Showing papers by "Martin Teufel published in 2023"

Needs and Demands for mHealth Cardiac Health Promotion Among Individuals with Cardiac Diseases: Patient-Centered Design Approach

Abstract: Cardiovascular diseases are one of the main contributors to disability and mortality worldwide. Meanwhile, risk factors can be modified by lifestyle changes. mHealth is an innovative and effective way to deliver cardiac health promotion. This study aims to examine the needs and demands regarding design and contents of an mHealth intervention for cardiac health promotion in individuals with cardiac diseases. Different clusters were determined and analyzed in terms of the intention to use an mHealth intervention. A cross-sectional study was conducted via a web-based survey. 304 individuals with coronary artery diseases and/or congestive heart failure were included in the data analysis. Descriptive statistics were applied to evaluate needs and demands regarding an mHealth intervention. A k-medoids cluster analysis was performed. Individuals with CAD and CHF favored an mHealth intervention which supports its users permanently and is easily integrated into everyday life. Handheld devices and content formats that involve active user participation and regular updates were preferred. Three clusters were observed and labelled high, moderate and low burden according to their psychometric properties. The high burden cluster indicated higher behavioral intention towards use of an mHealth intervention than the other clusters. The results of the study are a valuable foundation for the development of an mHealth intervention for cardiac health promotion following an user-centered design approach. Individuals with cardiac diseases report positive attitudes in form of high usage intention regarding mHealth. Highly burdened individuals report a high intention to use such interventions.

Neurofeedback Treatment Affects Affective Symptoms, But Not Perceived Cognitive Impairment in Cancer Patients: Results of an Explorative Randomized Controlled Trial

Abstract: Background: EEG biofeedback (NF) is an established therapy to enable individuals to influence their own cognitive-emotional state by addressing changes in brainwaves. Psycho-oncological approaches of NF in cancer patients are rare and effects are hardly studied. Objective: The aim of this explorative, randomized controlled trial was to test the effectiveness of an alpha and theta NF training protocol, compared to mindfulness based therapy as an established psycho-oncological treatment. Methods: Of initially 62 screened patients, 56 were included (inclusion criteria were cancer independent of tumor stage, age >18 years, German speaking; exclusion criteria suicidal ideation, brain tumor). Randomization and stratification (tumor stage) was conducted by a computer system. Participants got 10 sessions over 5 weeks, in (a) an NF intervention (n = 21; 13 female, 8 male; MAge = 52.95(10 519); range = 31 to 73 years)) or (b) a mindfulness group therapy as control condition (CG; n = 21; ie, 15 female, 6 male; MAge = 50.33(8708); range = 32 to 67 years)). Outcome parameters included self-reported cognitive impairment (PCI) as primary outcome, and secondary outcomes of emotional distress (DT, PHQ-8, GAD-7), fatigue (MFI-20), rumination (RSQ), quality of life (QoL, EORTC-30 QoL), self-efficacy (GSE), and changes in EEG alpha, and theta-beta band performance in the NF condition. Results: No changes in cognitive impairment were found (P = .079), neither in NF nor CG. High affective distress was evident, with 70.7% showing elevated distress and 34.1% showing severe depressive symptoms. Affective symptoms of distress (P ≤ .01), depression (P ≤ .05) and generalized anxiety (P ≤ .05) decreased significantly over time. No differences between NF and CG were found. There was a significant increase of the alpha band (P ≤ .05; N = 15) over the NF sessions. Self-efficacy predicted QoL increase in NF with P ≤ .001 and an explained variance of 48.2%. Conclusion: This is the first study to investigate NF technique with regard to basic mechanisms of effectiveness in a sample of cancer patients, compared to an established psycho-oncological intervention in this field. Though there were no changes in cognitive impairment, present data show that NF improves affective symptoms comparably to mindfulness-based therapy and even more pronounced in QoL and self-efficacy. Trial registration: ID: DRKS00015773

Determining the Acceptance of Digital Cardiac Rehabilitation and Its Influencing Factors among Patients Affected by Cardiac Diseases

Abstract: Background: Cardiac diseases are a major global health issue with an increasing prevalence of affected people. Rehabilitation following cardiac events is underutilized, despite its proven effectiveness. Digital interventions might present a useful addition to traditional cardiac rehabilitation. Aims: This study aims to assess the acceptance of mobile health (mHealth) cardiac rehabilitation and to investigate the underlying factors of acceptance in patients with ischemic heart disease and congestive heart failure. Methods: A cross-sectional study was conducted from November 2021 to September 2022 with N = 290 patients. Sociodemographic, medical, and eHealth-related data were assessed. The Unified Theory of Acceptance and Use of Technology (UTAUT) was applied. Group differences in acceptance were examined and a multiple hierarchical regression analysis was conducted. Results: The overall acceptance of mHealth cardiac rehabilitation was high (M = 4.05, SD = 0.93). Individuals with mental illness reported significantly higher acceptance (t(288) = 3.15, padj = 0.007, d = 0.43). Depressive symptoms (β = 0.34, p < 0.001); digital confidence (β = 0.19, p = 0.003); and the UTAUT predictors of performance expectancy (β = 0.34, p < 0.001), effort expectancy (β = 0.34, p < 0.001), and social influence (β = 0.26, p < 0.001) significantly predicted acceptance. The extended UTAUT model explained 69.5% of the variance in acceptance. Conclusions: As acceptance is associated with the actual use of mHealth, the high level of acceptance found in this study is a promising basis for the future implementation of innovative mHealth offers in cardiac rehabilitation.

Predictors of patients’ acceptance of video consultation in general practice during the coronavirus disease 2019 pandemic applying the unified theory of acceptance and use of technology model

Abstract: Background The coronavirus disease 2019 pandemic has led to an increase in remote consultations in health care. This study aimed to assess the acceptance of video consultation as an alternative to face-to-face in-office visits in general practice (GP) and to investigate its drivers and barriers. Methods A cross-sectional study was conducted in Germany during the coronavirus disease 2019 pandemic from December 2020 to April 2021. Participants were recruited among patients in 16 GP surgeries. Assessed were sociodemographic and medical data as well as information and communications technology related data. Acceptance of video consultation and its predictors were determined using a modified questionnaire based on a short version of the renowned unified theory of acceptance and use of technology model. Results In total, 371 participants were included in the data analysis. Acceptance of video consultation was moderate. A hierarchical regression revealed acceptance was significantly predicted by the PHQ-2, taking no regular medication, computer proficiency, knowledge about digital health care solutions, no prior use of video consultation, and the unified theory of acceptance and use of technology predictors performance expectancy, effort expectancy, and social influence. The extended unified theory of acceptance and use of technology model explained significantly more variance than the restricted unified theory of acceptance and use of technology model in acceptance of video consultation. Conclusions In this study computer proficiency, existing knowledge about digital health care solutions and depressive symptoms functioned as drivers to acceptance, no prior use of video consultation could be identified as a potential barrier. Patients with regular medication have been particularly receptive to video consultation. The study confirmed the validity of the unified theory of acceptance and use of technology model in determining acceptance of video consultation. Considering that there is growing demand and acceptance for different approaches to engage with health care providers, additional steps should be taken to establish video consultation as a genuine alternative.

Electronic Patient-Reported Outcome Measures (ePROMs) Improve the Assessment of Underrated Physical and Psychological Symptom Burden among Oncological Inpatients

Abstract: Simple Summary Professionals of the healthcare system face the challenge of providing suitable care delivery for inpatients with advanced cancer. External assessments, such as nurse-reported symptom burden, tend to underrate patients’ distress, as has already been shown in different studies. In contrast to that, patient-reported outcome measures (PROMs) have been shown to be effective as a systematic assessment; however, they are not yet implemented into daily routine. The aim of this retrospective study is to compare the information provided by PROMs and nurse-reported assessment to identify overlaps and differences in the current symptom burden. Therefore, collected data were analyzed from both PROMs and nurse-reported assessment from 230 inpatients of a major German Comprehensive Cancer Center. We discovered that some features of physical and psychological distress were underrated by nursing staff. Supplementing daily symptom assessment used by nursing staff with systematic ePROMs may improve the quality of supportive and palliative care of inpatients with advanced cancer. Abstract For advanced cancer inpatients, the established standard for gathering information about symptom burden involves a daily assessment by nursing staff using validated assessments. In contrast, a systematic assessment of patient-reported outcome measures (PROMs) is required, but it is not yet systematically implemented. We hypothesized that current practice results in underrating the severity of patients’ symptom burden. To explore this hypothesis, we have established systematic electronic PROMs (ePROMs) using validated instruments at a major German Comprehensive Cancer Center. In this retrospective, non-interventional study, lasting from September 2021 to February 2022, we analyzed collected data from 230 inpatients. Symptom burden obtained by nursing staff was compared to the data acquired by ePROMs. Differences were detected by performing descriptive analyses, Chi-Square tests, Fisher’s exact, Phi-correlation, Wilcoxon tests, and Cohen’s r. Our analyses pointed out that pain and anxiety especially were significantly underrated by nursing staff. Nursing staff ranked these symptoms as non-existent, whereas patients stated at least mild symptom burden (pain: meanNRS/epaAC = 0 (no); meanePROM = 1 (mild); p < 0.05; r = 0.46; anxiety: meanepaAC = 0 (no); meanePROM = 1 (mild); p < 0.05; r = 0.48). In conclusion, supplementing routine symptom assessment used daily by nursing staff with the systematic, e-health-enabled acquisition of PROMs may improve the quality of supportive and palliative care.

The SARS-CoV-2 pandemic causes a dysfunctional dietary behavior: A German cross-sectional study

Abstract: Background: Since the COVID-19 pandemic has been affected our daily lives, the global population has been exposed to permanent concerns and thus might suffer from the psychological burden. It is well known that psychological burdens can affect dietary behavior. Aim: The impact of a psychological burden on people, and in particular on their dietary patterns was investigated in this nationawide cross-sectional study. Methods: 7525 participants responded to the questionnaire regarding the psychological burden concerning the COVID-19 pandemic and their current dietary structure with changes in the pattern and food amount (between November 2020 and March 2021). Results: A pandemic-related dysfunction of dietary behavior was found. Some participants reported restrictive (conscious) food intake and as well impulsive food intake, which can be described as dysfunctional eating behaviors. In particular, younger persons and individuals who claimed an increased psychological burden reported dysfunctional dietary behavior. Data clearly show that psychological burdens affect an individual's dietary behavior. Conclusion: Public health strategies have to be developed to support individuals at risk to improve coping strategies. The long-term aim should be avoiding the maintenance of dysfunctional dietary behavior.

Exploring the Applicability of General Dietary Recommendations for People Affected by Obesity

Abstract: (1) Obesity has emerged as a major public health challenge with increasing prevalence globally. The General Dietary Behavior Inventory (GDBI) was developed based on official dietary recommendations. However, little is known about whether general dietary recommendations also apply to people affected by obesity and whether the GDBI can be used appropriately. (2) A cross-sectional study was conducted. A total of 458 people meeting the inclusion criteria participated in the study. The assessment consisted of the GDBI and behavioral, dietary, and health-related variables. We used descriptive analysis to examine the item characteristics of the GDBI and inferential statistics to investigate the associations between the GDBI score and behavioral, dietary, and health-related outcomes. (3) Several items of the GDBI were concerned by ceiling effects. A higher GDBI score (indicating a higher adherence to dietary recommendations) was related to higher age, higher nutrition knowledge, more restrained eating behavior, lower impulsivity, and higher body mass index. There were no associations between the GDBI score and reported physical and mental health or quality of life. (4) The GDBI showed inconsistent relationships with the study outcomes. General dietary recommendations do not appear to be applicable to people with obesity. Hence, there is an urgent need for specific recommendations and subsequent assessments of behavioral adherence for people affected by obesity.

Development and psychometric evaluation of the Man-Made Disaster-Related Distress Scale (MMDS)

Abstract: Man-made disasters (MMD2) are a widespread cause for psychological burden, both in directly and indirectly affected regions, as currently highlighted by the Russian invasion of Ukraine. Yet, measurement instruments that assess psychological distress associated with MMD are lacking. The study aimed to develop and validate such an instrument in an indirectly affected region. The resulting "man-made disaster-related distress scale" (MMDS) was tested within a German-speaking sample (N = 327). Exploratory and confirmatory factor analysis revealed a two-factorial structure ("Psychological distress" and "Change of existing belief systems") of the MMDS. The confirmatory model had an acceptable to good fit with CFI/TLI higher than 0.90. Internal consistency of the MMDS and its subscales was high with α and ω higher than 0.80. Correlational analyses suggested convergent, discriminant, and criterion validity. Measurement invariance was confirmed for gender and age with a change in CFI smaller than 0.01 but was rejected for educational level. The MMDS resulted in a 14-item assessment instrument based on a 7-point Likert-scale with good psychometric properties. Its administration is readily and economical, yielding the option to be used as a standardized measurement tool.

Acceptance, drivers, and barriers to use eHealth interventions in patients with post-COVID-19 syndrome for management of post-COVID-19 symptoms: a cross-sectional study

Abstract: Background: Post-COVID-19 syndrome is a new and debilitating disease without adequate treatment options. eHealth could be a reasonable approach for symptom management. Objectives: This study aims to evaluate the acceptance for eHealth interventions for symptom management in individuals with post-COVID-19 syndrome, as well as drivers and barriers influencing acceptance. Design: Cross-sectional study. Methods: This study was conducted from January 19 until 24 May 2022. Recruitment took place with a web-based survey. Acceptance and predictors of eHealth interventions were measured by the extended UTAUT model. Included in the model were the core predictor performance expectancy, social influence, and effort expectancy. Previously diagnosed mental illness was estimated and mental health by using the well-established Generalized Anxiety Disorder Scale-7 and the Patient Health Questionnaire Depression Scale. The effect of sociodemographic and medical data was assessed. Multiple hierarchical regression analyses as well as group comparisons were performed. Results: 342 individuals with post-COVID-19 syndrome were examined. The acceptance of eHealth interventions for symptom management was moderate to high (M = 3.60, SD = 0.89). Acceptance was significantly higher in individuals with lower/other education, patients with moderate to severe symptoms during initial COVID-19 infection, still significantly impaired patients, and individuals with a mental illness. Identified predictors of acceptance were age (β = .24, p < .001), current condition including moderate (β = .49, p = .002) and still significantly impaired (β = .67, p < .001), digital confidence (β = .19, p < .001), effort expectancy (β = .26, p < .001), performance expectancy (β = .33, p < .001), and social influence (β = .26, p < .001). Conclusion: Patients with post-COVID-19 syndrome reported a satisfying level of acceptance and drivers and barriers could be identified. These factors need to be considered for the implementation and future use of eHealth interventions.

Die Furcht, die Angst und der Krebs

Abstract: Im Kontext psychoonkologischer Erkrankungen gehört das Empfinden von Angst zum klinischen Alltag – für Betroffene, Angehörige sowie Behandler:innen. Hierbei kann es bei Betroffenen aufgrund diverser Risikofaktoren zu stark ausgeprägten pathologischen Ängsten und massivem Leidensdruck kommen, welche das Therapieoutcome beeinflussen können. Vor allem die Progredienzangst belastet einen Großteil der Betroffenen. Onkologisch tätige Kolleg:innen benötigen neben der Expertise um die somatische Behandlung einen geschärften Blick für mögliche Angstsymptomatik, insbesondere zu kritischen Behandlungszeitpunkten. Um den Bedarf erfassen und abdecken zu können, ist es notwendig, gemeinsam mit den Betroffenen die Behandlungsbedürftigkeit zu besprechen. Hierbei ist das Wissen um gezielte Therapieangebote und eine gestufte psychoonkologische Versorgungsstruktur vonnöten.

Psychotherapie in der Pandemie: Notwendigkeiten und Interventionsstrategien

Abstract: Die COVID-19-Pandemie wirkte sich weltweit auf Lebensführung und Gesundheit zahlreicher Menschen aus. Die mannigfaltigen Veränderungen, Einschränkungen und Konsequenzen der Pandemie sorgten sowohl in der Allgemeinbevölkerung als auch in vulnerablen Gruppen für psychische Belastung. Welche Faktoren beeinflussen das Ausmaß der psychischen Belastung? Welche Gruppen sind und waren besonders betroffen? Wie können Behandler*innen die Versorgung an den Bedarf der Patient*innen im Rahmen der pandemischen Situation anpassen? Klinische Überlegungen und eine ausführliche Literaturrecherche bilden das Fundament für diesen Artikel. Im Rahmen der COVID-19-Pandemie ist es v. a. in vulnerablen Gruppen, aber auch in der Allgemeinbevölkerung zu einem signifikanten Anstieg psychischer Belastung gekommen. Es konnten diverse Risiko- und Schutzfaktoren bezüglich der Ausprägung psychischer Belastung als auch therapeutische Implikationen eruiert werden. Hilfreiche Psychotherapieansätze umfassen u. a. die Validierung der Verunsicherung, selbstwirksamkeitsförderndes Verhalten, achtsamkeitsbasierte Techniken und kognitives Reframing. Präventive Strategien, gestufte Versorgung und digitale Interventionen können außerdem dem erhöhten Behandlungsbedarf entgegenwirken. Für zukünftiges Pandemiemanagement ist es unverzichtbar, zielgruppengerechte Präventionsmaßnahmen und therapeutische Versorgung zu gewährleisten.

E-Mental-Health in der Psychoonkologie: ein multizentrisches Projekt

Abstract: Bisher wird eine adäquate psychoonkologische Behandlung noch nicht flächendeckend angeboten. Um die Versorgungslücke zu schließen, können E-Mental-Health-Interventionen eingesetzt werden In diesem Beitrag wird eine aktuelle E-Mental-Health-Intervention in der Psychoonkologie vorgestellt.

Needs and Demands for eHealth Pain Management Interventions in Chronic Pain Patients

Abstract: Although chronic pain is a global health problem, the current care situation is often inadequate. eHealth offers many advantages as an additional option for treating chronic pain. Yet, an intervention’s efficacy can only be fully exhausted if patients intend to use it. This study aims to identify the needs and demands of patients with chronic pain regarding intervention concepts and frameworks to develop specifically tailored eHealth pain management interventions. A cross-sectional study was conducted, including 338 individuals with chronic pain. Within the cohort, a distinction between a high- and a low-burden group was made. Respondents generally preferred a permanently accompanying mobile app, but the preferred content varied with group. According to the majority, interventions should be made available on smartphones, offer sessions once per week with a duration from 10 to 30 min, and be recommended by experts. These results can provide the basis for future eHealth pain management interventions tailored to the patients’ needs and demands.

Psychological Burden during the COVID-19 Pandemic in Female Caregivers of Preterm versus Term Born Children

Abstract: Background: during the COVID-19 pandemic, psychological burden increased. Contact restrictions were predominantly stressful for families. Parenthood was reported to be especially challenging for parents of preterm children. Material and Methods: a cross-sectional online-based survey on the psychological burden of parents of preterm and full-term born infants and toddlers during the second lockdown of the COVID-19 pandemic in Germany was offered by social media, webpages, etc. Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-2 (PHQ-2), COVID-19 Anxiety (C-19-A), COVID-19-related child protection behavior (PB) were used. Results: 2742 parents—predominantly females—took part in the study, 2025 parents of full-term and 717 parents of preterm born children. Female caregivers of full-term children reported significantly more depression symptoms than those of preterm children during the second lockdown of the COVID-19 pandemic. The PB correlated with increased COVID-19 anxiety as well as with increased generalized anxiety and depression symptoms. Female caregivers of preterm children showed significantly more protection behavior than those of full-term born children.

Caring for dependent children impacts practical and emotional problems and need for support, but not perceived distress among cancer patients.

Abstract: OBJECTIVE More than one in 10 cancer patients care for dependent children. It is unclear whether this status makes a difference in terms of the distress and associated problems they experience, or whether it is linked to differences in the need for or utilization of psychosocial support. METHODS Secondary analysis of a cross-sectional German study in National Comprehensive Cancer Centers using self-report standardized questionnaires administered to inpatients. Patients living with dependent children (n = 161) were matched by age and sex with a subsample of 161 cancer patients not living with dependent children. The resulting sample was tested for between-group differences in Distress Thermometer (DT) scores and the corresponding DT Problem List. Additionally, between-group differences in measures of the need for and utilization of psychosocial support were examined. RESULTS More than 50% of all patients suffered from clinically relevant distress. Patients living with dependent children reported significantly more practical (p < 0.001, η2 p = 0.04), family (p < 0.001, η2 p = 0.03), and emotional problems (p < 0.001, η2 p = 0.01). Although reporting a greater need for psychological support, parents with cancer were not found to more frequently utilize any type of psychosocial support. CONCLUSIONS The specific problems and needs of parents with cancer who care for dependent children are currently not sufficiently addressed in the clinical care pathways. All families should be helped to establish open and honest communication as well as understand the available support systems and what they can provide. Tailored interventions should be implemented for highly distressed families.

Symptome und Bedarfe von onkologischen Patienten, digitale Erfassung und zielgerichtete multiprofessionelle Interventionsplanung

Abstract: Der Einsatz von Selbsterfassungsinstrumenten für das Assessment von Symptomen und subjektiven Bedarfen bei Patienten mit einer Krebserkrankung hat unbestritten wesentliche positive Effekte und wird zunehmend gefordert. Sie führen u.a. zu einer verbesserten Symptomkontrolle, erhöhten Lebensqualität sowie gesteigerten Überlebensrate 1 .