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In der vorliegenden kumulativen Dissertation wurde die Versorgung von Patienten mit einer koronaren Herzkrankheit (KHK) untersucht. Hierbei wurde unterschieden zwischen Patienten mit zusätzlichen psychischen Erkrankungen (MD) und solchen ohne psychische Beeinträchtigungen. In zwei Studien wurden (1) der aktuelle Stand der Diagnostik und Behandlung von KHK-Patienten mit und ohne psychische Erkrankung, (2) der Krankheitsverlauf dieser Patienten und die Erkennungsrate in der sekundären Routineversorgung, (3) der Einfluss von KHK und dessen Behandlung auf die Lebensqualität und die Patientenzufriedenheit, (4) der Zugang von Patienten und ihre Barrieren zum Gesundheitssystem und (4) Bedarfe dieser Patienten innerhalb von medizinischen Konsultationen und an das Gesundheitssystem untersucht. In einer zweiteiligen Querschnittsstudie wurden KHK-Patienten mit der Hospital Anxiety and Depression Scale (HADS) auf psychische Erkrankungen untersucht. Nach einem positiven Screening wurde das Structured Clinical Interview for DSM-IV (SCID-I) abgenommen. Die Studie wurde an sieben Rekrutierungsorten durchgeführt: Zwei Krankenhäusern, zwei Rehabilitationskliniken, drei kardiologische Praxen. Lebensqualität (EQ-5D), Patientenbeurteilung der Pflege bei chronischen Erkrankungen (PACIC) und frühere Routinediagnosen und -behandlungen wurden auch untersucht. Im zweiten Teil wurden 20 Teilnehmer in einem halb-strukturierten Interview befragt, um tiefer gehende Erkenntnisse zu gewinnen. Für die Analysen wurden deskriptive Statistiken, Chi-Quadrat-Tests und ANOVA verwendet. Die Analysen der Daten von 364 Patienten ergaben 33,8 % positive HADS-Screenings und 28 % SCID-I-Diagnosen. Die Erkennungsrate der korrekt vordiagnostizierten psychischen Erkrankungen lag bei 49 %. Etwa 30 % der MD-Patienten wurden von Ärzten aktiv angesprochen; allerdings unterzogen sich nur 6,6 % der Patienten einer Psychotherapie und 4,1 % einer medikamentösen Behandlung. MD-Patienten schnitten beim EQ-5D und beim PACIC

Introduction This mixed-method study explores psychological needs, access and barriers in coronary heart disease (CHD) patients with and without mental health issues (MHI) within the German healthcare system. Methods This study was conducted in three different healthcare settings: two hospitals, two rehabilitation clinics and three cardiology practices in Cologne, Germany. Patients were screened for angiographically documented CHD and other inclusion criteria. In total, 364 CHD patients took part in this study. It consisted of two parts: In the first part, participants filled in a newly developed questionnaire about their psychological needs, access and barriers within the healthcare system and their contact with their doctor in these matters. Then, patients were screened for MHIs with the help of the Hospital Anxiety and Depression Scale (HADS). When a score above seven was scored on the HADS, patients were additionally screened for specific MHIs using the Structured Clinical Interview for DSM-IV Axis I Disorders. In the second part, 20 participants were subsequently interviewed in a semi-structured interview to generate more in-depth findings. Results The interviews show that CHD patients with and without MHI experienced a cardiac event as life-changing and had an urgent need to talk about CHD with their doctor, mostly the general practitioner (GP). When the GP spoke to the patient shortly after the cardiac event, patients experienced relief and were better able to cope with their illness. Only 9.1% reported being aided in their search for psychotherapeutic treatment or drug treatment (4.1%). Conclusion The needs of CHD patients with and without MHI were not adequately satisfied within our sample. Psychological measures are necessary for sufficient improvement, such as training of doctors in doctor-patient communication (e.g., better support in coping with MHI/CHD), improvements in the procedure (more time for conversations during doctor contacts), and improvement

Objective The present study aimed to develop and validate an instrument for assessing the communication skills of oncology physicians from a patient's point of view. Methods A first draft of the questionnaire was compiled based on skills reflecting good physician-patient communication identified in the literature. The questionnaire was critically revised by experts to ensure the validity of its contents. The revised questionnaire was completed by a sample of 153 cancer patients. The questionnaire was developed in German and later translated into English. Results After analysis using classical test theory and an exploratory factor analysis, four different factors could be extracted. These factors were labelled setting, patient-centeredness, empathy and consulting competencies. Unsuitable items were eliminated within the analysis. All remaining items hold an appropriate degree of selectivity, item difficulty and reliability/consistency. Conclusion A novel questionnaire for evaluating communication skills of physicians was developed. It contains 36 items and is named 'Com-On Questionnaire: Questionnaire for the Evaluation of Physician's Communication Skills in Oncology'. Practice Implications The questionnaire is suitable for measuring both the strengths and deficits within the physician-patient communication in oncology from the patients' perspective.

Introduction: When making medical care more patient-centered, surveys on patients' and their relatives' experiences can be helpful in identifying opportunities for improvement. In cases where the targeted patients are unable to express their own perspective, for example, due to them being too young or suffering from severe impairments, proxies can serve as substitutes. Proxies are frequently used in care planning and consent. Nevertheless, it is unclear whether patients' assessments of how patient-centered their medical care is are similar to those of their proxies. This study aims to assess the level of consistency between patients' and their proxies' assessments using an adapted version of the Patient Assessment of Chronic Illness Care (PACIC) short form questionnaire. Methods: In a cross-sectional study, patients with coronary heart disease were recruited at cardiologists' offices, rehabilitation clinics and hospitals. Participants were surveyed with regard to the perceived level of patient-centeredness during their care using an adapted version of the German PACIC short form (PACIC-S11.1). Correlations in the assessments made by each patient and their respective proxy were analyzed. On the level of the patients group and the relatives group differences between mean ratings for each item were compared using paired t-tests. Results: In total, 74 pairs of patients and proxies submitted the completed questionnaire. On the level of the individual patient/proxy pairs, no correlation, or significant but low correlation, was found between the ratings. On the group level, patients' and their proxies' item ratings were similar in the interpretation of averages, but still demonstrated statistically significant differences. Overall, patients rated their care as more patient-centered than their proxies did. Conclusion: The study shows that, on the individual level, proxies' ratings do not necessarily reflect the patients' assessment of PCC. On the group level, the assessment

Mental disorders (MD) are associated with an increased risk of developing coronary heart disease (CHD) and with higher CHD-related morbidity and mortality. There is a strong recommendation to routinely screen CHD patients for MDs, diagnosis, and treatment by recent guidelines. The current study aimed at mapping CHD patients' (1) state of diagnostics and, if necessary, treatment of MDs, (2) trajectories and detection rate in healthcare, and (3) the influence of MDs and its management on quality of life and patient satisfaction. The design was a cross-sectional study in three settings (two hospitals, two rehabilitation clinics, three cardiology practices). CHD patients were screened for MDs with the Hospital Anxiety and Depression Scale (HADS), and, if screened-positive, examined for MDs with the Structured Clinical Interview for DSM-IV (SCID-I). Quality of Life (EQ-5D), Patient Assessment of Care for Chronic Conditions (PACIC), and previous routine diagnostics and treatment for MDs were examined. Descriptive statistics, Chi-squared tests, and ANOVA were used for analyses. Analyses of the data of 364 patients resulted in 33.8% positive HADS-screenings and 28.0% SCID-I diagnoses. The detection rate of correctly pre-diagnosed MDs was 49.0%. Physicians actively approached approximately thirty percent of patients on MDs; however, only 6.6% of patients underwent psychotherapy and 4.1% medication therapy through psychotherapists/psychiatrists. MD patients scored significantly lower on EQ-5D and the PACIC. The state of diagnostic and treatment of comorbid MDs in patients with CHD is insufficient. Patients showed a positive attitude towards addressing MDs and were satisfied with medical treatment, but less with MD-related advice. Physicians in secondary care need more training inadequately addressing mental comorbidity.