Lena Ansmann

Background: Despite robust evidence on the effectiveness of exercise therapy care as a supportive strategy in cancer care, access for cancer patients remains limited across Germany. This is due to a lack of renumeration opportunities, insufficient knowledge, and the absence of integrated provider networks. Existing care services have mainly arisen from individual initiatives and the unwavering commitment of sports science pioneers, who devoted their time, energy, and expertise to developing better methods of care. This study analyses the informal provider networks in the emerging field of exercise therapy care and research, focusing on recurring patterns of interaction between exercise therapy providers and medical professionals that enable patient access to exercise therapy care. Methods: This study employed a combination of qualitative network analysis and contextual analysis. A total of n = 31 qualitative interviews were carried out with representatives from the provider networks of exercise therapy care within seven comprehensive cancer centres (CCCs) to explore current patterns of care. The interview data were analysed using qualitative content analysis following Kuckartz, supported by MAXQDA software. Contextual analysis was supported by a survey of key informants (KIs) from exercise therapy care units in CCCs ( n = 7) to collect data on patient flow and CCC characteristics. Results: We identified seven recurring relational patterns of operation that facilitate patient access to exercise therapy care within care networks. These patterns include mutual recognition from previous projects and shared facilities, improved accessibility to exercise therapy care options, the development of reciprocity between supportive services, raising patient awareness and sensibilisation through existing patient navigators, planning for patient needs via structured screenings for supportive services, collaboration with medical care, and the sharing of knowledge through informational events for healthcare providers. Conclusion: Integrated provider networks of exercise therapy care have developed informally, resulting in structural fragility and limited robustness. As long as the effectiveness of exercise therapy care remains research-driven rather than embedded in standard care pathways, these networks remain vulnerable. Establishing formal policies and stable reimbursement mechanisms is essential to institutionalising network ties; strengthening social capital; and ensuring resilient, sustainable access to exercise therapy for all cancer patients. Trial registration: ClinicalTrials.gov (Clinical Trials Identifier NCT06185777), December 29, 2023.

In Germany, about 17% of households speak a non-German language, yet the absence of national guidelines in language-discordant encounters leaves hospitals

Background: Digital patient portals (PPs) are platforms that enhance patient engagement and promote active involvement in health care by providing remote access to personal health data. Although many hospitals are legally required to offer these portals, adoption varies widely among patients, often influenced by sociodemographic and socioeconomic determinants. Evidence suggests that higher income, education, employment status, and specific age groups correlate with increased portal usage, highlighting a digital divide. This study aims to analyze sociodemographic and socioeconomic determinants affecting digital PP usage, addressing inconsistencies in existing research and contributing to strategies for reducing digital health disparities. Objective: This study aimed to conduct a meta-analysis of the sociodemographic and socioeconomic factors contributing to the digital divide in the usage of digital PPs. Methods: A systematic review with meta-analysis was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in PubMed, Web of Science Core Collection, and EBSCOhost. Screening involved 3 reviewers with consensus meetings to resolve discrepancies. Data on sociodemographic and socioeconomic factors and statistical outcomes were extracted, and study quality was assessed using the Mixed Methods Appraisal tool. Results were visualized using forest and funnel plots to assess heterogeneity and publication bias. Results: A total of 2225 studies were identified through a systematic review, and after title and abstract screening, 17 studies were included in the quantitative and qualitative analysis. The qualitative analysis revealed that younger patients (younger than 65 y) were significantly more likely to use the digital PP, while the meta-analysis revealed that women had a 16% higher likelihood of using the digital PP than men. The relationship between income and digital PP usage was inconsistent, due to different scaling in different studies. A higher level of education was significantly associated with a 37% greater likelihood of using the digital PP in the meta-analysis. In addition, employed patients were 23% more likely to use the digital PP, while married patients had a 13% higher likelihood of using it than unmarried patients. Marital status and employment can be considered as measurable factors of social relationships. Conclusions: The review confirms that sociodemographic and socioeconomic factors significantly influence the usage of digital PP in hospital care. Marital status shows that social support plays a vital role, with married patients 13% more likely to engage with digital PPs. It is worth noting that social support through connections to society via work or work colleagues can also play an important role as like as a partner at home, with employed individuals being 22% more likely to use digital PPs. Overall, sociodemographic factors, like marital status, primarily affect usage patterns, while socioeconomic factors, like employment, enable access, emphasizing the need for comprehensive support systems to bridge the digital divide in health care. Trial Registration: German register of clinical trials DRKS00033125; https://drks.de/search/de/trial/DRKS00033125 and PROSPERO CRD42024567203; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024567203

Purpose: Multidisciplinary tumor boards (MTBs) intend to increase the quality of cancer care. Research on the association of adherence to MTB recommendations with survival is limited. This study aims to determine the impact of adherence to MTB recommendations on survival in colorectal cancer patients. Methods: This is a retrospective, observational study including patients diagnosed between 01.01.2014 and 31.12.2018. Electronic health records were reviewed to determine the adherence. Study endpoints were adherence rate, disease-free survival (DFS), and overall survival (OS). Follow-up was performed until 12.12.2023. Results: There was a significant difference in DFS (median DFS: 79 months [95% CI, 73-89] vs 22 months [95% CI, 17-87]) and OS (median OS: 78 months [95% CI, 75-86] vs 65 months [95% CI, 28-NR]) between the adherent group (n=406) versus the non-adherent group (n=52) (log-rank test, p<0.05). Performance status, stage and non-adherence were independent predictors of survival in the multivariate analysis (p<0.05 for all). The most common reason for non-adherence was patient preference (n=23). Conclusion: While MTBs have become an indispensable part of clinical practice, adherence to MTB recommendations was crucial to achieve survival benefit in this study. Patient preference should be prospectively analyzed from a patient and caregiver perspective in future studies.

Background: In connection with a hospital stay, patients have to make important health-related decisions. Adequately responding to the needs of patients requires good communication skills of healthcare professionals within healthcare organizations. The PIKoG project (As made for us – Improving professional health literacy in hospitals) aimed at improving professional health literacy by implementing participatory health literacy training and supporting measures in a hospital setting. This study aimed to analyze processes supporting and hindering the implementation of the complex intervention. Methods: A mixed-methods study was conducted, including focus group interviews and a paper-pencil survey with healthcare professionals. Data was combined and analyzed using categories derived from the Medical Research Council’s guidance on process evaluation: (1) Implementation, (2) Mechanisms of impact, and (3) Context. Interview data were analyzed using structured qualitative content analysis according to Kuckartz. Survey data were analyzed descriptively. Results: One of three on-site, full-day health literacy training sessions was offered weekly. Supporting measures were implemented step by step over the course of a year. Both the training and the supporting measures were rated positively overall, but they could not be effectively integrated into daily routines. The COVID-19 pandemic as well as resource constraints adversely affected implementation by altering workflows, increasing stress levels and shifting priorities. The participatory approach and individual change agents fostered the implementation of the complex intervention. Nurses were reached the most, while physicians engaged least in the interventions. Adaptations during the implementation increased the use of the implemented measures and gave rise to ideas for future improvements. Conclusion: The study highlights the challenges involved in implementing a complex intervention supporting professional health literacy in an organization and stresses the importance of considering available resources, recruiting opinion leaders, and being responsive to the needs of different groups. While the participatory co-design development approach was found to be valuable, it does not guarantee successful organizational change in times when hospitals face multiple challenges. Subsequent studies should therefore focus on investigating the capacities of healthcare organizations for organization-wide improvement processes and identify how healthcare organizations can be innovative and patient-centered even in the presence of extremely difficult contextual conditions. Trial registration: DRKS00019830, since 16th of April 2020.

Zusammenfassung: Die Nutzungsstruktur von Notaufnahmen gilt als Indikator für die Funktionsfähigkeit des Gesundheitssystems. In Deutschland besteht Handlungsdruck zur Verbesserung der Notfallversorgung. Notaufnahmen sind relativ eigenständige organisationale Einheiten, die mit anderen Ebenen innerhalb und außerhalb der Organisation Krankenhaus interagieren. Anhand eines Schemas der organisationsbezogenen Versorgungsforschung soll der Ist-Stand der Notfallversorgung beschrieben und Barrieren und Förderfaktoren gegenüber Veränderungen diskutiert werden. Es handelt sich um einen narrativen Review, der Literaturquellen zu organisationalen Einflüssen auf die Arbeitsweise in der Notaufnahme einbezieht. Dabei wurden Publikationen berücksichtigt, die neben der Schnittstellenperspektive einen aktuellen Bezug zum Ist-Zustand sowie zu den Änderungsvorschlägen des Gesetzgebers und weiterer an der Planung und Umsetzung beteiligter Akteur:innen haben. Diese wurden den jeweiligen organisationalen Ebenen zugeordnet und (potenzielle) Auswirkungen beschrieben. Als Heuristik dient das Makro-Meso-Mikro-Modell der organisationsbezogenen Versorgungsforschung. Unzureichende Berücksichtigung von Interdependenzen und Schnittstellen zwischen organisationalen Ebenen der Notfallversorgung begünstigen Friktionen und erschweren Versorgungsinnovation. Auf der Makroebene des Gesundheitswesens werden Strukturen, Zuständigkeiten sowie Finanzierungen geregelt, die die Arbeitsweise der Meso- und Mikroebene maßgeblich beeinflussen. Auf der Mesoebene Krankenhaus wird die Rolle der Notaufnahme durch kaum steuerbare Patient:innenströme und fehlende abrechnungsrelevante Diagnoses Related Groups (DRGs) für die ambulante Notaufnahmeversorgung beeinflusst. Die Mikroebene Notaufnahme muss Behandlungspriorisierungen vornehmen und ist mit Herausforderungen von „exit blocks“ bei Verlegungsindikationen konfrontiert. Bisherige Reformvorschläge erfassen diese organisationale Komplexität nicht. Reformvorschläge müssen die organisationale Komplexität berücksichtigen, die durch Schnittstellen, Wechselwirkungen und Akteursinteressen entstehen. Die organisationsbezogene Versorgungsforschung kann die Kontextbedingungen untersuchen, die auf die Notfallversorgung einwirken, um Empfehlungen für Versorgungsinnovationen abzuleiten.

Background: Physical activity has been shown to be beneficial for people diagnosed with cancer. MOVE-ONKO aims at implementing a new multiprofessional care pathway in 3 large regions in Germany at the interface of oncological treatment and exercise therapy for cancer patients. The related study aims to evaluate the implementation processes and patient outcomes. Methods: The project comprises 3 phases: 1) preparation, 2) implementation in Comprehensive Cancer Centres (CCCs), 3) implementation in remote cancer centres. In phase 1, individual prerequisites for the implementation are assessed in the participating CCCs. The care pathway which is supported by digital/app-based exercise oncology health record is developed and adapted to the CCCs. Phases 2 and 3 focus on the implementation and evaluation of the care pathway. To study the effectiveness, primarily changes in patients' health-related quality of life are examined in a prospective design. Secondary outcomes include physical activity behaviour, motivation for physical activity and patient activation. A sample of 2240 cancer patients ≥ 18 years (n = 280 patients at seven CCCs in phase 2 and n = 1.960 patients at the seven CCCs and 49 remote oncological centres in phase 3) are recruited for assessment at inclusion and at 4, 12 and 24 weeks. The newly implemented care structures and processes will be assessed from the perspective of key informants, healthcare providers and patients. The perspectives of key informants on the implementation from the CCCs will be recorded in a prospective design based on a questionnaire and supplemented by in-depth semi-structured interviews across the three phases. The implementation processes are documented by assessing existing structures in CCCs. In phase 2 (n = 105) and phase 3 (n = 350), healthcare providers will be surveyed with questionnaires. Based on purposeful sampling (n = 18) will be interviewed. Additionally, qualitative patient interviews will be conducted about their experiences in the care pathway. Discussion: A successful implementation of the care pathway as part of the study will contribute to the growing evidence on the implementation of a nationwide structured approach to exercise therapy for patients with cancer. Trial registration: ClinicalTrials.gov (ClinicalTrials Identifier NCT06185777) at December 29, 2023.