Forschung am Institut für Public Health
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Public Health Forschung
In der Epidemiologie sind Erkrankungen auf Bevölkerungsebene aus den Fachgebieten Niere, Herz-Kreislauf und Neurologie Ausgangspunkt der wissenschaftlichen Forschung am Institut. In der Versorgungsforschung stehen die Systeme und Strukturen der Kranken- und Gesundheitsversorgung im Vordergrund, in der Gesundheitsförderung & Prävention geht es um die Entwicklung und Evaluationen von Programmen zur Gesundheitsförderung und Prävention. Ein wichtiges Forschungsthema am Institut für Public Health ist die alternde Gesellschaft, ein Querschnittsthema, das sowohl Aspekte der Versorgungsforschung, der Prävention, Epidemiologie und Methodik beinhaltet. Im Bereich Versorgungsforschung wird am IPH das BMBF-geförderte Projekt NAVICARE koordiniert, dessen Ziel es unter anderem ist, ein patientenorientiertes Navigation-Modell zu entwickeln, welches die Patienten auf ihrem Weg durch das fragmentierte Versorgungssystem unterstützt.
Die Durchführung unserer Forschung richtet sich nach der Satzung der Charité zur Sicherung Guter Wissenschaftlicher Praxis.
Die Forschungsschwerpunkte des Instituts für Public Health in Berlin
Deciding on breast cancer risk reduction: The role of counseling in individual decisionmaking – A qualitative study
Deciding on breast cancer risk reduction: The role of counseling in individual decisionmaking
– A qualitative study, Patient Educ Couns (2017)
Sarah B. Blakeslee, Worta McCaskill-Stevens, Patricia A. Parkerc, Christine M. Gunn, Hanna Bandos, Therese B. Bevers, Tracy A. Battaglia, Angela Fagerlin, Jacqueline Müller-Nordhorn, Christine Holmberg
Objectives: The presentation of risks and benefits in clinical practice is common particularly in situations in which treatment recommendations involve trade-offs. The treatment of breast cancer risk with selective estrogen receptor modulators (SERMs) is such a decision. We investigated the influence of health care provider (HCP) counseling on women’s decision-making.
Methods: Thirty breast cancer risk counseling sessions were recorded from April 2012–August 2013 at a comprehensive cancer center and at a safety-net, community hospital in the US. Participating women and HCPs were interviewed. A cross-case synthesis was used for analysis.
Results: Of 30 participants 21 received a SERM-recommendation, 11 decided to take SERMs. Counseling impacted decision-making, but did not determine it. Three categories emerged: 1.) ability to change the decision anytime, 2.) perceptions on medications, and 3.) proximity of cancer.
Conclusion: Decision-making under conditions of a risk diagnosis such as increased breast cancer risk is a continuous process in which risk information is transformed into practical and experiential considerations.
Practice implications: Individuals’ health care decision-making is only marginally dependent on the interactions in the clinic. Accepting patients’ experiences and beliefs in their own right and letting them guide the discussion may be important for a satisfying decision-making process.
Exploring Explanatory Models of Risk in Breast Cancer Risk Counseling Discussions
Exploring Explanatory Models of Risk in Breast Cancer Risk Counseling Discussions: NSABP/NRG Oncology Decision-Making Project 1
Gunn CM1, Bokhour B, Parker VA, Parker PA, Blakeslee S, Bandos H, Holmberg C.
Explanatory models represent patient understanding of etiology, pathophysiology, illness, symptoms, and treatments, but little attention has been paid to how they are used by patients "at risk" for future disease.
The aims of this study were to elucidate what constitutes an explanatory model of risk and to describe explanatory models of risk related to developing breast cancer.
Thirty qualitative interviews with women identified as at an increased risk for breast cancer were conducted. Interviews were coded to identify domains of explanatory models of risk using a priori codes derived from the explanatory model of illness framework. Within each domain, a grounded thematic analysis described participants' explanatory models related to breast cancer risk.
The domains of treatment and etiology remained similar in a risk context compared with illness, whereas course of illness, symptoms, and pathophysiology differed. We identified a new, integrative concept relative to other domains within explanatory models of risk: social comparisons, which was dominant in risk perhaps due to the lack of physical experiences associated with being "at risk."
Developing inclusive understandings of risk and its treatment is key to developing a framework for the care of high-risk patients that is both evidence based and sensitive to patient preferences.
IMPLICATIONS FOR PRACTICE:
The concept of "social comparisons" can assist healthcare providers in understanding women's decision making under conditions of risk. Ensuring that healthcare providers understand patient perceptions of risk is important because it relates to patient decision making, particularly due to an increasing focus on risk assessment in cancer.
The politics of vaccination A global history
"Politics of Vaccination. A global history"
Christine Holmberg, senior researcher at the Institute of Public Health, together with Paul Greenough from the University of Iowa, and Stuart Blume, University of Amsterdam.
In this book scholars from around the globe analyse vaccination in relation to state power, concepts of national identity and solidarity, and of individuals' obligations to self and others. The essays provide a comparative overview of vaccination policies at different times, in widely different places, and under different types of political regime. Authors explore relationships between vaccination policies and vaccine-making, and the discourses and debates on citizenship and nationhood that have often accompanied mass campaigns. The analysis unmasks the idea of vaccination as a simple health technology, and makes visible the complexities in which vaccination is embedded.
The book provides a comprehensive overview of global vaccination politics, immunisation is analyzed and characterized in its political dimension in forming (or weakening ) nation-states. It is a truly global history, including scholars and cases not only from "the West", but also from such countries as Brazil, South Korea, and Mexico. The book suggests immunisation is a novel historical lens through which to view changes in 'society' and 'nation' over time.
Physician cooperation in outpatient cancer care
Physician cooperation in outpatient cancer care. An amplified secondary analysis of qualitative interview data
J. Engler, C. Güthlin, A. Dahlhaus, E. Kojima, J. Müller-Nordhorn, L. Weißbach, C. Holmberg
Objectives The importance of outpatient cancer care services is increasing due to the growing number of patients having or having had cancer. However, little is known about cooperation among physicians in outpatient settings. To understand what inter- and multidisciplinary care means in community settings, we conducted an amplified secondary analysis that combined qualitative interview data with 42 general practitioners (GPs), 21 oncologists and 21 urologists that mainly worked in medical practices in Germany.
Conclusions Our results indicate that all participants regarded cooperation as a prerequisite for good cancer care. Oncologists and urologists mainly reported cooperating for tumour-specific treatment tasks, while GPs' reasoning for cooperation was more patient-centred. While oncologists and urologists reported experiencing reciprocal communication with other physicians, GPs had to gather the information they needed. GPs seldom reported engaging in formal cooperation structures, while for specialists, participation in formal spaces of cooperation, such as tumour boards, facilitated a more frequent and informal discussion of patients, for instance on the phone.
Laufende Projekte (Auswahl)
Abgeschlossene Projekte (Auswahl)
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|Berufsprofil und Arbeitsfelder der Diätassistentinnen und Diätassistenten in Deutschland||Versorgungsforschung|
|Sozialpolitische Entwicklungen und die Einführung neuer medizinischer Praktiken||Wissenschaftssforschung|
|Medizinische Versorgung von Menschen ohne legalen Aufenthaltsstatus in Berlin. Eine Befragung von Ärzt/innen in Berlin||Versorgungsforschung|
|Evaluation des Projektes "Unsere Kommune ist demenzfreundlich"||Versorgungsforschung|
|Evaluation des Projektes "Menschen mit Demenz in der Kommune - Achtsamkeit und seelsorgerische Begleitung für Menschen mit Demenz"||Versorgungsforschung|
|Gesundheitsförderung durch Empowerment von Frauen im Setting Stadtteil – Evaluation des Projekts Stadtteilmütter in Berlin-Kreuzberg||Versorgungsforschung|
|Biobanks and the communication of risk knowledge: Interventions by researchers, practioners and artists||Wissenschaftsforschung|
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