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Surges SM, Brunsch H, Jaspers B, Apostolidis K, Cardone A, Centeno C, Cherny N, Csikós À, Fainsinger R, Garralda E, Ling J, Menten J, Mercadante S, Mosoiu D, Payne S, Preston N, Van den Block L, Hasselaar J, Radbruch L. Revised European Association for Palliative Care (EAPC) recommended framework on palliative sedation: An international Delphi study. Palliat Med 2024; 38:213-228. [PMID: 38297460 PMCID: PMC10865771 DOI: 10.1177/02692163231220225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND The European Association for Palliative Care (EAPC) acknowledges palliative sedation as an important, broadly accepted intervention for patients with life-limiting disease experiencing refractory symptoms. The EAPC therefore developed 2009 a framework on palliative sedation. A revision was needed due to new evidence from literature, ongoing debate and criticism of methodology, terminology and applicability. AIM To provide evidence- and consensus-based guidance on palliative sedation for healthcare professionals involved in end-of-life care, for medical associations and health policy decision-makers. DESIGN Revision between June 2020 and September 2022 of the 2009 framework using a literature update and a Delphi procedure. SETTING European. PARTICIPANTS International experts on palliative sedation (identified through literature search and nomination by national palliative care associations) and a European patient organisation. RESULTS A framework with 42 statements for which high or very high level of consensus was reached. Terminology is defined more precisely with the terms suffering used to encompass distressing physical and psychological symptoms as well as existential suffering and refractory to describe the untreatable (healthcare professionals) and intolerable (patient) nature of the suffering. The principle of proportionality is introduced in the definition of palliative sedation. No specific period of remaining life expectancy is defined, based on the principles of refractoriness of suffering, proportionality and independent decision-making for hydration. Patient autonomy is emphasised. A stepwise pharmacological approach and a guidance on hydration decision-making are provided. CONCLUSIONS This is the first framework on palliative sedation using a strict consensus methodology. It should serve as comprehensive and soundly developed information for healthcare professionals.
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Affiliation(s)
- Séverine M Surges
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Holger Brunsch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Birgit Jaspers
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
- Department of Palliative Medicine, University Medicine Goettingen, Goettingen, Germany
| | | | - Antonella Cardone
- Cancer Patients Europe, Brussels, Belgium
- Pancreatic Cancer Europe, Brussels, Belgium
| | - Carlos Centeno
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Nathan Cherny
- Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Àgnes Csikós
- Department of Primary Health Care, Department of Hospice-Palliative Care, University of Pecs Medical School, Pecs, Hungary
| | | | - Eduardo Garralda
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Julie Ling
- European Association for Palliative Care, Vilvoorde, Belgium
| | - Johan Menten
- Laboratory of Experimental Radiotherapy, KU Leuven, Leuven, Belgium
| | - Sebastiano Mercadante
- Main Regional Centre for Pain Relief and Palliative/Supportive Care, La Maddalena Cancer Centre, Palermo, Italy
| | - Daniela Mosoiu
- Medical Faculty, Transilvania University, Brasov, Romania
- Education and National Development Department, Hospice Casa Sperantei, Brasov, Romania
| | - Sheila Payne
- International Observatory on End-of-Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory on End-of-Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Lieve Van den Block
- VUB-UGhent End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jeroen Hasselaar
- Department of Primary Care, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Task Force on Palliative Sedation of the European Association for Palliative Care, Brussels, Belgium
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
- Task Force on Palliative Sedation of the European Association for Palliative Care, Brussels, Belgium
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Van der Elst M, Payne S, Arantzamendi M, Preston N, Hasselaar J, Centeno C, Belar A, Jaspers B, Brunsch H, Surges S, Adile C, Menten J. An analysis of the experiences of bereaved relatives and health care providers following palliative sedation: a study protocol for a qualitative international multicenter case study. BMC Palliat Care 2022; 21:227. [PMID: 36550539 PMCID: PMC9783747 DOI: 10.1186/s12904-022-01117-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients at the end-of-life may experience refractory symptoms of which pain, delirium, vomiting and dyspnea are the most frequent. Palliative sedation can be considered a last resort option to alleviate one or more refractory symptoms. There are only a limited number of (qualitative) studies exploring the experiences of relatives of sedated patients and their health care professionals (HCPs). The aims of this study protocol are: 1) to elicit the experiences of bereaved relatives and health care professionals of patients treated with palliative sedation and 2) to explore the understanding of the decision-making process to start palliative sedation across care settings in 5 European countries. METHODS This study protocol is part of the larger HORIZON 2020 Palliative Sedation project. Organisational case study methodology will be used to guide the study design. In total, 50 cases will be conducted in five European countries (10 per country). A case involves a semi-structured interview with a relative and an HCP closely involved in the care of a deceased patient who received some type of palliative sedation at the end-of-life. Relatives and health care professionals of deceased patients participating in a linked observational cohort study of sedated patients cared for in hospital wards, palliative care units and hospices will be recruited. The data will be analyzed using a framework analysis approach. The first full case will be analyzed by all researchers after being translated into English using a pre-prepared code book. Afterwards, bimonthly meetings will be organized to coordinate the data analysis. DISCUSSION The study aims to have a better understanding of the experiences of relatives and professional caregivers regarding palliative sedation and this within different settings and countries. Some limitations are: 1) the sensitivity of the topic may deter some relatives from participation, 2) since the data collection and analysis will be performed by at least 5 different researchers in 5 countries, some differences may occur which possibly makes it difficult to compare cases, but using a rigorous methodology will minimize this risk.
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Affiliation(s)
- M. Van der Elst
- grid.5596.f0000 0001 0668 7884Department of Oncology, Laboratory of Experimental Radiotherapy, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - S. Payne
- grid.9835.70000 0000 8190 6402International Observatory On End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4AT UK
| | - M. Arantzamendi
- grid.5924.a0000000419370271Institute for Culture and Society-ATLANTES, Universidad de Navarra, Calle Universidad 6, Navarra 31009 Pamplona, Spain ,grid.508840.10000 0004 7662 6114IdISNA- Instituto de Investigación Sanitaria de Navarra. Palliative Medicine, Pamplona, Spain
| | - N. Preston
- grid.9835.70000 0000 8190 6402International Observatory On End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4AT UK
| | - J. Hasselaar
- grid.5590.90000000122931605Department of Anesthesiology, Pain and Palliative Medicine, Radboud University and Radboudumc, Geert Grote Plein 10, HB6500 Nijmegen, Netherlands
| | - C. Centeno
- grid.5924.a0000000419370271Institute for Culture and Society-ATLANTES, Universidad de Navarra, Calle Universidad 6, Navarra 31009 Pamplona, Spain ,grid.508840.10000 0004 7662 6114IdISNA- Instituto de Investigación Sanitaria de Navarra. Palliative Medicine, Pamplona, Spain ,grid.411730.00000 0001 2191 685XClínica Universidad de Navarra, Palliative Medicine Department, Pamplona, Spain
| | - A. Belar
- grid.5924.a0000000419370271Institute for Culture and Society-ATLANTES, Universidad de Navarra, Calle Universidad 6, Navarra 31009 Pamplona, Spain ,grid.508840.10000 0004 7662 6114IdISNA- Instituto de Investigación Sanitaria de Navarra. Palliative Medicine, Pamplona, Spain
| | - B. Jaspers
- grid.15090.3d0000 0000 8786 803XDepartment of Palliative Medicine, Universitätsklinikum Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - H. Brunsch
- grid.15090.3d0000 0000 8786 803XDepartment of Palliative Medicine, Universitätsklinikum Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - S. Surges
- grid.15090.3d0000 0000 8786 803XDepartment of Palliative Medicine, Universitätsklinikum Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - C. Adile
- grid.10776.370000 0004 1762 5517La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy
| | - J. Menten
- grid.5596.f0000 0001 0668 7884Department of Oncology, Laboratory of Experimental Radiotherapy, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium
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Surges SM, Garralda E, Jaspers B, Brunsch H, Rijpstra M, Hasselaar J, Van der Elst M, Menten J, Csikós Á, Mercadante S, Mosoiu D, Payne S, Centeno C, Radbruch L. Review of European Guidelines on Palliative Sedation: A Foundation for the Updating of the European Association for Palliative Care Framework. J Palliat Med 2022; 25:1721-1731. [PMID: 35849746 DOI: 10.1089/jpm.2021.0646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In 2009, the European Association for Palliative Care (EAPC) developed a framework on palliative sedation, acknowledging this practice as an important and ethically acceptable intervention of last resort for terminally ill patients experiencing refractory symptoms. Before and after that, other guidelines on palliative sedation have been developed in Europe with variations in terminology and concepts. As part of the Palliative Sedation project (Horizon 2020 Funding No. 825700), a revision of the EAPC framework is planned. The aim of this article is to analyze the most frequently used palliative sedation guidelines as reported by experts from eight European countries to inform the discussion of the new framework. The three most reported documents per country were identified through an online survey among 124 clinical experts in December 2019. Those meeting guideline criteria were selected. Their content was assessed against the EAPC framework on palliative sedation. The quality of their methodology was evaluated with the Appraisal Guideline Research and Evaluation (AGREE) II instrument. Nine guidelines were included. All recognize palliative sedation as a last-resort treatment for refractory symptoms, but the criterion of refractoriness remains a matter of debate. Most guidelines recognize psychological or existential distress as (part of) an indication and some make specific recommendations for such cases. All agree that the assessment should be multiprofessional, but they diverge on the expertise required by the attending physician/team. Regarding decisions on hydration and nutrition, it is proposed that these should be independent of those for palliative sedation, but there is no clear consensus on the decision-making process. Several weaknesses were highlighted, particularly in areas of rigor of development and applicability. The identified points of debate and methodological weaknesses should be considered in any update or revision of the guidelines analyzed to improve the quality of their content and the applicability of their recommendations.
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Affiliation(s)
- Séverine M Surges
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Eduardo Garralda
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, Pamplona, Spain.,IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Birgit Jaspers
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.,Department of Palliative Medicine, University Medicine Goettingen, Goettingen, Germany
| | - Holger Brunsch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Maaike Rijpstra
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| | - Jeroen Hasselaar
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| | | | - Johan Menten
- Laboratory of Experimental Radiotherapy, UH & KU Leuven, Leuven, Belgium
| | - Ágnes Csikós
- Department of Primary Health Care, Department of Hospice-Palliative Care, University of Pecs Medical School, Pecs, Hungary
| | - Sebastiano Mercadante
- Main Regional Centre for Pain Relief and Palliative/Supportive Care, La Maddalena Cancer Centre, Palermo, Italy
| | - Daniela Mosoiu
- Medical Faculty, Transilvania University, Brasov, Brasov, Romania.,Education and National Development Department, Hospice Casa Sperantei, Brasov, Brasov, Romania
| | - Sheila Payne
- International Observatory on End-of-Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Carlos Centeno
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, Pamplona, Spain.,IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
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Ateș G, Jaspers B, Brunsch H, Radbruch L. Schnittstellen in der Versorgung am Lebensende. Ther Umsch 2022; 79:37-43. [PMID: 35100829 DOI: 10.1024/0040-5930/a001326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Schnittstellen stehen oft im Zusammenhang mit einer hohen Symptomlast, einem stetig wachsenden Versorgungsnetz und / oder einem häufigen Wechsel zwischen ambulanter und stationärer Versorgung. Schnittstellenproblematiken treten auf der Organisations-, Kommunikations-, Informations- und Wissensebene sowie beim Vernetzen von Institutionen auf. Hinweise auf Versorgungsdefizite am Lebensende und inwiefern eine nicht gelingende Symptomlinderung oder ein häufiger ambulanter und stationärer Versorgungswechsel abgefedert werden kann, wird anhand von Studienergebnissen erörtert. Am Lebensende sind offene empathische Gespräche, Symptomlinderung, psychosoziale Unterstützung und gegebenenfalls die Adressierung spiritueller Fragen bei bedarfsgerechter Anbindung an Einrichtungen und Dienste wichtige Grundpfeiler für Sterbende und Hinterbliebene. Ein Einblick in die unterschiedlichen hospizlichen und palliativen Versorgungsangebote im ambulanten und stationären Bereich, die mit ihren Angeboten auch Hinterbliebene mit einbeziehen, rundet diesen Beitrag ab.
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Affiliation(s)
- Gülay Ateș
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Deutschland
| | - Birgit Jaspers
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Deutschland
| | - Holger Brunsch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Deutschland
| | - Lukas Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Deutschland
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Schneider JN, Hiebel N, Kriegsmann-Rabe M, Schmuck J, Erim Y, Morawa E, Jerg-Bretzke L, Beschoner P, Albus C, Hannemann J, Weidner K, Steudte-Schmiedgen S, Radbruch L, Brunsch H, Geiser F. Moral Distress in Hospitals During the First Wave of the COVID-19 Pandemic: A Web-Based Survey Among 3,293 Healthcare Workers Within the German Network University Medicine. Front Psychol 2021; 12:775204. [PMID: 34867685 PMCID: PMC8636670 DOI: 10.3389/fpsyg.2021.775204] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The present study aimed to investigate the correlation between moral distress and mental health symptoms, socio-demographic, occupational, and COVID-19-related variables, and to determine differences in healthcare workers’ (HCW) moral distress during the first wave of the COVID-19 pandemic. Method: Data from 3,293 HCW from a web-based survey conducted between the 20th of April and the 5th of July 2020 were analyzed. We focused on moral distress (Moral Distress Thermometer, MDT), depressive symptoms (Patient Health Questionnaire-2, PHQ-2), anxiety symptoms (Generalized Anxiety Disorder-2, GAD-2), and increased general distress of nurses, physicians, medical-technical assistants (MTA), psychologists/psychotherapists, and pastoral counselors working in German hospitals. Results: The strongest correlations for moral distress were found with depressive symptoms, anxiety symptoms, occupancy rate at current work section, and contact with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Nurses and MTA experienced significantly higher moral distress than physicians, psychologists/psychotherapists, and pastoral counselors. The average level of moral distress reported by nurses from all work areas was similar to levels which before the pandemic were only experienced by nurses in intensive or critical care units. Conclusion: Results indicate that moral distress is a relevant phenomenon among HCW in hospitals during the COVID-19 pandemic, regardless of whether they work at the frontline or not and requires urgent attention.
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Affiliation(s)
- Juliane Nora Schneider
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Nina Hiebel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Milena Kriegsmann-Rabe
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Jonas Schmuck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Lucia Jerg-Bretzke
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Petra Beschoner
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
| | - Julian Hannemann
- Department of Psychosomatics and Psychotherapy, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Dresden University of Technology, Dresden, Germany
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Dresden University of Technology, Dresden, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Holger Brunsch
- Department of Palliative Medicine, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Medical Faculty, Bonn, Germany
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Schmuck J, Hiebel N, Rabe M, Schneider J, Erim Y, Morawa E, Jerg-Bretzke L, Beschoner P, Albus C, Hannemann J, Weidner K, Steudte-Schmiedgen S, Radbruch L, Brunsch H, Geiser F. Sense of coherence, social support and religiosity as resources for medical personnel during the COVID-19 pandemic: A web-based survey among 4324 health care workers within the German Network University Medicine. PLoS One 2021; 16:e0255211. [PMID: 34310616 PMCID: PMC8312980 DOI: 10.1371/journal.pone.0255211] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/13/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction The COVID-19 pandemic resulted in severe detrimental effects on the mental well-being of health care workers (HCW). Consequently, there has been a need to identify health-promoting resources in order to mitigate the psychological impact of the pandemic on HCW. Objective Our objective was to investigate the association of sense of coherence (SOC), social support and religiosity with self-reported mental symptoms and increase of subjective burden during the COVID-19 pandemic in HCW. Methods Our sample comprised 4324 HCW of four professions (physicians, nurses, medical technical assistants (MTA) and pastoral workers) who completed an online survey from 20 April to 5 July 2020. Health-promoting resources were assessed using the Sense of Coherence Scale Short Form (SOC-3), the ENRICHD Social Support Inventory (ESSI) and one item on religiosity derived from the Scale of Transpersonal Trust (TPV). Anxiety and depression symptoms were measured with the PHQ-2 and GAD-2. The increase of subjective burden due to the pandemic was assessed as the retrospective difference between burden during the pandemic and before the pandemic. Results In multiple regressions, higher SOC was strongly associated with fewer anxiety and depression symptoms. Higher social support was also related to less severe mental symptoms, but with a smaller effect size, while religiosity showed minimal to no correlation with anxiety or depression. In professional group analysis, SOC was negatively associated with mental symptoms in all groups, while social support only correlated significantly with mental health outcomes in physicians and MTA. In the total sample and among subgroups, an increase of subjective burden was meaningfully associated only with a weaker SOC. Conclusion Perceived social support and especially higher SOC appeared to be beneficial for mental health of HCW during the COVID-19 pandemic. However, the different importance of the resources in the respective occupations requires further research to identify possible reasons.
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Affiliation(s)
- Jonas Schmuck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University Hospital Bonn, Bonn, Germany
- * E-mail:
| | - Nina Hiebel
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University Hospital Bonn, Bonn, Germany
| | - Milena Rabe
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University Hospital Bonn, Bonn, Germany
| | - Juliane Schneider
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University Hospital Bonn, Bonn, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Lucia Jerg-Bretzke
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, University Ulm, Ulm, Germany
| | - Petra Beschoner
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, University Ulm, Ulm, Germany
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne, University Cologne, Cologne, Germany
| | - Julian Hannemann
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne, University Cologne, Cologne, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, Medical Faculty, University Hospital Bonn, Bonn, Germany
| | - Holger Brunsch
- Department of Palliative Medicine, Medical Faculty, University Hospital Bonn, Bonn, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University Hospital Bonn, Bonn, Germany
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Abstract
Pain is a common experience of mankind. Pain theories and the management of pain have been modified throughout the history of mankind. This article gives a brief review on pain, pain believes and pain management from early magico-demonic and magico-religious ideas and procedures to more empiric-scientific models; from ancient times and primitive cultures to the 20th century. Due to new anatomical, physiological and biochemical insights, modern pain theories developed in the 19th and 20th century. Modern analgesics were synthesized and new invasive procedures were approved having a major impact on pain management strategies. However, older traditional beliefs and attitudes have not been replaced completely and have survived to some degree in modern patients.
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Affiliation(s)
- R Sabatowski
- Pain Clinic, Department of Anesthesiology, University of Cologne, 50924 Cologne, Germany.
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