Rieka von der Warth

Zusammenfassung: Hintergrund: Sexuelle Belästigung und sexuelle Übergriffe gegenüber Medizinstudierenden sind weit verbreitet und können mit gesundheitlichen und beruflichen Folgen einhergehen. Trotzdem bleiben Melderaten niedrig. Daher sind wirksame Präventionsmaßnahmen für Medizinstudierende notwendig. Ziel der Arbeit: Auf dem 59. Kongress für Allgemeinmedizin und Familienmedizin wurde ein Workshop organsiert, der die Themen sexuelle Belästigung und Übergriffe im Medizinstudium thematisierte. Ziele waren: 1) bestehende Maßnahmen und Strategien in der Allgemeinmedizin und an Universitätskliniken zu diskutieren; 2) Vernetzung der an dem Thema interessierten Mitarbeitenden aus der Allgemeinmedizin; 3) Ideensammlung für weitere Präventionsstrategien. Methode: In einer World-Café-Diskussionsrunde wurden 1) Primärpräventionsmaßnahmen und 2) Unterstützungsstrukturen diskutiert. Jede Station spiegelte einen Ausbildungsabschnitt im Medizinstudium wider: Pflegepraktikum, Krankenhausstation, Hausarztpraxis. Die Ergebnisse wurden im Plenum zusammengeführt und diskutiert. Ergebnisse: Die diskutierten Maßnahmen ließen sich in die 4 Kategorien a) Richtlinien und Organisation, b) Schulungen, c) Fallmanagement und d) Unterstützungsstrukturen eingruppieren. Hierzu zählten die Teilnehmenden u. a. regelmäßige Schulungen von Personal und Medizinstudierenden zum richtigen Verhalten. Auf Systemebene wurden Meldesysteme, rechtliche und psychosoziale Beratungsangebote und ein unbürokratischer Wechsel der Einsatzstelle ohne Ausbildungsnachteil diskutiert. Diskussion: Mit den diskutierten Maßnahmen sollen Medizinstudierende besser vor sexuellen Übergriffen geschützt und in Akutfällen schnelle Hilfe ermöglicht werden. Leitendes Ziel sollte dabei eine Kulturveränderung in der Medizin sein.

Introduction: Long-term cancer survivors may suffer from significant bio-psycho-social burden even years after treatment. Yet, a structured approach to detect and address bio-psycho-social burden of long-term cancer survivors in primary care is missing in Germany, although family physicians are the primary medical contact for most patients. In this paper, we describe the DELPHIN study aiming to develop and test a structured care model for long-term cancer survivors. The DELPHIN study and intervention will facilitate networking of regional medical and non-medical services. This protocol describes the intervention as well as the pilot study. Methods: The DELPHIN study comprises a developmental and a feasibility phase. In the developmental phase, we will assess (1) the current care needs of long-term cancer survivors (n=1000) using a cross-sectional questionnaire survey; (2) in an additional cross-sectional questionnaire survey, we will address medical and non-medical care providers to assess current care practice for this patient group (n≥250); (3) a qualitative interview study with both long-term cancer survivors (n=12) and family physicians (n=10) will assess patients’ needs and barriers for effective care. Results will then be triangulated to inform development of the DELPHIN intervention. The intervention shall include the following elements: the DELPHIN mobile app for patients with a digital screening tool, a digital treatment plan, a survivorship passport and information on regional medical and non-medical providers. Additionally, a DELPHIN website and a DELPHIN eLearning tool for family physicians will be developed. The subsequent feasibility study will follow 100 long-term cancer survivors using the DELPHIN app for 4 months, with two assessments (t ⁰ =baseline; t ¹ =4 months follow-up) regarding the usability of the app and their health-related quality of life. The eLearning tool will be tested by 50 family physicians using three measurement points to evaluate learning success (t ^a =before; t ^b =directly after eLearning; t ^c =after 4 weeks). Discussion: The DELPHIN study seeks to address cancer survivors’ unmet bio-psycho-social needs through implementing a digital mobile application. Positive results in the feasibility study will provide the basis for a future effectiveness study and integration into routine care. Ethics and dissemination: The study was reviewed by the Ethics Committee of the University of Bonn, Germany (No: 2024-409 BO) which did not object to the study. Trial registration number: DRKS00035726.

Background: Hospitalization increases the risk of reduced mobility and diminished activities of daily living (ADL) in geriatric patients. Using a multimodal intervention including delirium prevention, mobility training, care planning, and polypharmacy management, the ReduRisk project aimed to mitigate these risks through a risk-adapted nursing approach. Aims: This paper seeks to describe the results of the multimodal ReduRisk study on the mobility and ADL in hospitalized geriatric patients. We hypothesized that patients in the intervention group will have better mobility and ADL than those in the control group. Methods: A monocentric, cluster-randomized trial enrolled a total of N = 589 participants. Clusters were based on different department at the University Hospital of Freiburg. Data collection occurred at three measurement points (hospital admission, discharge, and six months post-discharge) using the Barthel Index (ADL) and the Short Physical Performance Battery (SPPB, mobility). Multilevel analyses were conducted. Results: Of the N = 589 participants, 48% were female. Average age was 79.57 years (SD = 5.44 years). In the intervention group (IG), mobility significantly improved between t0 and t1 (β = 0.27; p <.01) and between t0 and t2 (β = 0.70; p <.001). Compared to the control group (CG), IG mobility improved significantly more from t0 to t2 (β=-0.30; p <.05). Regarding ADL, the IG also showed significant improvements between t0 and t1 (β = 3.69; p <.05) and t0 and t2 (β = 7.98; p <.001). Compared to the CG, IG participants experienced significantly more significant improvements (t0-t1: β=-6.93; p <.01; t0-t2: β=-8.40; p <.01). Discussion: The ReduRisk intervention led to moderate improvements in ADL and small gains in mobility. These findings support the importance of early and sustained mobility interventions in clinical care. Conclusions: We observed promising results for the risk-adjusted ReduRisk intervention in reducing health-related risks among geriatric patients. Trial registration: German Clinical Trials Register, DRKS00025594, date of registration 09/08/2021.

Background: Mobile health (mHealth) apps are playing an increasingly important role in health care, including in radiotherapy. However, adherence remains low. One way to increase adherence is to tailor app features to the patients’ preferences. Objective: This study aimed to explore the importance of patient preferences regarding the features of a therapy-supporting app in radiotherapy. In addition, we examined factors associated with the perceived importance of these features. Methods: A cross-sectional questionnaire study was conducted with patients undergoing radiotherapy between summer 2021 and winter 2022. The subjective importance of 18 features of a treatment-accompanying app was explored using a 5-point Likert scale from 1=not so important to 5=extremely important. Descriptive analyses were used to show the rated importance of app functions. Associations with possible predictors were examined using multiple hierarchical regressions, with age (interval-scaled), gender (dichotomous), previous experience with mHealth apps (dichotomous), education (3-level nominal), and supportive care needs (interval-scaled) as predictors. Results: A total of 84 radiotherapy patients participated. The average age was 62 (SD 12.5) years. The feature with the highest importance was security against hacking (46/77, 60% extremely important). Explained variances in the regression analyses ranged between R²=0.25 (The app should give me tips on suitable sporting activities that are possible with my illness) and R²=−.07 (The app should provide me with information about suitable self-help offers). Previous mHealth usage predicted the importance of 6 features, such as managing appointments (β=.275; P<.05). Decreasing age was related to 6 features, for example, showing test results and laboratory values (β=−.358; P<.05). Other predictors were an increasing age and greater supportive care needs. Conclusion: Patients undergoing radiotherapy rated app features as having varying levels of importance. The findings may help to tailor mHealth apps in radiotherapy, potentially improving adherence to app usage.

The majority of transgender and gender-nonconforming people (TGNC) report negative experiences with doctors in the healthcare system. As there is little knowledge about the communication behaviour of doctors towards TGNC, this survey aimed to assess the self-reported trans-inclusive communication of doctors and their willingness to communicate trans-inclusively, as well as their self-perceived barriers to it. A mixed-methods survey was applied for this. Firstly, we measured self-reported trans-inclusive communication behaviour based on the CommTrans questionnaire. Based on this, the overall willingness, as well as self-perceived barriers (qualitative) to communication, were assessed. In total, N = 57 doctors took part in the survey. Most participants reported not introducing themselves using pronouns (79.4%). Of these, 61.4% said that they would not be able to do this in the future either. Perceived barriers were classified into the following eight categories: necessity, sample-dependency, habit, structural barriers in practice, uncertainties in dealing with the topic, limits of patient-centredness, gender as a binary concept, and transphobia. In summary, doctors in Germany show different degrees of trans-inclusive communication. It is likely that this has a negative effect on TGNC, their health and access to the healthcare system.

Patient-doctor communication is an important component of patient-centered care and should be adapted to the target group. Adapting communication to transgender and gender-diverse individuals is particularly difficult, as little is known about the preferences of this group. Thus, the aim of the study was to develop a questionnaire to assess the communication preferences of the target group. Based on a qualitative study, an item pool was created, which was tested in a survey in September 2022. An item analysis was conducted and items with unacceptable characteristics were removed. The remaining item pool was examined with an explorative factor analysis. The sample consisted of N = 264 individuals. Of the initial k = 43 items, k = 9 items remained in the final factor analysis. The final two factor solution explained 60.7% of the variance. The factors describe the emotional resonance in communication (Cronbach's alpha = .74; e.g. "My medical doctors should be happy for me when my treatment progresses positively.") as well as gender-related communication (Cronbach's alpha = .85; e.g. "My medical doctors should introduce themselves with pronouns."). Overall, the questionnaire captures the communication preferences of transgender and gender-diverse individuals in medical conversations. It covers two important topics for the target group, but further validation is necessary.

Early response is considered to be an important predictor for therapy outcomes; yet little is known about its relevance in psychosomatic rehabilitation. This paper aims to describe the association of early response in psychosomatic rehabilitation, as well as the associations of early response with pre-rehabilitative factors such as illness and treatment beliefs. A longitudinal study with three measurement points was applied. Early response was defined using the percent improvement method after two weeks of treatment. Its association with therapy outcome and with illness and treatment beliefs was analyzed using multiple regression analyses. A total of 264 participants took part. Early response was a significant predictor of psychosomatic rehabilitation outcome, explaining an incremental variance of 1-30% after controlling for initial symptom burden. Illness and treatment beliefs predicted 6-20% variance in early response. Important illness beliefs referred to perceived symptoms, consequences and comprehensibility of the illness. Important treatment beliefs referred to expectations about rehabilitation structure, processes and concerns. Early response is associated with the therapy outcome of psychosomatic rehabilitation, with illness and treatment beliefs found to be associated with early response. Further research on the predictors of early response in psychosomatic rehabilitation is needed.

Introduction: To date, there has been little research on the general health literacy of trans and gender diverse individuals, even though previous research undermines the importance of good health literacy in this sample. The aim of the article is therefore to describe the general health literacy of trans and gender diverse individuals based on a German survey. Methods: In September 2022, a survey study was conducted in which health literacy was recorded using HLS-EU-16. Data will be presented descriptively; gender differences will be explored using a Χ²- test and a univariate analysis of variance (ANOVA). Results: Out of N = 223 participants, n = 129 individuals (57.8%) identified as non-binary; n = 49 (22.0%) identified themselves as male, while n = 45 (20.2%) identified as female. Mean age was 28.03 years. Overall, 26.4% of all the participants showed an inadequate health literacy, as proposed by the HLS-EU-16. In trend, health-related task related to media use were more often perceived as easy compared to the German general population. Conclusion: Individuals, who identify as trans and gender diverse may have a general health literacy below average compared to the German general population. However, tasks related to media use were perceived as easy, which might be a good starting point for health literacy related interventions. Trial registration: DRKS00026249, Date of registration: 15/03/2022.