Zusammenfassung
Ziel
Die Behandlung von systemischen Autoimmunerkrankungen wie dem SLE ist aufgrund ihrer Komplexität für alle Beteiligten eine große Herausforderung. Diese Studie geht der Frage nach, ob und wie dafür „shared decision making“ (SDM) gewinnbringend eingesetzt werden kann.
Methode
Zur Beantwortung dieser Fragestellung wurden qualitative Gruppenbefragungen mit Rheumatologen nach der standardisierten Methodik des K&A Psychodramas® durchgeführt. Insgesamt haben 41 deutsche Rheumatologen 2012 und 2013 an 4 Veranstaltungen in 2013 teilgenommen, zu denen GSK Deutschland eingeladen hatte und die von K&A BrandResearch durchgeführt wurden.
Ergebnisse
Allgemein zeigte sich, dass die Rheumatologen wegen ihres breit gefächerten Arbeitsfeldes, der Möglichkeit zu „tüfteln“ und durch das zunehmende Spektrum effektiver Therapien ihr Fach schätzen. Als negativ empfinden sie das zunehmende Arbeitspensum v. a. durch steigende bürokratische Prozesse, aber auch fordernde oder uneinsichtige Patienten. Bei der Behandlung von Indikationen, die klar diagnostizierbar und gut behandelbar sind, gelingt eine Kompensation dieser belastenden Umstände. Anders sieht es bei Indikationen aus, die weder für den Patienten noch für den Arzt ausreichend greifbar sind; und dazu gehört der SLE. Dann steht Angst im Vordergrund der Interaktion, zunächst bei Patientinnen und im Lauf der Behandlung letztlich auch dem Arzt. Dabei finden sich die Medikamente, die bei anderen Erkrankungen als Unterstützung Arzt und/oder Patient zur Seite stehen, als weiterer Angstfaktor zwischen beiden. Die notwendige emotionale Abgrenzung des Arztes wird durch ein Wechseln auf die rein sachliche Ebene erreicht. Eigene Emotionen werden durch das Vermeiden von Empathie abgewehrt.
Schlussfolgerung
Prinzipiell zeigen die Rheumatologen in dieser Studie hervorragende Voraussetzungen für eine partizipative Entscheidungsfindung. Für Krankheiten wie den SLE besteht allerdings auf der Arztseite deutlicher Handlungsbedarf, bevor SDM zum Gewinn für die Betroffenen werden kann.
Abstract
Objective
The treatment of systemic autoimmune diseases, such as systemic lupus erythematosus (SLE) is an enormous challenge for all involved due to the complexity. This study investigated whether shared decision making (SDM) can advantageously be implemented in such a situation.
Method
To answer this question qualitative group surveys were carried out with rheumatologists according to the standardized method of K&P Psychodrama®. A total of 41 German rheumatologists who had been invited by GlaxoSmithKline (GSK) Germany participated in 2 meetings over a complete day in 2012 and 2013 as well as 2 half-day meetings in 2013, which were carried out by K&A BrandResearch.
Results
In general rheumatologists were appreciative of their discipline because of the broadly spread field of work, the possibility to “tinker” and the increasing spectrum of effective forms of therapy. Negative points were the increasing amount of work, particularly due to increasing bureaucratic processes, demanding and unreasonable patients. These stressful situations were compensated by treatment of indications that can easily be diagnosed and treated; however, this is contrasted by indications which are insufficiently palpable for patients and physicians alike and this includes SLE. Fear is at the forefront of the interaction, initially by the patient and during the course of treatment ultimately by the physician. In this context, a further fear factor between both parties is the medications that are available for other diseases as support for physician and patient. The necessary emotional distancing of the physician is achieved by a switch to the purely professional level. Personal emotions are depressed by avoidance of empathy.
Conclusion
The rheumatologists in this study principally showed excellent prerequisites for SDM; however, for illnesses such as SLE there is a clear need for action on the part of physicians before SDM can be advantageous for affected patients.
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M. Schneider erhielt eine Forschungsförderung durch GSK sowie Honorare für Beratung und Vorträge. H. Carnarius und T.M. Schlegl geben an, dass kein Interessenkonflikt besteht.
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U. Müller-Ladner, Bad Nauheim
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Ein Erratum zu diesem Beitrag ist unter http://dx.doi.org/10.1007/s00393-016-0231-y zu finden.
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Schneider, M., Carnarius, H. & Schlegl, T. Partizipative Entscheidungsfindung auch bei komplexen systemischen Autoimmunerkrankungen wie dem systemischen Lupus erythematodes (SLE)?. Z Rheumatol 76, 219–227 (2017). https://doi.org/10.1007/s00393-016-0208-x
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DOI: https://doi.org/10.1007/s00393-016-0208-x