gms | German Medical Science

In oncology as well as in other fields of medicine, the term “patient competence” is frequently used to refer to either patients’ wishes for or their actual participation in medical treatment decision making. Viewed from a psychological perspective, however, it appears to be more straightforward to conceptualise “patient competence” as a specific ability. With respect to oncology, then, “patient competence” can be defined as a patient’s ability to handle the tasks and distress that derive from a life-threatening illness and its treatment, thereby being guided by personal needs and goals and making use of resources provided by either significant others or the health care system as a whole. Viewed that way, “patient competence” bears conceptual relations to constructs like “sense of coherence”, “dispositional optimism” or “self-efficacy” that are assumed to have beneficial effects on health outcomes. Potential effects of “patient competence” on health, however, can only be studied empirically, if measures of “patient competence” are available. Therefore, the Tumor Biology Centre, Freiburg i.Br., developed a questionnaire measure of “patient competence” with respect to the field of oncology and tested its factorial structure and its reliability in a multi-centre-study. 536 cancer patients rated the degree to which each of 140 statements describing behaviours, thoughts, or feelings concerning their disease applied to them; these statements had been judged before to be valid indicators of “patient competence” in two exploratory studies. In addition, participants were asked to provide information on demographic and medical data. Factor analyses favoured a 5-factor-solution distinguishing between the following dimensions of “patient competence”: “Seeking information on diagnosis and treatment”, “Being assertive interacting with physicians”, “Efforts to decide autonomously”, “Self-regulation with respect to social relationships and physical well-being”, and “Seeking information on support from social services”. Scales based on these results show satisfactory reliability (Cronbach-alphas between .76 and .83). At present, we are developing a shorter version of the questionnaire that will be tested for validity and reliability in another multi-centre-study. If these receive further support, the questionnaire may be used in additional studies addressing health effects of “patient competence” as well as means of developing “patient competence”.