Veränderung der psychischen Belastung von Krebspatienten im Rahmen einer strukturierten psychoonkologischen Versorgung

Zusammenfassung

Ziel dieser Studie ist eine Analyse der Veränderung der psychischen Belastung bei Krebspatienten im Rahmen des strukturierten psychoonkologischen Versorgungsprogramms Case Management Psychoonkologie (CMP), das in die onkologische Routineversorgung von 6 Akutkliniken implementiert wurde. Anhand der Veränderung der Angst- und Depressivitätssymptomatik der Krebspatienten soll ein Hinweis auf die Wirksamkeit des Versorgungsprogramms in der Versorgungswirklichkeit gefunden werden. Instrumente waren die deutsche Version der Hospital Anxiety and Depression Scale (HADS) und eine Checkliste mit Single-Item-Skalen zur Erfassung der persönlichen Problem- und Bedürfnislage der onkologischen Patienten. Die Datenerhebung erfolgte zu Beginn der stationären Behandlung (t1), ca. 120 Tage (t2) sowie ein Jahr nach stationärer Erstaufnahme (t3). Auf Grundlage der HADS-Gesamtwerte konnte für n = 258 Patienten eine Prä-Post-Effektstärke für die Verbesserung der psychischen Belastung von 0,35 zu t2 und von 0,46 zu t3 errechnet werden. Für die Subgruppe der zu t1 psychisch belasteten Patienten (n = 128) liegen die Effektstärken bei 1,05 zu t2 und bei 1,38 zu t3. Bei 34,4 % (t2) bzw. 45,3 % (t3) dieser Patienten lag eine klinisch signifikante Reduktion der psychischen Belastung vor. Relevante Faktoren für die Symptomverbesserung waren die Intensität der psychoonkologischen Gespräche und das Alter der Patienten. Patienten mit hoher Inanspruchnahme der psychoonkologischen Interventionen zeigten eine signifikant stärkere Symptomreduktion. Mittlere bis hohe Korrelationen zwischen der HADS und den Single-Item-Skalen verweisen darauf, dass sich im Langzeitverlauf nicht nur die psychische Belastung, sondern auch die Lebensqualität und Funktionalität verbessert hat. Diese Ergebnisse sind ein erster Hinweis auf die Effektivität strukturierter psychoonkologischer Interventionen in der Versorgungswirklichkeit onkologischer Akutversorgung.

Abstract

The aim of this health service research study was to investigate the change in the psychological distress of cancer in-patients. According to the structured psychooncological care program Case Management Psychoonkologie (CMP) the patients received psychological treatment during the acute cancer therapy. The CMP was implemented in routine healthcare practice of 6 hospitals. The improvement in the patient's symptoms of anxiety and depression was analyzed as an indication for the effectiveness of the CMP. In order to assess the psychological distress, quality of life, and the functional status the German version of the Hospital Anxiety and Depression Scale (HADS) and a checklist of single-item-scales were administered at hospital admission (t1), 120 days later (t2) and one year after the hospital admission (t3). According to the HADS, the pre-post effect sizes of the psychooncological care program for 258 patients were 0.35 at t2 and 0.46 at t3. The effect sizes of 1.05 at t2 and 1.38 at t3 were calculated for the sub-group of patients with high psychological distress at t1. In 34.4 % of these patients clinical significant improvements in symptoms of anxiety and depression could be identified at t2 and in 45.3 % of the cases at t3. Symptom changes were significantly influenced by the patient's age and the intensity of psychooncological interventions. Symptom improvement was most evident for patients with a high use of psychooncological care. The correlation between HADS and single Item scales is in the moderate to high range. This is an indication of improvement not only in the psychological domain but also in the quality of life and functional status one year after the beginning of cancer treatment. These findings implicate that this study is one of the first to demonstrate the potential effectiveness of structured psychooncological care interventions in routine hospital care.

Key words

distress - depression - anxiety - psychooncology - effectiveness - care program

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