Perceived Psychotherapist's Empathy and Therapy Motivation as Determinants of Long-Term Therapy Success-Results of a Cohort Study of Short Term Psychodynamic Inpatient Psychotherapy.

Objective: Outcome predictors and determinants for treatment outcome of inpatient psychotherapy will be assessed in a follow-up-study. Sociodemographic factors and the level of depressiveness at admission, the perceived psychotherapist's empathy rated by patients and the therapy motivation as possible moderators of treatment outcome (reduction of depressive symptoms) are analyzed. Methods: In a cohort study, the outcome of inpatient multimodal psychotherapy was examined with Beck-Depression-Inventory (BDI) at admission (T1), discharge (T2) and at follow-up (1-3 years after treatment) (T3). Inclusion criteria were: Inpatient psychotherapy between 2007 and 2010 with a duration of at least 1 week and complete data set. The influence on therapy success of (1) sociodemographic factors, (2) the perceived psychotherapist's empathy rated by patients using the Consultation and Relational Empathy Measure (CARE), and (3) the therapy motivation of the patients rated by therapists are examined by means of correlation analysis, distribution comparisons and subsequently logistic regression. Results: Ninety-two (64 females, average age 39 yrs.) of 182 eligible patients participated in the follow-up survey. Duration of inpatient psychotherapy lasted 8.7 weeks ± 3.6 [min. 1, max. 33 weeks]. The perceived psychotherapist's empathy, therapy motivation, education level and depression at baseline had a significant impact on therapy success. Gender, age, and partnership were not significant. The length between discharge and follow-up had no influence on the results. Based on these variables a multiple logistic regression explained 42% of the variation (goodness-of-fit). Conclusion: Due to the shown relevance of the psychotherapist's empathy perceived by patients and the therapy motivation of patients for therapy success, both factors should be considered already at the beginning of the therapy. Consequently, they should be recognized in the context of postgraduate training and education.

[Implementation of seasonal influenza and human papillomavirus vaccination recommendations in gynecological practices in Germany]. / Wie werden die Impfempfehlungen gegen saisonale Influenza und gegen humane Papillomaviren in gynäkologischen Praxen umgesetzt?

In Germany, seasonal influenza vaccination has been recommended for pregnant women since 2010 and human papillomavirus (HPV) vaccination for girls since 2007. Gynecologists play an important role in the communication and vaccination of these two target groups. Moreover, seasonal influenza vaccination is also recommended for healthcare workers, as well as adults aged ≥ 60 years and individuals with underlying chronic diseases. The aim of this study was to gain first insights into the acceptance and implementation of the seasonal influenza und HPV vaccination recommendations in gynecological practices. In the context of the national influenza immunization campaign-which is jointly carried out by the Robert Koch Institute (RKI) and the Federal Centre for Health Education (BZgA)-a questionnaire was sent together with influenza information kits to 7477 gynecologists in September 2014. Data from 1469 (20 %) gynecologists were included in the analysis. 72 % of respondents reported that they themselves received a seasonal influenza shot each year. The majority of gynecologists recommended seasonal influenza vaccination for pregnant women (93 %) and HPV vaccination for girls (97 %). The most commonly stated reasons against influenza vaccination were safety concerns. Those against HPV vaccination were effectiveness concerns. Additionally, for both vaccinations the provision of vaccine-related information to the patient was considered too time consuming.The high acceptance of seasonal influenza and HPV vaccination among gynecologists is discordant with the available vaccination coverage figures in Germany. Gynecologists must be reminded of their important role in the prevention of vaccine-preventable diseases in adolescents and adult women. Immunization and communication skills should be considered more strongly as an integral part of medical education and further training for gynecologists.

Short- and long-term subjective medical treatment outcome of trauma surgery patients: the importance of physician empathy.

PURPOSE: To investigate accident casualties' long-term subjective evaluation of treatment outcome 6 weeks and 12 months after discharge and its relation to the experienced surgeon's empathy during hospital treatment after trauma in consideration of patient-, injury-, and health-related factors. The long-term results are compared to the 6-week follow-up outcomes. PATIENTS AND METHODS: Two hundred and seventeen surgery patients were surveyed at 6 weeks, and 206 patients at 12 months after discharge from the trauma surgical general ward. The subjective evaluation of medical treatment outcome was measured 6 weeks and 12 months after discharge with the respective scale from the Cologne Patient Questionnaire. Physician Empathy was assessed with the Consultation and Relational Empathy Measure. The correlation between physician empathy and control variables with the subjective evaluation of medical treatment outcome 12 months after discharge was identified by means of logistic regression analysis under control of sociodemographic and injury-related factors. RESULTS: One hundred and thirty-six patients were included within the logistic regression analysis at the 12-month follow-up. Compared to the 6-week follow-up, the level of subjective evaluation of medical treatment outcome was slightly lower and the association with physician empathy was weaker. Compared to patients who rated the empathy of their surgeon lower than 31 points, patients with ratings of 41 points or higher had a 4.2-fold higher probability to be in the group with a better medical treatment outcome (3.5 and above) on the Cologne Patient Questionnaire scale 12 months after discharge from hospital (P=0.009, R (2)=33.5, 95% confidence interval: 1.440-12.629). CONCLUSION: Physician empathy is the strongest predictor for a higher level of trauma patients' subjective evaluation of treatment outcome 6 weeks and 12 months after discharge from the hospital. Interpersonal factors between surgeons and their patients are possible key levers for improving patient outcomes in an advanced health system. Communication trainings for surgeons might prepare them to react appropriately to their patients' needs and lead to satisfactory outcomes for both parties.

Physician empathy and subjective evaluation of medical treatment outcome in trauma surgery patients.

OBJECTIVE: To analyze whether patients' perception of their medical treatment outcome is higher among patients who experienced a higher empathy by trauma surgeons during their stay in hospital. METHODS: 127 patients were surveyed six weeks after discharge from the trauma surgical general ward. Subjective evaluation of medical treatment outcome was measured with the corresponding scale from the Cologne Patient Questionnaire. Clinical empathy was assessed by using the CARE measure. The influence of physician empathy and control variables on a dichotomized index of subjective evaluation of medical treatment outcome was identified with a logistic regression. RESULTS: 120 patients were included in the logistic regression analysis. Compared to patients with physician empathy ratings of less than 30 points, patients with ratings of 41 points or higher have a 20-fold higher probability to be in the group with a better medical treatment outcome on the CPQ-scale (α-level<.001, R(2) 46.9). CONCLUSION: Findings emphasize the importance of a well-functioning relationship between physician and patient even in a surgical setting where the focus is mostly on the bare medical treatment. PRACTICE IMPLICATIONS: Communication trainings i.e. in surgical education can be an effective way to improve the ability to show empathy with patients' concerns.

Do breast cancer patients receive less support from physicians in German hospitals with high physician workload? A multilevel analysis.

OBJECTIVE: Little is known about how organizational factors influence the patient-physician interaction. This study investigates the relationship between physician workload in hospitals and breast cancer patients' perceptions of the support provided by physicians. METHODS: Data from 1844 newly diagnosed breast cancer patients treated in 35 breast cancer center hospitals in the German state of North Rhine-Westphalia in 2010 were combined with data from 348 physicians from the same hospitals. Multilevel logistic regression models were calculated using 31 hospitals with complete patient and physician data. Patients' perceptions of physician support were studied in relation to physician workload in hospitals. RESULTS: Breast cancer patients perceived themselves as receiving less support from physicians when treated in hospitals where physicians reported working more overtime hours and having less time for patient care. CONCLUSION: This study provides preliminary evidence of the association between the hospital work environment and physicians' ability to support patients. Future studies should investigate the extent to which physicians' interaction performance can be modified through hospital-level interventions aimed at managing workload. PRACTICE IMPLICATIONS: By approaching the problem of physician staffing in hospitals and investing in the hospitals' working conditions, health policy and hospital management could create conditions conducive to better patient-physician interaction.

Direct, indirect, and intangible costs after severe trauma up to occupational reintegration - an empirical analysis of 113 seriously injured patients.

AIM: Although seriously injured patients account for a high medical as well as socioeconomic burden of disease in the German health care system, there are only very few data describing the costs that arise between the days of accident and occupational reintegration. With this study, a comprehensive cost model is developed that describes the direct, indirect and intangible costs of an accident and their relationship with socioeconomic background of the patients. METHODS: This study included 113 patients who each had at least two injuries and a total Abbreviated Injury Scale (AIS) greater than or equal to five. We calculated the direct, indirect and intangible costs that arose between the day of the accident and occupational reintegration. Direct costs were the treatment costs at hospitals and rehabilitation centers. Indirect costs were calculated using the human capital approach on the basis of the work days lost due to injury, including sickness allowance benefits. Intangible costs were assessed using the Short Form Survey (SF-36) and represented in non-monetary form. Following univariate analysis, a bivariate analysis of the above costs and the patients' sociodemographic and socioeconomic characteristics was performed. RESULTS: At an average Injury Severity Score (ISS) of 19.2, the average direct cost per patient were €35,661. An average of 185.2 work days were lost, resulting in indirect costs of €17,205. The resulting total costs per patient were €50,431. A bivariate analysis showed that the costs for hospital treatment were 58% higher in patients who graduated from lower secondary school [Hauptschule] (ISS 19.5) than in patients with qualification for university admission [Abitur] (ISS 19.4). CONCLUSIONS: The direct costs of treating trauma patients at the hospital appear to be lower in patients with a higher level of education than in the comparison group with a lower educational level. Because of missing data, the calculated indirect costs can merely represent a general trend, so that the bivariate analysis can only be seen as a starting point for further studies.

[Work engagement of hospital physicians: do social capital and personal traits matter?]. / Work Engagement von Krankenhausärzten: Welche Rolle spielen Sozialkapital und Persönlichkeitseigenschaften?

Work engagement has been proven to be a viable indicator of physical and mental well-being at work. Research findings have shown a link between work engagement and both individual and organizational resources. The aim of the present study is to test the hypothesized relationships between personal traits (Big-5), the quality of the social work environment (social capital) and work engagement among hospital (n=35) physicians (n=387) in North-Rhine-Westphalia, Germany. Structural equation modeling (SEM), combining confirmatory factor analysis (CFA) and path analysis, was employed to conduct the statistical analyses. The results of the SEM indicated that social capital and neuroticism were significantly associated with work engagement. The relationship between agreeableness and work engagement was fully mediated by social capital. Findings suggest that social capital plays a key role in promoting work engagement of physicians.

"Tendency to excuse" and patient satisfaction of those suffering with breast cancer.

OBJECTIVES: The purpose of this study was to analyse the extent to which breast cancer patients excuse inconveniences that occur during their hospitalisation, and how this "tendency to excuse" affects their satisfaction with the hospital stay. METHODS: Breast cancer patients undergoing treatment at one of 51 breast centres in North Rhine-Westphalia (Germany) in 2009 were asked to complete the Cologne Patient Questionnaire-Breast Cancer (CPQ-BC). For the analyses, the "tendency to excuse" scale was subdivided into three groups. Linear regressions were performed to investigate associations between the "tendency to excuse" and patient satisfaction. RESULTS: 88 % (3,950) of the patients completed the questionnaire. The results show that the inpatients excused inconsistencies to a moderate degree. The "excusers" and "non-excusers" showed greater satisfaction with hospital services than the "medium-excusers". CONCLUSIONS: The "tendency to excuse" scale could aid future data analysis of patient satisfaction surveys by identifying patients who are more likely to answer in an unbiased fashion. According to hospital survey outcomes, adjusting for the "tendency to excuse" scale however, does not lead to substantially different results when comparing health care providers.

Is social capital as perceived by the medical director associated with coordination among hospital staff? A nationwide survey in German hospitals.

Effective coordination among all members of hospital staff has been shown to be associated with better quality of care. The literature indicates that social capital, a form of organizational resource, may facilitate the task of coordination. However, to the best of our knowledge, no study has yet examined this link within a healthcare setting. Thus, the objective of this study was to analyze the relationship between social capital and coordination among hospital staff, as perceived by the medical director being a key informant of the hospital. In 2008, we surveyed the medical directors of 1224 German hospitals by the use of a standardized questionnaire. We conducted stepwise multivariate linear regression and controlled for hospital size, ownership and teaching status. In total, 551 medical directors (45%) responded to the survey. We found social capital to be a significant predictor of coordination (ß = 0.444, p < 0.001). The regression model explained 28% of the variance in coordination. Higher levels of social capital can be associated with better coordination among members of hospital staff, as perceived by the medical director. Therefore, investment in social capital may facilitate better organization of work processes in hospitals and may therefore help to improve patient outcomes. However, longitudinal studies are needed in order to explain the causal relationship between social capital and coordination among hospital staff.

The relationship between social capital and quality management systems in European hospitals: a quantitative study.

BACKGROUND: Strategic leadership is an important organizational capability and is essential for quality improvement in hospital settings. Furthermore, the quality of leadership depends crucially on a common set of shared values and mutual trust between hospital management board members. According to the concept of social capital, these are essential requirements for successful cooperation and coordination within groups. OBJECTIVES: We assume that social capital within hospital management boards is an important factor in the development of effective organizational systems for overseeing health care quality. We hypothesized that the degree of social capital within the hospital management board is associated with the effectiveness and maturity of the quality management system in European hospitals. METHODS: We used a mixed-method approach to data collection and measurement in 188 hospitals in 7 European countries. For this analysis, we used responses from hospital managers. To test our hypothesis, we conducted a multilevel linear regression analysis of the association between social capital and the quality management system score at the hospital level, controlling for hospital ownership, teaching status, number of beds, number of board members, organizational culture, and country clustering. RESULTS: The average social capital score within a hospital management board was 3.3 (standard deviation: 0.5; range: 1-4) and the average hospital score for the quality management index was 19.2 (standard deviation: 4.5; range: 0-27). Higher social capital was associated with higher quality management system scores (regression coefficient: 1.41; standard error: 0.64, p=0.029). CONCLUSION: The results suggest that a higher degree of social capital exists in hospitals that exhibit higher maturity in their quality management systems. Although uncontrolled confounding and reverse causation cannot be completely ruled out, our new findings, along with the results of previous research, could have important implications for the work of hospital managers and the design and evaluation of hospital quality management systems.

The association between psychosocial care by physicians and patients' trust: a retrospective analysis of severely injured patients in surgical intensive care units.

AIM: Trust is an essential element in physician-patient interaction fostering in general adherence and improving patient- and physician-reported outcomes. Regarding severely injured patients, trust-building behaviour is important because of the severity of injuries and therefore potential associated physical and psychological consequences. The objective of this study was to identify significant and relevant determinants on trust of severely injured patients in their physicians in surgical intensive care units. METHODS: Ninety-one severely injured patients completed a self-administered questionnaire after being transferred from surgical intensive care unit to surgical unit. All patients were treated in four hospitals of maximal care in North Rhine-Westphalia between 2001 and 2005. To assess different aspects of trust the "trust in physician" scale of the Cologne Patient Questionnaire (CPQ) was used. "Psychosocial care by physicians" is measured through: support, devotion, information and shared-decision making provided by physicians. Patient- and trauma related control variables are also included in a logistic regression model. RESULTS: Stepwise logistic regression identified "psychosocial care provided by physicians" as a significant contributor to severely injured patients' trust (Nagelkerke's R(2): 41%). "Trust in physicians" is correlated with all four dimensions of "psychosocial care by physicians": support (0.546), devotion (0.443), information (0.396), and shared-decision making behaviour (0.342) provided by physicians in surgical intensive care units. CONCLUSIONS: This finding confirms the importance of supportive communication style in physician-patient interaction concerning reported trust of severely injured patients on surgical intensive care units. Medical education should integrate sound knowledge about psychosocial aspects of interaction to provide effective emotional and informational support to build up and maintain patient trust.

Patients' perceived support from physicians and the role of hospital characteristics.

OBJECTIVE: Through patient-physician communication, physicians can support breast cancer patients in coping with the diagnosis and treatment of their cancer. Research on the influence of hospital characteristics on patient-reported outcomes suggests that patient-physician communication may be shaped by the hospital environment. The aim of this study is to investigate the relationship between hospital characteristics and breast cancer patients' perceptions of the support provided by physicians. DESIGN: Data from two cross-sectional surveys conducted in 2007 were combined and hierarchical logistic regression models were calculated. SETTING: Newly diagnosed breast cancer patients treated in breast center hospitals in North Rhine-Westphalia and at least one key person from these hospitals were surveyed. PARTICIPANTS: Data from 3285 newly diagnosed breast cancer patients and 172 key persons from 87 breast center hospitals were used. MAIN OUTCOME MEASURE: The patients' perceptions of support from physicians were measured with three items from the Cologne Patient Questionnaire. Physician support was studied in relation to patient characteristics as well as hospital structure and processes. RESULTS: The multilevel model showed that breast cancer patients perceived themselves as receiving less support from the physician when there were problems within the hospitals' organization of care, independent of patient characteristics. CONCLUSION: This study provides preliminary evidence that the quality of patient-physician communication depends not only on the patient or physician but also on hospital organization. Further studies should be conducted to determine the extent to which interventions for improving quality at the hospital level can modify physician communication performance.

The relationship between transformational leadership and social capital in hospitals--a survey of medical directors of all German hospitals.

CONTEXT: The German hospital market has been undergoing major changes in recent years. Success in this new market is determined by a multitude of factors. One is the quality of the social relationships between staff and the presence of shared values and rules. This factor can be considered an organization's "social capital." OBJECTIVE: This study investigates the relationship between social capital and leadership style in German hospitals using a written survey of medical directors. DESIGN AND SETTING: In 2008, a cross-sectional representative study was conducted with 1224 medical directors from every hospital in Germany with at least 1 internal medicine unit and 1 surgery unit. Among the scales included in the standardized questionnaire were scales used to assess the medical directors' evaluation of social capital and transformational leadership in the hospital. We used a multiple linear regression model to examine the relationship between social capital and internal coordination. We controlled for hospital ownership, teaching status, and number of beds. PARTICIPANTS: In total, we received questionnaires from 551 medical directors, resulting in a response rate of 45.2%. The participating hospitals had an average of 345 beds. The sample included public (41.3%), not-for-profit (46.9%), and for-profit (11.7%) hospitals. RESULTS: The data, which exclusively represent the perceptions of the medical directors, indicate a significant correlation between a transformational leadership style of the executive management and the social capital as perceived by medical directors. A transformational leadership style of the executive management accounted for 36% of variance of the perceived social capital. CONCLUSION: The perceived social capital in German hospitals is closely related to the leadership style of the executive management. A transformational leadership style of the executive management appears to successfully strengthen the hospital's social capital.

A longitudinal study of changes in provider-patient interaction in treatment of localized prostate cancer.

PURPOSE: Whilst much is known as to the met and unmet communication needs of prostate cancer patients, few studies have been conducted on the changes in communication between provider and patient over time. Therefore, the aim of our study is to examine (a) whether there are changes over time in the quality of psychosocial care in long-term treatment of localized prostate cancer and (b) whether those changes are associated with the treatment decision. METHODS: HAROW is a prospective, observational study designed to collect clinical data and patient reported outcomes (PROs) of different treatment options (hormonal therapy, active surveillance, radiation, operation, watchful waiting) for newly diagnosed patients with localized prostate cancer under real conditions. At 6-month intervals, general clinical data, PROs (e.g. quality of life, quality of physician-patient interaction) and individual costs are documented. We analysed data of N = 1,216 patients at the time of initial diagnosis (T1) and after 6 months (T2). RESULTS: There is a significant decline in shared decision-making behaviour of physicians for the group of patients undergoing a prostatectomy and for the hormonal therapy group at the time of initial diagnosis and after 6 months. In terms of emotional support by physicians, there is a significant difference between the treatment groups at the time of initial diagnosis with patients undergoing a prostatectomy reporting significantly less support than the hormonal therapy group. CONCLUSION: Future research from both, the providers' and the patients' perspective, will have to clarify if we can interpret our results as change in the communication behaviour once the treatment decision for prostatectomy or hormonal therapy is made.

Organizational factors and the attitude toward health promotion in German ICT-companies.

This study takes a first step toward examining the relationship between organizational characteristics and the perceived attitude toward health promotion in companies from the perspective of chief executive officers (CEOs). Data for the cross-sectional study were collected through telephone interviews with one CEO from randomly selected companies within the German information and communication technology (ICT) sector. Multivariate logistic regression analysis (LRA) was performed, and further LRA was conducted after stratifying on company size. LRA of data from a total of n = 522 interviews found significant associations between the attitude toward health promotion and the company's market position, its number of hierarchical levels, the percentage of permanent positions and the percentage of employees with an academic education. After stratification on company size, the association between the attitude toward health promotion and both market position and the percentage of employees with an academic education was still present in small companies. There were no significant relationships between the attitude toward health promotion and the structural characteristics of medium-sized and large companies. The preliminary results of the study indicate that a perceived attitude toward health promotion in companies can be explained, to a certain degree, by the intraorganizational characteristics analyzed. Our key findings highlight that efforts toward establishing a positive attitude toward health promotion should focus on small companies with a lower market position and a greater number of employees with a lower education level.

Psychometric properties of the Hospital Survey on Patient Safety Culture for hospital management (HSOPS_M).

BACKGROUND: From a management perspective, it is necessary to examine how a hospital's top management assess the patient safety culture in their organisation. This study examines whether the Hospital Survey on Patient Safety Culture for hospital management (HSOPS_M) has the same psychometric properties as the HSOPS for hospital employees does. METHODS: In 2008, a questionnaire survey including the HSOPS_M was conducted with 1,224 medical directors from German hospitals. When assessing the psychometric properties, we performed a confirmatory factor analysis (CFA). Additionally, we proved construct validity and internal consistency. RESULTS: A total of 551 medical directors returned the questionnaire. The results of the CFA suggested a satisfactory global data fit. The indices of local fit indicated a good, but not satisfactory convergent validity. Analyses of construct validity indicated that not all safety culture dimensions were readily distinguishable. However, Cronbach's alpha indicated that the dimensions had an acceptable level of reliability. CONCLUSION: The analyses of the psychometric properties of the HSOPS_M resulted in reasonably good levels of property values. Although the set of dimensions within the HSOPS_M needs further scale refinement, the questionnaire covers a broad range of sub-dimensions and supplies important information on safety culture. The HSOPS_M, therefore, is eligible to measure safety culture from the hospital management's points of view and could be used in nationwide hospital surveys to make inter-organisational comparisons.

Effect of guideline orientation on the outcomes of peripheral arterial disease in primary care.

OBJECTIVE: Peripheral arterial disease (PAD), an established marker of premature death and cardiovascular risk in general, is highly prevalent. We analysed factors associated with poor outcomes in an observational cohort, with particular focus on the effect of guideline orientation in the management of these patients. METHODS: PACE-PAD is a multicentre, prospective, observational study of PAD patients in primary care. PAD guideline orientation was stated, if patients received the following: exercise training, (if applicable) advice for smoking cessation and diet, therapy for diabetes mellitus, hypertension, hypercholesterolaemia, or antiplatelets/anticoagulants. Multivariate regression models were applied to assess factors associated with all cause death, cardiovascular/cerebrovascular death, or cardiovascular/cerebrovascular/peripheral vascular non-fatal events. RESULTS: After an 18-month follow-up, of the 5099 PAD patients analysed (mean age 68.0 ± 9.0 years, 68.5% males), only 28.4% of patients met all applicable quality indicators for guideline-oriented treatment. However, most patients were to a large extent managed in line with guidelines. While exercise training was reported in 41.8%, rates were very high for smoking cessation (90.7%), therapy for hypertension (92.5%), diabetes mellitus (82.0%), hypercholesterolemia (83.3%) and antiplatelet therapy (86.7%). Regarding events, there were inhomogeneous results with a statistically significant higher rate of cardiovascular/cerebrovascular deaths and all-cause deaths, but a lower rate of non-fatal vascular events in patients treated according to guidelines compared to those who were not. Limitations of this study include the open, non-controlled design, possible patient selection bias and misclassification of events. CONCLUSION: Even if the guideline orientation for the various indicators was remarkably stable across the three follow-up visits, the rate of patients comprehensively treated according to the guidelines was relatively low, which calls for optimisation. There was a lack of differentiation between the guideline-oriented and non-guideline-oriented therapy in terms of outcomes, which may be due to patient-related or other factors, and warrants further research.

Identifying and predicting subgroups of information needs among cancer patients: an initial study using latent class analysis.

PURPOSE: Understanding how the information needs of cancer patients (CaPts) vary is important because met information needs affect health outcomes and CaPts' satisfaction. The goals of the study were to identify subgroups of CaPts based on self-reported cancer- and treatment-related information needs and to determine whether subgroups could be predicted on the basis of selected sociodemographic, clinical and clinician-patient relationship variables. METHODS: Three hundred twenty-three CaPts participated in a survey using the "Cancer Patients Information Needs" scale, which is a new tool for measuring cancer-related information needs. The number of information need subgroups and need profiles within each subgroup was identified using latent class analysis (LCA). Multinomial logistic regression was applied to predict class membership. RESULTS: LCA identified a model of five subgroups exhibiting differences in type and extent of CaPts' unmet information needs: a subgroup with "no unmet needs" (31.4% of the sample), two subgroups with "high level of psychosocial unmet information needs" (27.0% and 12.0%), a subgroup with "high level of purely medical unmet information needs" (16.0%) and a subgroup with "high level of medical and psychosocial unmet information needs" (13.6%). An assessment of sociodemographic and clinical characteristics revealed that younger CaPts and CaPts' requiring psychological support seem to belong to subgroups with a higher level of unmet information needs. However, the most significant predictor for the subgroups with unmet information needs is a good clinician-patient relationship, i.e. subjective perception of high level of trust in and caring attention from nurses together with high degree of physician empathy seems to be predictive for inclusion in the subgroup with no unmet information needs. CONCLUSIONS: The results of our study can be used by oncology nurses and physicians to increase their awareness of the complexity and heterogeneity of information needs among CaPts and of clinically significant subgroups of CaPts. Moreover, regression analyses indicate the following association: Nurses and physicians seem to be able to reduce CaPts' unmet information needs by establishing a relationship with the patient, which is trusting, caring and empathic.

The relationship between social support, shared decision-making and patient's trust in doctors: a cross-sectional survey of 2,197 inpatients using the Cologne Patient Questionnaire.

OBJECTIVES: Empirical studies have confirmed that a trusting physician-patient interaction promotes patient satisfaction, adherence to treatment and improved health outcomes. The objective of this analysis was to investigate the relationship between social support, shared decision-making and inpatient's trust in physicians in a hospital setting. METHODS: A written questionnaire was completed by 2,197 patients who were treated in the year 2000 in six hospitals in Germany. Logistic regression was performed with a dichotomized index for patient's trust in physicians. RESULTS: The logistic regression model identified significant relationships (p < 0.05) in terms of emotional support (standardized effect coefficient [sc], 3.65), informational support (sc, 1.70), shared decision-making (sc, 1.40), age (sc, 1.14), socioeconomic status (sc, 1.15) and gender (sc, 1.15). We found no significant relationship between 'tendency to excuse' and trust. The last regression model accounted for 49.1% of Nagelkerke's R-square. CONCLUSIONS: Insufficient physician communication skills can lead to extensive negative effects on the trust of patients in their physicians. Thus, it becomes clear that medical support requires not only biomedical, but also psychosocial skills.