IntroductionResearch on the impact of cancer on close relationships brings up conflicting results. This systematic review collects empirical evidence on the research questions whether a cancer diagnosis in general or the type of cancer affects the divorce rate.Materials and MethodsThis systematic review was conducted according to the guidelines of the Cochrane Collaboration and the PRISMA statement. The following electronic databases were searched: Web of Science, Ovid SP MEDLINE, PsycINFO, PsyINDEX, CINAHL, ERIC. Risk of bias assessment was performed with the preliminary risk of bias for exposures tool template (ROBINS-E tool). The grading of methodological quality was assessed with the Newcastle-Ottawa Scale.ResultsOf 13,929 identified records, 15 were included in the qualitative synthesis. In 263,616 cancer patients and 3.4 million healthy individuals, we found that cancer is associated with a slightly decreased divorce rate, except for cervical cancer, which seems to be associated with an increased divorce rate.DiscussionAccording to this systematic review, cancer is associated with a tendency to a slightly decreased divorce rate. However, most of the included studies have methodologic weaknesses and an increased risk of bias. Further studies are needed.
Zusammenfassung Hintergrund Kommunikation und interprofessionelle Zusammenarbeit mit krebskranken Patient:innen ist herausfordernd. Ein strukturiertes Kommunikationstraining ist bisher nicht in die ärztliche Weiterbildung integriert. Ziel der Studie war es, die Machbarkeit eines 80 Unterrichtseinheiten (UE) umfassenden interprofessionellen Kommunikationstrainings (IKT), wie im Nationalen Krebsplan empfohlen, an einer Klinik mit uroonkologischem Schwerpunkt zu prüfen. Methode Eine Bedarfsanalyse wurde mittels Fokusgruppen und Einzelinterviews durchgeführt. Die Lernziele wurden mit (inter)nationalen Lernzielkatalogen abgestimmt. Das IKT wurde mittels des „six-step approach“ nach Kern und „design-based research“ erarbeitet. Die Inanspruchnahme und die Akzeptanz wurden evaluiert. Das IKT umfasste 6 Präsenzworkshops (50 UE) und eine Teamsupervision (10 UE). Für das individuelle arbeitsplatzbasierte Training (20 UE) wurden 6 definierte Settings identifiziert: Visite, Übergabe, Befundmitteilung, Aufnahme- und Entlassgespräch sowie ein Wunschsetting. Ergebnis Die ärztliche Teilnahmequote an den Präsenzworkshops war 83,0 %, die pflegerische 58,3 %. Die Inanspruchnahme des arbeitsplatzbasierten Trainings lag bei 97 %. Die Ärzt:innen evaluierten das IKT sehr positiv (in Schulnoten Mittelwert [MW] 1,2 ± 0,4). Alle Teilnehmenden fühlten sich auf die Gespräche mit Patient:innen und Angehörigen besser vorbereitet. Zur Verstetigung wurden Ärzt:innen zu Mentoren ausgebildet. Schlussfolgerung Die Implementierung eines IKT von 80 UE Umfang ist an einer urologischen Klinik erfolgreich durchführbar und führt u. a. durch eine Mentorenausbildung zu einer nachhaltigen Verbesserung der Kommunikationskultur.
<b><i>Aims:</i></b> To synthesize the empirical evidence on the effectiveness of shared decision making (SDM) compared to usual care for prostate cancer (PC) treatment. <b><i>Methods and results:</i></b> A systematic review of academic (MEDLINE, EMBASE, Cochrane Library, CINHAL, PsychINFO, and Scopus) and grey (clinicaltrials.gov, WHO trial search, meta-Register ISRCTN, Google Scholar, opengrey, and ohri.ca) literature, also identified from contacting authors and hand-searching bibliographies. We included randomized controlled trials (RCTs): 1) comparing SDM to usual care for decisions about PC treatment, 2) conducted in primary or specialized care, 3) fulfilling the key SDM features, and 4) reporting quantitative outcome data. Four RCTs from Canada (n=3) and the USA were included and comprised 1,065 randomized men, most (89.8%) of whom were in PC stage T1-T2. The studies reported 24 outcome measures. In 62.5% study estimates, SDM was similar to usual care at improving patient satisfaction and mood, and at reducing decisional conflict and decisional regret. In 37.5% study estimates, SDM significantly improved knowledge, perception of being informed and patient-perceived quality of life (QoL) at four weeks. There was a dearth of outcome data, particularly on the adherence to treatment and on patient-important and clinically relevant health outcomes such as symptoms and mortality. <b><i>Conclusion:</i></b> SDM may positively influence menʼs knowledge and may have a positive but short-term effect on patient-perceived QoL. The (long-term) effects of SDM on patient-related outcomes for decisions about PC treatment are unclear. Future research needs consensus about the interventions and outcomes needed to evaluate SDM and should address the absence of evidence on health outcomes.
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