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Background: To promote the quality and efficiency of postgraduate specialization in general practice (GP), competence centers (KW)were established throughout Germany according to § 75a SGB V. In 2017 the KW Baden-Württemberg (KWBW) emerged from the former postgraduate training program Verbundweiterbildungplus Baden- Württemberg. The aim of this study was to analyze the participants of the KWBW in order to draw conclusions about the target group and to allow a benchmarking with other GP trainees. Methods: In 2016 an ongoing observational study was initiated at the KWBW. New participants complete a self-developed questionnaire with 54 (to maximum 62) items upon entry covering topics on sociodemographic background, studies/qualifications, postgraduate medical training, future plans and lateral recruitment (if applicable). A descriptive data-analysis of the years 2016--2022was performed. Results: N= 884/929 GP trainees participated (participation rate 95.2%). The mean age was 34 years (Q1; Q3; [min-max]:31; 38 [24-65]). 72.6% (n= 642) were female, 84.2% (n= 741) were married or in a committed partnership. 56.9% (n= 503) were parents. The average high school grade was 1.6 (Q1; Q3; [min-max]: 1.2; 2.0 [1.0--3.4]), 61.7% (n= 475) had completed amedical dissertation (Dr.med.). 24.5% (n= 217)were in their first or second year of training, 50.9%(n= 450) in their third to fifth year of training and 23.8% (n= 210) were graduates fromother medical specialties (lateral recruits). 55.7% (n= 492) were working full-time, 33.7% (n= 298) part-time and 10.5% (n= 93) were without employment. After the specialist exam, 97.8% (n= 847) planned to work in GP and 91.9% (n= 791) planned to stay in Baden-Württemberg. Thirty percent (n= 259) planned to work in a rural medical practice. 37.9% (n= 331) planned to become selfemployed, 9.1%(n= 79) excluded self-employmentwhile the majority (52.1%; n= 462) was undecided. Conclusions: The results presented allow further comparative studies. The KWBW attracts GP trainees that plan to work in primary care in Baden-Württemberg. Many of them have not yet decided whether to work self-employed or not. Therefore direct entry frommedical school into GP-specialization must be fostered. [ABSTRACT FROM AUTHOR]

Purpose: Oncological societies advocate the continuity of care, specialized communication, and early integration of palliative care. To comply with these recommendations, an interprofessional, longitudinally-structured communication concept, the Milestone Communication Approach (MCA), was previously developed, implemented, and evaluated. Our research question is: what are possible explanations from the patient perspective for prognosis and advance care planning being rarely a topic and for finding no differences between MCA and control groups concerning distress, quality of life, and mood? Methods: A pragmatic epistemological stance guided the study. A mixed-methods design was chosen including a pragmatic randomized trial (n = 171), qualitative interviews with patients (n = 13) and caregivers (n = 12), and a content analysis (133 milestone conversations, 54 follow-up calls). Data analysis involved the pillar integration process. Results: Two pillar themes emerged: 1 “approaching prognosis and advance care planning”; 2 “living with a life-threatening illness”. Information on prognosis seemed to be offered, but patients’ reactions were diverse. Some patients have to deal with having advanced lung cancer while nonetheless feeling healthy and seem not to be ready for prognostic information. All patients seemed to struggle to preserve their quality of life and keep distress under control. Conclusion: Attending to patients’ questions, worries and needs early in a disease trajectory seems key to helping patients adjust to living with lung cancer. If necessary clinicians should name their predicament: having to inform about prognosis versus respecting the patients wish to avoid it. Research should support better understanding of patients not wishing for prognostic information to successfully improve communication strategies. Trial registration: Registration: German Clinical Trial Register No. DRKS00013649, registration date 12/22/2017, () and No. DRKS00013469, registration date 12/22/2017, (). [ABSTRACT FROM AUTHOR]

Objective: Salutogenetic aspects are valuable for consideration in patient-centred care of advanced oncological diseases with a limited life expectancy. The Milestone Communication Approach (MCA), involving physician-nurse tandems, addresses specific challenges and needs over the disease trajectory of patients with stage IV lung cancer and their informal caregivers. This study aims to explore patients' and informal caregivers' salutogenetic experiences with the MCA concept. Methods: This qualitative study used face-to-face semi-structured interviews with patients and informal caregivers. All generated data were audio-recorded, pseudonymised and transcribed verbatim. Data were structured using Qualitative Content Analysis. The material was coded deductively into themes related to the components of sense of coherence (Aaron Antonovsky) and emerging sub-themes. All data was managed and organised in MAXQDA. Results: In 25 interviews, sense of coherence was referred to with all three components: "Comprehensibility" was supported by information conveyed suitably for the patients; "meaningfulness" was addressed as accepting the situation; and "manageability" led to advance care planning the patients were comfortable with. Patients and informal caregivers experienced the interprofessional tandem as an added value for patient care. Conclusions: Participants appreciate the MCA in its support for coping with a life-limiting disease. Considering salutogenetic aspects facilitates prognostic awareness and advance care planning. Nevertheless, individual needs of patients and informal caregivers require an individualised application of the MCA. [ABSTRACT FROM AUTHOR]

The majority of lung cancer patients are diagnosed with an advanced stage IV, which has short survival time. Many lung cancer patients have comorbidities, which influence treatment and patients' quality of life. The aim of the study is to describe comorbidities in incident lung cancer patients and explore their attendance of ambulatory care physicians in Germany. In the observed period, 13,111 persons were first diagnosed with lung cancer (1-year incidence of 36.4 per 100,000). The mean number of comorbidities over 4 quarters was 30.77 ± 13.18; mean Charlson Comorbidity Index was 6.66 ± 2.24. In Germany, ambulatory care physicians most attended were general practitioners (2.6 quarters with contact within 4 quarters). Lung cancer was diagnosed by a general practitioner in 38% of the 13,111 incident patients. The average number of ambulatory care physician contacts over 4 quarters was 35.82 ± 27.31. High numbers of comorbidities and contacts in ambulatory care are common in patients with lung cancer. Therefore, a cross-sectoral and interdisciplinary approach is required for effective, patient-centred care. This was a 5-year cross-sectoral study, based on the InGef research database, which covers anonymized health insurance data of 7.2 million individuals in Germany. Incident lung cancer patients in a 5-year period (2013–2017) were identified. Descriptive statistics were calculated for sociodemographic characteristics, comorbidities, and attendance of ambulatory care physicians. [ABSTRACT FROM AUTHOR]

Background: Stigmatization and discrimination of people with obesity due to their weight are a common problem that may lead to additional weight gain. This study evaluated the influence of different parameters on the stigmatization of obesity. Material and Methods: Participants of six groups (general population, patients with obesity, medical students, physicians, nurses in training and nurses; n = 490) answered the short-form fat phobia scale (FPS) between August 2016 and July 2017. The influence of body mass index (BMI), gender and other factors on total scores and single adjective pairs was analyzed. Results: A total of 490 participants were evaluated. The total mean FPS rating was 3.5 ± 0.6. FPS was significantly lower (more positive) in participants with obesity (3.2 ± 0.7) compared with participants without obesity (3.5 ± 0.5, p < 0.001). Individuals with obesity and diabetes rated the FPS significantly lower (more positive), whereas age and gender did not have a significant influence. Participants with obesity linked obesity more often with good self-control (p < 0.001), being shapely (p = 0.002), industrious (p < 0.001), attractive (p < 0.001), active (p < 0.001), self-sacrificing (p < 0.001) and having more willpower (p < 0.001) than the participants without obesity. Females rated more positive in shapely versus shapeless (p = 0.038) and attractive versus non-attractive (p < 0.001) than males. Conclusions: The present study shows that stigmatization of obesity is present in medical professionals as well as the general population. People affected by obesity characterized other people with obesity more positively (e.g. attractive or active), whereas people without obesity linked negative characteristics with obesity. Gender had an influence only on single items of FPS but did not affect overall stigmatization of obesity. [ABSTRACT FROM AUTHOR]

Background: Obesity is a rising social and economic burden. Patients with obesity often suffer from stigmatization and discrimination. Underrecognition of obesity as a disease could be a contributing factor. The present study aimed to compare attitudes towards obesity with other chronic diseases and to evaluate the recognition of need of professional treatment. Methods: Nine hundred and forty-nine participants (subgroups: general population, patients with obesity, nurses in training, nurses, medical students, physicians) were randomized to video teaching on obesity and control. Questionnaires on the burden and influence of obesity on daily life compared to other chronic diseases and the fat phobia scale (FPS) were answered. Results: Burden of obesity was rated low (4.2 ± 1.3; rank 9 of 11) compared to other diseases. Bowel cancer (5.5 ± 0.9) had the highest and caries the lowest (2.7 ± 1.4) estimated impact. Females (p = 0.011) and older people (p < 0.001) rated burden of obesity high whereas general population (p < 0.001) and control (p < 0.001) rated it low. Females (p = 0.001) and people with higher BMI (p = 0.004) rated the influence of obesity on daily life high; the general population (p < 0.001; reference physicians) and the control group (p < 0.001) rated it low. FPS was lowest in patients with obesity (3.2 ± 0.7) and highest in the general population (3.6 ± 0.4) and medical students (3.6 ± 0.5; p < 0.001; compared to physicians). Conclusions: Obesity is underestimated as a disease compared to other chronic diseases and attitudes towards obesity are rather negative in comparison. Video teaching showed positive effects so a focus in medical education and public campaigns should aim to improve prevention and treatment of obesity. [ABSTRACT FROM AUTHOR]