Evaluación por parte del alumno

Ansermet François | KLS 01705-04-2005 | CHF 273,000.–

Service de psychiatrie de l’enfant et de l’adolescent (SPEA), Hôpitaux universitaires de Genève (HUG), Genève

187 Psychosocial research

List of approved research projects in 2009/2010

Total funds allocated: CHF 1,028,550.–

De Geest Sabina | KFS 02705-08-2010 | CHF 112,900.–

Institut für Pflegewissenschaften, Universität Basel, Basel

PROVIVO – patient reported outcomes in view of symptom experience of late effects and self­management of adult long­term survivors after allogeneic haematopoietic stem cell transplantation – a mixed methods study

Despland Jean-Nicolas | OCS 02338-02-2009 | CHF 251,350.–

Institut universitaire de psychothérapie (IUP), Département de psychiatrie, Centre hospitalier universitaire vaudois (CHUV), Prilly

Communication in cancer care: The relationship between clinician’s defense mechanisms, patient satisfaction and information recall

Ehlert Ulrike | KFS 02662-08-2010 | CHF 173 600.-

Klinische Psychologie und Psychotherapie, Psychologisches Institut, Universität Zürich, Zürich

Psychobiological factors influencing the course of HPV infections in young women: a longitudinal study

Kiss Alexander | OCS 02400-02-2009 | CHF 187,200.–

Abteilung Psychosomatik, Bereich Medizin, Universitätsspital Basel, Basel

A cognitive­behavioural mindfulness intervention to improve health­related quality of life, depression and fatigue among long­term haematopoietic stem cell transplant survivors

Mueller Michael D. | KFS 02456-08-2009 | CHF 116,500.–

Gynäkologie und gynäkologische Onkologie, Universitätsklinik für Frauenheilkunde, Inselspital, Bern

Creating and validating a patient­pertinent instrument to assess symptoms experienced related to surgical wounds in women with vulvar neoplasms – a mixed methods study (WOMAN­PRO)

Stiefel Friedrich | KFS 02353-02-2009 | CHF 124 200.–

Service de psychiatrie de liaison (PLI), Centre hospitalier universitaire vaudois (CHUV), Lausanne

Effects of communication skills training on oncology clinicians’ defense mechanisms, communication outcomes and working alliance – extension

Tschudin Sibil | KLS 02577-02-2010 | CHF 62,800.–

Gynäkologische Sozialmedizin und Psychosomatik, Frauenklinik, Universitätsspital Basel, Basel

Fertility preservation in young female cancer patients – assessment of needs regarding decision­making and development of a decision­aid

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Despland Jean-Nicolas | Communication in cancer care: The relationship between clinicians’ defense mechanisms, patient satisfaction and information recall (OCS 02338-02-2009)

Duration: 01.06.2009–01.12.2011

Communication has become a key element in oncology and has important consequences for both patients’ and clinicians’ well-being. Clinicians often need to regulate the emotions that occur during the discussion of sensitive topics, such as limited life expectancy, which might influ- ence the quality of communication.

Aim

We wish to better understand how the clinicians’ emo- tional regulation might influence communication in oncol- ogy.

Method

We analyze discussions between patients and their clini- cians in several hospitals in the French-speaking part of Switzerland. We pay particular attention to the clinicians’ defence mechanisms that are used to react to the emo- tional content of the discussions.

Potential advantages for the patients

A better understanding of the influence of the clinicians’ emotional regulation of communication in oncology will allow improvement in patient-clinician communication.

Project coordinator

Prof. Dr Jean-Nicolas Despland

Institut universitaire de psychothérapie (IUP) Département de psychiatrie

Centre hospitalier universitaire vaudois (CHUV) Site de Cery

Bât. Les Cèdres CH-1008 Prilly

Phone +41 (0)21 643 63 85 [email protected]

Kiss Alexander | A cognitive-behavioural mindfulness intervention to improve health-related quality of life, depression and fatigue among long-term haematopoi- etic stem cell transplant survivors

(OCS 2400-02-2009)

Duration: 01.09.2009–01.03.2012

Haematopoietic stem cell transplantation (HSCT) is a val- uable treatment employed to cure a variety of malignant blood disorders, bone marrow deficiency diseases and other diseases. Thanks to this therapy, many patients sur- vive disorders that in earlier times were fatal. Neverthe- less, there are often long-term adverse and challenging consequences of treatment, which include immunosup- pressive conditions, graft-vs.-host disease (GvHD), other disorders related to chemotherapy toxicities, chronic fa- tigue and sexual dysfunction. Because these conditions can often impair normal physical, professional and recre- ational activities, and social relationships, many patients

De Geest Sabina | PROVIVO – patient reported out- comes in view of symptom experience of late effects and self-management of adult long-term survivors after allogeneic haematopoietic stem cell transplanta- tion – a mixed methods study (KFS 2705-08-2010)

Duration: 01.01.2011–01.07.2013

Long-term survivors after allogeneic haematopoietic stem cell transplantation (HSCT) are presumably at a lifelong increased risk for developing various adverse side effects, also termed ‘late effects’. In addition to objective meas- ures, in particular the collection of patient self-report is important for the early detection, management and alle- viation of these symptoms. Moreover, health-promoting self-management behaviours might minimize the impact of chronic diseases.

This multicentre study (Basel and Zurich) uses a mixed- method design to develop a self-report instrument assess- ing symptom experience after HSCT. For the development of the instrument qualitative and quantitative research methods are used, and the content is based on the Pa- tient-Reported Outcomes Version of the Common Termi- nology Criteria for Adverse Events (PRO-CTCAE) symp- tom item bank recently developed by the National Cancer Institute (USA). Patient interviews, an expert survey and a review of the literature will be conducted.

In a subsequent study phase, the instrument will be vali- dated in a sample of 300 patients (≥ 1 year after alloge- neic HSCT). Additional data will be collected in order to investigate the relationship between symptom experience and objectively measured late effects, the perception of late effects by patients and their self-management (i. e. coping with emotions, roles, and medical and health- related tasks).

The systematic assessment of patient-reported outcomes can be an effective means of secondary prevention in or- der to timely detect, diagnose and manage late effects.

Project coordinator Prof. Dr. Sabina De Geest Institut für Pflegewissenschaften Universität Basel Bernoullistrasse 28 CH-4056 Basel Phone +41(0)61 267 30 40 Fax +41 (0)61 267 09 55 [email protected] Psychosocial research

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Mueller Michael D. | Creating and validating a patient- pertinent instrument to assess symptoms experienced related to surgical wounds in women with vulvar neo- plasms – a mixed methods study (WOMAN-PRO)

(KFS 02456-08-2009)

Duration: 01.01.2010–01.07.2012

Post-surgery complications in women with vulvar neo- plasms (vulvar intraepithelial neoplasia and vulvar cancer) are still high, and an instrument assessing patients’ self- reported post-vulval surgery symptom experiences is lack- ing.

This study aims to develop and validate a postoperative instrument to assess symptom experiences in women with vulvar neoplasms. In this mixed-method project 20 pa- tients were interviewed, a WOMAN-PRO instrument was developed and content validity was tested by 6 experts and 10 patients. The psychometric properties of the in- strument and the prevalence of symptoms will be exam- ined in a cross-sectional study at the university hospitals in Munich, Freiburg i. Br., Berlin, Düsseldorf, Zurich, Basel, and Bern and the Cantonal Hospital St Gallen (n=150). The goal of this project is that symptom assessment be- comes a standard component of clinical practice (to pro- mote the early detection and treatment of symptoms) and research.

Project coordinator Prof. Dr. Michael D. Mueller

Gynäkologie und gynäkologische Onkologie Universitätsklinik für Frauenheilkunde Inselspital Bern Effingerstrasse 102 CH-3010 Bern Phone +41 (0)31 632 12 03 Fax +41 (0)31 632 12 05 [email protected]

Stiefel Friedrich | Effects of communication skills training on oncology clinicians’ defense mechanisms, communication outcomes and working alliance – extension

(KLS 02715-08-2010, prolongation of the project KLS 02353-02-2009)

Duration: 01.05.2009–01.03.2011

For more than ten years, the Swiss Cancer League has or- ganized Communication Skills Training (CST) for physi- cians and nurses who work with patients with cancer. This training program is based in particular on the analysis of filmed interviews conducted by each participant with a simulated patient (an actor simulating a patient with can- cer with a complex situation). Conducted in small groups of 8–10 participants, the training lasts 16 hours. It begins with the filmed interview with a simulated patient, and it is completed by a monthly individual supervision for a pe- riod of six months and another day of training with a sec- ond filmed interview with a simulated patient. Although research has demonstrated that this type of training en- ables clinicians to adopt a more patient-centred communi- cation style, the question as to how this training amelio- report long-term impairment of sense of well-being, re-

flected by low levels of health-related quality of life (HRQoL) and high levels of depression and anxiety. Very little effort has been expended in examining whether behavioural interventions can serve to improve distinct parameters of well-being, e. g. HRQoL, depression, fatigue and anxiety.

Aim

Mindfulness-based intervention (MBI) is a group behav- ioural program aimed at improving aspects of well-being for patients with a broad spectrum of chronic disorders (detailed description provided later). The primary goal of this investigation is to examine whether MBI is a feasible and effective intervention for HSCT survivors in terms of enhancing different dimensions of HRQoL (e. g. psycho- logical functioning, positive emotions, social contact and ability to enjoy life) and decreasing depression, fatigue and anxiety.

Methods

Using a controlled patient-preference procedure, MBI is compared to a comparison intervention of augmented op- timal medical care, where patients, additional to usual medical care, receive brief telephone medical and psycho- social consultations twice a month during the intervention phase. Feasibility of interventions will be evaluated by measuring aspects of acceptability of interventions (per- centage of invited patients who participate, the dropout rate for the program, the average weekly attendance rate and the degree to which patients perceive that their per- sonal goals for the intervention have been met). Efficacy of treatment will be evaluated by validated inventories of HRQoL, depression and fatigue as primary outcomes. Anxiety, personal growth and physical health status will be employed as secondary measures. We plan to include 100 patients in the study and to examine benefits directly after the intervention period and at 3 months follow-up. Results

This study is ongoing, and 51 patients are thus far partic- ipating. Few patients dropped out of the study before completing the intervention (<10 %), and all dropouts were due to documented serious medical problems. How- ever, other results have not yet been analyzed.

Patient benefit

This study will be one of the first controlled investigations to evaluate a complementary behavioural intervention for the purpose of enhancing the well-being of HSCT survi- vors. Finding will indicate whether MBI or telephone con- sultation augmented care is effective at enhancing quality of life among HSCT survivors.

Project coordinator Prof. Dr. Alexander Kiss Abteilung Psychosomatik Universitätsspital Basel Petersgraben 4 CH-4031 Basel Phone +41 (0)61 265 53 09 [email protected]

190

Tschudin Sibil | Fertility preservation in young female cancer patients – assessment of needs regarding decision-making and development of a decision-aid

(KLS 02577-02-2010)

Duration: 01.07.2010–01.07.2012

Impaired fertility may be a consequence of successful can- cer treatment, and the use of one of the fertility preserva- tion (FP) techniques being developed currently might therefore be an option for all young patients with cancer. Decisions on fertility preservation have to be made in the short time period after diagnosis and before onset of can- cer treatment, and the dilemma confronting affected pa- tients, their families and their caretakers is considerable. The aim of this study is to gain deeper insight into the needs and conflicts occurring during this decision-making process. The study addresses former and current female patients with cancer at young age and consists of two parts. Part 1 is an anonymous online survey, which will be available via a link on cancer and fertility websites. Part 2 consists of standardized focus groups facilitated by a psy- chologist. The knowledge gained through this study will aid development of a standardized instrument that com- plements and supports shared decision-making in fertility issues and FP for young patients with cancer and their medical caretakers.

Project coordinator Dr. Sibil Tschudin

Gynäkologische Sozialmedizin und Psychosomatik Frauenklinik Universitätsspital Basel Spitalstrasse 21 CH-4031 Basel Phone +41 (0)61 265 90 43 [email protected] rates communication skills remains unanswered. To better

know and understand the mechanism that leads to im- provement, the filmed interviews before and after CST were analyzed and compared with filmed interviews of clinicians with simulated patients with a six-month inter- val who did not participate in CST.

The analysis of the interviews was based on methods uti- lized in psychotherapy, especially the identification of de- fence mechanisms. Defence mechanisms, such as denial or intellectualization, are unconscious processes triggered by emotions that may emerge during an interview, for ex- ample; they aim to protect the individual from threaten- ing affect. Although defence mechanisms protect the cli- nicians, they also have the effect that the clinician’s perception of the patient is coloured by the clinician’s psy- chological state. This hampers the clinician’s capacity to adequately perceive the needs of the patient. The results of the study show 1) that during an interview of a quarter of an hour with a simulated patient, clinicians’ defence mechanisms are triggered 15 times, illustrating the affec- tive load of such interviews, and 2) that defence mecha- nisms of participants are modified by CST, which increase the proportion of mature defence mechanisms, leading to more appropriate perception of the patient.

To conclude, this study demonstrated that patient inter- views represent an important stressor for the clinician and that improvement of communication skills by CST is linked to utilization of more mature defence mechanisms. The results have increased our knowledge of processes of im- provement of communication skills by CST and call for a modification of teaching with an increased focus on clini- cians’ emotional experiences and their professional iden- tity.

Project coordinator Prof. Dr Friedrich Stiefel Service de psychiatrie de liaison

Centre hospitalier universitaire vaudois (CHUV) Rue du Bugnon 44

CH-1011 Lausanne Phone +41 (0)21 314 10 90 Fax +41 (0)021 314 10 86 [email protected]