Patientenautonomie und -informiertheit in der Psychoonkologie: Computerbasiertes Belastungs-screening zur interaktiven Behandlungsplanung (ePOS-react)

Abstract

To identify distressed patients in oncology using screening questionnaires is quite challenging in clinical routine. Up to now there is no evidence based recommendation which instrument is most suitable and how to put a screening to practice. Using computer based screening tools offers the possibility to automatically analyse patient's data, inform psycho-oncological and medical staff about the results, and use reactive questionnaires. Studies on how to empower patients in decision making in psycho-oncology are rare.Methods Women with breast and gynaecological cancer have been consecutively included in this study (n=103) at time of inpatient surgical treatment in a gynaecological clinic. They answered the computer based screening questionnaire (ePOS-react) for routine distress screening at time of admission. At the end of the tool an individual recommendation concerning psycho-oncological treatment is given ( i) psycho-oncological counselling, ii) brief psycho-oncological contact, iii) no treatment suggestion). The informed patients could choose autonomously either the recommended treatment or an individually more favoured alternative possibility. Additionally, a clinical interview (approx. 30 min) based on the "Psychoonkologische Basisdiagnostik (PO-Bado)" has been carried out for a third-party assessment of patients' need for treatment.Results 68.9% followed the treatment recommendation. 22.3% asked for a more "intense" (e. g. counselling instead of recommended brief contact) and 8,7% for a "less intense" intervention than recommended. The accordance of third-party assessment (clinical interview "PO-Bado") and treatment recommendation is about 72.8%. The accordance of third-party assessment and patient's choice (ePOS-react) is about 58.3%. The latter is smaller because 29.1% asked for a brief psycho-oncological contact for whom from the third-party assessment's perspective no indication for treatment has been existent.Discussion A direct response of the screening result (treatment recommendation) during the computer based screening and asking for a patient's choice leads to an increase of brief psycho-oncological contacts for personal information about psycho-oncological interventions. Compared with a third-party assessment (clinical interview) there is no improvement of the accuracy of the indications. But it improves the transparency for the access to psycho-oncological interventions which may strengthen patient's autonomy and adherence.

The views of physicians and nurses on the potentials of an electronic assessment system for recognizing the needs of patients in palliative care

“…On the one hand the validity of the potential data is doubted, since scepticism prevails over patients' selfassessments (cf. [21]). This touches upon the general trustworthiness of PROs in the eyes of PC professionals.…”

“…Various electronic screening instruments and systems for patient self-assessment in oncology and PC have been developed and their implementation tested in English and German-speaking countries (e.g. [20][21][22]). However, paper-and-pencil procedures still dominate the assessment of PROs [3] and electronic assessments of PROs are not very widespread in standard care yet [5].…”

Patient-reported outcomes and psycho-oncological screening in hematology: a practical example of routine electronic monitoring

“…Fig. 2 (adapted from [45]) displays the possible outcomes and resulting actions taken by the staff depending on the HSI results.…”

“…Depending on the screening outcome of the Hornheider Screening Instrument (HSI), different clinical actions are executed. The blue exclamation mark is shown as an indicator of necessary clinical action for healthcare professionals.Adapted from Schäffeler et al[45]…”

Cancer-Related Distress: How Often Does It Co-occur With a Mental Disorder? – Results of a Secondary Analysis

“…Distress, as assessed by the DT, is conceptualized as multifactorial unpleasant experience (e.g., a cancer diagnosis) that may interfere with coping skills, ranging from common feelings of sadness and fears to severe reactions that can be diagnosed as psychiatric illnesses ( Riba et al, 2019 ). Yet, the DT’s performance as a screening tool is sometimes evaluated in terms of detecting the occurrence of a mental disorder ( Recklitis et al, 2016 ; Schaffeler et al, 2017 ). This conceptual vagueness is also reflected by the empirical questions regarding the extent to which emotional distress co-occurs with a diagnosis of a mental disorder (objective burden), or reflects psychological problems that are related to single symptoms of mental disorders.…”