1,720,987 research outputs found
Care-related questions for specialized outpatient palliative care teams when faced with requests for assisted suicide: A case series
No full textZusammenfassung Einleitung Seit der Aufhebung des § 217 StGB Anfang 2020 stellen sich auch in der spezialisierten ambulanten Palliativversorgung (SAPV) neue Herausforderungen im Umgang mit Wünschen nach Suizidassistenz, die bislang kaum systematisch untersucht wurden. Ziel der Arbeit ist es, Fälle mit einem Wunsch nach Suizidassistenz in der SAPV darzustellen und zu analysieren. Auf dieser Grundlage sollen zentrale Herausforderungen in der Versorgung identifiziert und Ansatzpunkte für Strategien zum Umgang mit diesen Wünschen entwickelt werden. Methoden Es wurde eine retrospektive Fallanalyse aller Patient:innen durchgeführt, die zwischen 02/2020 und 08/2025 durch das SAPV-Team der Uniklinik Köln betreut wurden und einen expliziten Wunsch nach Suizidassistenz geäußert haben. Die Daten wurden aus der elektronischen Dokumentation (PalliDoc®) extrahiert. Versorgungspraktische und -ethische Fragestellungen wurden im multiprofessionellen Team abgeleitet. Ergebnisse Insgesamt wurden sechs Patient:innen eingeschlossen. Fünf litten an amyotropher Lateralsklerose, eine Person an einer fortgeschrittenen onkologischen Erkrankung. Drei Patient:innen nahmen externe Suizidassistenz in Anspruch. Diskussion Zentrale Herausforderungen in der Versorgung betrafen die Rollenklärung der SAPV, die Kommunikation über Suizidassistenz, die Begleitung von Nahestehenden sowie den Versorgungsabschluss. Eine klare organisationsinterne Haltung sowie definierte Kommunikationswege im Team und gegenüber Patient:innen sowie deren Nahestehenden wirken unterstützend. Die Arbeit formuliert praxisrelevante Fragestellungen zur konzeptionellen Weiterentwicklung des Umgangs mit Wünschen nach Suizidassistenz.Abstract Introduction Following the repeal of § 217 of the German Criminal Code in early 2020, new related challenges have also emerged in specialized outpatient palliative care (SAPV) regarding how to address requests for assisted suicide that have so far received little systematic investigation. The aim of this study is to describe and analyze cases involving requests for assisted suicide within SAPV. On this basis, key challenges in care are identified and potential strategies for dealing with such requests are developed. Methods A retrospective case analysis was conducted of all patients who were cared for by the SAPV team at the University Hospital Cologne between February 2020 and August 2025 and explicitly expressed a wish for assisted suicide. Data were extracted from the electronic documentation system (PalliDoc®). Practical and ethical issues related to care were derived within the multiprofessional team. Results A total of six patients were included. Five patients suffered from amyotrophic lateral sclerosis and one patient had advanced oncological disease. Three patients made use of external assisted suicide services. Discussion Central challenges in care concerned clarification of the role of SAPV, communication about assisted suicide, support of relatives, and the conclusion of care. A clear internal organizational position, as well as defined communication pathways within the team towards patients and their relatives, proved to be supportive. This study formulates practice-relevant questions for the conceptual further development of approaches to requests for assisted suicides.Zusammenfassung Einleitung Seit der Aufhebung des § 217 StGB Anfang 2020 stellen sich auch in der spezialisierten ambulanten Palliativversorgung (SAPV) neue Herausforderungen im Umgang mit Wünschen nach Suizidassistenz, die bislang kaum systematisch untersucht wurden. Ziel der Arbeit ist es, Fälle mit einem Wunsch nach Suizidassistenz in der SAPV darzustellen und zu analysieren. Auf dieser Grundlage sollen zentrale Herausforderungen in der Versorgung identifiziert und Ansatzpunkte für Strategien zum Umgang mit diesen Wünschen entwickelt werden. Methoden Es wurde eine retrospektive Fallanalyse aller Patient:innen durchgeführt, die zwischen 02/2020 und 08/2025 durch das SAPV-Team der Uniklinik Köln betreut wurden und einen expliziten Wunsch nach Suizidassistenz geäußert haben. Die Daten wurden aus der elektronischen Dokumentation (PalliDoc®) extrahiert. Versorgungspraktische und -ethische Fragestellungen wurden im multiprofessionellen Team abgeleitet. Ergebnisse Insgesamt wurden sechs Patient:innen eingeschlossen. Fünf litten an amyotropher Lateralsklerose, eine Person an einer fortgeschrittenen onkologischen Erkrankung. Drei Patient:innen nahmen externe Suizidassistenz in Anspruch. Diskussion Zentrale Herausforderungen in der Versorgung betrafen die Rollenklärung der SAPV, die Kommunikation über Suizidassistenz, die Begleitung von Nahestehenden sowie den Versorgungsabschluss. Eine klare organisationsinterne Haltung sowie definierte Kommunikationswege im Team und gegenüber Patient:innen sowie deren Nahestehenden wirken unterstützend. Die Arbeit formuliert praxisrelevante Fragestellungen zur konzeptionellen Weiterentwicklung des Umgangs mit Wünschen nach Suizidassistenz.Abstract Introduction Following the repeal of § 217 of the German Criminal Code in early 2020, new related challenges have also emerged in specialized outpatient palliative care (SAPV) regarding how to address requests for assisted suicide that have so far received little systematic investigation. The aim of this study is to describe and analyze cases involving requests for assisted suicide within SAPV. On this basis, key challenges in care are identified and potential strategies for dealing with such requests are developed. Methods A retrospective case analysis was conducted of all patients who were cared for by the SAPV team at the University Hospital Cologne between February 2020 and August 2025 and explicitly expressed a wish for assisted suicide. Data were extracted from the electronic documentation system (PalliDoc®). Practical and ethical issues related to care were derived within the multiprofessional team. Results A total of six patients were included. Five patients suffered from amyotrophic lateral sclerosis and one patient had advanced oncological disease. Three patients made use of external assisted suicide services. Discussion Central challenges in care concerned clarification of the role of SAPV, communication about assisted suicide, support of relatives, and the conclusion of care. A clear internal organizational position, as well as defined communication pathways within the team towards patients and their relatives, proved to be supportive. This study formulates practice-relevant questions for the conceptual further development of approaches to requests for assisted suicides
Non-cancer patients in specialized palliative care in Germany: What are the problems?
No full text To determine the role of non-cancer palliative care in inpatient services in Germany, data from the Hospice and Palliative Care Evaluation (HOPE) were analysed. Since 1999, a three-month census has been conducted annually in German palliative care units. Pooled data from 2002–2005 were tested for differences between non-cancer patients (NCs) and cancer patients (Cs). A total of 4182 patients (NC: 3.5%; C: 96.5%) were documented; functional status (using Eastern Cooperative Oncology Group (ECOG) measures) in NCs was lower compared to Cs ( p = 0.009). NCs suffered more often from dyspnoea (40%; C: 29%; p = 0.004), weakness (92,3%; C: 84,5%; p = 0.011) and tiredness (75.4%; C: 66.7%; p = 0.03) and less from nausea (17.1%; C: 28.9%; p = 0.002), vomiting (8.2%; C: 19.4%; p = 0.001) or loss of appetite (55.5%; C: 67.9%; p = 0.002). There were no differences in pain and constipation. Other problems (nursing, psychological) were more frequent for NCs, in particular the need for support in the activities of daily life (90.3%; C: 72.8%; p < 0.001) and disorientation/confusion (32.1%; C: 17.2%; p < 0.001). There were no differences in social problems. NCs are still rare in specialized inpatient palliative care institutions in Germany. The palliative care needs in patients with non-malignant disease will challenge the health care system as the workload for these services will grow over proportionally. </jats:p
Desire for hastened death: how do professionals in specialized palliative care react?
No full textObjectiveDesires for hastened death (DHD; wish to hasten death is also in use) are prevalent in terminally ill patients. Studies show that health professionals (HP) are often underprepared when presented with DHD. HPs in specialized palliative care (SPC-HP) often encounter DHD. This study aimed to identify SPC-HP responses to DHD in daily practice and their corresponding functions. MethodsNarrative interviews were conducted with 19 SPC-HPs at four German University Hospitals. Transcripts were analyzed using the documentary method. An inventory of established responses to DHD was compiled, and their corresponding functions in the context of the patient-SPC-HP interaction were reconstructed. ResultsTwelve response categories and six corresponding functions were identified. On the patient level, responses categorized as symptom control, exploring the reasons and generating perspective, reorientation, and hope were particularly used to ease the patient's burden. On the interaction level, creating a relationship was fundamental. On the SPC-HP level, various methods served the functions self-protection and showed professional expertise. ConclusionsProfound personal and professional development is necessary to respond to the inherent challenges presented by DHD. Establishing helpful relationships with patients is essential regardless of SPC-HP specialization. SPC-HPs should maximize their skills in establishing and maintaining relationships as well as strengthening their own resilience, possibly in specific training courses. Copyright (c) 2015 John Wiley & Sons, Ltd.Koln Fortune [108/2010
Cross-cultural validation of the integrated palliative outcome scale for neurological patients (IPOS-Neuro S8) in multiple sclerosis patients
No full textAbstract Objectives Standardized measures to evaluate neurological patients in palliative care are missing. The Integrated Palliative Outcome Scale, a self-report tailored for neurological patients (IPOS Neuro-S8) helps identify symptom burden but lacks validation in German. This study aimed to validate the IPOS Neuro-S8 in severely affected multiple sclerosis (MS) patients. Methods This validation study is a secondary analysis of data from a clinical phase II intervention study with severely affected MS patients. The original study enrolled German-speaking patients aged 18 with severe MS who receive an escalating immunotherapeutic agent and/or exhibit a high level of disability were recruited from the administrative district Cologne (#DRKS00021783). In this validation study, we evaluated construct, discriminant, and convergent validity, internal consistency, test–retest reliability, and sensitivity to change of the IPOS Neuro-S8, using the “Hamburger Lebensqualitätsmessinstrument” (HALEMS), and the Hospice and Palliative Care Evaluation supplemented by neurological symptoms (HOPE+) as comparison measures. Results Data from 80 MS patients (mean age 56, SD = 11) were analyzed. Exploratory and confirmatory factor analyses revealed a 3-factor structure ( r = 0.34–0.63), reflecting distinct clinical patterns, i.e., breath-mouth connection, pain-sleep cycle , and nausea-vomiting link . Significant convergent validity to hypothesized total score of the HOPE+ ( r s (78) = 0.71, p < 0.001) and good discriminant validity using the HALEMS total score ( r s (78) = 0.48, p < 0.001) were observed. Correlation with physical symptoms of the HALEMS was stronger than with nonphysical aspects. Internal consistency (Cronbach’s α = 0.67) and test–retest reliability (intraclass coefficient = 0.75) were acceptable. Significance of results IPOS Neuro-S8 displays promising psychometric properties for assessing palliative care symptoms in severe MS, a model for other severe neurological diseases due to MS's broad central nervous involvement, allowing findings to be transferable to other neurological diseases. A criterion for minimal clinically important difference was established to evaluate the sensitivity to change. Additional validation across different neurological conditions and disease severities is warranted to enhance generalizability and clinical utility
Epidemiology and palliative care of in-patient cerebral metastases cases in Germany
No full textAbstract Introduction Cerebral metastases (CM) are the most common intracranial neoplasms, significantly impacting patient quality-of-life. Despite advancements in diagnostics and therapeutics, the burden remains high. This study evaluates inpatient management, palliative care use, and mortality outcomes for CM patients in German hospitals in 2022. Methods A cross-sectional analysis was conducted on 71,787 inpatient cases involving adult CM and leptomeningeal malignancies patients in German hospitals in 2022. Data submitted by hospitals according to §21 of the Hospital Remuneration Act were analyzed, focusing on demographic data, primary tumor types, treatment methods, participation in palliative care, and discharge outcomes. Results Among the 71,787 cases, 53.4% were patients aged 65 years or older. Malignant lung tumors were present in 61.6% of cases, followed by breast malignancies (12%) and malignant melanoma and diffuse diffuse large B-cell lymphoma (each 6.4%). Specialized inpatient palliative care (SIPC) was provided in 14.8% (10,636 cases), with 85.2% not receiving such care. Hospital mortality was 13.1% (9413 cases), with 42.2% of these involving patients who received SIPC. Discharge outcomes included discharge home (72.7%), transfers to other hospitals (7.1%), rehabilitation facilities (0.4%), nursing facilities (2%), and hospices (2.4%). Conclusion Despite treatment advances, high mortality rates for CM patients persist, underscoring the need for palliative care integration and comprehensive training to enhance patient outcomes. Health care planning is a growing topic, our study establishes a benchmark for CM care in German hospitals, revealing a significant number of patients not receiving SIPC. This research can inform future healthcare strategies in neuro-oncology
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
- …
