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Laura Kivelitz,1 Martin Härter,1 Jil Mohr,1 Hanne Melchior,1 Lutz Goetzmann,2 Max Holger Warnke,3 Silke Kleinschmidt,4 Jörg Dirmaier1 1Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 2Department of Psychosomatic Medicine and Psychotherapy, Segeberg Hospital, Bad Segeberg, Germany; 3Specialist Clinic for Psychosomatic Medicine and Psychotherapy, MediClin Seepark Klinik, Bad Bodenteich, Germany; 4Specialist Clinic for Psychosomatic Medicine and Psychotherapy, Curtius Klinik, Bad Malente-Gremsmühlen, Germany Background: Decisions on medical treatment setting are perceived as important but often difficult to make for patients with mental disorders. Shared decision-making as a strategy to decrease decisional conflict has been recommended, but is not yet widely implemented. This study aimed to investigate the information needs and the decision-making preferences of patients with mental disorders prior to the decision for a certain treatment setting. The results will serve as a prerequisite for the development of a high-quality patient decision aid (PtDA) regarding the treatment setting decision. Methods: We conducted retrospective individual semi-structured interviews with n=24 patients with mental disorders in three psychotherapeutic inpatient care units. The interviews were audiotaped, transcribed, coded, and content-analyzed. Results: The majority of the patients wanted to be involved in the decision-making process. They reported high information needs regarding treatment options in order to feel empowered to participate adequately in the decision for a certain treatment setting. However, some patients did not want to participate or receive information, for example, because of their high burden of mental disorder. Whereas the majority were satisfied with the extent they were involved in the decision, few participants felt sufficiently informed about treatment options. Most patients reported that a decision aid regarding an appropriate treatment setting would have been helpful for them. Important information that should be included in a PtDA was general information about mental illness, effective treatment options, specific information about the different treatment settings, and access to treatment. Discussion: The identified information and decision-making needs provide a valuable basis for the development of a PtDA aiming to support patients and caregivers regarding the decision for an adequate treatment setting. As preferences for participation vary among patients and also depend on the current mental state, a flexible approach is needed to meet patients’ individual wishes and needs. Keywords: mental disorders, needs assessment, psychotherapy, treatment decision, treatment setting, shared decision-making, qualitative interviews

Sarah Liebherz, Lisa Tlach, Martin Härter, Jörg Dirmaier Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Background: Patient decision aids are one possibility for enabling and encouraging patients to participate in medical decisions.Objective: This paper aims to describe patients’ information and decision-making needs as a prerequisite for the development of high-quality, web-based patient decision aids for affective disorders.Design: We conducted an online cross-sectional survey by using a self-administered questionnaire including items on Internet use, online health information needs, role in decision making, and important treatment decisions, performing descriptive and comparative statistical analyses.Participants: A total of 210 people with bipolar disorder/mania as well as 112 people with unipolar depression participated in the survey.Results: Both groups specified general information search as their most relevant information need and decisions on treatment setting (inpatient or outpatient) as well as decisions on pharmacological treatment as the most difficult treatment decisions. For participants with unipolar depression, decisions concerning psychotherapeutic treatment were also especially difficult. Most participants of both groups preferred shared decisions but experienced less shared decisions than desired.Discussion and conclusion: Our results show the importance of information for patients with affective disorders, with a focus on pharmacological treatment and on the different treatment settings, and highlight patients’ requirements to be involved in the decision-making process. Since our sample reported a chronic course of disease, we do not know if our results are applicable for newly diagnosed patients. Further studies should consider how the reported needs could be addressed in health care practice. Keywords: bipolar disorder, computer/Internet technology, depression, empirical supported treatment, mood disorders, pharmacotherapy

Isabelle Scholl, Jördis M Zill, Martin Härter, Jörg Dirmaier Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Background: The concept of patient-centeredness has gained in importance over recent decades, including its growing importance on a health policy level. However, many different definitions and frameworks exist. This renders both research and implementation into clinical practice difficult. This study aimed at assessing how German researchers conceptualize patient-centeredness, how they translate the German equivalent into English, and what they consider the most important references on the topic. Methods: All researchers within a German research priority program on patient-centeredness were invited to participate in an online survey with open questions. The data regarding the definitions of patient-centeredness were analyzed using the method of conventional content analysis. Descriptive statistics were used to analyze the responses on translations and references. Results: Thirty-eight (28%) of 136 invited researchers participated in the study. The definitions given by the participants could be classified into ten categories: patient as a unique person, involvement in decision-making, patient information, essential characteristics of the physician, biopsychosocial perspective, patient empowerment, individualized services, patient-reported outcomes, involvement in health policy and coordination and teamwork. The results for the translation of the German word “Patientenorientierung” into English indicate that uncertainty regarding the appropriate English terminology exists. All participants provided a different reference on patient-centeredness that was important to them. Conclusion: The results show a certain degree of “shared meaning” regarding the concept of patient-centeredness. However, they also indicate a considerable amount of “surplus meaning”, which can be seen as an indicator for the fuzziness of a theoretical concept. All in all, this study has shown that the conceptual ambiguity found in the literature on patient-centeredness is partly reflected in the conceptualizations of German researchers working in that field. This calls for more conceptual work, eg, developing an integrative model on patient-centeredness grounded in the international literature. Keywords: patient-centered care, concept analysis, expert survey

Nina Weymann,1 Martin Härter,1 Frank Petrak,2 Jörg Dirmaier11Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, 2Clinic of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University Bochum, Bochum, GermanyPurpose: Patient involvement in diabetes treatment such as shared decision-making and patient self-management has significant effects on clinical parameters. As a prerequisite for active involvement, patients need to be informed in an adequate and preference-sensitive way. Interactive Health Communication Applications (IHCAs) that combine web-based health information for patients with additional support offer the opportunity to reach great numbers of patients at low cost and provide them with high-quality information and support at the time, place, and learning speed they prefer. Still, web-based interventions often suffer from high attrition. Tailoring the intervention to patients’ needs and preferences might reduce attrition and should thereby increase effectiveness. The purpose of this study was to develop a tailored IHCA offering evidence-based, preference-sensitive content and treatment decision support to patients with type 2 diabetes. The content was developed based on a needs assessment and two evidence-based treatment guidelines. The delivery format is a dialogue-based, tunneled design tailoring the content and tone of the dialogue to relevant patient characteristics (health literacy, attitudes toward self-care, and psychological barriers to insulin treatment). Both content and tailoring were revised by an interdisciplinary advisory committee.Conclusion: The World Wide Web holds great potential for patient information and self-management interventions. With the development and evaluation of a tailored IHCA, we complement face-to-face consultations of patients with their health care practitioners and make them more efficient and satisfying for both sides. Effects of the application are currently being tested within a randomized controlled trial.Keywords: type 2 diabetes, interactive health communication application, development, Internet

Jördis M Zill, Isabelle Scholl, Martin Härter, Jörg Dirmaier Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Background: Patient-centeredness has gained importance over the last two decades. However, there is an absence of theoretical clarity regarding the term patient-centeredness. This results in inconsistent measurement of patient-centeredness, which leads to difficulties in comparing research results. To overcome these difficulties, the aims of this study are (1) to identify the dimensions of patient-centeredness and include them in an integrative model, (2) to select and assess the most relevant dimensions of the model, (3) to identify and assess measurement instruments and find evidence for the selected dimensions, and (4) to assess the relevance and applicability of the conceptualization and measurement of patient-centeredness in clinical practice and health services research. Methods: This project is divided into four phases. First, a systematic review will be conducted to identify the constructs and dimensions of patient-centeredness. Second, experts (eg, researchers, clinicians, and patient representatives) will assess and prioritize the identified relevant dimensions using a Delphi survey. Third, the selected dimensions will be assessed regarding their operationalization, and the results will be summarized in a systematic review. Evidence of the measures will be assessed in a scoping review. Fourth, an expert workshop will be held. Experts will assess the results of the previous phases regarding the relevance and applicability of the conceptualization and measurement of patient-centeredness. Discussion: This study will provide an integrative model of patient-centeredness based on the current literature. This model can be used to improve upon the comparability of research results. Through a detailed insight into the existence and evidence of measurement dimensions of patient-centeredness, existing gaps in this field will be shown. Finally, the expert assessment will show the relevance and feasibility of the concept and measures in clinical practice and health services research. Therefore, this study will contribute important knowledge to enhance future research on patient-centeredness and establish a foundation for its implementation. Keywords: patient-centeredness, measurement, conceptual framework

Summary: Background: Psoriasis can lead to high psychosocial burden, and the occurrence of psoriasis is related to psychological distress. Objectives: This study provides an overview of psychosocial interventions for patients with psoriasis and examines their effects on patient‐reported outcomes. Methods: A systematic search of four electronic databases (CENTRAL, MEDLINE, Embase and PsycINFO) was conducted in January 2017. All trials on psychosocial interventions for patients with psoriasis that used patient‐reported outcomes and a comparison group were included. Data were extracted on intervention, study population and outcomes. Risk of bias was assessed according to the Cochrane Handbook. A meta‐analysis on quality of life, depression and anxiety was performed. This review was registered on PROSPERO (CRD42016037934). Results: Nineteen studies were included. Interventions primarily used cognitive behavioural or mindfulness‐based techniques. Risk of bias was mostly rated 'unclear' due to nontransparent reporting (e.g. no study protocols were published, only one study reported blinding of patients). Meta‐analysis using standardized mean differences between the intervention and control groups showed significant, small‐to‐medium effects (given with 95% confidence intervals) on quality of life (0·28, 0·04–0·51; six studies, n = 664) and anxiety (0·36, 0·15–0·57; six studies, n = 363). The effect on depression was not significant (0·37, −0·05 to 0·80; five studies, n = 326). Conclusions: Psychosocial interventions offer an effective means to improve quality of life and anxiety in patients with psoriasis. Although the importance of such psychosocial aspects for psoriasis is unquestioned, there is a lack of high‐quality evaluation studies. Nontransparent reporting of risk of bias, low power and a lack of replication studies make it difficult to reach confident conclusions from the evidence. What's already known about this topic? Psoriasis symptoms and psychosocial burden reinforce one another.Different psychosocial interventions for patients with psoriasis exist to address this problem.Most studies report positive effects on psoriasis severity, and some also on certain patient‐reported outcomes such as quality of life.Only a very few interventions have been subject to rigorous testing.Further research is needed on the evaluation of the effects and the methodological quality of these interventions. What does this study add? This review provides a comprehensive overview of psychosocial interventions for patients with psoriasis.It evaluates the effects of the interventions on patient‐reported outcomes and rates the methodological quality of their evaluation studies.It underlines the importance and effectiveness of addressing psychosocial burden in patients with psoriasis by identifying adequate interventions.The results of this study show that further research, especially with adequately tested interventions, is strongly needed. [ABSTRACT FROM AUTHOR]