1
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Donath C, Ostgathe C, Heckel M. Dementia patients in palliative care according to data from the German National Hospice and Palliative Care Register (2009-2021). BMC Palliat Care 2024; 23:185. [PMID: 39054518 PMCID: PMC11271063 DOI: 10.1186/s12904-024-01509-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND People with dementia are less in focus of palliative care research than other patient groups even though the awareness of their palliative and end-of-life care needs is rising. Empirical data analyses on people with dementia in palliative care services are lacking. AIM To explore the prevalence of dementia diagnoses as per the ICD criteria among users of various palliative care settings and to compare use of palliative services, care pathways, and outcomes in people with and without a dementia diagnosis. DESIGN We conducted retrospective analysis of dementia diagnoses as per ICD (F00-F03/G30) in the German National Hospice and Palliative Care Register between 2009 and 2021. The analysis used methods of descriptive and inferential statistics, including the Bonferroni correction for alpha error inflation. SETTING/PARTICIPANTS We limited the analysis to the subsample of people aged over 64. RESULTS The prevalence of dementia in the different settings of palliative care was lower than in the age-comparable population: Of the 69,116 data sets included in the analysis, a small minority (3.3%) was coded with dementia as the principal diagnosis. Among patients on inpatient palliative care wards, 0.8% (148 of 19,161) had a dementia diagnosis, as did 2.2% (52 of 2,380) of those under hospital palliative care support teams and 4.3% (2,014 of 46,803) of those receiving specialized palliative care at home. CONCLUSIONS The records of the German National Hospice and Palliative Care Register suggest that the prevalence of dementia is lower than one might expect from general population data, though numbers are in line with international studies on proportion of dementia patients receiving palliative care. Future research could usefully examine whether this discrepancy stems either from omissions in coding dementia as patients' principal diagnosis respectively from lapses in documentation of a dementia diagnosis previously made, or from barriers to accessing palliative care services or even displays being excluded from palliative care when trying to access it. TRIAL REGISTRATION No registration.
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Affiliation(s)
- Carolin Donath
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine & Comprehensive Cancer Center, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Maria Heckel
- Department of Palliative Medicine & Comprehensive Cancer Center, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
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Eichenauer DA, Heger JM, Kruschel I, Kutsch N, Gödel P, Garcia Borrega J, Schnetzke U, Böll B, Neumann MAC, Gebel C, Pralong A, Borchmann P, Voltz R, Wedding U, Simon ST. Specialized palliative care in patients with haematological malignancies receiving chimeric antigen receptor T-cell therapy. Br J Haematol 2024; 205:343-346. [PMID: 38522848 DOI: 10.1111/bjh.19434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Dennis A Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
| | - Jan-Michel Heger
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
- Mildred Scheel School of Oncology Aachen Bonn Cologne Dusseldorf (MSSO ABCD), Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Isabel Kruschel
- Department of Palliative Care, University Hospital Jena, Jena, Germany
| | - Nadine Kutsch
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
| | - Philipp Gödel
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
| | - Jorge Garcia Borrega
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
| | - Ulf Schnetzke
- Department of Internal Medicine II, University Hospital Jena, Jena, Germany
| | - Boris Böll
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
| | - Marie Anne-Catherine Neumann
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
| | - Cordula Gebel
- Department of Palliative Care, University Hospital Jena, Jena, Germany
| | - Anne Pralong
- Department of Palliative Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Peter Borchmann
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ulrich Wedding
- Department of Palliative Care, University Hospital Jena, Jena, Germany
| | - Steffen T Simon
- Department of Palliative Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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3
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Fink M, Müller S, Warnecke E, Hense J, Schuler M, Teufel M, Comino MRS, Tewes M. Relevance of Patient-Reported Outcome Measures in Patients with Cancer: Detection of Underrated Psychological Distress of Palliative Care Patients in an Outpatient Setting. Palliat Med Rep 2024; 5:194-200. [PMID: 39050775 PMCID: PMC11265614 DOI: 10.1089/pmr.2023.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 07/27/2024] Open
Abstract
Background The overall level of physical and psychological symptom burden of advanced cancer patients (ACP) in an outpatient setting is notoriously difficult to assess. Therefore, more efficient and objective assessment is needed to accomplish this important task. Objectives The aim of this study was to compare the physical and psychological symptom burden rated by palliative care nurse (PCN) versus patient's self-rating. Design This retrospective German cohort study analyzed symptom burden using an electronic patient-reported outcome measure (ePROM). After referral to an outpatient specialized palliative care team, a PCN assessed the patient's symptoms both up to three months before initial presentation (IP) and at IP.Group differences were identified using analyses of variance (ANOVA). Further descriptive analysis of patient characteristics was used. Subjects The study enrolled 164 ACP who were referred to a specialized palliative care (SPC) team. Mean age was 62 (± 12.6) years. Gastrointestinal (n = 46; 28.0%), lung (n = 32; 19.5%), and breast cancer (n = 34; 20.7%) were the most common entities. Results Most frequent reasons for referral were pain (n = 55; 33.5%) and social care problems (n = 36; 22.0%). Patients reported significantly higher grades on depression (n = 144; Z = -2.8, p = 0.005), anxiety (n = 144; Z = -2.376, p = 0.018), and worsened general condition (n = 139; Z = -7.005, p < 0.001). Conclusion ACP in an outpatient setting were more frequently referred to SPC for pain management and assistance with social problems with regard to the cancer and its limitations. Psychological distress was underrated by the PCN in comparison with patient self-reporting through ePROM. This underlines the importance of self-reported outcome measurement.
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Affiliation(s)
- Madeleine Fink
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Psycho-Oncology, West German Cancer Center, National Center for Tumor Diseases (NCT), Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Sandy Müller
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Eva Warnecke
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jörg Hense
- Department of Medical Oncology, West German Cancer Center Essen, University Hospital Essen, Essen, Germany
- National Center for Tumor Diseases (NCT) West, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center Essen, University Hospital Essen, Essen, Germany
- National Center for Tumor Diseases (NCT) West, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Psycho-Oncology, West German Cancer Center, National Center for Tumor Diseases (NCT), Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Maria Rosa Salvador Comino
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Mitra Tewes
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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4
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Berendt J, Brunner S, Heckel M, Tewes M, Ostgathe C, Gahr S. Symptom burden and relief in palliative care units of German Comprehensive Cancer Center and other hospitals. J Cancer Res Clin Oncol 2024; 150:160. [PMID: 38532121 PMCID: PMC10965705 DOI: 10.1007/s00432-023-05557-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/27/2023] [Indexed: 03/28/2024]
Abstract
PURPOSE The National Hospice and Palliative Registry contains patient data from German hospice and palliative care facilities about symptoms. The aim of the study at hand is to differentiate symptom burden of patients in palliative care units between Comprehensive Cancer Center (CCC) and other hospitals regarding symptom burden and relief of patients in palliative care units. METHODS The registry analysis provided data of patients in palliative care units (2014-2018). We analyzed characteristic and symptom-related data on 18 symptoms, with considerable symptom-burdened patients (moderate or severe). We followed a cancer (yes/no) and facility-specific descriptive analysis (f, %, μ, Mdn, SD, V, r) using SPSS. RESULTS We evaluated 10,447 patient records (CCC: 4234 pts/non CCC 6,213 pts), 82% with a cancer diagnosis. For cancer patients, the mean age in CCC-affiliated palliative care units was 68 (SD 19-99) years, in others 73 (SD 23-104) years (p < 0.05; V = 0.2). The proportion of patients with significant symptom burden is lower in CCC-affiliated than in other palliative care units. The difference between facilities shows a significant weak effect in pain, vomiting and constipation, depressiveness, anxiety, and tension. The proportion of cases which symptom burden could be alleviated is higher in CCC-affiliated palliative care units with significant weak/medium effect in pain, nausea, vomiting, shortness of breath, constipation, wound care problems, depressiveness, anxiety, tension, confusion, and problems in organizing care. CONCLUSION We found differences in symptom burden and symptom relief between CCC-affiliated and other palliative care units. CCCs should continue to feel responsible for sharing knowledge about symptom relief, such as through standard operating procedures and education.
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Affiliation(s)
- Julia Berendt
- Department of Palliative Medicine and Comprehensive Cancer Center, CCC Erlangen-EMN, University Hospital Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
| | - Sarah Brunner
- Department of Palliative Medicine and Comprehensive Cancer Center, CCC Erlangen-EMN, University Hospital Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
- Medical Informatics and Communication Center and Comprehensive Cancer Center, CCC Erlangen-EMN, University Hospital Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Maria Heckel
- Department of Palliative Medicine and Comprehensive Cancer Center, CCC Erlangen-EMN, University Hospital Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Mitra Tewes
- Department of Palliative Medicine, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine and Comprehensive Cancer Center, CCC Erlangen-EMN, University Hospital Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Susanne Gahr
- Department of Palliative Medicine and Comprehensive Cancer Center, CCC Erlangen-EMN, University Hospital Erlangen Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
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Mochamat M, Przyborek M, Jaspers B, Cuhls H, Conrad R, Mücke M, Radbruch L. Development of Care Pathway for Assessment and Treatment of Fatigue in Palliative Care. Indian J Palliat Care 2023; 29:256-265. [PMID: 37700894 PMCID: PMC10493685 DOI: 10.25259/ijpc_194_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/15/2022] [Indexed: 01/13/2023] Open
Abstract
Objectives Fatigue is a frequent and burdensome symptom in patients with advanced disease in palliative care. However, it is under-assessed and undertreated in clinical practice, even though many treatment options have been identified in systematic reviews. Care pathways with defined and standardised steps have been recommended for effective management in the clinical setting. This paper describes a care pathway for managing fatigue in palliative care patients. This study aims to develop a care pathway with detailed guidance for screening, assessment, diagnosis, and treatment of fatigue in palliative care patients. Material and methods A collaborative effort of multidisciplinary clinicians participated in constructing the care pathway. The care pathway was developed using the following steps: (a) Developing an intervention; (b) piloting and feasibility; (c) evaluating the intervention; (d) reporting; and (e) implementation. This paper covers the first step, which includes the evidence base identification, theory identification/development, and process/outcomes modeling. A literature search was conducted to understand the extent of the fatigue problem in the palliative care setting and identify existing guidelines and strategies for managing fatigue. Consistent recommendations emanating from the included papers were then contributed to a care pathway. Patient representatives and palliative care professionals provided feedback on the draft. Results The care pathway address the following care processes: (1) Screening for the presence of fatigue; (2) assessment to evaluate the severity of fatigue; (3) diagnostic procedure, including history, physical examination, and laboratory finding; (4) therapeutic management pathway for clinical decision-making; and (5) valuation of treatment effect, using questionnaires, diaries and physical activity monitoring with body-worn sensors. Conclusion The development of a care pathway will help to implement regular and structured assessment, diagnosis, and treatment of fatigue for healthcare professionals treating palliative care patients. Reviewing the pathway with a multidisciplinary expert group and field testing the pathway will be the next steps toward implementation.
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Affiliation(s)
- Mochamat Mochamat
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Diponegoro University Semarang, Indonesia, Germany
- Dr. Kariadi General Hospital, Semarang, Indonesia, Germany
| | - Marta Przyborek
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
| | - Birgit Jaspers
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
| | - Henning Cuhls
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Aachen, Germany
| | - Martin Mücke
- Department of Digitalization and General Practice, RWTH Aachen, Aachen, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
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6
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Gahr S, Brunner S, Heckel M, Ostgathe C. Gibt es entitätsspezifische Kriterien für den Beginn der spezialisierten Palliativversorgung für nicht heilbare Krebserkrankungen? Ein Scoping Review. ZEITSCHRIFT FÜR PALLIATIVMEDIZIN 2023. [DOI: 10.1055/a-2054-1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Zusammenfassung
Hintergrund/Ziel Patienten mit nicht heilbaren Krebserkrankungen eine spezialisierte Palliativversorgung zum richtigen Zeitpunkt anzubieten, stellt eine Herausforderung dar. Ziel des Scoping Reviews war, geeignete entitätsspezifische Kriterien zu finden.
Methode Im Februar 2020 wurde in den Online-Datenbanken PubMed und Scopus ein Scoping Review durchgeführt. Ziel der Literatursuche war die Identifikation von englisch- und deutschsprachigen Originalarbeiten, die zwischen 2009 und Februar 2020 veröffentlicht wurden und Hinweise darauf geben, welche entitätsspezifischen und entitätsunabhängigen Kriterien nicht heilbarer Krebserkrankungen herangezogen werden, um betroffene Patienten zeitgerecht in die spezialisierte Palliativversorgung zu integrieren. Insgesamt wurden 13 relevante Artikel identifiziert. Der Methode des Scoping Reviews entsprechend, wurde auf eine formale Bewertung der methodischen Qualität der eingeschlossenen Literatur verzichtet.
Ergebnisse Unter den relevanten Publikationen waren 6 Reviews und 7 Originalarbeiten. In keiner der analysierten Publikationen wurden explizit charakteristische Kriterien zu spezifischen Krebsentitäten angeführt. Für die Integration in eine spezialisierte Palliativversorgung wurden unabhängig der Krebsentität als Kriterien Unheilbarkeit/fortgeschrittenes Tumorleiden, Lebensqualität, belastende Symptome, ECOG-Status, psychosoziale Bedürfnisse, Komorbiditäten, tumorassoziierte Komplikationen, Behandlungsentscheidung/keine Behandlungsmöglichkeiten und begrenzte Lebenszeitprognose herangezogen oder vorgeschlagen. Die Erhebung der Kriterien erfolgte mittels Instrumenten, für die keine konkreten Kennwerte angegeben waren, die eine zur Einbindung in spezialisierte Palliativversorgung relevante Ausprägung der Kriterien detektieren könnten.
Schlussfolgerung Für den Zeitpunkt einer zeitgerechten Integration der spezialisierten Palliativversorgung bei nicht heilbaren Krebserkrankungen gibt es bislang keine entitätsspezifischen Kriterien und Kennwerte. Aus der Analyse lässt sich jedoch ableiten, dass entitätsunabhängig alle Patienten mit einer nicht heilbaren bzw. fortgeschrittenen Krebserkrankung, die unter Verminderung/Verlust ihrer Lebensqualität und einer komplexen Symptomlast, v.a. Depressionen und Schmerzen leiden, das Angebot einer spezialisierten Palliativversorgung erhalten sollten. Kriterien generell als Kennwerte festzulegen und konsekutiv einen Messwert bzw. Cut-off-Wert zu definieren, könnte eine Möglichkeit sein, über z.B. ein Scoringsystem eine zeitgerechte Integration der Palliativmedizin zu erleichtern. Unklar ist bislang, welche Kombinationen von Erhebungsinstrumenten oder Screeningtools der Erfassung einer zeitgerechten Integration dienen könnten.
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Affiliation(s)
- Susanne Gahr
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN-Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Sarah Brunner
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN-Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
- Medizinisches Zentrum für Informations- und Kommunikationstechnik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Maria Heckel
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN-Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Christoph Ostgathe
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Comprehensive Cancer Center EMN-Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
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7
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Müller S, Fink M, Hense J, Comino MRS, Schuler M, Teufel M, Tewes M. Palliative care outpatients in a German comprehensive cancer center-identifying indicators for early and late referral. BMC Palliat Care 2022; 21:221. [PMID: 36503625 PMCID: PMC9743520 DOI: 10.1186/s12904-022-01114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Despite that early integration of palliative care is recommended in advanced cancer patients, referrals to outpatient specialised palliative care (SPC) frequently occur late. Well-defined referral criteria are still missing. We analysed indicators associated with early (ER) and late referral (LR) to SPC of an high volume outpatient unit of a comprehensive cancer center. METHODS Characteristics, laboratory parameters and symptom burden of 281 patients at first SPC referral were analysed. Timing of referral was categorized as early, intermediate and late (> 12, 3-12 and < 3 months before death). Ordinal logistic regression analysis was used to identify factors related to referral timing. Kruskal-Wallis test was used to determine symptom severity and laboratory parameter in each referral category. RESULTS LRs (50.7%) had worse scores of weakness, loss of appetite, drowsiness, assistance of daily living (all p < 0.001) and organisation of care (p < 0.01) in contrast to ERs. The mean symptom sum score was significantly higher in LRs than ERs (13.03 vs. 16.08; p < 0.01). Parameters indicative of poor prognosis, such as elevated LDH, CRP and neutrophil-to-lymphocyte ratio (NLR) (p < 0.01) as well as the presence of ascites (p < 0.05), were significantly higher (all p < 0.001) in LRs. In univariable analyses, psychological distress (p < 0.05) and female gender (p < 0.05) were independently associated with an ER. CONCLUSION A symptom sum score and parameters of poor prognosis like NLR or LDH might be useful to integrate into palliative care screening tools.
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Affiliation(s)
- S. Müller
- grid.410718.b0000 0001 0262 7331Department of Palliative Medicine, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany
| | - M. Fink
- grid.5718.b0000 0001 2187 5445Clinic of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147 Essen, Germany
| | - J. Hense
- grid.410718.b0000 0001 0262 7331Department of Medical Oncology, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany
| | - M. R. Salvador Comino
- grid.410718.b0000 0001 0262 7331Department of Palliative Medicine, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany
| | - M. Schuler
- grid.410718.b0000 0001 0262 7331Department of Medical Oncology, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany ,grid.410718.b0000 0001 0262 7331German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147 Essen, Germany
| | - M. Teufel
- grid.5718.b0000 0001 2187 5445Clinic of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147 Essen, Germany
| | - M. Tewes
- grid.410718.b0000 0001 0262 7331Department of Palliative Medicine, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany
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8
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Haas O, Lopera Gonzalez LI, Hofmann S, Ostgathe C, Maier A, Rothgang E, Amft O, Steigleder T. Predicting Anxiety in Routine Palliative Care Using Bayesian-Inspired Association Rule Mining. Front Digit Health 2021; 3:724049. [PMID: 34713190 PMCID: PMC8521932 DOI: 10.3389/fdgth.2021.724049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
We propose a novel knowledge extraction method based on Bayesian-inspired association rule mining to classify anxiety in heterogeneous, routinely collected data from 9,924 palliative patients. The method extracts association rules mined using lift and local support as selection criteria. The extracted rules are used to assess the maximum evidence supporting and rejecting anxiety for each patient in the test set. We evaluated the predictive accuracy by calculating the area under the receiver operating characteristic curve (AUC). The evaluation produced an AUC of 0.89 and a set of 55 atomic rules with one item in the premise and the conclusion, respectively. The selected rules include variables like pain, nausea, and various medications. Our method outperforms the previous state of the art (AUC = 0.72). We analyzed the relevance and novelty of the mined rules. Palliative experts were asked about the correlation between variables in the data set and anxiety. By comparing expert answers with the retrieved rules, we grouped rules into expected and unexpected ones and found several rules for which experts' opinions and the data-backed rules differ, most notably with the patients' sex. The proposed method offers a novel way to predict anxiety in palliative settings using routinely collected data with an explainable and effective model based on Bayesian-inspired association rule mining. The extracted rules give further insight into potential knowledge gaps in the palliative care field.
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Affiliation(s)
- Oliver Haas
- Department of Industrial Engineering and Health, Institute of Medical Engineering, Technical University Amberg-Weiden, Weiden, Germany.,Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander University, Erlangen-Nürnberg, Germany
| | | | - Sonja Hofmann
- Department of Palliative Medicine, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander University, Erlangen-Nürnberg, Germany
| | - Eva Rothgang
- Department of Industrial Engineering and Health, Institute of Medical Engineering, Technical University Amberg-Weiden, Weiden, Germany
| | - Oliver Amft
- Chair of Digital Health, Friedrich-Alexander University, Erlangen-Nürnberg, Germany
| | - Tobias Steigleder
- Department of Palliative Medicine, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany
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9
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Harms D, Reinwald M, Krauthausen F, Stein D, Deckert PM. A phenomenological three-parameter model for predicting the extent of outpatient palliative care. Mol Clin Oncol 2021; 15:194. [PMID: 34349993 PMCID: PMC8327081 DOI: 10.3892/mco.2021.2356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/01/2021] [Indexed: 12/02/2022] Open
Abstract
Whether a patient receives general or specialized outpatient palliative cancer care rarely follows clear criteria, leading to undertreatment or overtreatment. Detailed scores exist to predict prognosis, but not treatment requirements, leaving caregivers to follow their intuition. As a phenomenological indicator incorporating possibly important subjective information, intuition may in fact be a helpful tool. In this prospective observational study, a score to estimate three global dimensions of patients' resources was applied: Medical prognosis, feeling of strength and feeling of support. The score results were correlated with the actual amount and effort of care required during the subsequent palliative care time. This phenomenological score correlated well with the performance index and the Hospice and Palliative care Evaluation score. Whilst various individual items correlated significantly with the score or its constituent parameters, there was no uniform coherent pattern, reflecting the complexity of palliative care and the potential value of this predictive tool.
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Affiliation(s)
- Dirk Harms
- Faculty of Medicine and Psychology, Brandenburg Medical School Theodor Fontane, D-14770 Brandenburg an der Havel, Germany.,Outpatient Palliative Care Team Brandenburg, D-14770 Brandenburg an der Havel, Germany
| | - Mark Reinwald
- Faculty of Medicine and Psychology, Brandenburg Medical School Theodor Fontane, D-14770 Brandenburg an der Havel, Germany
| | - Felise Krauthausen
- Outpatient Palliative Care Team Brandenburg, D-14770 Brandenburg an der Havel, Germany
| | - Dagmar Stein
- Outpatient Palliative Care Team Brandenburg, D-14770 Brandenburg an der Havel, Germany
| | - Peter Markus Deckert
- Faculty of Medicine and Psychology, Brandenburg Medical School Theodor Fontane, D-14770 Brandenburg an der Havel, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, D-14770 Brandenburg an der Havel, Germany
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10
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Goni-Fuste B, Crespo I, Monforte-Royo C, Porta-Sales J, Balaguer A, Pergolizzi D. What defines the comprehensive assessment of needs in palliative care? An integrative systematic review. Palliat Med 2021; 35:651-669. [PMID: 33648403 DOI: 10.1177/0269216321996985] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The comprehensive assessment of needs in palliative care identifies where patients most want attention to guide clinical decisions that tailor care provision from their first encounters. AIM To define how and what needs are identified by the comprehensive assessment of needs in the original peer-reviewed articles in the field of palliative care. DESIGN An integrative systematic review as outlined by Whittemore and Knafl. Quality appraisal performed using the Mixed Methods Appraisal Tool. DATA SOURCES PubMed, CINAHL, PsycINFO, Web of Science databases searched through May 2019 and updated in July 2020. RESULTS Forty-nine articles met inclusion criteria for original articles in English or Spanish reporting comprehensive assessment of needs of adult patients receiving palliative care. The majority (41/49) of studies were moderate to high quality. Two themes were identified: (1) How a comprehensive assessment of needs should be carried out in palliative care, which reflected a preference to develop structured tools for assessment; (2) What needs of patients should be assessed in the comprehensive assessment of needs in palliative care, which conveyed a trend to assess beyond core domains - physical, psychological, social, spiritual - with information and practical most prevalent, but with substantial variation in specifying and classifying needs into domains. CONCLUSIONS The assessment of needs in palliative care is comprehensive but lacks consensus on the needs and domains that should be assessed by the palliative care team. Future studies should better define what needs can be standardized into the assessment to improve process of care and patient satisfaction.
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Affiliation(s)
- Blanca Goni-Fuste
- Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
| | - Iris Crespo
- Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Monforte-Royo
- Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
| | - Josep Porta-Sales
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain.,Institut Català d'Oncologia Girona, Girona, Spain
| | - Albert Balaguer
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain.,Universitat Internacional de Catalunya, Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Denise Pergolizzi
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
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11
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Heppner HJ, Lente A, Hag H. Therapiezieländerung in der Kardiologie am Beispiel der Herzinsuffizienz. AKTUELLE KARDIOLOGIE 2020. [DOI: 10.1055/a-1219-7554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungDie demografische Entwicklung sowie der Anstieg chronischer Erkrankungen und der Fortschritt in der Medizin bewirken, dass der Anteil alter und hochbetagter Patienten in den Krankenhäusern aller Versorgungsstufen stetig ansteigt. Viele kardiovaskuläre Erkrankungen münden letztendlich in eine Herzinsuffizienz. Die Herzinsuffizienz zählt zu den häufigsten Ursachen für Krankenhauseinweisungen. Mit etwa 35 000 Sterbefällen im Jahr blieb die Krankenhaussterblichkeit der Herzinsuffizienzpatienten unverändert hoch. Wenn hierbei das Therapieziel nicht mehr klar zu formulieren ist oder der Patientenwunsch der medizinischen Indikation entgegensteht, muss eine Therapiezieländerung hin zur Palliation besprochen und umgesetzt werden. Ziele der Palliativversorgung bei Herzinsuffizienz sind die Symptomlinderung und die Verbesserung der Kommunikation. Entscheidend ist die frühzeitige, individuelle und zielgerichtete Vorsorgeplanung, einschließlich Patientenaufklärung. So lassen sich bei
einer Therapiezieländerung im Rahmen der Palliativversorgung Lebensqualität und Zufriedenheit sowohl vom Patienten als auch der Angehörigen verbessern. Palliative Konzepte müssen integraler Bestandteil in der interdisziplinären Versorgung von Kardiologie, Geriatrie und Palliativmedizin sein.
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Affiliation(s)
- Hans Jürgen Heppner
- Klinik für Geriatrie mit Tagesklinik, HELIOS Klinikum Schwelm
- Lehrstuhl für Geriatrie, Universität Witten Herdecke, Witten
- Institut für Biomedizin des Alterns, FAU Erlangen, Nürnberg
| | - Alina Lente
- Lehrstuhl für Geriatrie, Universität Witten Herdecke, Witten
| | - Haitham Hag
- Klinik für Geriatrie mit Tagesklinik, HELIOS Klinikum Schwelm
- Lehrstuhl für Geriatrie, Universität Witten Herdecke, Witten
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12
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Coym A, Ullrich A, Hackspiel LK, Ahrenholz M, Bokemeyer C, Oechsle K. Systematic symptom and problem assessment at admission to the palliative care ward - perspectives and prognostic impacts. BMC Palliat Care 2020; 19:75. [PMID: 32466759 PMCID: PMC7257199 DOI: 10.1186/s12904-020-00576-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 05/10/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Symptom assessment is essential in palliative care, but holds challenges concerning implementation and relevance. This study aims to evaluate patients' main symptoms and problems at admission to a specialist inpatient palliative care (SIPC) ward using physician proxy- and patient self-assessment, and aims to identify their prognostic impact as well as the agreement between both assessments. METHODS Within 12 h after admission, palliative care specialists completed the Symptom and Problem Checklist of the German Hospice and Palliative Care Evaluation (HOPE-SP-CL). Patients either used the new version of the minimal documentation system for patients in palliative care (MIDOS) or the Integrated Palliative Care Outcome Scale (IPOS) plus the Distress Thermometer (DT). RESULTS Between 01.01.2016-30.09.2018, 1206 patients were included (HOPE-SP-CL 98%; MIDOS 21%, IPOS 34%, DT 27%) whereof 59% died on the ward. Proxy-assessment showed a mean HOPE-SP-CL Total Score of 24.6 ± 5.9 of 45. Most frequent symptoms/problems of at least moderate intensity were weakness (95%), needs of assistance with activities of daily living (88%), overburdening of family caregivers (83%), and tiredness (75%). Factor analysis identified four symptom clusters (SCs): (1) Deteriorated Physical Condition/Decompensation of Home Care, (2) Emotional Problems, (3) Gastrointestinal Symptoms and (4) Other Symptoms. Self-assessment showed a mean MIDOS Total Score of 11.3 ± 5.3 of 30, a mean IPOS Total Score of 32.0 ± 9.0 of 68, and a mean distress of 6.6 ± 2.5 of 10. Agreement of self- and proxy-assessment was moderate for pain (ƙ = 0.438) and dyspnea (ƙ = 0.503), fair for other physical (ƙ = 0.297 to 0.394) and poor for psychological symptoms (ƙ = 0.101 to 0.202). Multivariate regression analyses for single symptoms and SCs revealed that predictors for dying on the SIPC ward included impaired ECOG performance status, moderate/severe dyspnea, appetite loss, tiredness, disorientation/confusion, and the SC Deteriorated Physical Condition/Decompensation of Home Care. CONCLUSION Admissions to a SIPC ward are mainly caused by problems impairing mobility and autonomy. Results demonstrate that implementation of self- and reliability of proxy- and self-assessment is challenging, especially concerning non-physical symptoms/problems. We identified, specific symptoms and problems that might provide information needed for treatment discussions regarding the medical prognosis.
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Affiliation(s)
- Anja Coym
- Department of Oncology, Hematology and BMT, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Anneke Ullrich
- Department of Oncology, Hematology and BMT, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Lisa Kathrin Hackspiel
- Department of Oncology, Hematology and BMT, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Mareike Ahrenholz
- Department of Oncology, Hematology and BMT, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and BMT, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Hematology and BMT, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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13
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Gahr S, Lödel S, Berendt J, Thomas M, Ostgathe C. Implementation of Best Practice Recommendations for Palliative Care in German Comprehensive Cancer Centers. Oncologist 2020; 25:e259-e265. [PMID: 32043783 PMCID: PMC7011673 DOI: 10.1634/theoncologist.2019-0126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/09/2019] [Indexed: 01/03/2023] Open
Abstract
Background From 2014 to 2017, the Palliative Medicine Working Group developed and published best practice recommendations for the integration of palliative care in Comprehensive Cancer Centers (CCCs) in Germany. To evaluate the implementation level of these recommendations in the CCCs an online survey was performed. Based on the results of this study, strategic tandem partnerships between CCCs should be built in order to foster further local development. Materials and Methods Directors of all CCCs were contacted by e‐mail between December 2017 and February 2018. At the time of the survey, 15 CCCs were funded by the German Cancer Aid. The level of implementation of the recommendations in individual CCCs was established using a transtheoretical model. Results Between December 2017 and February 2018, all 15 contacted directors or their representatives of the CCCs took part in the survey. More than two thirds of the CCCs have a palliative service as well as a day clinic and palliative outpatient clinic. Regional networking and the provision of a palliative care unit were approved by all CCCs. Conclusion The publication of best practice recommendations was a milestone for the integration of palliative care in the CCCs. The majority of the German CCCs already fulfill essential organizational and structural requirements. There is a particular need for optimization in the provision of a basic qualification for general palliative care and emergency admission personnel. Implications for Practice In 2017, the Palliative Medicine Working Group in the network of the German Comprehensive Cancer Centers (CCCs) published the best practice recommendations it had developed for the integration of palliative medicine in CCCs in Germany. In order to evaluate the level of implementation of the recommendations, an online survey of the CCC directors was established. The majority of German CCCs fulfil elementary organizational and structural requirements. However, there is still room for improvement in the provision of a basic qualification for general palliative care and emergency admission personnel. This article evaluates the implementation of best practice recommendations for the integration of palliative care in Comprehensive Cancer Centers in Germany and calls for strategic partnerships between cancer centers to foster local development. NOTE: authors indicated financial conflicts but they are of a non‐commercial nature and thus do not need to be disclosed per journal policy.
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Affiliation(s)
- Susanne Gahr
- Department of Palliative Medicine, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg and Comprehensive Cancer Center Erlangen–Europäische Metropolregion Nürnberg (EMN), University Hospital ErlangenErlangenGermany
| | - Sarah Lödel
- Department of Palliative Medicine, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg and Comprehensive Cancer Center Erlangen–Europäische Metropolregion Nürnberg (EMN), University Hospital ErlangenErlangenGermany
| | - Julia Berendt
- Bavarian Health and Food Safety AuthorityNürnbergGermany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg (TLRC‐H), member of the German Center for Lung Research (DZL)HeidelbergGermany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg and Comprehensive Cancer Center Erlangen–Europäische Metropolregion Nürnberg (EMN), University Hospital ErlangenErlangenGermany
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14
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Dillen K, Ebke M, Koch A, Becker I, Ostgathe C, Voltz R, Golla H. Validation of a palliative care outcome measurement tool supplemented by neurological symptoms (HOPE+): Identification of palliative concerns of neurological patients. Palliat Med 2019; 33:1221-1231. [PMID: 31280657 DOI: 10.1177/0269216319861927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is growing interest to integrate palliative care and its structures into the care of neurological patients. However, in Germany there is no comprehensive assessment tool capturing the symptoms of patients with advanced neurological diseases. AIM To validate a newly developed palliative care measurement tool based on an extension of the validated core documentation system Hospice and Palliative Care Evaluation considering additional neurological issues (HOPE+). DESIGN Prospective, observational study using HOPE+ and as external criteria, the Eastern Cooperative Oncology Group (ECOG) performance status and the 12 months "surprise" question (12-SQ) in a neurological population, and assessment for its construct validity and diagnostic accuracy. SETTING/PARTICIPANTS All newly admitted patients to the Department of Neurorehabilitation, Dr. Becker Rhein-Sieg-Clinic aged 18-100 years (#DRKS00010947). RESULTS Data from 263 patients (63 ± 14 years of age) were analyzed. HOPE+ revealed a moderately correlated six-factor structure (r = -0.543-0.525). Correlation analysis to evaluate discriminant validity using ECOG as external criterion was high (rs(261) = 0.724, p < 0.001) and confirmed for severely affected patients by adding the 12-SQ ("No"-group: 48.00 ± 14.92 vs "Yes"-group: 18.67 ± 7.57, p < 0.009). Operating characteristics show satisfactory diagnostic accuracy (area under the curve: 0.746 ± 0.049, 95% confidence interval = 0.650-0.842). CONCLUSION HOPE+ demonstrates promising psychometric properties. It helps to assess palliative care issues of patients in neurological settings and, in combination with the 12-SQ, conceivably conditions when to initiate the palliative care approach in a population underrepresented in palliative care structures so far.
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Affiliation(s)
- Kim Dillen
- Department of Palliative Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Markus Ebke
- Neurological Centre for Rehabilitation-MEDIAN-Clinics, Bad Salzuflen, Germany.,Dr. Becker Rhein Sieg Clinic, Nümbrecht, Germany
| | - Andreas Koch
- Department of Palliative Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,Center for Integrated Oncology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,Center for Clinical Trials, University of Cologne, Cologne, Germany.,Center for Health Services Research (ZVFK), Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Heidrun Golla
- Department of Palliative Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,Center for Integrated Oncology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
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15
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Hodiamont F, Jünger S, Leidl R, Maier BO, Schildmann E, Bausewein C. Understanding complexity - the palliative care situation as a complex adaptive system. BMC Health Serv Res 2019; 19:157. [PMID: 30866912 PMCID: PMC6417077 DOI: 10.1186/s12913-019-3961-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 02/20/2019] [Indexed: 12/30/2022] Open
Abstract
Background The concept of complexity is used in palliative care (PC) to describe the nature of patients’ situations and the extent of resulting needs and care demands. However, the term or concept is not clearly defined and operationalised with respect to its particular application in PC. As a complex problem, a care situation in PC is characterized by reciprocal, nonlinear relations and uncertainties. Dealing with complex problems necessitates problem-solving methods tailored to specific situations. The theory of complex adaptive systems (CAS) provides a framework for locating problems and solutions. This study aims to describe criteria contributing to complexity of PC situations from the professionals’ view and to develop a conceptual framework to improve understanding of the concept of “complexity” and related elements of a PC situation by locating the complex problem “PC situation” in a CAS. Methods Qualitative interview study with 42 semi-structured expert (clinical/economical/political) interviews. Data was analysed using the framework method. The thematic framework was developed inductively. Categories were reviewed, subsumed and connected considering CAS theory. Results The CAS of a PC situation consists of three subsystems: patient, social system, and team. Agents in the "system patient" are allocated to further subsystems on patient level: physical, psycho-spiritual, and socio-cultural. The "social system" and the "system team" are composed of social agents, who affect the CAS as carriers of characteristics, roles, and relationships. Environmental factors interact with the care situation from outside the system. Agents within subsystems and subsystems themselves interact on all hierarchical system levels and shape the system behaviour of a PC situation. Conclusions This paper provides a conceptual framework and comprehensive understanding of complexity in PC. The systemic view can help to understand and shape situations and dynamics of individual care situations; on higher hierarchical level, it can support an understanding and framework for the development of care structures and concepts. The framework provides a foundation for the development of a model to differentiate PC situations by complexity of patients and care needs. To enable an operationalisation and classification of complexity, relevant outcome measures mirroring the identified system elements should be identified and implemented in clinical practice. Electronic supplementary material The online version of this article (10.1186/s12913-019-3961-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Farina Hodiamont
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Saskia Jünger
- Research Unit Ethics, University Hospital Cologne, Cologne, Germany.,Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health, University of Cologne, Cologne, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Munich, Germany.,Ludwig-Maximilians-Universitaet Munich, Munich School of Management, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Munich, Germany
| | - Bernd Oliver Maier
- St. Josephs-Hospital, Department of Palliative Medicine and Interdisciplinary Oncology, Wiesbaden, Germany
| | - Eva Schildmann
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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16
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Ebke M, Koch A, Dillen K, Becker I, Voltz R, Golla H. The "Surprise Question" in Neurorehabilitation-Prognosis Estimation by Neurologist and Palliative Care Physician; a Longitudinal, Prospective, Observational Study. Front Neurol 2018; 9:792. [PMID: 30319526 PMCID: PMC6165871 DOI: 10.3389/fneur.2018.00792] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/03/2018] [Indexed: 12/12/2022] Open
Abstract
Background: The 12-months “surprise” question (12-SQ) for estimating prognosis and the need for integrating palliative care (PC) services has not yet been investigated for neurological patients. Objective: Test the value of the 12-SQ on a sample of neurorehabilitation patients. Methods: All patients newly registered in the Department of Neurorehabilitation, Dr. Becker Rhein-Sieg-Clinic (8/2016-03/2017) were asked to participate. The treating neurorehabilitation physicians (NP) and an external consulting PC physician (PCP) independently estimated patients' prognosis using the 12-SQ; while symptom burden was independently assessed using the standardized palliative outcome measurement HOPE-SP-CL, a set of additional neurological issues, and ECOG. Follow-up with consenting patients 12 months later was via telephone. Descriptive and inferential statistics were utilized in data analysis. Results: Of 634 patients, 279 (44%) patients (male: 57.7%, female: 42.3%; mean age: 63 ± 14) (or, alternatively, their legal representative) consented and were assessed at baseline. Per patient NP and PCP both answered the 12-SQ with “Yes” (164), with “No” (42), or had different opinions (73). The “No” group displayed the highest symptom burden on all three measures for both disciplines. Overall, PCP scored higher (i.e., worse) than NP on all measures used. Follow-up was possible for 236 (drop-out: 15.4%) patients (deceased: 34 (14.4%), alive: 202 (85.6%)). Baseline scores on all measures were higher for deceased patients compared to those still living. Prognostic characteristics were: sensitivity: NP 50%, PCP 67.6%; specificity: NP 86.1%, PCP 70.3%, p < 0.001; positive predictive value: NP 37.8%, PCP 27.7%; negative predictive value: NP 91.1%, PCP 92.8%; area under the curve: NP 0.68, PCP 0.69; success rate: NP 80.9%, PCP 69.9%, p = 0.002. Regression analysis indicated that age, dysphagia and overburdening of family (NP answering the 12-SQ), dysphagia and rehabilitation phase (PCP answering the 12-SQ) were associated with increased likelihood of dying within 12 months. Without the 12-SQ as relevant predictor, age, dysphagia and ECOG were significant predictors (NP and PCP). Conclusion: Combining the 12-SQ with a measurement assessing PC and neurological issues could potentially improve the 12-SQ's predictive performance of 12-month survival and help to identify when to initiate the PC approach. Clinical experiences influence assessment and prognosis estimation.
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Affiliation(s)
- Markus Ebke
- Neurological Centre for Rehabilitation-MEDIAN-Clinics, Bad Salzuflen, Germany.,Dr. Becker Rhein Sieg Clinic, Nümbrecht, Germany
| | - Andreas Koch
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
| | - Kim Dillen
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
| | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany.,Center for Integrated Oncology Cologne/Bonn, Cologne, Germany.,Center for Clinical Trials, University of Cologne, Cologne, Germany.,Medical Faculty, Center for Health Services Research (ZVFK), University of Cologne, Cologne, Germany
| | - Heidrun Golla
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany.,Center for Integrated Oncology Cologne/Bonn, Cologne, Germany
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Fetz K, Vogt H, Ostermann T, Schmitz A, Schulz-Quach C. Evaluation of the palliative symptom burden score (PSBS) in a specialised palliative care unit of a university medical centre - a longitudinal study. BMC Palliat Care 2018; 17:92. [PMID: 29981577 PMCID: PMC6035799 DOI: 10.1186/s12904-018-0342-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/19/2018] [Indexed: 12/01/2022] Open
Abstract
Background The implementation of standardised, valid and reliable measurements in palliative care is subject to practical and methodological challenges. One aspect of ongoing discussion is the value of systematic proxy-based assessment of symptom burden in palliative care. In 2011, an expert-developed proxy-based instrument for the assessment of symptom burden in palliative patients, the Palliative Symptom Burden Score (PSBS), was implemented at the Specialised Palliative Care Unit of the University Medical Centre in Dusseldorf, Germany. The present study investigated its feasibility, acceptance and psychometric properties. Methods The PSBS was rated by nursing staff three times a day over 5 years (N = 820 patients). Feasibility and nurses’ acceptance of PSBS were analysed. Structural validity was investigated by principal component analysis. Construct validity was examined via cross-validation with the Hospice and Palliative Care Evaluation checklist. Discriminative validity of the PSBS was analysed by means of Kruskal-Wallis test of patients’ performance score. Reliability of the PSBS was evaluated by internal consistency analysis, test-retest and split-half-reliability. Inter-rater reliability was investigated by observer agreement of nurses’ ratings of symptom burden within a day. Sensitivity to change was analysed by Wilcoxon test with repeated measures of the PSBS before and after palliative complex treatment. Results A high degree of acceptance and the feasibility of a high-frequency proxy-based symptom burden assessment approach were demonstrated. There were low rates of missing values and no indications of the adoption of prior ratings. PSBS in its present form demonstrates good structural and construct validity (rs = .27–.79, p’s < .001) and high sensitivity to changes in symptom burden (p’s < .01, except sweating), but unsatisfactory reliability (α = .41–.67; test-retest: rs = .30–.88; p’s < .001; split-half: rs = .69; p < .001; inter-rater: n.s.). Conclusions The study presents a framework for the post hoc validation of an already existing documentation tool in palliative care. This study supports the notion that PSBS might not be reflective of an overall construct and will therefore require further development and critical comparison to other already established symptom burden instruments in palliative care.
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Affiliation(s)
- Katharina Fetz
- Chair of Research Methodology and Statistics in Psychology, Department of Psychology & Psychotherapy, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Hendrik Vogt
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Dusseldorf, Düsseldorf, Germany
| | - Thomas Ostermann
- Chair of Research Methodology and Statistics in Psychology, Department of Psychology & Psychotherapy, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Andrea Schmitz
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Dusseldorf, Düsseldorf, Germany
| | - Christian Schulz-Quach
- Institute of Psychiatry, Psychology and Neuroscience; Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,St. Christopher's Hospice, London, UK
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Strupp J, Groebe B, Knies A, Mai M, Voltz R, Golla H. Evaluation of a palliative and hospice care telephone hotline for patients severely affected by multiple sclerosis and their caregivers. Eur J Neurol 2017; 24:1518-1524. [PMID: 28926157 DOI: 10.1111/ene.13462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 09/11/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Palliative and hospice care (PHC) still mainly focuses on patients with cancer. In order to connect patients severely affected by multiple sclerosis (MS) and caregivers to PHC, a nationwide hotline was implemented to facilitate access to PHC. METHODS The hotline was designed in cooperation with the German Multiple Sclerosis Society. Self-disclosed information given by callers was documented using case-report forms supplemented by personal notes. Data were analysed descriptively. RESULTS A total of 222 calls were documented in 27 months. The patients' mean age was 51.12 years (range 27-84 years) and mean illness duration was 18 years (range 1 month to 50 years). Inquiries included information on PHC (28.8%) and access to PHC (due to previous refusal of PHC, 5.4%), general care for MS (36.1%), adequate housing (9.0%) and emotional support in crisis (4.5%). A total of 31.1% of callers reported 'typical' palliative symptoms (e.g. pain, 88.4%), 50.5% reported symptoms evolving from MS and 35.6% reported psychosocial problems. For 67 callers (30.2%), PHC services were recommended as indicated. CONCLUSIONS The hotline provided insight into the needs and problems of patients severely affected by MS and their caregivers, some of which may be met by PHC. Future follow-up calls will demonstrate if the hotline helped to improve access to PHC beyond providing information. Overall, the hotline seemed to be easily accessible for patients severely affected by MS whose mobility is limited.
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Affiliation(s)
- J Strupp
- Department of Palliative Medicine, Medical Faculty of the University of Cologne, Cologne, Germany
| | - B Groebe
- Department of Palliative Medicine, Medical Faculty of the University of Cologne, Cologne, Germany
| | - A Knies
- Yale School of Nursing, New Haven, CT, USA
| | - M Mai
- German Multiple Sclerosis Society, Hannover
| | - R Voltz
- Department of Palliative Medicine, Medical Faculty of the University of Cologne, Cologne, Germany.,Center for Integrated Oncology, Cologne/Bonn.,Clinical Trials Center, Cologne.,Center for Health Services Research, Medical Faculty of the University of Cologne, Cologne, Germany
| | - H Golla
- Department of Palliative Medicine, Medical Faculty of the University of Cologne, Cologne, Germany
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Kremeike K, Wetter RML, Burst V, Voltz R, Kuhr K, Simon ST. Prevalence of hyponatremia in inpatients with incurable and life-limiting diseases and its association with physical symptoms-a retrospective descriptive study. Support Care Cancer 2017; 26:213-222. [PMID: 28821989 DOI: 10.1007/s00520-017-3837-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/24/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE Hyponatremia is a common electrolyte abnormality seen in hospitalized patients. It may cause a variety of symptoms and is associated with longer hospitalizations and higher mortality. However, to date, only little is known about the extent of hyponatremia in patients with incurable diseases and whether it is associated with physical symptoms in this patient group. This study aims to describe the prevalence of hyponatremia, associated symptoms, and symptom intensity in inpatients with hyponatremia receiving specialist palliative care (SPC). METHODS This is a retrospective study. Demographic and clinical data as well as symptoms, scored symptom intensity, and laboratory values were collected. All inpatients of a large German University Hospital receiving SPC in 2013 with documented sodium values were included. RESULTS In 2013, 789 inpatients received SPC of which 710 had documented sodium values. The prevalence of hyponatremia was 38.7% (275/710). A mild degree showed 220 (31,0%), 44 (6.2%) had a moderate, and 11 (1.6%) a severe form. Hyponatremia patients experienced significantly more symptoms than normonatremic patients (mean = 7.71 vs 6.63; p < 0.001). Breathlessness, depressiveness, nausea, vomiting, poor appetite, constipation, and weakness were significantly more frequent in patients with hyponatremia. Furthermore, hyponatremia severity was associated with higher symptom intensity (mean = 13.29 vs 11.28; p < 0.001). CONCLUSIONS More than one third of all SPC patients showed a hyponatremia, and the hyponatremia grade was associated with symptom burden and symptom intensity. A prospective analysis is needed to further examine this association and the possible influence of hyponatremia correction on symptom burden reduction.
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Affiliation(s)
- Kerstin Kremeike
- Department of Palliative Medicine, University Hospital Cologne, Kerpener Str. 62, 50397, Cologne, Germany.,Centre for Integrated Oncology Köln Bonn (CIO), University Hospital Cologne, Cologne, Germany
| | - Ricarda M L Wetter
- Department of Palliative Medicine, University Hospital Cologne, Kerpener Str. 62, 50397, Cologne, Germany.,Centre for Integrated Oncology Köln Bonn (CIO), University Hospital Cologne, Cologne, Germany
| | - Volker Burst
- Department 2 of Internal Medicine, Nephrology, University Hospital Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, University Hospital Cologne, Kerpener Str. 62, 50397, Cologne, Germany.,Centre for Integrated Oncology Köln Bonn (CIO), University Hospital Cologne, Cologne, Germany.,Clinical Trials Center Cologne, (ZKS), Köln, Germany.,Center for Health Services Research (ZVFK), Medical Faculty, University of Cologne, Cologne, Germany
| | - Kathrin Kuhr
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University Hospital Cologne, Cologne, Germany
| | - Steffen T Simon
- Department of Palliative Medicine, University Hospital Cologne, Kerpener Str. 62, 50397, Cologne, Germany. .,Centre for Integrated Oncology Köln Bonn (CIO), University Hospital Cologne, Cologne, Germany. .,Clinical Trials Center Cologne, (ZKS), Köln, Germany.
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20
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Hofmann S, Hess S, Klein C, Lindena G, Radbruch L, Ostgathe C. Patients in palliative care-Development of a predictive model for anxiety using routine data. PLoS One 2017; 12:e0179415. [PMID: 28771478 PMCID: PMC5542653 DOI: 10.1371/journal.pone.0179415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 05/29/2017] [Indexed: 12/04/2022] Open
Abstract
Introduction Anxiety is one of the most common psychological symptoms in patients in a palliative care situation. This study aims to develop a predictive model for anxiety using data from the standard documentation routine. Methods Data sets of palliative care patients collected by the German quality management benchmarking system called Hospice and Palliative Care Evaluation (HOPE) from 2007 to 2011 were randomly divided into a training set containing two-thirds of the data and a test set with the remaining one-third. We dichotomized anxiety levels, proxy rated by medical staff using the validated HOPE Symptom and Problem Checklist, into two groups with no or mild anxiety versus moderate or severe anxiety. Using the training set, a multivariable logistic regression model was developed by backward stepwise selection. Predictive accuracy was evaluated by the area under the receiver operating characteristic curve (AUC) based on the test set. Results An analysis of 9924 data sets suggests a predictive model for anxiety in patients receiving palliative care which contains gender, age, ECOG, living situation, pain, nausea, dyspnea, loss of appetite, tiredness, need for assistance with activities of daily living, problems with organization of care, medication with sedatives/anxiolytics, antidepressants, antihypertensive drugs, laxatives, and antibiotics. It results in a fair predictive value (AUC = 0.72). Conclusions Routinely collected data providing individual-, disease- and therapy-related information contain valuable information that is useful for the prediction of anxiety risks in patients receiving palliative care. These findings could thus be advantageous for providing appropriate support for patients in palliative care settings and should receive special attention in future research.
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Affiliation(s)
- Sonja Hofmann
- Department of Palliative Medicine, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich- Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- * E-mail:
| | - Stephanie Hess
- Department of Anaesthesiology, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carsten Klein
- Department of Palliative Medicine, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich- Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Gabriele Lindena
- Clinical Analysis, Research and Application (CLARA), Kleinmachnow, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich- Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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21
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[Data on palliative care in Germany : Which data sources are available and what do they tell?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 60:26-36. [PMID: 27966014 DOI: 10.1007/s00103-016-2483-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Palliative care is more and more in the focus of politics and the public. Although provision and utilization of palliative care have increased considerably in recent years, there is still a great need for palliative services and a comprehensive supply has not yet been achieved. Reliable and continually available data are indispensable to describe developments in Germany, to identify existing gaps in palliative care provision, and to assess the impact of relevant policies. In this article, we present a systematic outline of publicly available data sources on palliative care in Germany and point out their potentials and limitations. We show that mainly data on palliative care provision are available. Data on utilization are basically limited to inpatient and specialized outpatient palliative care ("spezialisierte ambulante Palliativversorgung", SAPV). Periodical analyses of routine data, e. g. from statutory health insurances or from the Association of Statutory Health Insurance Physicians, would be helpful to fill these data gaps. Monitoring the sociodemographic characteristics of users of palliative care could also be of major interest. Another important indicator is the place of death. The difference between the places where people die and where they wish to die indicates that there is a continuous need to strengthen outpatient structures of palliative care.
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Ueberall MA, Lorenzl S, Lux EA, Voltz R, Perelman M. Efficacy, safety, and tolerability of fentanyl pectin nasal spray in patients with breakthrough cancer pain. J Pain Res 2016; 9:571-85. [PMID: 27574463 PMCID: PMC4993561 DOI: 10.2147/jpr.s106177] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective Assessment of analgesic effectiveness, safety, and tolerability of fentanyl pectin nasal spray (FPNS) in the treatment of breakthrough cancer pain (BTcP) in routine clinical practice. Methods A prospective, open-label, noninterventional study (4-week observation period, 3 month follow-up) of opioid-tolerant adults with BTcP in 41 pain and palliative care centers in Germany. Standardized BTcP questionnaires and patient diaries were used. Evaluation was made of patient-reported outcomes with respect to “time to first effect”, “time to maximum effect”, BTcP relief, as well as changes in BTcP-related impairment of daily life activities, quality-of-life restrictions, and health care resource utilization. Results A total of 235 patients were recruited of whom 220 completed all questionnaires and reported on 1,569 BTcP episodes. Patients reported a significant reduction of maximum BTcP intensity (11-stage numerical rating scale [0= no pain, 10= worst pain conceivable]) with FPNS (mean ± standard deviation = 2.8±2.3) compared with either that reported at baseline (8.5±1.5), experienced immediately before FPNS application (7.4±1.7), or that achieved with previous BTcP medication (6.0±2.0; P<0.001 for each comparison). In 12.3% of BTcP episodes, onset of pain relief occurred ≤2 minutes and in 48.4% ≤5 minutes; maximum effects were reported within 10 minutes for 37.9% and within 15 minutes for 79.4%. By the end of the study, there had been significant improvements versus baseline in BTcP-related daily life activities (28.3±16.9 vs 53.1±11.9), physical (35.9±8.4 vs 26.8±6.5), and mental quality of life (38.7±8.5 vs 29.9±7.9) (P<0.001 for each comparison vs baseline); in addition, health care resource utilization requirements directly related to BTcP were reduced by 67.5%. FPNS was well tolerated; seven patients (3.2%) experienced eight treatment-emergent adverse events of which none was serious. There were no indicators of misuse or abuse. Conclusion FPNS provided rapid and highly effective BTcP relief in opioid-tolerant cancer patients with substantial improvements in daily functioning and quality of life. FPNS was well tolerated and associated with significant reductions in health care resource utilization and nursing assistance.
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Affiliation(s)
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Private Medical University of Salzburg, Salzburg, Austria
| | - Eberhard A Lux
- Faculty of Medicine, Witten/Herdecke University, Witten, Germany; Clinic for Pain and Palliative Care Medicine, St.- Marien-Hospital, Luenen, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, University Hospital Cologne, Cologne, Germany
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Rugno FC, Carlo MMRDPD. The Palliative Outcome Scale (POS) applied to clinical practice and research: an integrative review. Rev Lat Am Enfermagem 2016; 24:e2764. [PMID: 27533273 PMCID: PMC4996092 DOI: 10.1590/1518-8345.0993.2764] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 01/29/2016] [Indexed: 11/28/2022] Open
Abstract
Objective: to identify and evaluate the evidence found in the international scientific
literature on the application of the Palliative Outcome Scale (POS) in clinical
practice and research in Palliative Care (PC). Method: integrative literature review, through the search of publications in journals
indexed in PubMed / MEDLINE, LILACS, SciELO and CINAHL databases, between the
years 1999 and 2014. Results: the final sample consisted of 11 articles. In the data analysis, the articles
were classified into 2 units of analysis (studies using the POS as a resource in
research and studies using the POS in clinical practice), in which the information
was presented in the form of sub-themes related to publications of the selected
studies, highlighting the synthesis of the results. Conclusion: POS emerged as an important tool for measuring outcomes to assess the quality of
life of patients and families, of the quality of care provided and the PC service
organization. The international scientific literature on the application of POS
proved to be relevant to the advancement and consolidation of the field of
knowledge related to PC.
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Affiliation(s)
- Fernanda Capella Rugno
- Doctoral Student, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Schnakenberg R, Goeldlin A, Boehm-Stiel C, Bleckwenn M, Weckbecker K, Radbruch L. Written survey on recently deceased patients in germany and switzerland: how do general practitioners see their role? BMC Health Serv Res 2016; 16:22. [PMID: 26787308 PMCID: PMC4719660 DOI: 10.1186/s12913-016-1257-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/06/2016] [Indexed: 11/17/2022] Open
Abstract
Background General practitioners (GPs) play an important role in end-of-life care due to their proximity to the patient’s dwelling-place and their contact to relatives and other care providers. Methods In order to get a better understanding of the role which the GP sees him- or herself as playing in end-of-life care and which care their dying patients get, we conducted this written survey. It asked questions about the most recently deceased patient of each physician. The questionnaire was sent to 1,201 GPs in southern North Rhine-Westphalia (Germany) and the Canton of Bern (Switzerland). Results Response rate was 27.5 % (n = 330). The average age of responding physicians was 54.5 years (range: 34–76; standard derivation: 7.4), 68 % of them were male and 45 % worked alone in their practice. Primary outcome measures of this observational study are the characteristics of recently deceased patients as well as their care and the involvement of other professional caregivers. Almost half of the most recently deceased patients had cancer. Only 3 to 16 % of all deceased suffered from severe levels of pain, nausea, dyspnea or emesis. More than 80 % of the doctors considered themselves to be an indispensable part of their patient’s end-of-life care. Almost 90 % of the doctors were in contact with the patient’s family and 50 % with the responsible nursing service. The majority of the GPs had taken over the coordination of care and cooperation with other attending physicians. Conclusion The study confirms the relevance of caring for dying patients in GPs work and provides an important insight into their perception of their own role.
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Affiliation(s)
- Rieke Schnakenberg
- Department of General Practice and Family Medicine, University Medical Center Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Adrian Goeldlin
- Institute of General Practice, University of Bern, Gesellschaftsstrasse 49, CH-3012, Bern, Switzerland.
| | - Christina Boehm-Stiel
- Department of Palliative Medicine, University Medical Center Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Markus Bleckwenn
- Department of General Practice and Family Medicine, University Medical Center Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Klaus Weckbecker
- Department of General Practice and Family Medicine, University Medical Center Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Lukas Radbruch
- Department of Palliative Medicine, University Medical Center Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
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Masel E, Berghoff A, Schur S, Maehr B, Schrank B, Simanek R, Preusser M, Marosi C, Watzke H. The PERS2ON score for systemic assessment of symptomatology in palliative care: a pilot study. Eur J Cancer Care (Engl) 2015; 25:544-50. [DOI: 10.1111/ecc.12419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 01/06/2023]
Affiliation(s)
- E.K. Masel
- Clinical Division of Palliative Care; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - A.S. Berghoff
- Clinical Division of Oncology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - S. Schur
- Clinical Division of Palliative Care; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - B. Maehr
- Clinical Division of Palliative Care; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - B. Schrank
- Department of Psychiatry and Psychotherapy; Medical University of Vienna; Vienna Austria
| | - R. Simanek
- Department of Internal Medicine, Hematology and Oncology; Hanusch Hospital; Vienna Austria
| | - M. Preusser
- Clinical Division of Oncology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - C. Marosi
- Clinical Division of Oncology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - H.H. Watzke
- Clinical Division of Palliative Care; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
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Pestinger M, Stiel S, Elsner F, Widdershoven G, Voltz R, Nauck F, Radbruch L. The desire to hasten death: Using Grounded Theory for a better understanding "When perception of time tends to be a slippery slope". Palliat Med 2015; 29:711-9. [PMID: 25802321 DOI: 10.1177/0269216315577748] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Some patients with advanced and progressive diseases express a desire to hasten death. AIM This study evaluated the motivations of patients expressing such a desire in a country with prohibitive legislation on euthanasia and physician-assisted suicide. DESIGN A modified form of Grounded Theory was used. SETTING/PARTICIPANTS Patients from the departments of palliative medicine in three hospitals in Germany were recruited when they had made a statement or request to hasten death. Participants were interviewed face to face. Recruitment was stopped with 12 participants because of data saturation. RESULTS Thematic analysis revealed three main motivational themes: self-determination, agony, and time. Expectations toward health professionals, attitudes toward death, and secureness related to the end of life were additional main themes emerging from the analysis. CONCLUSIONS The desire to hasten death may be used as an extreme coping strategy to maintain control against anticipated agony. Patients expected health professionals to listen to and respect their experiences. Emerging hypotheses included the following: (a) patients try to balance life time and anticipated agony, and the perception of time is distressing in this balancing act; (b) anticipated images of agony and suffering in the dying process occur frequently and are experienced by patients as intrusive; (c) patients expressing a desire to hasten death are in need of more information about the dying process; and (d) patients wanted their caregivers to listen to and respect their wish to hasten death, and they did not expect the caregivers to understand this as an order to actually hasten their death.
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Affiliation(s)
- Martina Pestinger
- Department for Palliative Medicine, RWTH Aachen University, Aachen, Germany
| | - Stephanie Stiel
- Department of Palliative Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Comprehensive Cancer Center (CCC) Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Frank Elsner
- Department for Palliative Medicine, RWTH Aachen University, Aachen, Germany
| | - Guy Widdershoven
- Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Raymond Voltz
- Department for Palliative Medicine, University Hospital Cologne, Cologne, Germany
| | - Friedemann Nauck
- Department for Palliative Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany Centre for Palliative Care, Malteser Hospital Seliger Gerhard Bonn/Rhein-Sieg, Bonn, Germany
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Stiel S, Heckel M, Seifert A, Frauendorf T, Hanke RM, Ostgathe C. Comparison of terminally ill cancer- vs. non-cancer patients in specialized palliative home care in Germany - a single service analysis. BMC Palliat Care 2015. [PMID: 26209094 PMCID: PMC4514986 DOI: 10.1186/s12904-015-0033-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Palliative care (PC) is no longer offered with preference to cancer patients (CA), but also to patients with non-malignant, progressive diseases. Taking current death statistics into account, PC in Europe will face a growing number of patients dying from non-cancer diseases (NCA). More insights into specialized palliative home care (SPHC) in NCAs are needed. Methods Retrospective analysis and group comparisons between CAs and NCAs of anonymous data of all patients cared for between December 2009 and June 2012 by one SPHC team in Germany. Patient-, disease- and care-related data are documented in clinical routine by specialized PC physicians and nurses in the Information System Palliative Care 3.0 ® (ISPC®). Results Overall, 502 patients were cared for by the SPHC team; from 387 patients comprehensive data sets were documented. These 387 data sets (CA: N = 300, 77.5 % and NCA: N = 87, 22.5 %) are used for further analysis here. NCAs were significantly older (81 vs. 73 years; p < .001), than CAs and most often suffered from diseases of the nervous system (40 %). They needed significantly more assistance with defecation (87 vs. 74 %; p < .001) and urination (47 vs. 29 %; p < .001) and were more often affected from impaired vigilance (30 vs. 11 %; p < .001) than CAs. A by trend higher proportion of NCAs died within one day after admission to palliative home care (12 vs. 5 %; p < .05) and a smaller proportion was re-admitted to hospital during home care (6 vs. 20 %; p < .001). NCAs died predominantly in nursing homes (50 vs. 20 %; p < .001). Conclusions Although the proportion of NCAs was relatively high in this study, the access to PC services seems to takes place late in the disease trajectory, as demonstrated by the lower survival rate for NCAs. Nevertheless, the results show, that NCAs PC needs are as complex and intense as in CAs.
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Affiliation(s)
- Stephanie Stiel
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
| | - Maria Heckel
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
| | - Andreas Seifert
- Innovation Incubator, Leuphana University of Lüneburg, Lüneburg, Germany.
| | - Tobias Frauendorf
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
| | | | - Christoph Ostgathe
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
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Bartz L, Klein C, Seifert A, Herget I, Ostgathe C, Stiel S. Subcutaneous administration of drugs in palliative care: results of a systematic observational study. J Pain Symptom Manage 2014; 48:540-7. [PMID: 24766744 DOI: 10.1016/j.jpainsymman.2013.10.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/30/2013] [Accepted: 10/30/2013] [Indexed: 10/25/2022]
Abstract
CONTEXT Especially in palliative care, safe and manageable administration of medication is essential. Subcutaneous drug administration is a possible alternative, when oral intake is hampered. However, evidence for this method is rare. OBJECTIVES This observational study assessed the clinical practice of subcutaneous drug administration, focusing on the evaluation of local reactions or complications to further develop recommendations. METHODS Over 14 months, patients in a specialized inpatient palliative care unit treated by the subcutaneous route were invited to participate in this clinical study. All subcutaneous medications including dosage and volume of injection, type of needles, and injection site were documented. The injection sites were systematically assessed including the subjective perceptions of patients for analysis of patient tolerability and acceptability. T-tests and Chi-squared tests of these variables were performed to calculate group differences between needles with vs. without complications (P < 0.05). RESULTS In 120 patients, 3957 applications were administered via 243 needles. The needles were placed in thighs (38.7%) and upper arms (28.8%). Most frequently used medications were hydromorphone (59.0%), haloperidol (12.3%), and midazolam (8.3%). Complications were diagnosed most often on the third or fourth day of the needle in situ and occurred significantly more often in (fully) active patients and patients transferred or discharged at the end of treatment. The mean time of needle in situ was significantly lower (4.1 vs. 5.0 days) in complication cases than in noncomplication cases (t-test: P = 0.027). CONCLUSION The results of this study acknowledge the clinical practice of subcutaneous administration of medication as a very flexible, broadly feasible, rather safe, and nonburdensome method. Nevertheless, this practice is not free from complications, needs appropriate nursing care, and requires standardized policies and procedures.
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Affiliation(s)
- Lena Bartz
- Department of Palliative Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carsten Klein
- Department of Palliative Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Seifert
- Innovation Incubator, Leuphana University of Lüneburg, Lüneburg, Germany
| | - Iris Herget
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephanie Stiel
- Department of Palliative Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
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Kötzsch F, Stiel S, Heckel M, Ostgathe C, Klein C. Care trajectories and survival after discharge from specialized inpatient palliative care--results from an observational follow-up study. Support Care Cancer 2014; 23:627-34. [PMID: 25142704 DOI: 10.1007/s00520-014-2393-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 08/05/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about the patients' individual care trajectories after discharge or transfer from inpatient palliative care units (PCU) to other care settings. This study aims to survey the further care trajectory and overall survival from the time of discharge of patients in a palliative care situation. Patient groups from either the PCU or the palliative care mobile support team (PCMT) are compared in order to analyze the demographic data, discharge settings, frequency of changes of care settings, overall survival from the time of discharge and place of death. METHODS In a mono-centre prospective observational study, patients discharged or transferred from a German inpatient PCU or from other hospital wards with support of the PCMT were invited to participate in this study. After discharge, the central care provider, such as inpatient hospices, nursing homes or general practitioners, was asked for information on the care trajectory and on readmissions to hospital in four weekly follow-up phone calls until the patients' death. Place of death and overall survival from the time of discharge were noted. RESULTS During the study period, 467 inpatients from the PCU and 554 inpatients from the PCMT were treated. Ultimately, 418 were discharged. Two hundred forty-five patients agreed to participate in the study, and the majority of them were either discharged home (60.8 %), to inpatient hospices (20.0 %) or to nursing homes (11.0 %). More than half of all of them (55.9 %) stayed continuously in their discharge setting. The remaining 44.1 % experienced a mean number of 3.1 ± 4.1 changes of care setting. Most frequently, patients changed their care setting from private home to hospital (N = 110; 32.4 %) and from hospital back to private home (N = 82; 24.4 %). Patients' mean overall survival from the time of discharge was 51.7 days (median 24.0 days, range 1-488 days). Most patients died in their private home (35.9 %), inpatient hospices (23.3 %) or inpatient PCUs (22.4 %). CONCLUSIONS The results show a high percentage of stable care trajectories at the end of life with few or no changes of care setting. To achieve this, well-considered discharge planning and an adequately chosen network of care providers are necessary.
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Affiliation(s)
- Franziska Kötzsch
- Department of Palliative Medicine & Comprehensive Cancer Center, CCC Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
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Golla H, Ale Ahmad M, Galushko M, Hampl J, Maarouf M, Schroeter M, Herrlinger U, Hellmich M, Voltz R. Glioblastoma multiforme from diagnosis to death: a prospective, hospital-based, cohort, pilot feasibility study of patient reported symptoms and needs. Support Care Cancer 2014; 22:3341-52. [DOI: 10.1007/s00520-014-2384-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
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Stiel S, Matthies DMK, Seuß D, Walsh D, Lindena G, Ostgathe C. Symptoms and problem clusters in cancer and non-cancer patients in specialized palliative care-is there a difference? J Pain Symptom Manage 2014; 48:26-35. [PMID: 24417808 DOI: 10.1016/j.jpainsymman.2013.08.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/14/2013] [Accepted: 08/16/2013] [Indexed: 10/25/2022]
Abstract
CONTEXT In clinical practice, some symptoms and problems frequently occur in combination, which may have consequences for symptom management. OBJECTIVES Facing a growing number of non-cancer patients in palliative care, this study aimed to differentiate symptom clusters in the non-cancer population from those in cancer patients. METHODS Inpatient data from the German Hospice and Palliative Care Evaluation between 2007 and 2011 were used for a cluster analysis of a 16-item symptom and problem checklist. An agglomerative hierarchical method was chosen. Coefficients from distance matrix ranging between 0 and 1 were calculated to indicate the interrelationship of clustered symptoms. RESULTS The analysis identified five clusters in cancer patients: 1) nausea and vomiting (d = 0.000); 2) anxiety, tension, and feeling depressed (d = 0.125); 3) wound care and disorientation/confusion (d = 0.229); 4) organization of care and overburdening of family (d = 0.202); and 5) weakness, tiredness, need for assistance with activities of daily living, and loss of appetite (d = 0.207). Five comparable clusters were identified in non-cancer patients: 1) nausea and vomiting (d = 0.000); 2) anxiety, tension, and feeling depressed (d = 0.166); 3) organization of care and overburdening of family (d = 0.187); 4) weakness and need for assistance with activities of daily living (d = 0.139); and 5) tiredness and loss of appetite (d = 0.182). CONCLUSION As symptom clusters do not significantly differ between cancer and non-cancer patients, specific frequent symptoms in non-cancer patients should be assessed. Identification of symptom clusters may help to target therapies and focus the use of medications to improve patients' quality of life.
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Affiliation(s)
- Stephanie Stiel
- Department of Palliative Medicine, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Dominik M K Matthies
- Department of Palliative Medicine, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dominik Seuß
- Cognitive Systems Group, Faculty Information Systems and Applied Computer Science, University of Bamberg, Bamberg, Germany
| | - Declan Walsh
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio, USA
| | - Gabriele Lindena
- Clinical Analysis, Research and Application (CLARA), Kleinmachnow, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Sigurdardottir KR, Kaasa S, Rosland JH, Bausewein C, Radbruch L, Haugen DF. The European Association for Palliative Care basic dataset to describe a palliative care cancer population: Results from an international Delphi process. Palliat Med 2014; 28:463-473. [PMID: 24503559 DOI: 10.1177/0269216314521264] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND One of the barriers identified in palliative care research is the lack of common criteria to describe the population. AIM The aim of this Delphi process was to obtain consensus on a basic set of core variables to describe or classify a palliative care cancer population. DESIGN AND SETTING This was a five-step international Delphi exercise. A total of 117 experts were invited to participate. Based on a literature review and analyses of existing minimum datasets for national databases, a list of 18 proposed variables was presented in the first Delphi round. The two first rounds focused on which variables to include, and several new variables were proposed. The three last Delphi rounds focused on how the agreed variables should be recorded. Consensus was defined as at least 70% agreement. RESULTS A total of 64 experts from 30 countries participated. High consensus was reached on 31 variables, divided between a 'patient form' - date of birth, gender, living situation, education, ethnicity and 12 symptoms - and a 'health-care personnel form' - patient's date of birth, principal diagnosis, date of the principal diagnosis, stage of the cancer disease, site of metastases, present anticancer treatment, main additional diagnoses, stage of the additional diagnoses, medication, weight loss, performance status, cognitive impairment, place of care and provision of care. It was more difficult to agree upon how to record the variables, but consensus was reached on all except ethnicity, vomiting and weight loss. CONCLUSION Consensus was reached on a set of core variables and how they should be recorded.
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Affiliation(s)
- Katrin R Sigurdardottir
- 1 European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- 2 Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway
- 3 Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Stein Kaasa
- 1 European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- 4 Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jan H Rosland
- 2 Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway
- 5 Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Claudia Bausewein
- 6 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
- 7 Department for Palliative Medicine, University Hospital Munich, Munich, Germany
| | - Lukas Radbruch
- 8 Department of Palliative Medicine, University of Bonn, Bonn, Germany
- 9 European Association for Palliative Care (EAPC), Milan, Italy
| | - Dagny F Haugen
- 1 European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- 3 Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
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Validation of the German version of the Schedule of Attitudes Toward Hastened Death (SAHD-D) with patients in palliative care. Palliat Support Care 2014; 13:713-23. [PMID: 24849188 DOI: 10.1017/s1478951514000492] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Reliable and validated instruments are needed in order to study the desire for hastened death (DHD). As there is no instrument in the German language to measure DHD, our aim was to validate a German version of the Schedule of Attitudes Toward Hastened Death (SAHD-D). METHOD The SAHD was translated following guidelines promulgated by the European Organization for Research and Treatment of Cancer (EORTC). In eligible patients (clinical situation adequate, MMSE ≥21), the following instruments were employed: a symptom checklist (HOPE), the HADS-D (Hospital Anxiety and Depression Scale), the EORTC-QLQ-PAL15, and the SAHD-D, as well as an external estimation of DHD provided by the attending physician. A high level of DHD was defined as the mean plus one standard deviation (SD). RESULTS Of the 869 patients assessed, 92 were eligible for inclusion (66% females, mean age of 64.5 years). The SAHD-D total score ranged from 0 to 18, with a mean of 5 and a standard deviation (SD) of 3.7. A high level of DHD was found in 20% (n = 19). For discriminant validity, significant correlations were found between the SAHD-D and depression (r rho = 0.472), anxiety (r rho = 0.224), and clinical state (r rho = 0.178). For criterion validity, the external estimate of DHD showed a low significant correlation with patient score (r rho = 0.290). Factor analysis of the SAHD-D identified two factors. SIGNIFICANCE OF RESULTS Validation of the SAHD-D illustrated good discriminant validity, confirming that a desire to hasten death is a construct separate from depression, anxiety, or physical state. The unidimensionality of the SAHD could not be reproduced. Our findings support the multifactorial interdependencies on DHD and suggest that the SAHD-D should be refined by considering actual wishes, general attitudes, and options of patients.
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Simon ST, Altfelder N, Alt-Epping B, Bausewein C, Weingärtner V, Voltz R, Ostgathe C, Radbruch L, Lindena G, Nauck F. Is breathlessness what the professional says it is? Analysis of patient and professionals’ assessments from a German nationwide register. Support Care Cancer 2014; 22:1825-32. [DOI: 10.1007/s00520-014-2131-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
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Hess S, Stiel S, Hofmann S, Klein C, Lindena G, Ostgathe C. Trends in specialized palliative care for non-cancer patients in Germany--data from the national hospice and palliative care evaluation (HOPE). Eur J Intern Med 2014; 25:187-92. [PMID: 24389372 DOI: 10.1016/j.ejim.2013.11.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/25/2013] [Accepted: 11/27/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The proportion of non-cancer patients (NCs) admitted to palliative care (PC) services increases steadily. Nevertheless, little is known not only about their specific problems, needs that have to be met, but also about improvements that have taken place already. This analysis focuses on developments seen in NC management concerning end-of-life care. METHODS The German Hospice and Palliative Care Evaluation (HOPE) is a national long-term quality assurance project providing information on PC patients. Data from yearly evaluation periods between 2007 and 2011 are used to investigate differences between NC patients documented from 2002 to 2005 in symptoms, treatment and general condition. RESULTS The proportion of NC patients increased from 3.5% (147/4182) to 8.1% (558/6854). NC patients, which are now referred to PC services, are younger, show less need for nursing support, die less often during inpatient stay. Overall a greater variety of diagnoses were found and patients suffer from less complex symptoms and problems at admission. CONCLUSIONS Despite the continuously growing number of patients with non-malignant diseases, their number in PC services is still low. As small steps in the right direction have been taken, integrating PC ideas earlier into treatment of chronic diseases to improve quality of life of NCs during the final stages of their diseases will continue to challenge the health care system in terms of workload, need of more staff and further training of medical professionals dealing with NCs in the future.
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Affiliation(s)
- Stephanie Hess
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen -EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Stephanie Stiel
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen -EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Sonja Hofmann
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen -EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Carsten Klein
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen -EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Gabriele Lindena
- Clinical Analysis, Research and Application (CLARA), Kleinmachnow, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen -EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany.
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Paiva CE, Barroso EM, Carneseca EC, de Pádua Souza C, dos Santos FT, Mendoza López RV, Ribeiro Paiva SB. A critical analysis of test-retest reliability in instrument validation studies of cancer patients under palliative care: a systematic review. BMC Med Res Methodol 2014; 14:8. [PMID: 24447633 PMCID: PMC3899385 DOI: 10.1186/1471-2288-14-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/13/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Patient-reported outcome validation needs to achieve validity and reliability standards. Among reliability analysis parameters, test-retest reliability is an important psychometric property. Retested patients must be in a clinically stable condition. This is particularly problematic in palliative care (PC) settings because advanced cancer patients are prone to a faster rate of clinical deterioration. The aim of this study was to evaluate the methods by which multi-symptom and health-related qualities of life (HRQoL) based on patient-reported outcomes (PROs) have been validated in oncological PC settings with regards to test-retest reliability. METHODS A systematic search of PubMed (1966 to June 2013), EMBASE (1980 to June 2013), PsychInfo (1806 to June 2013), CINAHL (1980 to June 2013), and SCIELO (1998 to June 2013), and specific PRO databases was performed. Studies were included if they described a set of validation studies. Studies were included if they described a set of validation studies for an instrument developed to measure multi-symptom or multidimensional HRQoL in advanced cancer patients under PC. The COSMIN checklist was used to rate the methodological quality of the study designs. RESULTS We identified 89 validation studies from 746 potentially relevant articles. From those 89 articles, 31 measured test-retest reliability and were included in this review. Upon critical analysis of the overall quality of the criteria used to determine the test-retest reliability, 6 (19.4%), 17 (54.8%), and 8 (25.8%) of these articles were rated as good, fair, or poor, respectively, and no article was classified as excellent. Multi-symptom instruments were retested over a shortened interval when compared to the HRQoL instruments (median values 24 hours and 168 hours, respectively; p = 0.001). Validation studies that included objective confirmation of clinical stability in their design yielded better results for the test-retest analysis with regard to both pain and global HRQoL scores (p < 0.05). The quality of the statistical analysis and its description were of great concern. CONCLUSION Test-retest reliability has been infrequently and poorly evaluated. The confirmation of clinical stability was an important factor in our analysis, and we suggest that special attention be focused on clinical stability when designing a PRO validation study that includes advanced cancer patients under PC.
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Affiliation(s)
- Carlos Eduardo Paiva
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo CEP 14784-400, Brazil
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Researcher Support Center, Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Eliane Marçon Barroso
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Estela Cristina Carneseca
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Researcher Support Center, Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Cristiano de Pádua Souza
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo CEP 14784-400, Brazil
| | - Felipe Thomé dos Santos
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo CEP 14784-400, Brazil
| | | | - Sakamoto Bianca Ribeiro Paiva
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Researcher Support Center, Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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Pinzon LCE, Claus M, Perrar KM, Zepf KI, Letzel S, Weber M. Dying with dementia: symptom burden, quality of care, and place of death. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:195-202. [PMID: 23589742 DOI: 10.3238/arztebl.2013.0195] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 12/21/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND No detailed information has been available until now about the care setting, circumstances and place of death, symptom burden, and quality of care of persons with end-stage dementia in Germany. METHODS This cross-sectional study is based on a random sample of 5000 persons who died in the period from 25 May to 24 August 2008 in the German federal state of Rhineland-Palatinate. Their surviving relatives were contacted and asked to participate in a questionnaire survey. Data were obtained in this way for 310 persons with dementia and 931 persons without dementia. RESULTS 42.4% of the persons with dementia died at home. Most patients and their relatives preferred death at home to death anywhere else (94.8% of patients, 77.5% of relatives). Persons living with at least one relative were more likely to die at home (adjusted odds ratio [aOR] 4.69, 95% confidence interval [CI] 2.71-8.11). According to information supplied by the relatives, the overwhelming majority of patients suffered, two days before death, from moderate to severe weakness (94.9%), fatigue (94.4%), disorientation/confusion (86.9%), and appetite loss (86.4%). Other common symptoms were anxiety (61.0%), tension (59.9%), dyspnea (56.7%), and pain (52.5%). The relatives were critical of the quality of care on standard hospital wards, citing the limited temporal availability of staff and limited emotional support. CONCLUSION These data indicate the high symptom burden of persons with dementia in Germany at the end of their lives. They underscore the need for proper palliative care in all of the settings where persons with dementia die. Specialized in- and outpatient palliative care should not be offered only to patients with cancer, but should rather be made available to all who need it.
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Affiliation(s)
- Luis Carlos Escobar Pinzon
- Institute of Occupational, Social and Environmental Medicine, University Medical Center of the Johannes Gutenberg University of Mainz.
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Bükki J, Scherbel J, Stiel S, Klein C, Meidenbauer N, Ostgathe C. Palliative care needs, symptoms, and treatment intensity along the disease trajectory in medical oncology outpatients: a retrospective chart review. Support Care Cancer 2013; 21:1743-50. [PMID: 23344656 DOI: 10.1007/s00520-013-1721-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 01/09/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Early integration of palliative care into cancer disease management is beneficial for patients with advanced tumors. However, little is known about the association of palliative care interventions with symptom burden and treatment aggressiveness at the end of life (EoL). METHODS To assess determinants of symptom burden and treatment intensity at the EoL, a retrospective chart review was conducted in university cancer clinic outpatients who died between July 2009 and June 2011. The objective was the correlation of place of death, palliative care utilization, prior EoL discussion, and social background (determinant variables) with symptom burden and treatment intensity (outcome variables). RESULTS Ninety-six patients (61 men and 35 women) died; the mean age at death was 62.4 years (range 24-83). Mean duration of treatment was 17.9 months (range 1-129). Data on the last 14 days (3) of life were available for 62 (44) patients. Forty-seven patients received aggressive EoL care which was strongly associated with hospital death (p = 0.000, χ2 test). The 15 patients having used palliative care services or dying in a palliative care unit (PCU) had fewer symptoms (p = 0.006, t test) and interventions (p = 0.000, t test) at the EoL. Having addressed EoL issues was correlated with fewer procedures during the last 3 days (p = 0.035, t test). CONCLUSIONS Most cancer patients receive aggressive EoL care interfering with quality of life. Despite limitations by small sample size and missing data, the results suggest that palliative care utilization is associated with reduced symptom burden and intensity of treatment at the EoL. Timely discussion of EoL issues may reduce the number of unnecessary interventions and facilitate referral to the PCU.
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Affiliation(s)
- Johannes Bükki
- Departement of Palliative Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
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Pfister D, Müller M, Müller S, Kern M, Rolke R, Radbruch L. [Validation of the Bonn test for knowledge in palliative care (BPW)]. Schmerz 2012; 25:643-53. [PMID: 22120918 DOI: 10.1007/s00482-011-1111-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Palliative care in nursing homes has become an increasing focal point of healthcare in Germany and the evaluation of the specific quality of palliative care in this setting is under discussion. The assessment of quantitative data has the advantage of allowing pre-post comparisons of different interventions and implementation procedures and can therefore be used for evaluation of effectiveness. However, no assessment tool in German is available yet. Recent research on the assessment of healthcare professionals' knowledge indicated that knowing about technical and psychosocial aspects of palliative care is an easily measurable index for the quality of care. In consequence this index will be used as the core of the test instrument. The specific self-efficacy related to palliative care should be additionally included. METHOD An analysis of the two most common tests of palliative care knowledge by three experts revealed that these instruments were only partly useful in Germany because of differences in the healthcare systems. The experts also criticised that the tests included only a few items concerning psychosocial care and that these items often showed ceiling effects. In addition, the instruments were not suitable for use in nursing homes. For specific self-efficacy only one test is available in Dutch. The items of these three instruments were face validated by 5 experts and new items were generated where needed. The content validity was verified again by five experts with the think-aloud method. Items were validated in 23 calliative care trainers whose expert knowledge served as an external criterion. Items that scored low in this group were eliminated. A second sample of 36 assistant nurses working in nursing homes who took part in a workshop for palliative care was used to assess change sensitivity before and after training. RESULTS A total of 23 items for the knowledge test and 15 items for specific self-efficacy were selected. The level of difficulty was suitable because an expert group could answer the questions while for assistant nurses the items were sufficiently difficult to show a difference between groups. Items were very sensitive to change after a training course. CONCLUSION The BPW is the first standardized test instrument for palliative care in the German language. In comparison to the other tests it includes items from the psychosocial domain without demonstrating a ceiling effect for these items. Content and criterion validity were good. Additional tests with larger samples and with other groups of nurses working in other settings would be needed to improve the data on reliability and to extend the validation to other settings.
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Affiliation(s)
- D Pfister
- ALPHA Rheinland, Von-Hompesch-Str. 1, 53123, Bonn, Deutschland.
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Gaertner J, Frechen S, Sladek M, Ostgathe C, Voltz R. Palliative care consultation service and palliative care unit: why do we need both? Oncologist 2012; 17:428-35. [PMID: 22357732 DOI: 10.1634/theoncologist.2011-0326] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Palliative care (PC) infrastructure has developed differently around the globe. Whereas some institutions consider the palliative care unit (PCU) a valuable component, others report that the sole provision of a state-of-the art palliative care consultation service (PCCS) suffices to adequately care for the severely ill and dying. OBJECTIVE To aid institutional planning, this study aimed at gathering patient data to distinguish assignments of a concomitantly run PCU and PCCS at a large hospital and academic medical center. METHODS Demographics, Eastern Cooperative Oncology Group performance status, symptom/problem burden, discharge modality, and team satisfaction with care for all 601 PCU and 851 PCCS patients treated in 2009 and 2010 were retrospectively analyzed. RESULTS Patients admitted to the PCU versus those consulted by the PCCS: (a) had a significantly worse performance status (odds ratio [OR], 1.48); (b) were significantly more likely to suffer from severe symptoms and psychosocial problems (OR, 2.05), in particular concerning physical suffering and complexity of care; and (c) were significantly much more likely to die during hospital stay (OR, 11.03). For patients who were dying or in other challenging clinical situations (suffering from various severe symptoms), self-rated team satisfaction was significantly higher for the PCU than the PCCS. CONCLUSION This study presents a direct comparison between patients in a PCU and a PCCS. Results strongly support the hypothesis that the coexistence of both institutions in one hospital contributes to the goal of ensuring optimal high-quality PC for patients in complex and challenging clinical situations.
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Affiliation(s)
- Jan Gaertner
- Department of Palliative Care, University Hospital Cologne, 50924 Cologne, Germany.
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