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  • 1
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    Online Resource
    Using decision tree analysis to identify population groups at risk of subjective unmet need for assistance with activities of daily living
    Springer Science and Business Media LLC ; 2023
    In:  BMC Geriatrics Vol. 23, No. 1 ( 2023-09-07)
    Details
    In: BMC Geriatrics, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2023-09-07)
    Abstract: Identifying predictors of subjective unmet need for assistance with activities of daily living (ADL) is necessary to allocate resources in social care effectively to the most vulnerable populations. In this study, we aimed at identifying population groups at risk of subjective unmet need for assistance with ADL and instrumental ADL (IADL) taking complex interaction patterns between multiple predictors into account. Methods We included participants aged 55 or older from the cross-sectional German Health Update Study (GEDA 2019/2020-EHIS). Subjective unmet need for assistance was defined as needing any help or more help with ADL (analysis 1) and IADL (analysis 2). Analysis 1 was restricted to participants indicating at least one limitation in ADL ( N  = 1,957). Similarly, analysis 2 was restricted to participants indicating at least one limitation in IADL ( N  = 3,801). Conditional inference trees with a Bonferroni-corrected type 1 error rate were used to build classification models of subjective unmet need for assistance with ADL and IADL, respectively. A total of 36 variables representing sociodemographics and impairments of body function were used as covariates for both analyses. In addition, the area under the receiver operating characteristics curve (AUC) was calculated for each decision tree. Results Depressive symptoms according to the PHQ-8 was the most important predictor of subjective unmet need for assistance with ADL. Further classifiers that were selected from the 36 independent variables were gender identity, employment status, severity of pain, marital status, and educational level according to ISCED-11. The AUC of this decision tree was 0.66. Similarly, depressive symptoms was the most important predictor of subjective unmet need for assistance with IADL. In this analysis, further classifiers were severity of pain, social support according to the Oslo-3 scale, self-reported prevalent asthma, and gender identity (AUC = 0.63). Conclusions Reporting depressive symptoms was the most important predictor of subjective unmet need for assistance among participants with limitations in ADL or IADL. Our findings do not allow conclusions on causal relationships. Predictive performance of the decision trees should be further investigated before conclusions for practice can be drawn.
    Type of Medium: Online Resource
    ISSN: 1471-2318
    URL: Article
    DOI: 10.1186/s12877-023-04238-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2059865-8
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  • 2
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    Strukturierte Erfassung von Unterstützungsangeboten für Lungenkrebs- und Schlaganfallbetroffene in Berlin
    Georg Thieme Verlag KG ; 2022
    In:  Das Gesundheitswesen Vol. 84, No. 01 ( 2022-01), p. 35-42
    Details
    In: Das Gesundheitswesen, Georg Thieme Verlag KG, Vol. 84, No. 01 ( 2022-01), p. 35-42
    Abstract: Ziel Es soll untersucht werden, welche Arten an Unterstützungsangeboten neben der direkten medizinisch-therapeutischen Versorgung für Betroffene der altersassoziierten Erkrankungen Lungenkrebs und Schlaganfall und deren Angehörige, in der Region Berlin, zur Verfügung stehen. In diesem Rahmen wurden auch relevante Unterstützungsthemen für diese Patientengruppen und Barrieren für die Nutzung von Unterstützungsangeboten aus der Perspektive von Experten der Versorgung betrachtet. Methodik Es erfolgte eine strukturierte Suche nach Unterstützungsangeboten, welche Lungenkrebs- und Schlaganfallpatienten und ihren Angehörigen im Umgang mit der neuen krankheitsbezogenen Lebenssituation in Berlin zur Verfügung stehen. Dafür wurden unterschiedliche Quellen, wie Internetrecherche und Printsuche genutzt sowie Experteninterviews und ein Gruppengespräch durchgeführt. Identifizierte Angebote wurden in Bezug auf ihre Zielgruppe verifiziert und Informationen per Fragebogen eingeholt. Die Experteninterviews und das Gruppengespräch wurden zusätzlich genutzt, um Unterstützungsthemen sowie Hürden der Nutzung von Angeboten aufzunehmen. Ergebnisse In Berlin wurden für Patienten mit Lungenkrebs und Schlaganfall und ihre Angehörigen 150 Unterstützungsangebote identifiziert. Diese bieten Unterstützung unter anderem in den Bereichen Informationsvermittlung und Beratung, Hilfe bei der Organisation und Koordination der neuen Lebenssituation sowie psychosoziale Hilfe. Als Hürden der Nutzung wurden unter anderem fehlende oder nicht an den Bildungsstand angepasste Informationen über Leistungsansprüche, die Unkenntnis des Unterstützungsangebots und räumliche Entfernung genannt. Schlussfolgerung Eine Reihe an Angeboten ist in Berlin vorhanden um unterschiedliche Unterstützungsbedarfe von Schlaganfall- und Lungenkrebspatienten und ihren Angehörigen abzudecken, welche aufgrund der neuen Gesundheits- und Lebenssituation entstehen können. Durch flächendeckende Information über dieses bestehende Angebot und eine regionale Verfügbarkeit kann die Nutzung von Unterstützung durch Betroffene optimiert werden.
    Type of Medium: Online Resource
    ISSN: 0941-3790 , 1439-4421
    URL: Article
    DOI: 10.1055/a-1179-5487
    RVK:
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    QX 700
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    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2022
    detail.hit.zdb_id: 1101426-X
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  • 3
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    Development of a patient-oriented navigation model for lung cancer patients.
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 15_suppl ( 2019-05-20), p. e18033-e18033
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 15_suppl ( 2019-05-20), p. e18033-e18033
    Abstract: e18033 Background: Patient navigation is seen to support and enable patient-oriented, optimal care both in palliative and in screening settings. However, the evidence remains inconclusive on what patient groups are best targeted by navigation and what may be improved by such a care model. Lung cancer patients are at particular risk for sub-optimal care because they face complex care trajectories due to severe and rapid disease progression and accompanying comorbidity. Methods: To develop a navigation model for lung cancer, we conducted a mixed-methods study to investigate who may be at risk of receiving sub-optimal care in the German health care setting. To capture the patient perspective a longitudinal qualitative component was included with patients (N = 20) assessed at three dtime points. In addition, a secondary data analysis of cancer registry data of a comprehensive cancer center was conducted and a repository of patient support offers gathered. Results of the study components were integrated to develop a patient-oriented navigation model. Results: Secondary data analysis showed that medical care functioned according to tumor board recommendations. Patient data revealed institutional barriers that conflict with individual needs and preferences. A lack of contact persons, information provision as well as bureaucratic difficulties were identified. Patients without a social network seem particularly in need for support. Identification of regional support offers shows that there are resources available to meet some of these needs. However, knowledge on such offers was not common among patients and caregivers. Navigators should provide practical support, give advice on social care issues and refer to existing support offers. Conclusions: Social networks crucial. Patients lack knowledge to use available resources. Navigation needs to be implemented within existing care structures to reach patients.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2019.37.15_suppl.e18033
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
    detail.hit.zdb_id: 2005181-5
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  • 4
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    Development of a patient-oriented navigation model for patients with lung cancer and stroke in Germany
    Springer Science and Business Media LLC ; 2022
    In:  BMC Health Services Research Vol. 22, No. 1 ( 2022-06-16)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2022-06-16)
    Abstract: The concept of patient navigation was first established in the USA to support vulnerable patient groups in receiving timely and comprehensive access to cancer care. It has recently gained increasing interest in Germany to support patients with chronic diseases in a fragmented healthcare system. The aim of this paper is to present the development of such a model adapted to the German context based on the results of mixed-methods studies investigating the need for and barriers to patient-oriented care. Methods In a process adapted from Delphi rounds, we conducted regular structured workshops with investigators of the project to discuss results of their studies and identify content and structure of the model based on the data. Workshop discussions were structured along seven core components of a navigation model including target patient groups, navigator tasks, occupational background and education of navigators, and patient-navigator interaction mode. Results Using an approach based on empirical data of current care practices with special focus on patients’ perspectives, we developed a patient-oriented navigation model for patients who have experienced stroke and lung cancer in the German healthcare context. Patients without personal social support were viewed as struggling most with the healthcare system, as well as multimorbid and elderly patients. Navigators should serve as a longer-term contact person with a flexible contact mode and timing based on the individual situation and preferences of patients. Navigator tasks include the provision of administrative and organizational support as well as referral and guidance to available resources and beneficial health programs with special forms of knowledge. Implementation of the navigator should be flexibly located to ensure a reliable outreach to vulnerable patients for first contact in settings like specialized in-patient and out-patient settings, while navigation itself focuses on care coordination in the out-patient setting. Conclusion Flexibility of navigator tasks needed to be a core characteristic of a navigation model to be perceived as supportive from patients’ perspectives. In a subsequent feasibility study, an intervention based on the model will be evaluated according to its acceptance, demand, and practicality.
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/s12913-022-08063-6
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2050434-2
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  • 5
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    Can routine register data be used to identify vulnerable lung cancer patients of suboptimal care in a German comprehensive cancer centre?
    Hindawi Limited ; 2021
    In:  European Journal of Cancer Care Vol. 30, No. 4 ( 2021-07)
    Details
    In: European Journal of Cancer Care, Hindawi Limited, Vol. 30, No. 4 ( 2021-07)
    Type of Medium: Online Resource
    ISSN: 0961-5423 , 1365-2354
    URL: Issue
    URL: Article
    DOI: 10.1111/ecc.v30.4
    DOI: 10.1111/ecc.13398
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2021
    detail.hit.zdb_id: 2020234-9
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  • 6
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    What do people with lung cancer and stroke expect from patient navigation? A qualitative study in Germany
    BMJ ; 2021
    In:  BMJ Open Vol. 11, No. 12 ( 2021-12), p. e050601-
    Details
    In: BMJ Open, BMJ, Vol. 11, No. 12 ( 2021-12), p. e050601-
    Abstract: This qualitative study investigated patients’ needs and wishes in relation to patient navigation. Design A qualitative interview study was conducted. Participants were invited to take part in three in-depth interviews over a period of 6–12 months. Thematic analysis was used. Setting Interviewees were sought in the Berlin metropolitan area of Germany in academic university hospitals, in rehabilitation clinics and through self-help organisations. Participants The sample consisted of individuals diagnosed with lung cancer (n=20) or stroke (n=20). Results From the perspective of interviewees, patient navigators should function as consistent contact persons, present during the whole care trajectory. Their role would be to guide patients through an often confusing healthcare landscape, offering practical, advisory and emotional assistance corresponding to patients’ needs. The study shows that—independent of the disease—participants had similar expectations and needs regarding support from navigators. Conclusion For chronic and complex diseases—as is the case with lung cancer and stroke—it appears less important for navigators to fulfil disease-specific tasks. Rather, they should ensure that patients’ more general needs, in relation to social, practical and emotional support, are met in a way that suits their individual wishes. Following these results, patient navigation programmes might be designed to include generic elements, which should then be adapted to the infrastructure in a particular healthcare region and to the particularities of a specific healthcare system.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2021-050601
    Language: English
    Publisher: BMJ
    Publication Date: 2021
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  • 7
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    “Psychologist was a luxury present”—Emotional challenges and need for psycho-oncological care of people with a diagnosis of lung cancer
    Springer Science and Business Media LLC ; 2022
    In:  Die Onkologie Vol. 28, No. 12 ( 2022-12), p. 1105-1110
    Details
    In: Die Onkologie, Springer Science and Business Media LLC, Vol. 28, No. 12 ( 2022-12), p. 1105-1110
    Abstract: Lung cancer survivors are particularly affected by psychological distress. At the same time, rates of utilization of psycho-oncological support are relatively low. Little is known about the reasons for (non)utilization. Objective What psychological and emotional distress do people with lung cancer experience? What are their reasons for (not) utilizing psycho-oncological support? Material and methods Qualitative interviews with 20 people affected by lung cancer were conducted and analyzed as part of the CoreNAVI study. Results Respondents experience psychological distress in the form of uncertainties and fears about the future. Those affected also perceive the pressure of having to go quickly from one treatment to the next and having no time for themselves as stressful. The users of psycho-oncology find it very helpful to speak openly without having to burden their personal relationships, and to receive concrete advice. Nonutilization is explained by a lack of need and a lack of capacity. In addition, reluctance to use psychological support is evident in the interviews. Conclusion Individuals with lung cancer also experience psychological and emotional distress due to the large number and high density of therapies. The resulting lack of capacity could be an explanation for the low utilization of psycho-oncological support. A greater emphasis on psycho-oncology over costly medical therapies that often only marginally prolong life and reducing reluctance to accept psychological help should be a greater focus in healthcare practice.
    Type of Medium: Online Resource
    ISSN: 2731-7226 , 2731-7234
    URL: Article
    DOI: 10.1007/s00761-022-01235-3
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 8
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    Feasibility of a patient-oriented navigation programme for patients with lung cancer or stroke in Germany: Protocol of the CoreNAVI study
    Public Library of Science (PLoS) ; 2023
    In:  PLOS ONE Vol. 18, No. 6 ( 2023-6-29), p. e0287638-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 18, No. 6 ( 2023-6-29), p. e0287638-
    Abstract: Patient navigation programmes were introduced in the United States and recently gained interest in Germany, where the health care system is fragmented. Navigation programmes aim to decrease barriers to care for patients with age-associated diseases and complex care paths. Here we describe a feasibility study to evaluate a patient-oriented navigation model that was developed in a first project phase by integrating data about barriers to care, vulnerable patient populations and existing support services. Methods We designed a mixed-methods feasibility study that consists of two two-arm randomized controlled trials aligned with observational cohorts. The intervention group of the RCTs gets support by personal navigators for 12 months. The control group receives a brochure with regional support offers for patients and caregivers. The feasibility of the patient-oriented navigation model for two prototypic age-associated diseases, lung cancer and stroke, is evaluated with regard to its acceptance, demand, practicality and efficacy. This investigation includes process evaluation measures with detailed documentation of the screening and recruitment process, questionnaires about satisfaction with navigation, observant participation and qualitative interviews. Estimates of efficacy for patient-reported outcomes are obtained at three follow-up time points including satisfaction with care and health-related quality of life. Furthermore, we analyze health insurance data from patients of the RCT insured at a large German health insurance (AOK Nordost) to investigate heath care utilization, costs and cost effectiveness. Trial registration The study is registered at the German Clinical Trial Register (DRKS-ID: DRKS00025476 ).
    Type of Medium: Online Resource
    ISSN: 1932-6203
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    DOI: 10.1371/journal.pone.0287638
    DOI: 10.1371/journal.pone.0287638.g001
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    DOI: 10.1371/journal.pone.0287638.r001
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    DOI: 10.1371/journal.pone.0287638.r004
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2023
    detail.hit.zdb_id: 2267670-3
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  • 9
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    Using others’ experiences. Cancer patients’ expectations and navigation of a website providing narratives on prostate, breast and colorectal cancer
    Elsevier BV ; 2016
    In:  Patient Education and Counseling Vol. 99, No. 8 ( 2016-08), p. 1325-1332
    Details
    In: Patient Education and Counseling, Elsevier BV, Vol. 99, No. 8 ( 2016-08), p. 1325-1332
    Type of Medium: Online Resource
    ISSN: 0738-3991
    URL: Article
    DOI: 10.1016/j.pec.2016.03.015
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2016
    detail.hit.zdb_id: 2019572-2
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  • 10
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    Patient Navigation—Who Needs What? Awareness of Patient Navigators and Ranking of Their Tasks in the General Population in Germany
    MDPI AG ; 2022
    In:  International Journal of Environmental Research and Public Health Vol. 19, No. 5 ( 2022-03-01), p. 2846-
    Details
    In: International Journal of Environmental Research and Public Health, MDPI AG, Vol. 19, No. 5 ( 2022-03-01), p. 2846-
    Abstract: The aim of the present study was to investigate the awareness of patient navigation (PN) in the general population in Germany and to assess which navigator tasks are considered most important. The analysis drew on a 2019 nationwide telephone survey of 6110 adults. We compared rankings of emotional support, administrative support and information among respondents with and without experience of patient navigation. One-fifth of the sample reported having heard of PNs; 13% of this group already had experience with PN. In both groups, the majority ( 〉 47%) considered assistance with applications to be most important. This was particularly the case among younger adults and those with a chronic disease. Within the inexperienced group, higher educated people had higher odds of ranking provision of information as most important for them, whereas women and those without a partner had higher odds of ranking emotional support as the most important task. This study shows that the majority of people predominantly expect PN services to offer administrative support, irrespective of their socioeconomic and health status. Whether these expectations are met by the diverse existing PN programs, which often have a strong focus on other tasks (e.g., increasing health literacy), has yet to be evaluated.
    Type of Medium: Online Resource
    ISSN: 1660-4601
    URL: Article
    DOI: 10.3390/ijerph19052846
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2175195-X
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