the task following the workshop. Finally, the necessities and limits of psychosocial training for doctors and their staff are discussed.

[Validation of a German Version of the Fatigue Impact Scale FIS-D]. / Validierung der deutschen Version der Fatigue Impact Scale FIS-D.

OBJECTIVE: The Fatigue Impact Scale, FIS, is an internationally used instrument for the assessment of the impact of fatigue on Health-Related Quality of Life, HRQOL, also in patients with chronic liver diseases. In the German-speaking countries a validated instrument for measuring the impact of fatigue on patients with chronic liver diseases has not been available so far. METHODS: The German linguistic adaptation of the FIS using a forward-backward procedure was administered to 204 patients (age 52,7 +/- 13,9 years; 47 % female, 53 % male, 45 % no cirrhosis, 22 % Child's A, 15 % Child's B and 17 % Child's C cirrhosis; 53 % with chronic viral hepatitis, 32 % with alcoholic and 15 % with other liver diseases) of a secondary care hospital. The following internationally accepted instruments were used for validation: The Short Form Health Survey, SF 36, the Hospital Anxiety and Depression Scale German Version, HADS-D, and the Giessener Symptom Scale, GBB 24. Fifty patients in clinically stable situation filled out the FIS-D within 3 - 8 days. RESULTS: The acceptance of the FIS-D was high with 98 % answered items. The internal consistency of the three subscales was excellent (0.94 - 0.96), the test-retest reliability of the three subscales was good (0.72 - 0.83). The correlation coefficients with the validation instruments ranged between 0.49 and 0.80 (all p < 0 001). No differences in the FIS-D subscale scores were found in patients with and without cirrhosis and between the different Child-Pugh stages of liver cirrhosis. Patients treated with tranquilizer or antidepressants scored higher in the FIS-D than patients without this treatment (p < 0.05). CONCLUSION: The FIS-D is well accepted by patients in clinical routine care and has been shown to have good acceptance and reliability in the assessment of fatigue in chronic liver patients.

[Subjective theories of illness in the Greek culture]. / Subjektive Krankheitstheorien in der griechischen Kultur.

In this cross-sectional study, 100 Greeks were asked about their lay theories for cancer and myocardial infarction via a standardized questionnaire. Most Greeks questioned are to some extent informed about both diseases and receive their information from the media. In contrast to the epidemiologic data, the results of this study show that the Greeks questioned only rarely know of relatives suffering from myocardial infarction, but have often experienced close relatives with cancer. As a possible pathogenesis they believe in a combination or interaction of psychological and somatic components. Most of them are more likely to think of cancer as a disease with somatic causes while myocardial infarction is more often held to be psychologically evoked. Main causal attributions are unhealthy way of life, pollution and predisposition. Negative environmental factors are thought of as the leading cause of cancer, while psychosocial stress is thought to be the leading cause of myocardial infarction. Both diseases are believed to be very dangerous. However, the Greeks questioned believe in better chances for prevention and therapy of myocardial infarction than of cancer. With respect to subgroup analyses, education shows the most important influence: Better educated subjects show a significantly stronger internal and less fatalistic orientation than the less educated Greeks. The males questioned are more likely to hold psychosocial factors responsible for the onset of myocardial infarction and thus are more internally oriented than their female counterparts. The older Greeks tend to believe significantly stronger in external causes like negative environmental factors and negative aspects of life than the younger Greeks of the sample.

[Treatment satisfaction in cardiologic rehabilitation and attitude to various forms of rehabilitation]. / Behandlungszufriedenheit in der kardiologischen Rehabilitation und Einstellungen zu verschiedenen Rehabilitationsformen.

A great majority (85% to 92%, N = 196) of the cardiological patients in inpatient rehabilitation, who were investigated in this study, expressed clear satisfaction with inpatient care and in particular with medical treatment as well as with the commitment and skills of doctors and other caregivers. The usefulness of treatments and measures was mainly confirmed, especially with respect to remedial gymnastics, physiotherapy and rehabilitation sports. But unspecific offers of inpatient rehabilitation are obviously also evaluated positively, e.g. "distancing from everyday stress" and "cultural events" outside the clinics. Relaxation training and psychosocial counseling were used only by one third approximately, but most of the users gave "useful" or "very useful" evaluation ratings. 77% would again choose inpatient rehabilitation if they were confronted with this decision. 15% would prefer partial-hospitalization, only 4% ambulatory rehabilitation. 36% say that "near-home rehabilitation" basically is more favourable, but 33% prefer the opposite and say that rehabilitation far away from home has greater advantages. Only 8% consider ambulatory rehabilitation a possible replacement of inpatient rehabilitation, 66% say it is complementary to the inpatient mode.

[Psychosocial strain and work satisfaction of oncologic nurses. Results of an empirical study in an acute care hospital]. / Psychosoziale Belastungen und Arbeitszufriedenheit onkologischer Pflegekräfte. Ergebnisse einer empirischen Untersuchung im Akutkrankenhaus.

78 nurses in acute care of cancer patients were questioned during the implementation of psychooncology at the hospital of Herford ("Herford Model", supported by the SULO-Stiftung) on psychosocial aspects of the job. The predominant source of strain as reported by the nurses are doubts about the principle of maximum therapy in many cases (57% expressing considerable strain), followed by suffering with the patient and from team interactions. Positive aspects of the job are seen in "autonomous and responsible work" (84%), but also in teamwork and intense contact with patients. Overall job satisfaction is rather high, only 10% express clear dissatisfaction in this confidential investigation. Nurses expect from psychooncology the psychosocial care for the patients, but also a clear feedback for the staff and psychosocial staff training.

[Quality of life after implantation of a cardioverter-defibrillator (ICD)--results of an empirical study of 132 ICD patients]. / Lebensqualität nach Implantation eines Kardioverter-Defibrillators (ICD)--Ergebnisse einer empirischen Untersuchung bei 132 ICD-Patienten.

All 181 patients with malignant arrhythmias who have been provided with an implantable cardioverter-defibrillator (ICD) at the University Clinics of Muenster during the last 3 years, were investigated by a clinical questionnaire on quality of life (QOL). 132 patients answered and could be included in the study (response rate 73%). The mean age of the patients was 55 +/- 11.8 years, 73% males, 60% had already retired. In the general view 51% of the patients reported fair to excellent quality of life, while 24% gave a negative description of their QOL. 26% of the patients suffered from side-effects of the treatment, primarily from unspecific psychological complaints and ICD-related disturbances. "Unrest" was the predominant psychological complaint (64% of the patients), followed by rumification, shortness of breath, weakness and sleep disturbances. Somatic function and sex life were the functional areas primarily affected (more than half of the patients complaining about these). The "Psychological General Well-Being Index (PGWB)" showed reduced well-being in 61% of the patients. Comparing with the literature and regarding the PGWB-scales well-being, anxiety, and depression no significant differences could be found in comparison with other cardiologic samples after bypass-surgery or valve replacement. The results indicate the need of individual counseling and offers of psychosocial support for this highly strained group to reduce anxiety and to improve the quality of life in order to help the patient to gain greater overall benefit from the new ICD-therapy.

[Psychosocial aspects of chronic respiratory tract diseases (COPD): relevance and consequences for pulmonary rehabilitation]. / Psychosoziale Aspekte bei chronischen Atemwegserkrankungen (COPD): Relevanz und Konsequenzen für die pneumologische Rehabilitation.

As a part of the Davoser-Reha-Study, the significance of psychosocial aspects on the course of chronic pulmonary disease has been investigated on 414 patients (mean age = 47.1 years) with COPD (mean duration = 16 years) and a high percentage of multimorbidity (75%). Of special interest was the question, what kind of impact coping strategies do have on certain aspects of quality of life, in the sense of outcome criterias of the medical rehabilitation. Also it is not possible for the moment to draw final conclusions, because the knowledge about coping strategies and their adaptability is still very limited, the current study indicates, that some coping strategies are more supportive for adaptation than others. Positive for adaptation are strategies, which can be described as active exposition with the disease (fighting spirit, information seeking and active problem solving). Depressive coping strategies and the tendency to deny the disease seem to have a negative effect. All in all the results verify the strong necessity of taking psychosocial aspects into account for the complete treatment of chronically ill patients with COPD.

[Psychosocial acceptance of surgical interventions of the breast in oncological gynecology]. / Psychosoziale Akzeptanz mammachirurgischer Eingriffe in der Gynäko-Onkologie.

In a retrospective analysis of 197/600 women (33%) treated for primary breast cancer at the Department of Obstetrics and Gynecology at the University of Münster (1984 to 1994) the psycho-social acceptance of mastectomy vs. breast conservative treatment (BET) was evaluated. Mean age was 59 years (range, 31-87 yrs.). BET was performed in 58% (n = 114), modified radical mastectomy (MRM) in 42% (n = 83). Reconstructive surgery after MRM was performed in 40% (n = 33) either as primary procedure in 39% (n = 14) or as secondary procedure in 61% (n = 20). In addition to somatic patterns, features of pre- and postoperative coping, individual psycho-social burden, cosmetic results, contentment of treatment, social rehabilitation and quality of life were evaluated. Performance status and quality of human relations are discussed. In terms of psycho-social acceptance the results of BET are in general not superior to MRM at a mean follow-up of six years. Coping and postoperative quality of life are almost similar within the two groups. Although the alteration of body image after BET is less compared to MRM, the psychologic burden of postoperative radiotherapy and the fear of local recurrence are experienced worst compared to all other features analyzed after BET.

[Psychophysiologic and psychoneuroimmunologic studies in neurodermatitis. Overview and critical evaluation]. / Psychophysiologische und psychoneuroimmunologische Ergebnisse zur Neurodermitis. Ubersicht und kritische Bilanz.

Results of psychophysiological, psychoendocrinological, and psychoneuroimmunological research on the skin in patients with atopic dermatitis were evaluated. 11 investigations were selected and analysed with respect to both design and results. In 6 instances, healthy or ill control groups were included, rarely did the sample size exceed 30. With respect to physiology, blood pressure, heart rate and EDA were most commonly assessed; with respect to immunology, number of leucocytes and differential blood count and with respect to psychology, anxiety, neuroticism and stress perception. The results involving stress induction, itching induction and the relationship of personality and skin parameters were not consistent. The best established relationship is that between skin reactivity (flare, wheal size and pruritus) on the one hand and cognitive appraisal of stress-stimuli and the experimental situation on the other hand. Psychoendocrinological and even more psychoimmunological indicators of the stress of reaction-unlike psychophysiological indicators-were correlated with the skin response. Only half of the studies found an elevated physiological stress reaction in patients with atopic dermatitis.

[References for evaluation scales in quality assurance in rehabilitation--6. Assessment of coping processes with the Freiburg Questionnaire of Illness Coping]. / Hinweise auf Bewertungsinstrumente zur Qualitätssicherung in der Rehabilitation-Blatt 6. Erfassung von Verarbeitungsprozessen mit dem Freiburger Fragebogen zur Krankheitsverarbeitung (FKV).

Advantages of coping assessment for the understanding of individual impacts of severe illness are pointed out, the benefit for a better understanding of the rehabilitation process is demonstrated. After the basic positions and preliminary assumptions are described, the guidelines of the development of the inventory are introduced: Assessment of a broad spectrum of coping with chronic diseases with ratings by the patient himself and by others (doctors, relatives), suitability for process measuring, good acceptance, and economical application. Statistical properties of the questionnaires are reported with respect to achieved acceptance, reliability, and validity data. Using selected results as examples, possible applications in psychosomatic research are pointed out for issues such as illness-specific components of coping with chronic diseases, discrepancies between patients' and doctors' views of coping, and adaptational success. Finally, possibilities and limits of the inventory are discussed in terms of research issues and methodology.

[Attitude of physicians to rehabilitation--an empirical study of rheumatologists]. / Was Arzte von der Rehabilitation halten--eine empirische Untersuchung mit Rheumatologen.

Although the medical doctor holds a central steering function in making rehabilitation referrals, hardly any empirically founded information is available on physicians' attitudes towards rehabilitation, their indication considerations and actual referral practice. Prompted essentially by this information deficit, an anonymous questionnaire study was undertaken with 49 rheumatologists concerning their knowledge and experience in rehabilitation, their views of various forms of rehabilitation (inpatient, partial-hospitalization, out-patient) as well as medical further education in rehabilitation subjects. Reflecting a positive basic view of rehabilitation, nearly half of the responding rheumatologists subjectively felt well-informed about rehabilitative issues, with 49% stating that they frequently recommended patients for rehabilitation. As far as preferences are concerned in terms of community vs. non-community rehabilitation concepts, priority is given by 39% to partial-hospitalization rehabilitation ("most favourable"); more than 75% of the interviewees however advocated case-by-case decision-making. Accordingly, only 18% consider ambulatory or day centre programmes true alternatives for inpatient rehabilitation, and 78% rather consider them complementary to each other. The advantage of partial-hospitalization rehabilitation close to the rehabilitee's place of living is seen above all in potential involvement of relatives and family doctor. Aspects stated in favour of non-community inpatient rehabilitation primarily are getting away from stressful family surroundings and the comprehensive medical programme available. A strong need for rehabilitation-related further education is expressed, with forms of rehabilitation, psychosocial rehabilitation, and access modes among the primary contents to be addressed.

[Perceived stress and need for psychosocial education/supervision in inpatient care of the aged]. / Erlebte Belastungen und Bedarf an psychosozialer Fortbildung/Supervision in der stationären Altenpflege.

255 staff persons in the inpatient care of the aged, mainly nursing home staff, nurses and assisting personnel, were included in a multicenter questionnaire study. As expected, the great majority define their job as nursing, but approx. 20% identify themselves also with the work of a chaplain or a psychologist. Time pressure at work (59%) was reported as the main strain, followed by organizational deficits (22%) and compassion with the suffering of some inhabitants (20%). Among the positive and motivating aspects of the job teamwork and contact with the aged was said to be most important (59% and 57%, respectively), followed by autonomy and responsibility in the job. Approximately half of the staff expressed high job satisfaction, especially with respect to teamwork and the relationship with the aged. Actually staff training and supervision is reported to be extremely deficient, more than half confirmed that psychosocial staff training and supervision is important and necessary and should mainly deal with problems of team interaction and ways of emotional release. Main issues desired were aspects of interaction with depressive or aggressive persons as well as for caring for the terminal patient. The results clearly stress the important role of psychosocial staff training and supervision in this field, in order to improve competence as well as to achieve an emotional release and to prevent "burnout".

["Burnout" and the need for psychosocial education and supervision in inpatient care of the aged]. / "Burnout" und Bedarf an psychosozialer Fortbildung und Supervision in der stationären Altenpflege.

255 staff persons in the inpatient care for elderly (mainly nursing home staff, nurses and assisting personal) were included in a multicenter questionnaire study. Main strain was reported as time pressure at work (59%), followed by organisational deficits (22%) and compassion with the suffering of some inhabitants. The analysis of influencing factors yielded only a few results, job- and occupation-related factors might increase the risk of getting "burned out" (especially qualification and responsibility taken), as well as younger age. Two risk groups with respect to "burnout" were identified by cluster analysis: a bigger group (47%) of younger staff, markedly strained, but also highly skilled and motivated ("burnout-endangered" group), and a smaller group (8%) with high strain and low job satisfaction ("burnout-group"). More than half confirmed that psychosocial staff training and supervision is important and necessary and should mainly deal with problems of team interaction and ways of emotional relieve. Training units of 90 minutes once a month was the mode mostly favoured. Main issues were aspects of interaction with problematic elderlies (especially with depressive or aggressive persons) as well as dealing with death and dying.

[Lay etiologic theories and coping with illness in severe physical diseases. An empirical comparative study of female myocardial infarct, cancer, dialysis and multiple sclerosis patients]. / Laienätiologien und Krankheitsverarbeitung bei schweren körperlichen Erkrankungen. Eine empirische Vergleichsstudie mit Herzinfarkt-, Krebs-, Dialyse- und MS-Patientinnen.

In a multicenter approach 451 female patients, suffering from severe somatic diseases, were investigated on strains, disease-related attributions, coping and quality of life. Four diagnostic groups were involved, myocardial infarction (MI), Cancer (CA), end-stage renal disease (ESRD), and multiple sclerosis (MS). With respect to coping with the onset of illness or the diagnosis, all four groups accordingly reported placing trust in the doctors, compliance-related strategies, fighting spirit and information seeking as most markedly applied coping modes. But in each group a different predominant causal attribution of the disease was found, heredity in the MS-, pollution in the cancer, stress in the MI- and iatrogenic factors in the ESRD-group. The main influencing factors on the future course of the disease accordingly in all groups were "progress of medicine" and internal cognitive and behavioral factors. After statistical control of age, education, and duration of illness only the score "depressive coping" discriminated between the groups (MS-patients with highest, MI-patients with lowest scores). With respect to life satisfaction, MI- and cancer patients together formed a cluster with higher and ESRD- and MS-patients one with lower satisfaction. Cancer- and MS-patients considered fighting spirit as "most helpful" coping mode, while MI-patients favoured placing trust in the doctors and information seeking. Religion was found as second or third helpful coping mode.