1,720,993 research outputs found
Assessment of Distress with Physical and Psychological Symptoms of Patients in German Palliative Care Services
No full textBACKGROUND: Within the framework of the nationwide Hospice and Palliative Care Evaluation (HOPE), the German Basic Documentation for Psycho-oncology (PO-Bado) was used from 2004 to 2006 as an optional module in most participating palliative care services to investigate how patient distress due to symptom burdens in different palliative care settings should be assessed and how professional interventions could be derived. PATIENTS AND METHODS: The distress scores of 3,317 PO-Bado records out of a total of 6,958 consecutive participants from 3 yearly samples of HOPE were evaluated descriptively and compared with a reference sample of cancer patients from both general and university hospitals. RESULTS: The relative values of distress from physical and psychological symptoms were 0.57 and 0.37 (maximum of 1.0), respectively. In 38.2% of the patients, professional psychosocial interventions were indicated. Compared to the reference sample of cancer patients, palliative care patients clearly showed more specific physical distress, but psychological symptoms were varied; in particular, distress from cognitive impairment, helplessness and grief showed higher intensities in palliative care patients than in the reference group. CONCLUSIONS: The PO-Bado rating scales assessed high levels of distress, particularly from physical symptoms, in palliative care patients. A large percentage of palliative care patients required professional psychosocial support.Hintergrund: Im Rahmen der bundesweiten Hospiz- und Palliativerhebung HOPE wurde von 2004 bis 2006 die Psychoonkologische Basisdokumentation (PO-Bado) in den meisten teilnehmenden Institutionen als optionale Ergänzung eingesetzt, um festzustellen, wie die psychische Belastung der Patienten in Hospiz- und Palliativeinrichtungen eingeschätzt und wie daraus die Indikation für eine professionelle Intervention abgeleitet werden kann. Patienten und Methoden: Die Belastungsangaben in 3317 PO-Bado-Datensätzen von insgesamt 6958 Teilnehmern aus 3 jährlichen Stichproben der bundesweiten HOPE-Dokumentation wurden deskriptiv ausgewertet und mit Daten einer Referenzgruppe aus allgemein onkologischen Einrichtungen verglichen. Ergebnisse: Der relative Summenwert der Belastung durch somatische Symptome lag bei 0,57 (maximal 1), durch psychische Symptome bei 0,37. Eine Indikation für eine professionelle psychosoziale Unterstützung wurde bei 38,2% der Patienten gesehen. Im Vergleich zu einer Referenzstichprobe von onkologischen Patienten zeigen Palliativpatienten deutlich stärkere körperliche Belastungen, während die psychischen Belastungen sich differenzieren: höher als in der Referenzgruppe waren die Belastungen durch kognitive Einschränkungen, Hilflosigkeit/Ausgeliefertsein und Trauer/Niedergeschlagenheit. Schlussfolgerungen: Die hohe psychische Belastung durch vor allem somatische Symptome wird bei Palliativpatienten in Deutschland mit Hilfe des PO-Bado-Moduls erfasst. Eine psychosoziale Unterstützung wird in vielen Fällen als notwendig angesehen
Anticancer therapies in specialized palliative care-a multicenter survey
No full textAnticancer therapies gain increasing attention and discussion in specialized palliative care institutions. Frequency, indication, attitude of team members, and modes of these therapies implemented in specialized palliative care settings are still under investigation. Descriptive analysis of the nationwide Hospice and Palliative Care Evaluation 2007 that collected data from palliative medicine, hospice care, and oncology institutions concerning the use of anticancer therapies. Three thousand one hundred eighty-four patients from 67 palliative care units, eight oncology wards, and other in- and outpatient institutions were registered. Two hundred eleven therapeutic interventions, mostly i.v. chemotherapy (28.9%), have been documented in all institutions except from inpatient hospices. Although all institutions were asked to keep records from "palliative patients", those patients treated in oncology services differed from patients on palliative care units with respect to prognosis, therapeutic intention (symptom control versus tumor remission), and team attitude. Anticancer therapies are incorporated into palliative care concepts. The described differences in palliative patients that are treated in specialized palliative care as compared to oncology services will have to be discussed with regard to selection of patients for specialized palliative care and the range of suitable treatment modalities in palliative care concepts
Befinden von Palliativpatienten im Verlauf einer spezialisierten ambulanten oder stationären Versorgung
No full textA major goal of palliative care is sustaining quality of life (QoL) for patients suffering from severe symptoms, which is determined by physical and psychological consequences of an illness as well as other factors, such as the meaning of life and family support. Patients have reported high levels of QoL despite worsening symptoms. The self-estimated QoL of patients receiving outpatient and inpatient palliative care was analyzed using retrospective data from the German Hospice and Palliative Care Evaluation (HOPE). A descriptive analysis of questionnaires given to 2,030 patients (1,616 inpatients, 414 outpatients) and their professional care takers was carried out assessing symptoms, well-being and care-related information. At the beginning of treatment inpatients had a higher symptom burden than outpatients. Reduced pain, tiredness and weakness and improved well-being allowed inpatients to be discharged. Outpatients suffering from severe dyspnea, constipation and anxiety were more likely to be admitted to hospital. Well-being was associated with symptom burden, weakness and tiredness in both self-evaluation and care-taker assessment particularly for outpatients. While tiredness and weakness influenced QoL especially for outpatients, patient-specific factors may surpass them in patient perception. To improve the QoL of palliative care patients, individual factors must be assessed in addition to symptom control
Morphine responsiveness, efficacy and tolerability in patients with chronic non-tumor associated pain - results of a double-blind placebo-controlled trial (MONTAS)
No full textEfficacy, long-term effectiveness and safety of opioids in chronic non-tumor associated pain syndromes (NTAS) are still under debate. The study (MONTAS) was performed by physicians and psychologists as a multicenter prospective, randomized, double-blind placebo-controlled crossover trial, followed by an open long-term study. Patients were enrolled only when pain relief from specific defined pretreatment was insufficient. Patients were randomly assigned to group I receiving sustained-release morphine (doses: 20 mg/d titrated appropriately to a maximum of 180 mg/d) in the first week, placebo in the second week or group 11 receiving study medication in reverse order. The primary endpoint was defined as: (i) adequate pain relief (pain intensity of less than 50% of pretreatment intensity or less than 5 on a I I point Numerical Rating Scale) and (ii) pain rated as tolerable and (iii) adverse effects rated as tolerable. Full responders (all criteria fulfilled under morphine) and partial responders (less pain relief, but tolerable side effects) were offered continuation of treatment with oral morphine in an open long-term study (LAMONTAS), to be published later. Forty-nine patients of 997 patients screened fulfilled the inclusion criteria for MONTAS and were enrolled. Mean pain intensity in all patients was reduced by morphine from 7.8 to 5.2 (NNT: 2.2); in 17 (35.4%) responders from 7.4 to 2.9, in 17 (35.4%) partial responders from 7.8 to 5.6 and in 14 (29.2%) non-responders from 8.2 to 7.7. Pain reduction correlated with improvement of physical function. Pain disability, depression score, mood and exercise endurance improved, particularly in responders. Gastrointestinal complaints increased, central nervous system-related complaints were reduced. Efficacy and safety of morphine in WAS were demonstrated in this randomized-controlled trial. Pretreatment failure was the indication for trying morphine treatment; predictive factors for responsiveness could not be identified. (C) 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved
Pain treatment facilities at hospitals in Germany. Outpatient, daycare and inpatient facilities for patients with chronic pain
No full textSpecialised pain treatment is available at inpatient, daycare and outpatient units at hospitals in Germany. A total of 579 hospitals in Germany offer at least one of the three pain treatment options. The main treatment involves outpatient care, but inpatient wards and daycare institutions have become more common. The type and number of pain treatment facilities differ regionally. Five of the 16 counties do not officially offer inpatient care at all, although pain treatment sites have been opened on the initiative of the hospitals themselves. Since specialised pain treatment is insufficiently defined by diagnosis (ICD-10) or procedures (OPS) in the German DRG system, it is not possible to recognise its availability when the facilities are not officially named. Pain treatment should be differentiated dependent on whether patients are treated within a single area of expertise or by specialised multiprofessional pain facilities. At hospitals, systematic multimodal pain treatment is possible. Inpatient and daycare pain treatment programs are suitable when outpatient treatment has failed. An overview of the pain therapies offered is a prerequisite for their optimal use,the demonstration of their necessity and for their continued development throughout Germany. This study was planned and supervised by the commission for quality assurance of the German IASP chapter and was sponsored by the German IASP chapter
Comparison of two screening questionnaires for patients with low back pain. Collation of risk factors for chronification
No full textScreening for risk factors for chronic low back pain (LBP) (yellow flags) is recommended by clinical guidelines. Various questionnaires to assess yellow flags have been proposed. The aim of this study was to compare the prognostic validity of two screening questionnaires. This was a prospective observational study with 241 LBP patients from 9 general practitioners, 4 orthopedic surgeons and 2 pain clinics. We compared the A-rebro musculoskeletal pain questionnaire (A-MSPQ) and the Heidelberg short questionnaire (HKF-R10) which were completed by all patients at inclusion before the consultation. Primary outcomes were assessed after 3 months by mail. Clinical endpoints were pain intensity, disability and more than two follow-up consultations. The sensitivity of the HKF-R10 to predict the primary outcome ranged from 81 % to 88 %, while the specificity was much lower (37-47 %). The A-MSPQ showed an opposite pattern with a low sensitivity ranging from 50 % to 58 % but a higher specificity (77-80 %). In patients initially classified as having chronic LBP (n = 81), using the questionnaires as a diagnostic tool, the sensitivity of both questionnaires increased but specificity decreased. Single items may perform better with regard to primary outcome than the sum scores. Both screening questionnaires for chronic LBP have insufficient diagnostic and prognostic validity for routine use in ambulatory care. Further studies are needed to improve diagnostic and prognostic validity and to elaborate criteria for a targeted use of screening questionnaires to guide therapeutic interventions
Palliative sedation in Germany: how much do we know? A prospective survey
No full textBackground: Little is known about the practice of palliative sedation (PS) in Germany. This paper presents an analysis of sedation-related data obtained from the German standardized core documentation system (HOPE) for palliative care patients. Methods: HOPE was complemented by an optional module on ethical decision making (EDM) which was pretested in 2004, data was collected in 2005-6 during the annual 3-month census. Data was analyzed descriptively from palliative care units (PCU - representative) and inpatient hospice (H - non-representative control group). Chi(2) test was used to test for differences between the reported data per item and year within one kind of setting (significance level p <= 0.05). Free-text entries were categorized inductively. Results: Datasets were obtained for 1,944 patients (P) with EDM. PS was performed in 13.0/11.8% (2005/2006) P in palliative care units (PCU) and 25.5/22.9% in hospices (H). Main reasons for PS in PCU were dyspnea, pain, fear or anxiety, in H reasons were inconsistent, high prevalence of psychosocial reasons. Most PS in PCU and about half of the PS in H were intermittent. Sedated P were younger than non-sedated. Only 7 P received PS after asking for euthanasia. The most used medication was midazolam. Conclusions: This study reveals a first insight into the use and practice of PS in German PCU and H. For a more detailed systematic survey into the course of decision-making and procedures, a new complementary optional module on PS is being developed by the HOPE group
Construct and predictive validity of the German A-rebro questionnaire short form for psychosocial risk factor screening of patients with low back pain
No full textRecognizing patients at risk of developing chronic low back pain is essential for targeted interventions. One of the best researched screening instruments for this purpose is the A-rebro Musculoskeletal Pain Questionnaire (A-MSPQ). This work addresses psychometric properties of the German A-MSPQ short form and its construct and prognostic validity. Analyses are based on a cluster-randomized trial assessing a risk tailored intervention for patients consulting for low back pain in 35 general practices. A total of 360 patients consulting for acute and sub-acute back pain, aged 20-60 years, were included. All patients received a 10-item German short version of the A-MSPQ, and other generic instruments (Graded Chronic Pain Scale, Patient Health Questionnaire-Depression, Hannover Functional Ability Questionnaire, Fear-Avoidance Beliefs Questionnaire). The construct validity was assessed based on the factorial structure of the items and correlations with generic instruments. The area under the curve (AUC), sensitivity and specificity were calculated as measures of prognostic validity. A-MSPQ items belonging to the same subscale correlated highest among each other. The internal consistency of the A-MSPQ items was 0.80 (Cronbach's alpha). The factorial structure corresponds with theoretic expectations. A-MSPQ subscales on pain related disability, depression, and fear-avoidance beliefs correlated highest with their counterpart generic scales. The AUC for three A-MSPQ-based prediction models ranged from 0.77 to 0.81. Our results support a satisfactory factorial and prognostic validity of the German short A-MSPQ. The instrument may guide the provision of targeted interventions. Further research should link it to targeted treatments.Federal Ministry of Education and Research [01EM0113
What Is Special about Patients with Lung Cancer and Pulmonary Metastases in Palliative Care? Results from a Nationwide Survey
No full textBackground: Patients with advanced lung cancer constitute a special focus in palliative care not only for epidemiological or prognostic reasons, but also because their symptom burden is felt to be widespread and difficult to treat. This study describes disease-specific characteristics and the symptom burden of patients with advanced incurable lung cancer, comparing them with patients suffering from other diseaseentities. Methods: A secondary analysis of the nationwide Hospice and Palliative Care Evaluation (HOPE) was performed, by focussing on inpatient hospice and palliative care unit patients and by using descriptive methods. Results: From 2006 to 2008, 5487 inpatients were registered, 874 of which were diagnosed with lung cancer and 1884 with pulmonary metastases. Symptoms such as weakness, tiredness, or pain were most prevalent in all subgroups. Dyspnea was significantly more prevalent in all patients with different kinds of pulmonary tumor manifestations; confusion was significantly more prevalent in patients with lung cancer. Dyspnea could not be treated as effectively as pain or nausea. Confusion and nursing problems worsened during the observation period. Dyspnea and confusion were associated with increased risk of death during the observational period. Conclusion: The symptom pattern of patients with lung cancer is characterized by dyspnea and confusion-symptoms that are difficult to treat until discharge and that imply a worse prognosis. Therefore, increased research on the pathophysiology and treatment of dyspnea and confusion is required, and efforts in advance care planning and anticipation of dyspnea and confusion as a critical symptom in patients with lung cancer should be reinforced
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