GESCO
Funded by the Federal Ministry of Health (BMG)
Project overview
The project is researching the development and piloting of a gender-sensitive care concept for patients with chronic non-tumour-related pain undergoing long-term opiate therapy.
GESCO is part of the Gender-specific characteristics in health care, prevention and health promotion programme, a funding priority of the Federal Ministry of Health.
GESCO stands for the development and piloting of a gender-sensitive care concept for patients with chronic non-tumour-related pain under long-term opiate therapy. To achieve this goal, the project consists of four phases:
1) Research & analysis of the current study situation, especially with regard to different genders.
Among other things, gender aspects have an influence on the perception of pain, how pain is dealt with and how pain is described.
The gender of the GP treating the patient and that of the patient receiving care also plays a role in communication and thus also in medical treatment.
In order to process relevant current research results for the GESCO project and the development of the care concept (intervention), a systematic literature review will be carried out in the first project phase.
2) Development of the care concept (intervention) together with GPs, patients and other experts.
Various methods will be used to develop the gender-sensitive care concept within the 2nd project phase:
- Expert workshops with researchers and teachers from research areas relevant to the project (including systemic family therapy and health-orientated dialogue)
- Interviews with self-affected pain patients
- Focus groups with GPs who have experience in the care of patients with chronic non-tumour-related pain
- Development and testing of the care concept (intervention) with GPs
3) Testing of the care concept (intervention) in 10 GP practices with at least 4 patients each (so-called pilot study).
In the course of testing the treatment concept, 10 GPs from different GP practices will each receive two half-day training sessions. It is planned that the GPs will conduct two intervention interviews with each of the 4 patients they have recruited in the practices at the beginning and after 6-8 weeks.
The GPs and patients will be recruited with a balanced distribution of gender and region of the practice (urban/rural). The treatment concept will be tested in a target group of adult patients (≥18 years) with chronic non-tumour-related pain who have been receiving opioid painkillers for at least three months.
In order to measure the effect of the new treatment concept, the pain-associated impairment in everyday life, which is measured per patient using the Pain Disability Index (PDI) before and after the intervention, is used. After completing the testing of the intervention with the patients, all participating GPs will be asked about its feasibility in a telephone interview. In addition, the GPs will be invited to a joint focus group discussion to analyse their experiences in more detail and identify possible areas for adaptation. The patients will be contacted by telephone and asked to report on their experiences with the treatment concept and possible needs for adaptation.
4) Consolidation of all results and dissemination via various channels with the help of all those involved in the project.
The aim is to develop a care concept that can be used in practice and meets the needs of patients and GPs.
All results developed in the project should be processed and communicated with the participation of all project partners and all GPs and patients involved. The results should also be usable for other fields of treatment.
What does gender-sensitive mean?
With what understanding of gender do we approach the topic as a research group?
As a project team, we orientate ourselves on scientifically published definitions, such as the guidelines of the European Commission or SAGER (1-5).
In English, two different terms are used for sex: sex and gender. In German, these are translated as biological and social sex.
Biological sex (sex) is generally operationalised by biological markers such as primary and secondary sex organs, chromosomes and hormone concentrations (2,3). Biological sex is usually categorised as female, male or intersex. At the same time, a continuum can be assumed in the way in which biological characteristics are expressed (1).
Social gender refers to people's socially constructed gender roles, gender identities and relationships. In reality, there is a spectrum of gender identities with which people identify and express themselves (1). Gender is multidimensional and complex and changes as social norms and values change (4). Social gender also intersects with other socio-cultural categories (e.g. socio-economic position) (3).
Sources:
- Heidari, Shirin; Babor, Thomas F.; Castro, Paola de; Tort, Sera; Curno, Mirjam (2016): Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use. In: Research integrity and peer review 1, p. 2. DOI: 10.1186/s41073-016-0007-6.
- European Commission. Directorate General for Research and Innovation. In Horizon Europe Guidance on Gender Equality Plans; Publications Office: Luxembourg, 2021.
- Horstmann, Sophie; Schmechel, Corinna; Palm, Kerstin; Oertelt-Prigione, Sabine; Bolte, Gabriele (2022): The Operationalisation of Sex and Gender in Quantitative Health-Related Research: A Scoping Review. In: International journal of environmental research and public health 19 (12). DOI: 10.3390/ijerph19127493.
- Nielsen, Mathias W.; Stefanick, Marcia L.; Peragine, Diana; Neilands, Torsten B.; Ioannidis, John P. A.; Pilote, Louise et al. (2021): Gender-related variables for health research. In: Biology of sex differences 12 (1), p. 23. DOI: 10.1186/s13293-021-00366-3.
- Kindler-Röhrborn, Andrea; Pfleiderer, Bettina (2012): Gender medicine - buzzword or necessity? - The role of gender in medicine. In: XX 1 (03), pp. 146-152. DOI: 10.1055/s-0032-1316277.
What do we mean by a gender-sensitive intervention?
Studies have shown that biological sex (sex) and social gender (gender) have an influence on health and illness.
This influence is expressed, among other things, in disposition, frequency of illness, coping strategies and course of therapy. The biological and social gender of the patient on the one hand and that of the healthcare professional on the other can influence the care process (1). Taking gender into account is therefore relevant for medical care in order to ensure adequate treatment.
By gender-sensitive intervention, we mean the consideration of biological and social aspects of gender in the therapeutic process.
Sources:
- Kindler-Röhrborn, Andrea; Pfleiderer, Bettina (2012): Gender medicine - buzzword or necessity? - The role of gender in medicine. In: XX 1 (03), pp. 146-152. DOI: 10.1055/s-0032-1316277.
Our goal - What is it all about?
The aim of the project is to develop and test a new health-promoting, gender-sensitive care concept to improve the care of patients with chronic pain on long-term opioid therapy in GP practices without cancer. We want to achieve this goal together with patients, GPs and other researchers from related fields.
Germany is one of the countries in the world with the highest per capita consumption of opioids (very strong painkillers) among patients with chronic, non-tumour-related pain. Analyses of health insurance data show that these patients receive inadequate care, especially if they have other, primarily mental illnesses in addition to pain. The current guideline on the treatment of pain patients with opioids recommends that doctors critically examine the use of opioids in patients and make better use of alternatives.
Possible differences between men and women should also be taken into account when treating pain patients. This includes, for example, how medication is processed in the body, how pain is perceived and how pain is dealt with. In addition to gender, this may also be influenced by other personal circumstances (e.g. cultural background, family circumstances). In order to reduce the misuse of opioids, there is therefore a need to develop treatment concepts that take gender into account and can be adapted to different patients and their individual needs. The development and testing of such a concept is the aim of the GESCO project.
Further information
- Duration: 04/2022 - 03/2025
- Funding: Federal Ministry of Health (BMG)
- Responsible: Institute of General Practice and Primary Care and the Chair of Clinical Pharmacology at Witten/Herdecke University and IT Services Applications Science & Laboratory, MHH Information Technology at Hannover Medical School.
- Co-operation partners: This is a joint project with the MHH Hannover.
- Contact: Alexandra Schmidt (02302 / 926 7373)
- Further information on GESCO
Participation - researching together
It is planned to include the perspective of patients, GPs and other researchers in each project phase. To this end, strategies for participation will be designed, discussed and their practicability evaluated. Participation is intended to ensure that the new care concept is appropriate and practical.
The participation concept itself will be planned and implemented taking into account the wishes and needs of the patients, GPs, other researchers and researchers involved in the project. A joint workshop on participation planning was held for this purpose.
Workshop on participation planning (Photo: IAMAG)
Alexandra Schmidt
Researcher
Faculty of Health (School of Medicine) | Institute for General Practice and Outpatient Healthcare (iamag)
Alfred-Herrhausen-Straße 48
58455 WittenRoom number: NB-2.037
Michaela Maas
Study assistance
Faculty of Health (School of Medicine) | Chair of General Medicine I and Interprofessional Care
Alfred-Herrhausen-Straße 50
58455 WittenRoom number: 2.037
Alexandra Piotrowski
Researcher
Faculty of Health (School of Medicine) | Institute for General Practice and Outpatient Healthcare (iamag)
Alfred-Herrhausen-Straße 50
58455 Witten
Contact for scientific enquiries
Prof. Dr med.
Achim Mortsiefer
Chair holder
Faculty of Health (School of Medicine) | Chair of General Medicine II and Patient Orientation in Primary Care
Alfred-Herrhausen-Straße 50
58455 Witten
Room number: NB-2.038.2
Orcid ID: 0000-0001-9901-1727
Publications
Publications
- Kersting, C., Just, J., Piotrowski, A., Schmidt, A., Kufeld, N., Bisplinghoff, R., Maas, M., Bencheva, V., Preuß, J., Wiese, B., Weckbecker, K., Mortsiefer, A., Thürmann, P. A., & on behalf of the GESCO study group. (2024). Development and feasibility of a sex- and gender-sensitive primary care intervention for patients with chronic non-cancer pain receiving long-term opioid therapy (GESCO): a study protocol. Pilot and Feasibility Studies, 10(1). https://doi.org/10.1186/s40814-024-01564-7
- Piotrowski (2024) Feasibility of a GP intervention for gender-sensitive pain therapy (GESCO project) - a realist evaluation
23rd German Congress for Health Care Research (DKVF). Potsdam, 25-27 September 2024. Düsseldorf: German Medical Science GMS Publishing House; 2024. Doc24dkvf295
DOI: 10.3205/24dkvf295 - Schmidt (2024) Intervention for gender-sensitive pain therapy in GP practices - a feasibility study (GESCO)
German Society for General Practice and Family Medicine. 58th Congress of General Practice and Family Medicine. Würzburg, 26-28 September 2024. Düsseldorf: German Medical Science GMS Publishing House; 2024. DocP-04-04
DOI: 10.3205/24degam194 - Piotrowski A, Schmidt A, Just J, Kufeld N, Bencheva V, Preuß J, Maas M, Wiese B, Tönnies L, Weckbecker K, Thürmann P, Mortsiefer A. Development of gender-sensitive care for patients with chronic non-tumour-related pain - participatory development of an impact model in the GESCO project. 22nd German Congress for Health Care Research. German Medical Science Publishing House 2023, DOI: https: //dx.doi.org/10.3205/23dkvf097
- Schmidt A, Piotrowski A, Just J, Kufeld N, Bencheva V, Preuß J, Maas M, Kersting C, Wiese B, Lauf U, Klee U, Scholz B, Weckbecker K, Thürmann P, Mortsiefer A. What do patients with chronic non-tumour-related pain want from primary care? A qualitative needs analysis in the GESCO project. 57th Congress of General Practice and Family Medicine. German Medical Science GMS Publishing House 2023,
DOI: https://dx.doi.org/10.3205/23degam171 - Piotrowski A, Schmidt A, Just J, Bencheva V, Preuß J, Maas M, Kersting C, Wiese B, Lauf U, Klee U, Kufeld N, Scholz B, Weckbecker K, Thürmann P, Mortsiefer A. What needs do general practitioners express regarding the care of patients with chronic non-tumour-related pain? A qualitative needs analysis in the GESCO project. 57th Congress of General Practice and Family Medicine. German Medical Science GMS Publishing House 2023,
DOI: https://dx.doi.org/10.3205/23degam162 - Schmidt A, Duck M, Just J, Kufeld N, Bisplinghoff R, Bencheva V, Preuß J, Maas M, Kersting C, Wiese B, Weckbecker K, Thürmann P, Mortsiefer A. Development and piloting of an intervention to improve gender-sensitive primary medical care for chronic non-tumour pain patients on long-term opioid therapy: study protocol for the GESCO model project. 56th Congress of General Practice and Family Medicine. German Medical Science GMS Publishing House 2022,
DOI: https://dx.doi.org/10.3205/22degam160 - Schmidt A, Duck M, Just J, Kufeld N, Bisplinghoff R, Bencheva V, Preuß J, Maas M, Kersting C, Wiese B, Weckbecker K, Thürmann P, Mortsiefer A. Development and piloting of an intervention to improve gender-sensitive primary medical care for chronic non-tumour pain patients on long-term opioid therapy: study protocol for the GESCO model project. 21st German Congress for Health Care Research. German Medical Science Publishing House 2022,
DOI: dx.doi.org/10.3205/22dkvf357