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In September 2021, volcanic aerosol (mainly freshly formed sulfate plumes) originating from the eruption of Cumbre Vieja on La Palma, Canary Islands, Spain, crossed Cabo Verde at altitudes below 2 km. On 24 September 2021, an extraordinary large aerosol optical depth (AOD) close to 1 (daily mean at 500 nm) was observed at Mindelo, Cabo Verde. This event provided favorable conditions to obtain lidar-derived profiles of extinction and backscatter coefficients, lidar ratio, and depolarization ratio at 355, 532 and 1064 nm in the sulfate aerosol plume. A novel feature of the lidar system operated at Mindelo is the availability of extinction, lidar ratio and depolarization measurements at 1064 nm in addition to the standard wavelengths of 355 and 532 nm. Having measurements of these parameters at all three wavelengths is a major advantage for the aerosol characterization and in aerosol typing efforts as the lidar ratio and the particle linear depolarization ratio are key parameters for this purpose. In this article, we present the key results of the lidar observations obtained on one specific day, namely on 24 September 2021 at 04:38–05:57 UTC, including the first ever measurements of the particle extinction coefficient, the lidar ratio and the depolarization ratio at 1064 nm for volcanic sulfate, and discuss the findings in terms of aerosol optical properties and mass concentrations by comparison with a reference observation (16 September 2021) representing the typical background conditions before the start of the eruptions. We found an unusual high particle extinction coefficient of 721 ± 51, 549 ± 38 and 178 ± 13 Mm−1, as well as an enhanced lidar ratio of 66.9 ± 10.1, 60.2 ± 9.2 and 30.8 ± 8.7 sr at 355, 532 and 1064 nm, respectively, in the sulfate-dominated planetary boundary layer (PBL). The particle linear depolarization ratio was ≤ 0.9 % at all respective wavelengths. It is the first time that lidar-derived intensive aerosol optical properties could be derived for volcanic sulfate at all three wavelengths, and thus it is a highly valuable data set for global aerosol characterization. The lidar analysis also revealed a sulfate-related AOD of about 0.35 ± 0.03 at 532 nm of the total PBL-related AOD of 0.43. The rest of the AOD contribution was caused by a lofted Saharan dust layer extending from 1.4 to 5 km and leading to a total AOD of 0.79 at 532 nm. Volcanic ash contribution to the observed aerosol plumes could be mostly excluded based on trajectory analysis and the observed optical properties. Peak mass concentration was 178.5 ± 44.6 µg m−3 in the volcanic-influenced and sulfate-dominated polluted PBL, showing the hazardous potential of such sulfate plumes to significantly worsen local air quality even at remote locations.

Mineral dust aerosols are composed of a complex assemblage of various minerals depending on the region in which they originated. Given the different mineral composition of desert dust aerosols, different physicochemical properties and therefore varying climate effects are expected. Despite the known regional variations in mineral composition, chemical transport models typically assume that mineral dust aerosols have uniform composition. This study adds, for the first time, mineralogical information to the mineral dust emission scheme used in the chemical transport model COSMO–MUSCAT. We provide a detailed description of the implementation of the mineralogical database, GMINER (Nickovic et al., 2012), together with a specific set of physical parameterizations in the model's mineral dust emission module, which led to a general improvement of the model performance when comparing the simulated mineral dust aerosols with measurements over the Sahara region for January–February 2022. The simulated mineral dust aerosol vertical distribution is tested by a comparison with aerosol lidar measurements from the lidar system PollyXT, located at Cape Verde. For a lofted mineral dust aerosol layer on 2 February at 05:00 UTC the lidar retrievals yield a dust mass concentration peak of 156 µg m−3, while the model calculates the mineral dust peak at 136 µg m−3. The results highlight the possibility of using the model with resolved mineral dust composition for interpretation of the lidar measurements since a higher absorption in the UV–Vis wavelengths is correlated with particles having a higher hematite content. Additionally, the comparison with in situ mineralogical measurements of dust aerosol particles shows that more of them are needed for model evaluation.

Purpose: The association between preoperative expectations and treatment outcomes in total hip arthroplasty (THA) or total knee arthroplasty (TKA) is still unclear. Therefore the aim is to examine the association between preoperative outcome expectations, process expectations, and self-efficacy, and the postoperative outcomes overall outcome, pain, function, stiffness, satisfaction, and quality of life following THA/TKA. Methods: A systematic review with narrative synthesis was conducted. PubMed, EMBASE, PsycINFO, CINAHL and Cochrane Library were searched from inception to October 17, 2022. Included were prospective longitudinal cohort studies published in English, German, or Dutch, with an adult population undergoing THA/TKA, and including at least one measure of preoperative expectations and the postoperative outcomes mentioned earlier. Two independent reviewers screened the retrieved articles for eligibility, a third solved disagreements. Risk of bias (RoB) was assessed using the QUIPS tool. Results: Of the 50 included studies, 38 had high RoB and 12 moderate RoB. Unadjusted results suggest a positive association between preoperative outcome expectations and overall outcome in the medium and long term, and between self-efficacy and change in ‘overall outcome’ in the long term. Adjusted results suggest positive associations between outcome expectations and function and between self-efficacy and overall outcome in the medium term, and for outcome expectations with pain and change in pain, respectively, and self-efficacy and stiffness in the long term. Conclusions: Preoperative expectations show a possible positive association with specific outcome measures, such as pain or function. For future research, it is advised to link matching specific expectations with specific outcomes.

The presented study investigates the efficiency of heterogeneous ice formation in natural clouds over Lauder, New Zealand / Aotearoa. Aerosol conditions in the middle troposphere above Lauder are subject to huge contrasts. Clean, pristine air masses from Antarctica and the Southern Ocean arrive under southerly flow conditions, while high aerosol loads can occur when air masses are advected from nearby Australia. This study assesses how these contrasts in aerosol load affect the ice formation efficiency in stratiform midlevel clouds in the heterogeneous freezing range (−40 to 0 ∘C). For this purpose, an 11-year dataset was analyzed from a dual-wavelength polarization lidar system operated by National Institute of Water and Atmospheric Research (NIWA), Taihoro Nukurangi, at Lauder in collaboration with the National Institute for Environmental Studies in Japan and the Meteorological Research Institute of the Japan Meteorological Agency. These data were used to investigate the efficiency of heterogeneous ice formation in clouds over the site as a function of cloud-top temperature as in previous studies at other locations. The Lauder cloud dataset was put into context with lidar studies from contrasting regions such as Germany and southern Chile. The ice formation efficiency found at Lauder is lower than in polluted midlatitudes (i.e., Germany) but higher than, for example, in southern Chile. Both Lauder and southern Chile are subject to generally low free-tropospheric aerosol loads, which suggests that the low ice formation efficiency at these two sites is related to low ice-nucleating-particle (INP) concentrations. However, Lauder sees episodes of continental aerosol, more than southern Chile does, which seems to lead to the moderately increased ice formation efficiency. Trajectory-based tools and aerosol model reanalyses are used to relate this cloud dataset to the aerosol load and the air mass sources. Both analyses point clearly to higher ice formation efficiency for clouds which are more strongly influenced by continental aerosol and to lower ice formation efficiency for clouds which are more influenced by Antarctic/marine aerosol and air masses.

Abstract Objective Multidisciplinary tumor conference (MTC) is a key instrument in multidisciplinary cancer care. In recent years, if and how patient participation in MTC can contribute to a more patient‐centered care have been scientifically discussed. This study aimed to identify determinants of treatment confidence in the context of patient participation in MTC. Therefore, the association among health literacy‐sensitive communication, trust in health‐care providers (HCP), and treatment confidence is examined. Methods This study used data from the multicenter, observational study “PINTU” on patient participation in MTC. Data were collected from November 2018 to February 2020. Validated scales for treatment confidence, health literacy‐sensitive communication, and trust in providers were included in the structural equation modeling (SEM) analysis. Results A total of 95 patients participated in MTC. The sample compromised n = 80 completed datasets. The SEM fit measures indicated good fit of the proposed model. The analysis showed a positive association between health literacy‐sensitive communication and treatment confidence when adding the mediating effect of trust in providers. Conclusion Patient‐centered communication during MTC in combination with a trustful relationship between participating patients and health‐care providers is positively associated with treatment confidence. The results indicated the relevance of a trustful doctor–patient communication and relationship. Trainings for physicians targeting patient‐centered communication could be a promising approach to strengthen patient participation.

Abstract Although healthcare systems across Europe face rather similar challenges, their organization varies widely. Even neighbouring countries substantially differ with respect to healthcare structures, processes, and resulting outcomes. Focusing on Germany and the Netherlands as examples of such neighbouring countries, this paper will first identify and discuss similarities and major differences between both systems on the macro-level of healthcare. It further argues that it is often unknown how these differences trickle down to individual healthcare organizations, providers, patients or citizens, i.e., to the meso- and micro-level of healthcare. Hence, in a second step, potential implications of macro-level differences are described by considering the examples of total hip arthroplasty, antibiotic prescription practices and resistance, and nursing home care in Germany and the Netherlands. The paper concludes with an outlook on how these differences can be studied using the example of the project “Comparison of healthcare structures, processes and outcomes in the Northern German and Dutch cross-border region” (CHARE-GD). It further discusses potential prospects and challenges of corresponding cross-national research.

The number of intense wildfires may increase further in upcoming years as a consequence of climate change. It is therefore necessary to improve our knowledge about the role of smoke in the climate system, with emphasis on the impact of smoke particles on the evolution of clouds, precipitation, and cloud radiative properties. Presently, one key aspect of research is whether or not wildfire smoke particles can initiate cirrus formation. In this study, we present lidar observations over Limassol, Cyprus, from 27 October to 3 November 2020, when extended wildfire smoke fields crossed the Mediterranean Basin from Portugal to Cyprus. We found strong evidence that aged smoke (organic aerosol particles) originating from wildfires in North America triggered significant ice nucleation at temperatures from −47 to −53 ∘C and caused the formation of extended cirrus layers. The observations suggest that the ice crystals were nucleated just below the tropopause in the presence of smoke particles serving as ice-nucleating particles (INPs). The main part of the 2–3 km thick smoke layer was, however, in the lower stratosphere just above the tropopause. With actual radiosonde observations of temperature and relative humidity and lidar-derived smoke particle surface area concentrations used as starting values, gravity wave simulations show that the lofting of air by 100–200 m is sufficient to initiate significant ice nucleation on the smoke particles, leading to ice crystal number concentrations of 1–100 L−1.

The MOSAiC (Multidisciplinary drifting Observatory for the Study of Arctic Climate) expedition was the largest Arctic field campaign ever conducted. MOSAiC offered the unique opportunity to monitor and characterize aerosols and clouds with high vertical resolution up to 30 km height at latitudes from 80 to 90∘ N over an entire year (October 2019 to September 2020). Without a clear knowledge of the complex aerosol layering, vertical structures, and dominant aerosol types and their impact on cloud formation, a full understanding of the meteorological processes in the Arctic, and thus advanced climate change research, is impossible. Widespread ground-based in situ observations in the Arctic are insufficient to provide these required aerosol and cloud data. In this article, a summary of our MOSAiC observations of tropospheric aerosol profiles with a state-of-the-art multiwavelength polarization Raman lidar aboard the icebreaker Polarstern is presented. Particle optical properties, i.e., light-extinction profiles and aerosol optical thickness (AOT), and estimates of cloud-relevant aerosol properties such as the number concentration of cloud condensation nuclei (CCN) and ice-nucleating particles (INPs) are discussed, separately for the lowest part of the troposphere (atmospheric boundary layer, ABL), within the lower free troposphere (around 2000 m height), and at the cirrus level close to the tropopause. In situ observations of the particle number concentration and INPs aboard Polarstern are included in the study. A strong decrease in the aerosol amount with height in winter and moderate vertical variations in summer were observed in terms of the particle extinction coefficient. The 532 nm light-extinction values dropped from >50 Mm−1 close to the surface to Mm−1 at 4–6 km height in the winter months. Lofted, aged wildfire smoke layers caused a re-increase in the aerosol concentration towards the tropopause. In summer (June to August 2020), much lower particle extinction coefficients, frequently as low as 1–5 Mm−1, were observed in the ABL. Aerosol removal, controlled by in-cloud and below-cloud scavenging processes (widely suppressed in winter and very efficient in summer) in the lowermost 1–2 km of the atmosphere, seems to be the main reason for the strong differences between winter and summer aerosol conditions. A complete annual cycle of the AOT in the central Arctic could be measured. This is a valuable addition to the summertime observations with the sun photometers of the Arctic Aerosol Robotic Network (AERONET). In line with the pronounced annual cycle in the aerosol optical properties, typical CCN number concentrations (0.2 % supersaturation level) ranged from 50–500 cm−3 in winter to 10–100 cm−3 in summer in the ABL. In the lower free troposphere (at 2000 m), however, the CCN level was roughly constant throughout the year, with values mostly from 30 to 100 cm−3. A strong contrast between winter and summer was also given in terms of ABL INPs which control ice production in low-level clouds. While soil dust (from surrounding continents) is probably the main INP type during the autumn, winter, and spring months, local sea spray aerosol (with a biogenic aerosol component) seems to dominate the ice nucleation in the ABL during the summer months (June–August). The strong winter vs. summer contrast in the INP number concentration by roughly 2–3 orders of magnitude in the lower troposphere is, however, mainly caused by the strong cloud temperature contrast. A unique event of the MOSAiC expedition was the occurrence of a long-lasting wildfire smoke layer in the upper troposphere and lower stratosphere. Our observations suggest that the smoke particles frequently triggered cirrus formation close to the tropopause from October 2019 to May 2020.

Abstract Background The current uptake of many vaccinations recommended for persons aged 60 and older is unsatisfactory in Germany. Lack of confidence in the safety and efficacy of vaccinations, lack of knowledge and insecurities about possible side effects, and numerous pragmatic barriers are just some of the reasons to be mentioned. General practitioners (GPs) play a central role in the vaccination process. Therefore, effective interventions in this context are needed to address the various barriers and improve the vaccination uptake rates. Methods A complex intervention will be implemented and evaluated in 1057 GPs’ practices in two German federal states. The components include trainings for GPs and medical assistants on communication psychology, medical aspects, and organisational vaccination processes. The primary outcome influenza vaccination rate and the secondary outcomes vaccination uptake rate of other vaccinations as well as vaccine literacy of patients will be examined. The intervention will be evaluated in a mixed methods study with a controlled design. Survey data will be analysed descriptively and by using mean comparisons as well as multivariable multilevel analyses. The qualitative data will be analysed with qualitative content analysis. The secondary data will be analysed by using descriptive statistics, a pre-post comparison by performing mean comparisons, cluster analysis, and subgroup analyses. Discussion In this study, a complex intervention to improve vaccination rates in GP practices for the vaccinations recommended for people aged 60 years and older will be implemented and evaluated. Additionally, improvements in patients’ vaccine-related health literacy and knowledge, and patients’ intention to get vaccinated are expected. The mixed methods design can deliver results that can be used to improve preventive health care for elderly people and to gain more knowledge on vaccination uptake and the intervention’s effectiveness. Trial registration Trial registration number: DRKS00027252 (retrospectively registered).

This paper presents a collection of lidar-derived aerosol intensive optical properties for several aerosol types, namely the particle linear depolarization ratio, the extinction-to-backscatter ratio (lidar ratio) and the Ångström exponent. The data collection, named DeLiAn, is based on globally distributed, long-term, ground-based, multiwavelength, Raman and polarization lidar measurements, conducted mainly with lidars that have been developed at the Leibniz Institute for Tropospheric Research. The intensive optical properties are presented at two wavelengths, 355 and 532 nm, for 13 aerosol categories. The categories cover the basic aerosol types (i.e., marine, pollution, continental European background, volcanic ash, smoke, mineral dust), as well as the most frequently observed mixtures they form. This extensive collection also incorporates more peculiar aerosol categories, including dried marine aerosol that, compared to marine aerosol, exhibits a significantly enhanced depolarization ratio (up to 15 %). Besides Saharan dust, additional mineral dust types related to their source region were identified due to their lower lidar ratios (Central Asian and Middle Eastern dust). In addition, extreme wildfire events (such as in north America and Australia) emitted smoke into the stratosphere showing significantly different optical properties, i.e., high depolarization values (up to 25 %), compared to tropospheric smoke. The data collection reflects and underlines the variety of aerosol mixtures in the atmosphere and can be used for the development of aerosol-typing schemes. The paper contains the most up-to-date and comprehensive overview of optical properties from aerosol lidar measurements and, therefore, provides a solid basis for future aerosol retrievals in the frame of both spaceborne and ground-based lidars. Furthermore, DeLiAn can assist the efforts for the harmonization of satellite records of aerosol properties performed at different wavelengths.

The Hybrid End-To-End Aerosol Classification (HETEAC) model for the Earth Clouds, Aerosols and Radiation Explorer (EarthCARE) mission is introduced. The model serves as the common baseline for the development, evaluation, and implementation of EarthCARE algorithms. It guarantees the consistency of different aerosol products from the multi-instrument platform and facilitates the conformity of broad-band optical properties needed for EarthCARE radiative-closure assessments. While the hybrid approach ensures that the theoretical description of aerosol microphysical properties is consistent with the optical properties of the measured aerosol types, the end-to-end model permits the uniform representation of aerosol types in terms of microphysical, optical, and radiative properties. Four basic aerosol components with prescribed microphysical properties are used to compose various natural and anthropogenic aerosols of the troposphere. The components contain weakly and strongly absorbing fine-mode and spherical and non-spherical coarse-mode particles and thus are representative for pollution, smoke, sea salt, and dust, respectively. Their microphysical properties are selected such that good coverage of the observational phase space of intensive, i.e., concentration-independent, optical aerosol properties derived from EarthCARE measurements is obtained. Mixing rules to calculate optical and radiative properties of any aerosol blend composed of the four basic components are provided. Applications of HETEAC in the generation of test scenes, the development of retrieval algorithms for stand-alone and synergistic aerosol products from EarthCARE's atmospheric lidar (ATLID) and multi-spectral imager (MSI), and for radiative-closure assessments are introduced. Finally, the implications of simplifying model assumptions and possible improvements are discussed, and conclusions for future validation and development work are drawn.

Aerosol–cloud interactions (ACIs) are the largest contributor to the uncertainty in the global radiation budget. To improve the current consideration of ACIs in global circulation models, it is necessary to characterize the 3-D distribution of dust-related cloud condensation nuclei concentration (CCNC) and ice-nucleating particle concentration (INPC) globally. This can potentially be realized using the POlarization LIdar PHOtometer Networking (POLIPHON) method together with spaceborne lidar observations. However, dust-related conversion factors that convert bulk aerosol optical properties from lidar measurements to aerosol microphysical properties are still less constrained in many regions, which limits the applications of the POLIPHON method. Here we retrieve the essential dust-related conversion factors at remote oceanic and coastal sites using the historical AErosol RObotic NETwork (AERONET) database. Depolarization-ratio-based dust ratios Rd at 1020 nm are applied to identify the dust-occurring cases, thus enabling us to contain fine-mode dust-dominated cases (after the preferential removal of large-sized dust particles during transport), study the evolution of dust microphysical properties along the transoceanic pathway, and mitigate occasional interference of large-sized marine aerosols. The newly proposed scheme is proven to be valid and feasible by intercomparisons with previous studies at nine sites in/near deserts. The dust-related conversion factors are calculated at 20 oceanic and coastal sites using both pure dust (PD) and PD plus dust-dominated mixture (PD+DDM) datasets. At nearly half of the sites, the conversion factors are solely calculated using the PD datasets, while at the remaining sites, the participation of DDM datasets is required to ensure a sufficient number of data for the calculation. Evident variation trends in conversion factors are found for cv,d (extinction-to-volume concentration, gradually decreasing), c250,d (extinction-to-particle (with a radius > 250 nm) number concentration, gradually increasing), and cs,d (extinction-to-surface-area concentration, gradually decreasing) along both the transpacific and transatlantic dust transport pathways. The retrieved dust-related conversion factors are anticipated to inverse 3-D dust-related CCNC and INPC distributions globally, thereby improving the understanding of ACIs in atmospheric circulation models.

Abstract Objective Due to communication barriers, people without natural speech who use augmentative and alternative communication (AAC) are rarely interviewed about their healthcare needs, expectations, and experiences. This qualitative interview study aims to investigate how AAC users evaluate a new service delivery (nSD) in AAC care in Germany. Results We conducted 8 semi-structured qualitative interviews with 8 AAC users. The results of the performed qualitative content analysis show a positive evaluation of the nSD among AAC users. Contextual factors were identified that seem to hinder the achievement of the intervention goals. These include caregivers' prejudice and inexperience with AAC and an unfavourable environment in which AAC is used.

Wildfire smoke is known as a highly absorptive aerosol type in the shortwave wavelength range. The absorption of sunlight by optically thick smoke layers results in heating of the ambient air. This heating is translated into self-lofting of the smoke up to more than 1 km in altitude per day. This study aims for a detailed analysis of tropospheric and stratospheric smoke lofting rates based on simulations and observations. The main goal is to demonstrate that radiative heating of intense smoke plumes is capable of lofting them from the lower and middle free troposphere (injection heights) up to the tropopause without the need of pyrocumulonimbus (pyroCb) convection. The further subsequent ascent within the lower stratosphere (caused by self-lofting) is already well documented in the literature. Simulations of absorbed solar radiation by smoke particles and resulting heating rates, which are then converted into lofting rates, are conducted by using the ECRAD (European Centre for Medium-Range Weather Forecasts Radiation) scheme. As input parameters thermodynamic profiles from CAMS (Copernicus Atmosphere Monitoring Service) reanalysis data, aerosol profiles from ground-based lidar observations, radiosonde potential temperature profiles, CALIOP (Cloud–Aerosol Lidar with Orthogonal Polarization) aerosol measurements, and MODIS (Moderate Resolution Imaging Spectroradiometer) aerosol optical depth retrievals were used. The sensitivity analysis revealed that the lofting rate strongly depends on aerosol optical thickness (AOT), layer depth, layer height, and black carbon (BC) fraction. We also looked at the influence of different meteorological parameters such as cloudiness, relative humidity, and potential temperature gradient. To demonstrate the applicability of our self-lofting model, we compared our simulations with the lofting processes in the stratosphere observed with CALIOP after major pyroCb events (Canadian fires in 2017, Australian fires in 2019–2020). We analyzed long-term CALIOP observations of smoke layers and plumes evolving in the UTLS (upper troposphere and lower stratosphere) height region over Siberia and the adjacent Arctic Ocean during the summer season of 2019. Our results indicate that self-lofting contributed to the vertical transport of smoke. We hypothesize that the formation of a near-tropopause aerosol layer, observed with CALIOP, was the result of self-lofting processes because this is in line with the simulations. Furthermore, Raman-lidar-based aerosol typing (in Leipzig and the High Arctic) clearly indicated the dominance of smoke in the UTLS aerosol layer since August 2019, most probably also the result of smoke self-lofting.

Purpose: Quality management has become an integral part of management reforms in public sector organizations. Drawing on a new institutionalist perspective, this study aims to investigate the relation of management reforms and organizational performance in the context of higher education. Design/methodology/approach: The authors analyse the interaction between isomorphic conformity in quality management adoption, organizational learning and quality improvement and, in so doing, address the central theoretical question of what effects isomorphic conformity has on organizational performance. Empirically, the study draws on survey data from quality managers at public higher education institutions in Germany. Methodically, it applies confirmatory factor analysis and structural equation modelling. Findings: The results suggest that mimetic isomorphism is surprisingly compatible with processes of organizational learning, and thus, does not inevitably compromise organizational development. Originality/value By presenting these findings, the authors contribute to the controversial theoretical debate concerning the effects of isomorphism and to the ongoing discussion regarding the organizational impact of quality management in higher education.

Christian Heuser,1,2 Barbara Schellenberger,1,2 Nicole Ernstmann,1,2 Annika Diekmann,1 Emily Krüger,1 Leonie Schreiber,1 Isabelle Scholl,3 Lena Ansmann4 1Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, 53127, Germany; 2Chair for Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50933, Germany; 3Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany; 4Division for Organizational Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, 26129, GermanyCorrespondence: Christian Heuser, Chair for Health Services Research, Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50933, Germany, Tel +49-221-478-97133, Email christian.heuser1@uk-koeln.dePurpose: This study aimed (1) to analyze patients’ perceived shared decision-making (SDM) experiences over 4 weeks between patients participating or not in multidisciplinary tumor conferences (MTCs) and (2) to analyze the association of patients’ active participation in and organizational variables of MTCs with patients’ perceived SDM experience directly after MTC.Patients and Methods: From the N=317 patients, this observational study included patient surveys, observations, and audio transcripts from MTCs with (N=82) and without (N=145) patient participation in six breast and gynecologic cancer centers. We performed t tests for within- and between-group comparisons and linear regression with “patients’ perceived SDM experiences in MTC” as the dependent variable.Results: Patients’ perceived SDM experiences increased at 4 weeks after MTC (p< 0.001) with lower perceived SDM experiences for participating versus nonparticipating patients (p< 0.001). Linear regression showed that the organizational variable “round table seating arrangement” was significantly associated with higher perceived SDM experiences compared with a theater or U-shape arrangement (beta=− 0.38, p=0.043; beta=− 0.69, p=0.010) directly after MTC.Conclusion: Results provide first insights into patients’ perceived SDM experiences in MTCs. SDM in MTCs is associated with organizational variables of MTCs. A round table seating arrangement in MTCs with patient participation seems important for patients’ perceived SDM experiences. The relatively low perceived SDM experiences of participating patients directly after MTC indicates room for improvement, eg concerning patient-centered communication.Keywords: multidisciplinary healthcare, multidisciplinary tumor conference, multidisciplinary team meetings, shared decision making, oncology, patient-centered communication

Abstract Background People with disabilities and without natural speech often rely on care provided by informal caregivers. The caregiving situation of these informal caregivers has been poorly researched. The objectives of the study are 1) to identify stressors, resources, and coping strategies among informal caregivers of people without natural speech and 2) to examine whether a complex intervention in augmentative and alternative communication (AAC) that is not primarily tailored to the needs of informal caregivers can reduce care-related burden. Methods The main components of the AAC intervention were (1) initial counselling session, (2) 4 AAC training sessions, (3) 20 AAC therapy sessions and (4) accompanying case management. The control group received only the initial counselling session. Within a quasi-experimental intervention study, survey data on self-perceived burden (Burden Scale for Family Caregivers, BSFC-s) from n = 154 informal caregivers of people without natural speech were collected at three time points between June 2018 and April 2021 from a postal survey. Qualitative interviews with n = 16 informal caregivers were conducted. Results Caregivers reported various stressors such as limited communication with the cared-for person and concerns about the living situation in adulthood. Diverse resources and effective coping strategies, which the caregivers refer to when dealing with stressors, could also be identified. Burden was significantly reduced in the intervention group compared to the control group. According to the results of the qualitative study, AAC use led to better communication skills and a reduction in behavioural problems and thus a decreased burden. Conclusions The AAC intervention seems to have a positive impact on self-perceived burden. Linkages between intervention components and burden reduction as well as stressors and coping strategies could be identified and provide an evidence-based foundation for developing future holistic interventions for families with individuals without natural speech. Trial registration German Clinical Trials Register (DRKS); ID: DRKS00013628 (registered on 05/02/2018).

Abstract Background In some breast and gynaecologic cancer centres in Germany, patients participate in their own case discussion in multidisciplinary tumour conferences (MTCs), where treatment recommendations are discussed and finalized. However, the extent to which patients in MTCs are involved in decision‐making on treatment recommendations remains largely unexplored. Hence, this study investigates how recommendations are communicated to patients and the extent to which the interactions with patients in MTCs are in line with shared decision‐making (SDM). Methods In this observational study, we audio‐recorded MTCs with patient participation in three breast and gynaecologic cancer centres in Germany. We qualitatively analysed the data with regard to content and linguistic aspects. Results We analysed 82 case discussions. Recommendations made during MTCs were regarding (i) treatment options, (ii) treatment initiation, (iii) next (treatment) steps and (iv) whether a treatment method should be initiated at all. The decision about recommendations depended in part on patients' preferences or further course/further outcomes. Although the purpose of MTCs is to provide recommendations, some recommendations were framed as the final decision. The majority of the decision‐making conversation could be characterized as option talk (78%), during which patients were mostly proposed only one (treatment) option. Conclusions This study establishes limited SDM in MTCs with patient participation. By indicating choices and thereby creating awareness of choices among patients, MTCs with patient participation could be used to foster SDM implementation. Patient or Public Contribution Two representatives of a large self‐help organization for patients with breast cancer assisted the research project, particularly, in discussing the results.