Nadine Janis Pohontsch’s research while affiliated with University Medical Center Hamburg - Eppendorf and other places

Zusammenfassung Patient*innen mit chronischen, nicht-onkologischen Erkrankungen erhalten seltener spezialisierte Palliativversorgung (SAPV) als jene mit onkologischen Erkrankungen. Die KOPAL-Studie untersuchte die Durchführung einer zeitgerechten Fallbesprechung durch SAPV-Pflegefachpersonen (SAPV-PP), Palliativmediziner*in und Hausärzt*in. Ziel ist die Bewertung der Intervention aus SAPV-PP-Sicht. 16 thematisch fokussierte, narrative Interviews mit SAPV-PPs, Analyse mittels Grounded Theory. Im Falle einer SAPV-Zuweisung der Patient*innen sollte diese zeitgerecht und gemeinsam mit Hausärzt*innen erfolgen. Die Zusammenarbeit mit Hausärzt*innen erleben die SAPV-PPs als Balanceakt. Zudem fühlen sie sich durch die Intervention in ihrem Vorgehen im Patient*innengespräch eingeschränkt. Sie nehmen ihre gewohnte, beratende Rolle ein und erleben es als Belastung, wenn keine gemeinsame Versorgung erfolgt. Eine Zusammenarbeit von Hausärzt*innen und SAPV-PPs sollte frühzeitig unter besonderer Beachtung der Pflegeperspektive umgesetzt werden.

Hintergrund/Fragestellung: Der Versorgungsbedarf älterer Menschen in der stationären Langzeitpflege wird durch Multimorbidität und chronische Erkrankungen komplexer. Ungeplante Krankenhauseinweisungen sind in dieser Zielgruppe häufig. Pflegefachpersonen mit Qualifikation auf Bachelorniveau können die Versorgungsqualität verbessern, in Deutschland fehlen dafür noch geeignete Rollenprofile. Ziel: Evaluation der Machbarkeit sowie potenzieller Effekte eines neuen Rollenprofils für Pflegefachpersonen auf die Lebensqualität und die Häufigkeit akutmedizinischer Versorgungsereignisse in der stationären Langzeitpflege. Methoden: Durchführung einer explorativen, bi-zentrischen, cluster-randomisierten kontrollierten Studie in 11 Pflegeeinrichtungen (Cluster) mit begleitender Prozessevaluation [1]. Teilnehmende Bewohnende (BW) hatten einen komplexen Versorgungsbedarf (Pflegegrad ≥3 oder Grad 2 und Multimorbidität). Interventionseinrichtungen stellten eine Pflegefachperson mit erweitertem Qualifikationsprofil für die Intervention frei. Das Rollenprofil umfasste definierte Komponenten (Aufgaben in der bewohnernahen Versorgung und organisationsbezogene Aufgaben). Pflegefachpersonen erhielten eine Zusatzqualifizierung von 300 Stunden. Hauptzielgrößen waren der Anteil von BW mit akutmedizinischer Versorgung (Hospitalisierung, Bereitschaftsdienst, Notaufnahme: nach 6 Monaten) und die gesundheitsbezogene Lebensqualität (EQ5D-5L [2]: nach 6 Monaten). Daten wurden deskriptiv ausgewertet und binäre Zielgrößen mittels logistischer Regression analysiert. Ergebnisse: Insgesamt nahmen in 11 Einrichtungen (IG: 5; KG: 6) 139 BW teil (IG 60; KG 79). Nach 6 Monaten (t2) lag der Anteil der BW mit mindestens einer Hospitalisierung insgesamt bei 38,84% (IG 40,00%; KG 37,97%; OR 1,19 [95% KI: 0,56 bis 2,54]), über 80% davon waren ungeplant. Der Bereitschaftsdienst wurde von 21,67% (IG) bzw. 13,92% (KG) der BW in Anspruch genommen (OR 1,50 [KI: 0,55 bis 4,04]). Ein Rettungsdiensteinsatz fand bei 38,33% (IG), bzw. 32,91% (KG) der BW statt (OR 1,40 [KI: 0,66 bis 2,99]). Es gab zu t2 keinen Unterschied in der Lebensqualität (EQ5D-5L Index und VAS) zwischen den Gruppen. Die Prozessevaluation ergab, dass die Erfahrung der Pflegefachperson sowie Führungskultur und Einrichtungsstruktur für die erfolgreiche Umsetzung relevant waren. Schlussfolgerung: Das Rollenprofil war umsetzbar, in der Pilotstudie waren keine Effekte sichtbar. Mit der Studie wurde die Grundlage für die Weiterentwicklung und Wirksamkeitstestung der Intervention gelegt.

Background Empathy plays an important role in the interaction and communication with patients. Physicians’ empathy has various positive patients’ and physicians’ outcomes. Despite the inclusion of empathy in medical curricula and the relevance of empathy in general and physicians’ concept of it to medical care, there is no common definition of empathy in the clinical context: definitions tend to be abstract and we do not know enough about medical students’ conceptualization of clinical empathy. A clear and consensual definition of empathy is needed to be able to teach and measure empathy adequately. We aimed to explore German medical students’ views and understanding of (clinical) empathy. Methods We interviewed 24 students from the second half of the 3rd year and in their final clinical year (six female and male students in each subgroup) using a semi-structured interview guide. Interviews were digitally recorded and transcribed verbatim. We analysed the transcripts using thematic synthesis (Braun & Clarke). Results We found three overarching themes: (1) empathy means perceiving and understanding patients’ needs and acting accordingly, (2) empathy as an interpersonal, intangible construct and (3) taking time for patients. Showing interests, impartiality and openness towards the patients as well as the need to take patients seriously, treating them with respect, having a holistic view on patients and generate some kind of closeness with patients are subthemes of the first overarching theme. Conclusions Although it is often stated that the various existing definitions of empathy are abstract or far from practice, German medical students seem to have a good idea how to define empathy. Their definition resembles definitions known from the literature and used in education. Further research is needed to compare concepts of empathy of medical students from different countries and cultural backgrounds to inform research and teaching. It would also be interesting to investigate how concepts of empathy change over the course of study and affect perceptions of empathy in third party assessments.

Background: The management of the long-term sequelae of coronavirus disease 2019 (COVID-19) infection, known as post-COVID-19 syndrome (PCS), continues to challenge the medical community, largely owing to a significant gap in the understanding of its aetiology, diagnosis and effective treatment. Aim: To examine general practitioners' (GPs) experiences of caring for patients with PCS and to identify unmet care needs and opportunities for improvement. Design and setting: This study follows a qualitative design, using in-depth semi-structured telephone interviews with GPs (N = 31) from across Germany. Method: Interviews were audio-recorded, transcribed verbatim and analysed using qualitative content analysis. Results: GPs reported that they were often the first point of contact for patients with persistent symptoms following SARS-CoV-2 infection, with symptoms typically resolving within weeks. While ongoing symptomatic COVID-19 is perceived to be more common, the relevance of PCS to GP practices is considerable given its severe impact on patients' functioning, social participation and the substantial time required for patient care. GPs coordinate diagnosis and treatment but face challenges because of the unclear definition of PCS and difficulties in attributing symptoms, resulting in a cautious approach to ICD-10 coding. Interviewees highlight lengthy diagnostic pathways and barriers to accessing specialist care. Conclusion: The findings confirm the high functional limitations and psychosocial burden of PCS on patients, and the central role of GPs in their care. The study suggests a need for further research and health policy measures to support GPs in navigating diagnostic uncertainty, interprofessional communication and the limited evidence on effective treatments.

Background Chronic, non-malignant diseases (CNMD) like chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and dementia in advanced stages are very burdensome for patients. Timely palliative care with strong collaboration between general practitioners (GPs) and specialist palliative home care (SPHC) teams can reduce symptom burden, hospitalization rates, hospitalization costs and overall healthcare costs. The KOPAL-study on strengthening interprofessional collaboration for patients with palliative care needs tested the effect of an intervention comprising of a SPHC nurse assessment and an interprofessional case conference. This qualitative evaluative study explores patients’, proxies’ and their associates’ motivation to participate in the KOPAL-study and views on the (benefits of the) intervention. Methods We interviewed 13 male and 10 female patients as well as 14 proxies of patients with dementia and six associates of study participants using a semi-structured interview guide. All interviews were digitally recorded, transcribed verbatim and analysed with deductive-inductive qualitative content analysis. Results Motivation for participation was driven by curiosity, the aim to please the GP or to support research, respectively to help other patients. Few interviewees pointed out to have expected positive effects for themselves. The nurse visit was evaluated very positively. Positive changes concerning health care or quality of life were reported sparsely. Most study participants did not prepare for the SPHC nurse assessment. They had no expectations concerning potential benefits of such an assessment, the interdisciplinary case conference and an early integration of palliative care. The majority of interviewees reported that they did not talk about the nurse visit and the interprofessional case conference with their GPs. Conclusion Our results lead to the conclusion that SPHC nurses can serve as an advocate for the patient and thereby support the patients’ autonomy. GPs should actively discuss the results of the interdisciplinary case conference with patients and collaboratively decide on further actions. Patient participation in the interdisciplinary case conference could be another way to increase the effects of the intervention by empowering patients to not just passively receive the intervention. Trial registration DRKS00017795 German Clinical Trials Register, 17Nov2021, version 05.

Objective Chronic non-malignant diseases (CNMDs) are under-represented in specialist palliative home care (SPHC). The timely integration of SPHC for patients suffering from these diseases can reduce hospitalisation and alleviate symptom burdens. An intervention of an SPHC nurse–patient consultation followed by an interprofessional telephone case conference with the general practitioner (GP) was tested in the KOPAL trial (‘Concept for strengthening interprofessional collaboration for patients with palliative care needs’). As part of the trial, the aim of this study was to gain in-depth insights into SPHC physicians’ perspective on care with and without the KOPAL intervention for patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and dementia (D). Design Qualitative evaluation of the KOPAL intervention from the perspective of SPHC physicians as part of the KOPAL trial. Thematic-focused narrative interviews analysed with grounded theory. Setting We conducted the KOPAL study and its qualitative evaluation in Lower Saxony and the greater Hamburg area, Germany. Participants 11 physicians from 14 SPHC teams who participated in the trial were interviewed. Results A grounded theory of the necessity of collaboration between GPs and SPHC teams for patients with CHF, COPD and dementia was developed. From the perspective of SPHC physicians, patients with CNMD are generally difficult to manage in GP care. The timing of SPHC initiation is patient-specific, underscoring the need for collaboration between SPHC physicians and GPs. However, the primary mandate for healthcare should remain with GPs. SPHC physicians actively seek collaboration with GPs (eg, through the KOPAL intervention), viewing themselves as advisors for GPs and aspiring to collaborate as equal partners. Conclusion Effective communication and the negotiation of future interprofessional collaboration are essential for SPHC teams. Trial registration number DRKS00017795.

Background: The management of the long-term sequelae of COVID-19 infection, known as post-COVID-19 syndrome (PCS), continues to challenge the medical community, largely due to a significant gap in the understanding of its aetiology, diagnosis and effective treatment. Aim: To examine general practitioners′ (GPs) experiences of caring for patients with PCS and to identify unmet care needs and opportunities for improvement. Design and setting: This study follows a qualitative design, using in-depth semi-structured telephone interviews with GPs (N=31) from across Germany. Method: Interviews were audio-recorded, transcribed verbatim and analysed using qualitative content analysis. Results: Patients with persistent symptoms after SARS-CoV-2 infection often consult their GPs as the first point of contact, with symptoms typically resolving within weeks. While ongoing symptomatic COVID-19 is perceived to be more common, the relevance of PCS to GP practices is considerable given its severe impact on patients′ functioning, social participation, and the substantial time required for patient care. GPs coordinate diagnosis and treatment, but face difficulties because of the unclear definition of PCS and difficulties in attributing symptoms, resulting in a cautious approach to ICD-10 coding. Interviewees highlight lengthy diagnostic pathways and barriers to accessing specialist care. Conclusion: The findings confirm the high functional limitations and psychosocial burden of PCS on patients and the central role of GPs in their care. The study suggests a need for further research and health policy measures to support GPs in navigating diagnostic uncertainty, interprofessional communication and the limited evidence on effective treatments Keywords: Primary Health Care, Post-Acute COVID-19 Syndrome, COVID-19, Pandemics, Qualitative Research How this fits in: Post-COVID-19 syndrome has garnered attention in research and healthcare, but limited evidence on its causes and effective treatment challenges clinicians. This study illustrates the symptom-driven approaches to diagnosis and treatment adopted by general practitioners and their concerns about referring patients to specialist clinics. Greater collaboration and communication across sectors and disciplines is needed to meet the identified need for interprofessional care. Research should also focus on developing comprehensive differential diagnostic protocols, and health policy should address barriers to accessing specific outpatient services.

Zusammenfassung Qualitative Evidenzsynthesen (QES) werden in der deutschen Rehabilitationsforschung bislang selten durchgeführt, obwohl robuste Synthesen qualitativer Evidenz zu wissenschaftlich fundierteren Entscheidungen im Gesundheitssystem führen können. Der Artikel führt in das Thema der qualitativen Evidenzsynthese ein, indem drei verschiedene Synthesemethoden – Thematische Synthese, Meta-Ethnografie und Grounded-Theory-Synthese – exemplarisch beschrieben und mit Beispielen aus der Rehabilitationsforschung illustriert werden. Es folgen Hinweise zur Auswahl geeigneter QES-Methoden und Überlegungen zu den Herausforderungen von QES, die mit der Literaturrecherche und Qualitätsbewertung der eingeschlossenen Studien verbunden sind. Auch werden Gütekriterien und Leitfäden für deren Anwendung vorgestellt. GRADE-CERQual kann zur Messung der Zuverlässigkeit der Ergebnisse aus QES angewendet werden. Der Artikel schließt mit Überlegungen zur Bedeutsamkeit der QES für die Rehabilitationsforschung.

Pflegefachpersonen sind mit komplexen Versorgungsherausforderungen konfrontiert: Hohes Alter und Multimorbidität führen zu hohen Hospitalisierungsraten von Bewohner:innen in Langzeitpflegeeinrichtungen. Im Krankenhaus können unerkannte Bedarfe von Personen mit kognitiven Beeinträchtigungen zu Komplikationen und einer erhöhten Krankenhausverweildauer beitragen. International sind akademisch qualifizierte Pflegefachpersonen, „Advanced Practice Nurses“, etabliert und tragen zu einer gesteigerten Versorgungsqualität bei. In Deutschland arbeiten bisher wenige akademisch qualifizierte Pflegefachpersonen in der akut- und langzeitstationären Pflege, Rollenprofile sind heterogen und als Insellösungen entstanden. In den BMBF-geförderten Projekten ENROLE-acute (ISRCTN81391868) und Expand-Care (DRKS00028708) wurden anhand etablierter Methoden Rollenprofile für die Person-zentrierte Versorgung von Menschen mit komplexen Versorgungsbedarfen in zwei verschiedenen Settings entwickelt und erprobt. Das Symposium gibt einen Überblick über die Methoden der Interventionsentwicklung, die erweiterten Rollenprofile der Pflegefachpersonen sowie deren Umsetzung und Evaluation.