Andreas Dinkel

Background: Fear of cancer recurrence (FCR) is a common, distressing concern among cancer survivors, with implications for psychological well-being and quality of life. Despite the proliferation of patient-reported outcome measures (PROMs) to assess FCR, consensus on the most valid and reliable instruments remains limited. Objective: To conduct a comprehensive psychometric evaluation of FCR PROMs developed or validated between 2011 and 2023, using the full COSMIN methodology. This review builds on earlier work by systematically appraising both newly developed and adapted instruments to inform evidence-based PROM selection for clinical and research use. Methods: This review followed the COSMIN 10-step procedure and PRISMA 2020 guidelines. Six databases were searched from January 2011 to December 2023. A search cut-off of 31 December 2023 was applied to align with COSMIN feasibility recommendations and ensure sufficient time and resources for full psychometric evaluation across all included PROMs. Eligible studies included adults diagnosed with cancer and reported on the psychometric evaluation of a self-reported, Likert-scale-based FCR PROM. PROMs were appraised across eight psychometric properties using COSMIN’s Risk of Bias checklist, criteria for good measurement properties, and modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) for evidence quality. Instruments were categorized as A, B, or C according to COSMIN’s recommendations. Results: Of the 34 PROMs evaluated across 32 studies, 28 achieved COSMIN Category A status, indicating sufficient psychometric quality for clinical or research use. Among the 19 FCRI and FoP-Q instruments validated in new cultural or population contexts, 15 received a Category A rating, reflecting strong cross-cultural performance. Short forms such as the FCRI-SF and FoP-Q-SF demonstrated consistent psychometric strength across French, English, Portuguese, and Asian-language versions. Of the 14 newly developed PROMs—including the CWS-6, FCR4/7, CARQ-4, and FCR-1—12 achieved Category A. The FCR-1 was the only single-item PROM to demonstrate responsiveness, supporting its use in both screening and longitudinal monitoring. For practical guidance, five PROMs (FCR-1, FCRI-SF, FoP-Q-SF, FCR-7, and CWS) emerged as the most strongly supported for clinical use. Conclusions: This review provides a comprehensive evaluation of contemporary FCR PROMs and highlights substantial progress in the development of valid, reliable, and culturally adaptable tools. The FCRI, FoP-Q-SF, and several newly developed short forms, such as FCR7, CWS, and particularly, the FCR-1, emerge as strong candidates for use in clinical screening and longitudinal assessment. These findings offer clear evidence-based guidance for instrument selection in research and survivorship care. PROSPERO registration: CRD42023453783.

Most people in Germany fear cancer more than anything else (e1). Cancer is generally thought of as a disease that develops slowly and insidiously, is frightening, and must be ?defeated? in ?battle? (e2). The common view of cancer as an ever-present...

Cancer worry and risk perception are relevant psychological factors that influence preventive health behaviors. Therefore, a thorough understanding of the factors that impact their occurrence and manifestation is critical. The objective of this study was to assess prevalence and factors associated with worry about prostate cancer (PCa) and absolute/comparative risk perception in a community-based sample of 45-year-old men. Data were collected within the German PCa screening trial PROBASE. Variables were assessed by self-report questionnaires and a clinical interview. Worry about PCa and absolute/comparative risk perception were assessed each on a 5-point-Likert scale. Multivariable logistic regression was used to identify factors associated with the outcomes of interest. Data were available for 33,476 (72.0%) of 46,495 men at enrollment. 7.3% had sometimes/(very) often worry about PCa. 3.7% and 9.9% perceived their absolute risk and comparative risk as somewhat high/very high and somewhat higher/much higher, respectively. 18.8% reported a positive PCa family history. Important factors of worry about PCa, absolute risk perception, and comparative risk perception were lower urinary tract symptoms (LUTS) (OR 3.00, 95% CI 2.63–3.42; OR 2.09, CI 1.71–2.56; OR 2.41, CI 2.10–2.76) and a positive PCa family history (OR 2.35, CI 2.08–2.65; OR 15.13, CI 12.73–17.97; OR 9.69, CI 8.76–10.72). A positive history of urological (OR 3.85, CI 2.63–5.63) and non-urological cancers (OR 1.97, CI 1.52–2.54) were associated with a higher comparative risk perception. In conclusion, worry about PCa and risk perception are influenced by non-cancer-related symptoms as well as by a positive PCa family history. These findings need to be addressed in risk communication with patients.

Student engagement is perceived as an increasingly important but complex phenomenon in medical education. Recently, integrated theoretical frameworks have been introduced to conceptualize student engagement from a psychological, behavioral, and psychosocial perspective. The body of literature underpinning the development of the frameworks is enormous, but there is a relative paucity of reports detailing the use of the frameworks in practice. Here, we present a case study of three de novo student initiatives at the Technical University of Munich. The initiatives cover various topics, from case-based learning tutorials to extracurricular offerings on mental health and mentoring. We will map each project to the integrated framework proposed by Kassab et al. (Med Teach 45:949–965, 2023) and assess its usefulness in capturing student engagement. We conclude that the framework holistically describes the engagement profile of each project but does not consider the different roles students assume when participating in a project or incentivizing it.

Zusammenfassung: Symptome, Funktionsbeeinträchtigungen und die Lebensqualität können nur Patientinnen und Patienten adäquat beurteilen, die Einschätzung der Behandelnden stimmt diesbezüglich häufig nicht mit der von Betroffenen überein. Dem Rechnung tragend gewinnt die Berücksichtigung von patientenberichteten Endpunkten („patient-reported outcomes“, PROs) sowohl in der Forschung wie auch in der klinischen Routine an Bedeutung. In der praktischen Anwendung werden PROs nicht nur bei der Evaluation des Ergebnisses einer Behandlung berücksichtigt, sie können auch den Status vor einer therapeutischen Maßnahme beschreiben. Für die Erfassung der wichtigsten PROs liegen typischerweise mehrere reliable und valide Selbstbeurteilungsinstrumente vor, sog. „patient-reported outcome measures“ (PROMs). Im klinischen Alltag können PROs z. B. für die Diagnostik und Behandlungsplanung oder im Rahmen des Qualitätsmanagements genutzt werden. Das routinemäßige Patientenmonitoring mittels digitaler Medien (ePROMs) stellt gegenwärtig das vielversprechendste und am meisten beachtete Anwendungsgebiet in der klinischen Routine dar. Systematische Übersichtsarbeiten zeigen, dass die routinemäßige Erfassung von PROs u. a. mit einer Verbesserung der Arzt-Patient-Kommunikation, gesteigerter Patientenzufriedenheit, Symptombesserung, höherer Lebensqualität und einer höheren Überlebensdauer assoziiert ist. Dies gilt insbesondere dann, wenn die Ergebnisse des PRO-Monitorings an die Behandelnden zurückgemeldet werden. Trotz des inzwischen von vielen erkannten Nutzens von PROs und PROMs und der hohen Bereitschaft von Patienten, Angaben zu subjektiven Gesundheitsmerkmalen zu machen, gibt es noch zahlreiche Hürden bei deren Implementierung.

Background: Precision oncology, using comprehensive biomarker testing (cBT) to inform individual cancer diagnosis, prognosis and treatment, includes increasingly complex technology and clinical data sets. People impacted by cancer (patients and caregivers) and healthcare professionals (HCPs) face distinct challenges in navigating the cBT and personalized treatment landscape. This review summarizes evidence regarding cBT‐related communication between people impacted by cancer and HCPs and identifies important avenues for future research in precision oncology.Methods: A scoping review was conducted using records published in PubMed during January 2017–August 2022, focusing on the breadth of topics on patient‐HCP communication and knowledge resources used by HCPs as guidance in cBT‐related communication. Data were extracted from records meeting inclusion criteria, and findings were summarized according to main topics.Results: The search identified 287 unique records and data were extracted from 42 records, including nine from expert input. Most records originated from the United States included patients with different types of cancer, and oncologists were the main HCPs. Patients' motivation for undergoing cBT and receiving results was generally high in different settings. However, patients' understanding of cBT‐related concepts was limited, and their knowledge and information preferences changed based on cBT implications and significance to family members. HCPs were valued by patients as a trusted source of information. Limited evidence was available on HCPs' information‐seeking behavior and factors influencing cBT‐related knowledge and confidence, often self‐reported as insufficient.Conclusions: Patient education by knowledgeable and confident HCPs, information management and a caring patient‐HCP relationship communicating continuity of care regardless of cBT results are crucial to empower patients and shared decision‐making in precision oncology. More data on the process and structure of cBT‐related communication, distinction between and characterization of different timepoints of patient‐HCP interactions are needed.

It is generally assumed that psychodynamic therapy and cognitive behavioral therapy (CBT) differ in terms of applied techniques and processes. To date, however, little is known about whether and how such differences can actually be observed at a basic linguistic level and in what the two treatment approaches differ most strongly (i.e., how psychodynamic and CBT therapists differ in what they actually say word-by-word in therapy sessions). Building on theoretical models and previous research that used observer ratings, we formulated specific hypotheses regarding which word categories psychodynamic and CBT therapists who treat patients with an eating disorder should differ in. To investigate these hypotheses, we used verbatim transcripts from 297 therapy sessions of a randomized controlled trial in which patients with anorexia nervosa (n = 88) received either focal psychodynamic therapy (FPT) or CBT. These transcripts were then examined using computerized quantitative text analysis. In line with our hypotheses, we found that CBT therapists overall spoke more than their FPT counterparts and that they used more words related to eating. Also in line with our hypotheses, FPT therapists used more words related to social processes. Contrary to our expectations, CBT therapists did not show a stronger focus on the future but talked more about emotions than FPT therapists. The latter effect, however, appears to be driven by a stronger focus on positive emotions. These findings suggest that computerized quantitative text analysis can differentiate meaningful language characteristics of CBT and FPT on spoken-word level and that it holds potential as a tool for researchers and therapists. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: Patients with localized prostate cancer (PC) are faced with a wide spectrum of therapeutic options at initial diagnosis. Following radical prostatectomy (RP), PC patients may experience regret regarding their initial choice of treatment, especially when oncological and functional outcomes are poor. Impacts of psychosocial factors on decision regret, especially after long-term follow-up, are not well understood. This study aimed to investigate the prevalence and determinants of decision regret in long-term PC survivors following RP. Methods: 3408 PC survivors (mean age 78.8 years, SD = 6.5) from the multicenter German Familial PC Database returned questionnaires after an average of 16.5 (SD = 3.8) years following RP. The outcome of decision regret concerning the initial choice of RP was assessed with one item from the Decision Regret Scale. Health-related quality of life (HRQoL), PC-anxiety, PSA-anxiety, as well as anxiety and depressive symptoms were considered for independent association with decision regret via multivariable logistic regression. Results: 10.9% (373/3408) of PC survivors reported decision regret. Organ-confined disease at RP (OR 1.39, 95%CI 1.02–1.91), biochemical recurrence (OR 1.34, 1.00-1.80), low HRQoL (OR 1.69,1.28–2.24), depressive symptoms (OR 2.32, 1.52–3.53), and prevalent PSA anxiety (OR 1.88,1.17–3.01) were significantly associated with increased risk of decision regret. Shared decision-making reduced the odds of decision regret by 40% (OR 0.59, 0.41–0.86). Conclusions: PC survivors may experience decision regret even after 16 years following RP. Promoting shared decision-making in light of both established and novel, potentially less invasive treatments at initial diagnosis may help mitigate long-term regret. Awareness regarding patients showing depressive symptoms or PSA anxiety should be encouraged to identify patients at risk of decision regret in need of additional psychological support.

Patienten mit einer chronischen Krankheit leiden oft unter krankheitsassoziierten Ängsten. Dazu zählt auch die Progredienzangst. Diese Realangst ist prinzipiell angemessen. Sie kann aber auch als sehr belastend erlebt werden, sodass sich ein psychotherapeutischer Behandlungsbedarf ergibt.