47 results on '"Eychmüller, Steffen"'
Search Results
2. How to talk about dying? The development of an evidence-based model for communication with patients in their last days of life and their family caregivers
- Author
-
Felber, Sibylle J., Zambrano, Sofia C., Guffi, Tommaso, Schmitz, Felix M., Brem, Beate G., Schnabel, Kai P., Guttormsen, Sissel, and Eychmüller, Steffen
- Published
- 2024
- Full Text
- View/download PDF
3. Palliative care and COVID-19: a bibliometric analysis.
- Author
-
Bernardis, Alessandra, Gonzalez-Jaramillo, Valentina, Ebneter, Andreas S., and Eychmüller, Steffen
- Published
- 2024
- Full Text
- View/download PDF
4. Early palliative care integration trial: consultation content and interaction dynamics.
- Author
-
Kleiner, Nadine, Zambrano, Sofia C., Eychmüller, Steffen, and Zwahlen, Susanne
- Published
- 2024
- Full Text
- View/download PDF
5. Facilitators and barriers of implementing end-of-life care volunteering in a hospital in five European countries: the iLIVE study.
- Author
-
Yildiz, Berivan, van der Heide, Agnes, Bakan, Misa, Iversen, Grethe Skorpen, Haugen, Dagny Faksvåg, McGlinchey, Tamsin, Smeding, Ruthmarijke, Ellershaw, John, Fischer, Claudia, Simon, Judit, Vibora-Martin, Eva, Ruiz-Torreras, Inmaculada, Goossensen, Anne, Allan, Simon, Barnestein-Fonseca, Pilar, Boughey, Mark, Christen, Andri, Lüthi, Nora, Egloff, Martina, and Eychmüller, Steffen
- Subjects
HEALTH services accessibility ,VOLUNTEER service ,PALLIATIVE treatment ,HUMAN services programs ,FOCUS groups ,RESEARCH funding ,INTERVIEWING ,HOSPITALS ,DESCRIPTIVE statistics ,CONCEPTUAL structures ,MATHEMATICAL models ,THEORY - Abstract
Background: End-of-life (EoL) care volunteers in hospitals are a novel approach to support patients and their close ones. The iLIVE Volunteer Study supported hospital volunteer coordinators from five European countries to design and implement an EoL care volunteer service on general wards in their hospitals. This study aimed to identify and explore barriers and facilitators to the implementation of EoL care volunteer services in the five hospitals. Methods: Volunteer coordinators (VCs) from the Netherlands (NL), Norway (NO), Slovenia (SI), Spain (ES) and United Kingdom (UK) participated in a focus group interview and subsequent in-depth one-to-one interviews. A theory-inspired framework based on the five domains of the Consolidated Framework for Implementation Research (CFIR) was used for data collection and analysis. Results from the focus group were depicted in radar charts per hospital. Results: Barriers across all hospitals were the COVID-19 pandemic delaying the implementation process, and the lack of recognition of the added value of EoL care volunteers by hospital staff. Site-specific barriers were struggles with promoting the service in a highly structured setting with many stakeholders (NL), negative views among nurses on hospital volunteering (NL, NO), a lack of support from healthcare professionals and the management (SI, ES), and uncertainty about their role in implementation among VCs (ES). Site-specific facilitators were training of volunteers (NO, SI, NL), involving volunteers in promoting the service (NO), and education and awareness for healthcare professionals about the role and boundaries of volunteers (UK). Conclusion: Establishing a comprehensive EoL care volunteer service for patients in non-specialist palliative care wards involves multiple considerations including training, creating awareness and ensuring management support. Implementation requires involvement of stakeholders in a way that enables medical EoL care and volunteering to co-exist. Further research is needed to explore how trust and equal partnerships between volunteers and professional staff can be built and sustained. Trial registration: NCT04678310. Registered 21/12/2020. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
6. The 'Surprise question' in heart failure: a prospective cohort study.
- Author
-
Gonzalez-Jaramillo, Valentina, Arenas Ochoa, Luisa Fernanda, Saldarriaga, Clara, Krikorian, Alicia, Vargas, John Jairo, Gonzalez-Jaramillo, Nathalia, Eychmüller, Steffen, and Maessen, Maud
- Published
- 2024
- Full Text
- View/download PDF
7. Prevalence and characteristics of patients with heart failure needing palliative care
- Author
-
Arenas Ochoa, Luisa Fernanda, González-Jaramillo, Valentina, Saldarriaga, Clara, Lemos, Mariantonia, Krikorian, Alicia, Vargas, John Jairo, Gómez-Batiste, Xavier, Gonzalez-Jaramillo, Nathalia, and Eychmüller, Steffen
- Published
- 2021
- Full Text
- View/download PDF
8. Validation of the German version of the needs assessment tool: progressive disease-heart failure
- Author
-
Gonzalez-Jaramillo, Valentina, Guyer, Jelena, Luethi, Nora, Sobanski, Piotr, Zbinden, Rut, Rodriguez, Eveline, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
- Published
- 2021
- Full Text
- View/download PDF
9. Which Cost Components Influence the Cost of Palliative Care in the Last Hospitalization? A Retrospective Analysis of Palliative Care Versus Usual Care at a Swiss University Hospital
- Author
-
Hagemann, Monika, Zambrano, Sofia C., Bütikofer, Lukas, Bergmann, Antje, Voigt, Karen, and Eychmüller, Steffen
- Published
- 2020
- Full Text
- View/download PDF
10. Correction to: An online international comparison of thresholds for triggering a negative response to the “Surprise Question”: a study protocol
- Author
-
White, Nicola, Oostendorp, Linda, Vickerstaff, Victoria, Gerlach, Christina, Engels, Yvonne, Maessen, Maud, Tomlinson, Christopher, Wens, Johan, Leysen, Bert, Biasco, Guido, Zambrano, Sofia, Eychmüller, Steffen, Avgerinou, Christina, Chattat, Rabih, Ottoboni, Giovanni, Veldhoven, Carel, and Stone, Patrick
- Published
- 2020
- Full Text
- View/download PDF
11. An online international comparison of thresholds for triggering a negative response to the “Surprise Question”: a study protocol
- Author
-
White, Nicola, Oostendorp, Linda, Vickerstaff, Victoria, Gerlach, Christina, Engels, Yvonne, Maessen, Maud, Tomlinson, Christopher, Wens, Johan, Leysen, Bert, Biasco, Guido, Zambrano, Sofia, Eychmüller, Steffen, Avgerinou, Christina, Chattat, Rabih, Ottoboni, Giovanni, Veldhoven, Carel, and Stone, Patrick
- Published
- 2019
- Full Text
- View/download PDF
12. Compassionate communities: How to assess their benefit? A protocol of a collaborative study between different countries.
- Author
-
González-Jaramillo, Valentina, Krikorian, Alicia, Tripodoro, Vilma, Jorge, Margarita, Zambrano, Sofia C., López, Francy, Vélez, Maria Clara, Noguera, Tatiana, Orellana, Sebastián, Montilla, Silvina, Christen-Cevallos Rosero, Andri, and Eychmüller, Steffen
- Subjects
INTERNATIONAL relations ,COMMUNITIES ,HEALTH outcome assessment ,PUBLIC health ,COMPASSION ,GOVERNMENT programs ,INTERPROFESSIONAL relations ,PALLIATIVE treatment - Abstract
Background: Communities and local governments invest in compassionate communities (CCs) a great deal of time, money, effort, and work. However, it is not known whether the CCs are having the effect they are expected to have, so the value of continuing with these initiatives is unknown, and there is a need for a model for evaluating CCs to solve the question. Objectives: To identify a set of core outcomes or benefits that should be measured to assess the impact of the CCs. Design: Multiple-methods study involving three communities, each in a different country (Argentina, Colombia, and Switzerland). Methods and analysis: To identifying the set of core outcomes, which is the first step in developing the CC evaluation model, five phases will follow: online meetings, literature review, fieldwork, Delphi survey, and social transfer. We will involve members of the local communities of Bern, Buenos Aires, and Medellin at three different levels: (1) citizens (e.g. patients, caregivers, and family members), (2) organizations and institutions involved in the program implementation (e.g. health care organizations, churches, non-governmental organizations, and schools), and (3) political and governmental sectors. Ethics: The study will be conducted following existing international regulations and guidance such as the Declaration of Helsinki. The ethics committee of Pallium Latin America and the ethics committee of the canton of Bern considered our application exempt from the need for approval. Ethics approval in Bern and Buenos Aires is in the process of being obtained. The ethics committee of the Pontifical Bolivarian University approved this protocol. Discussion: We expect that this project will help bridge the gap in knowledge regarding the measurable impact of the CCs and enhance more CC development. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
13. Applications of Machine Learning in Palliative Care: A Systematic Review.
- Author
-
Vu, Erwin, Steinmann, Nina, Schröder, Christina, Förster, Robert, Aebersold, Daniel M., Eychmüller, Steffen, Cihoric, Nikola, Hertler, Caroline, Windisch, Paul, and Zwahlen, Daniel R.
- Subjects
DEEP learning ,DATA curation ,SYSTEMATIC reviews ,NATURAL language processing ,MACHINE learning ,ARTIFICIAL intelligence ,RESEARCH funding ,MEDLINE ,ARTIFICIAL neural networks ,PALLIATIVE treatment - Abstract
Simple Summary: To investigate the adoption of machine learning in palliative care research and clinical practice, we systematically searched for published research papers on the topic. We found several publications that used different kinds of machine learning in palliative care for different use cases. However, on average, there needs to be more rigorous testing of the models to ensure that they work well in different settings. Objective: To summarize the available literature on using machine learning (ML) for palliative care practice as well as research and to assess the adherence of the published studies to the most important ML best practices. Methods: The MEDLINE database was searched for the use of ML in palliative care practice or research, and the records were screened according to PRISMA guidelines. Results: In total, 22 publications using machine learning for mortality prediction (n = 15), data annotation (n = 5), predicting morbidity under palliative therapy (n = 1), and predicting response to palliative therapy (n = 1) were included. Publications used a variety of supervised or unsupervised models, but mostly tree-based classifiers and neural networks. Two publications had code uploaded to a public repository, and one publication uploaded the dataset. Conclusions: Machine learning in palliative care is mainly used to predict mortality. Similarly to other applications of ML, external test sets and prospective validations are the exception. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
14. Quality of care as an individual concept: Proposition of a three-level concept for clinical practice
- Author
-
Ebneter, Andreas Samuel, Vonlanthen, Ronald, and Eychmueller, Steffen
- Published
- 2022
- Full Text
- View/download PDF
15. International palliative care experts’ view on phenomena indicating the last hours and days of life
- Author
-
Domeisen Benedetti, Franzisca, Ostgathe, Christoph, Clark, Jean, Costantini, Massimo, Daud, Maria Laura, Grossenbacher-Gschwend, Barbara, Latten, Richard, Lindqvist, Olav, Peternelj, Andreja, Schuler, Stefanie, Tal, Kali, van der Heide, Agnes, Eychmüller, Steffen, and on behalf of OPCARE9
- Published
- 2013
- Full Text
- View/download PDF
16. O.5.4 - Identifying the essentials of communicating about imminent death from key stakeholders’ perspectives: Presenter(s): Sibylle J. Felber, University Centre for Palliative Care, Inselspital, University Hospital Bern, Switzerland
- Author
-
Guffi, Tommaso, Brem, Beate G., Schmitz, Felix M., Schnabel, Kai P., Schär, Sissel Guttormsen, Eychmüller, Steffen, and Zambrano, Sofia C.
- Published
- 2023
- Full Text
- View/download PDF
17. An online international comparison of palliative care identification in primary care using the Surprise Question.
- Author
-
White, Nicola, Oostendorp, Linda JM, Vickerstaff, Victoria, Gerlach, Christina, Engels, Yvonne, Maessen, Maud, Tomlinson, Christopher, Wens, Johan, Leysen, Bert, Biasco, Guido, Zambrano, Sofia, Eychmüller, Steffen, Avgerinou, Christina, Chattat, Rabih, Ottoboni, Giovanni, Veldhoven, Carel, and Stone, Patrick
- Subjects
SURVIVAL ,STATISTICS ,LIFE expectancy ,CROSS-sectional method ,MULTIVARIATE analysis ,PHYSICIANS' attitudes ,REGRESSION analysis ,PRIMARY health care ,COMPARATIVE studies ,CASE studies ,PALLIATIVE treatment - Abstract
Background: The Surprise Question ('Would I be surprised if this patient died within 12 months?') identifies patients in the last year of life. It is unclear if 'surprised' means the same for each clinician, and whether their responses are internally consistent. Aim: To determine the consistency with which the Surprise Question is used. Design: A cross-sectional online study of participants located in Belgium, Germany, Italy, The Netherlands, Switzerland and UK. Participants completed 20 hypothetical patient summaries ('vignettes'). Primary outcome measure: continuous estimate of probability of death within 12 months (0% [certain survival]–100% [certain death]). A threshold (probability estimate above which Surprise Question responses were consistently 'no') and an inconsistency range (range of probability estimates where respondents vacillated between responses) were calculated. Univariable and multivariable linear regression explored differences in consistency. Trial registration: NCT03697213. Setting/participants: Registered General Practitioners (GPs). Of the 307 GPs who started the study, 250 completed 15 or more vignettes. Results: Participants had a consistency threshold of 49.8% (SD 22.7) and inconsistency range of 17% (SD 22.4). Italy had a significantly higher threshold than other countries (p = 0.002). There was also a difference in threshold levels depending on age of clinician, for every yearly increase, participants had a higher threshold. There was no difference in inconsistency between countries (p = 0.53). Conclusions: There is variation between clinicians regarding the use of the Surprise Question. Over half of GPs were not internally consistent in their responses to the Surprise Question. Future research with standardised terms and real patients is warranted. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
18. Impact of home-based palliative care on health care costs and hospital use: A systematic review.
- Author
-
Gonzalez-Jaramillo, Valentina, Fuhrer, Valérie, Gonzalez-Jaramillo, Nathalia, Kopp-Heim, Doris, Eychmüller, Steffen, and Maessen, Maud
- Subjects
HOSPITALS ,RESEARCH ,NURSING specialties ,HOME care services ,RESEARCH methodology ,SYSTEMATIC reviews ,MEDICAL care costs ,MEDICAL cooperation ,EVALUATION research ,COMPARATIVE studies ,HOSPICE nurses ,PALLIATIVE treatment - Abstract
Objective: To assess the effectiveness of home-based palliative care (HBPC) on reducing hospital visits and whether HBPC lowered health care cost.Method: We searched six bibliographic databases (Embase (Ovid); Cochrane Central Register of Controlled Trials; Medline (Ovid); PubMed; Web of Science Core Collection; and, CINAHL) until February 2019 and performed a narrative synthesis of our findings.Results: Of the 1,426 identified references, 21 articles based on 19 unique studies met our inclusion criteria, which involved 92,000 participants. In both oncological and non-oncological patients, HBPC consistently reduced the number of hospital visits and their length, as well as hospitalization costs and overall health care costs. Even though home-treated patients consumed more outpatient resources, a higher saving in the hospital costs counterbalanced this. The reduction in overall health care costs was most noticeable for study periods closer to death, with greater reductions in the last 2 months, last month, and last two weeks of life.Significance Of Results: Stakeholders should recognize HBPC as an intervention that decreases patient care costs at end of life and therefore health care providers should assess the preferences of patients nearing the end-of-life to identify those who will benefit most from HBPC. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
19. Single early palliative care intervention added to usual oncology care for patients with advanced cancer: A randomized controlled trial (SENS Trial).
- Author
-
Eychmüller, Steffen, Zwahlen, Susanne, Fliedner, Monica C, Jüni, Peter, Aebersold, Daniel M, Aujesky, Drahomir, Fey, Martin F, Maessen, Maud, and Trelle, Sven
- Subjects
- *
TUMOR treatment , *PREVENTION of psychological stress , *RESEARCH , *MEDICAL cooperation , *TUMOR classification , *RANDOMIZED controlled trials , *COMPARATIVE studies , *QUALITY of life , *HEALTH care teams , *QUESTIONNAIRES , *PALLIATIVE treatment , *CANCER patient medical care , *EARLY medical intervention , *MEDICAL needs assessment - Abstract
Background: International oncology societies recommend early palliative care. Specific models to integrate early palliative care efficiently into clinical practice are debated. The authors designed a study to look at the quantitative and qualitative outcomes of an early palliative care intervention in oncological care to decrease stress and improve quality of life. Aims: To compare a single structured early palliative care intervention added to a usual oncology care in terms of distress and health-related quality of life at baseline compared to 6 months after enrollment. Design: This multicenter randomized controlled trial (NCT01983956) enrolled adult patients with advanced cancer. Participants were either randomly assigned to usual oncology care alone or usual care plus a structured early palliative care intervention. Setting/participants: One hundred fifty adult patients with a variety of advanced cancer diagnoses were randomized. Seventy-four participants were in the intervention and 76 participants in the control group. The primary outcome was the change in patient distress assessed by the National Comprehensive Cancer Network distress thermometer at 6 months. Health-related quality of life, the secondary outcome, was assessed by the Functional Assessment of Cancer Therapy–General Questionnaire. Results: The results showed no significant effect of the early palliative care intervention neither on patient distress nor on health-related quality of life. Conclusion: The addition of an early intervention to usual care for patients with advanced cancer did not improve distress or quality of life. Thus, patients may need more intensive early palliative care with continuous professional support to identify and address their palliative needs early. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
20. Clinically significant bleeding in incurable cancer patients: effectiveness of hemostatic radiotherapy
- Author
-
Cihoric Nikola, Crowe Susanne, Eychmüller Steffen, Aebersold Daniel M, and Ghadjar Pirus
- Subjects
Cancer ,Bleeding ,Hemostatic ,Palliative ,Radiotherapy ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background This study was performed to evaluate the outcome after hemostatic radiotherapy (RT) of significant bleeding in incurable cancer patients. Methods Patients treated by hemostatic RT between November 2006 and February 2010 were retrospectively analyzed. Bleeding was assessed according to the World Health Organization (WHO) scale (grade 0 = no bleeding, 1 = petechial bleeding, 2 = clinically significant bleeding, 3 = bleeding requiring transfusion, 4 = bleeding associated with fatality). The primary endpoint was bleeding at the end of RT. Key secondary endpoints included overall survival (OS) and acute toxicity. The bleeding score before and after RT were compared using the Wilcoxon signed rank test. Time to event endpoints were estimated using the Kaplan Meier method. Results Overall 62 patients were analyzed including 1 patient whose benign cause of bleeding was pseudomyxoma peritonei. Median age was 66 (range, 37–93) years. Before RT, bleeding was graded as 2 and 3 in 24 (39%) and 38 (61%) patients, respectively. A median dose of 20 (range, 5–45) Gy of hemostatic RT was applied to the bleeding site. At the end of RT, there was a statistically significant difference in bleeding (p n = 39), 1 ( n = 12), 2 ( n = 6), 3 ( n = 4) and 4 (n = 1). With a median follow-up of 19.3 (range, 0.3-19.3) months, the 6-month OS rate was 43%. Forty patients died (65%); 5 due to bleeding. No grade 3 or above acute toxicity was observed. Conclusions Hemostatic RT seems to be a safe and effective treatment for clinically and statistically significantly reducing bleeding in incurable cancer patients.
- Published
- 2012
- Full Text
- View/download PDF
21. Potential economic impact of mobile specialist palliative care teams in Switzerland
- Author
-
Maessen, Maud, Steck, N, Zwahlen, M, and Eychmüller, Steffen
- Subjects
610 Medicine & health - Published
- 2018
- Full Text
- View/download PDF
22. Does Time for (in)Direct Nursing Care Activities at the End of Life for Patients With or Without Specialized Palliative Care in a University Hospital Differ? A Retrospective Analysis.
- Author
-
Fliedner, Monica C., Hagemann, Monika, Eychmüller, Steffen, King, Cynthia, Lohrmann, Christa, Halfens, Ruud J. G., and Schols, Jos M. G. A.
- Abstract
Background: Nurses' end of life (EoL) care focuses on direct (eg, physical) and indirect (e,g, coordination) care. Little is known about how much time nurses actually devote to these activities and if activities change due to support by specialized palliative care (SPC) in hospitalized patients. Aims: (1) Comparing care time for EoL patients receiving SPC to usual palliative care (UPC);(2) Comparing time spent for direct/indirect care in the SPC group before and after SPC. Methods: Retrospective observational study; nursing care time for EoL patients based on tacs® data using nonparametric and parametric tests. The Swiss data method tacs measures (in)direct nursing care time for monitoring and cost analyses. Results: Analysis of tacs® data (UPC, n = 642; SPC, n = 104) during hospitalization before death in 2015. Overall, SPC patients had higher tacs® than UPC patients by 40 direct (95% confidence interval [CI]: 5.7-75, P =.023) and 14 indirect tacs® (95% CI: 6.0-23, P <.001). No difference for tacs® by day, as SPC patients were treated for a longer time (mean number of days 7.2 vs 16, P <.001).Subanalysis for SPC patients showed increased direct care time on the day of and after SPC (P <.001), whereas indirect care time increased only on the day of SPC. Conclusions: This study gives insight into nurses' time for (in)direct care activities with/without SPC before death. The higher (in)direct nursing care time in SPC patients compared to UPC may reflect higher complexity. Consensus-based measurements to monitor nurses' care activities may be helpful for benchmarking or reimbursement analysis. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
23. Unmet device reprogramming needs at the end of life among patients with implantable cardioverter defibrillator: A systematic review and meta-analysis.
- Author
-
Gonzalez-Jaramillo, Valentina, Sobanski, Piotr, Calvache, Jose A, Arenas-Ochoa, Luisa F, Franco, Oscar H, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
- Subjects
PREVENTION of psychological stress ,CARDIAC pacing ,CARDIOGENIC shock ,CINAHL database ,CONFIDENCE intervals ,HEART failure ,IMPLANTABLE cardioverter-defibrillators ,INFORMATION storage & retrieval systems ,MEDICAL databases ,MEDICAL information storage & retrieval systems ,PSYCHOLOGY information storage & retrieval systems ,MEDICAL needs assessment ,MEDICAL protocols ,MEDLINE ,META-analysis ,TERMINAL care ,TERMINALLY ill ,SYSTEMATIC reviews ,DECISION making in clinical medicine ,ADVANCE directives (Medical care) ,MULTIPLE regression analysis ,DESCRIPTIVE statistics - Abstract
Background: Use of implantable cardioverter defibrillators is increasingly common. As patients approach the end of life, it is appropriate to deactivate the shock function. Aim: To assess the prevalence of implantable cardioverter defibrillator reprogramming to deactivate the shock function at the end of life and the prevalence of advance directives among this population. Design: Following a previously established protocol available in PROSPERO, we performed a narrative synthesis of our findings and used the logit transformation method to perform our quantitative synthesis. Data sources: We searched seven bibliographic databases (Embase, Cochrane Central register of controlled Trials, Medline-Ovid, Web-of-Science, Scopus, PsychInfo, and CINAHL) and additional sources until April 2019. Results: Of the references we identified, 14 were included. We found a pooled prevalence of implantable cardioverter defibrillator reprogramming at the end of life of 28% (95% confidence interval, 22%–36%) with higher reprogramming rates after the recommendations for managing the device at the end of life were published. Among patients with advance directives, the pooled prevalence of advance directives that explicitly mentioned the device was 1% (95% confidence interval, 1%–3%). Conclusions: The prevalence of implantable cardioverter defibrillator reprogramming and advance directives that explicitly mentioned the device was very low. Study data suggested reprogramming decisions were made very late, after the patient experienced multiple shocks. Patient suffering could be ameliorated if physicians and other healthcare professionals adhere to clinical guidelines for the good management of the device at the end of life and include deactivating the shock function in the discussion that leads to the advance directive. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
24. Using the Term "Palliative Care": International Survey of How Palliative Care Researchers and Academics Perceive the Term "Palliative Care".
- Author
-
Zambrano, Sofia C., Centeno, Carlos, Larkin, Philip J., and Eychmüller, Steffen
- Subjects
AGE distribution ,ATTITUDE (Psychology) ,CONTENT analysis ,MEDICAL personnel ,NONPARAMETRIC statistics ,PALLIATIVE treatment ,PHYSICIANS ,QUESTIONNAIRES ,TERMS & phrases ,CROSS-sectional method ,COLLEGE teacher attitudes ,DESCRIPTIVE statistics - Abstract
Background: The term "palliative care" (PC) has often been found to have a negative connotation leading some to suggest rebranding and some services to change their name. Perceptions of the PC community about the term remain largely unexplored. Objective: To explore how PC researchers/academics perceive the term is the objective of this study. Design: This is a cross-sectional survey of attendees to the 10th World Research Congress of the EAPC. The questionnaire covered areas of academic activity, including the use of the term. We analyzed data through descriptive and nonparametric statistics and open responses through content analysis. Participants: Academics and researchers in PC were the participants in this study. Results: Of 318 respondents, the majority were women (65%), physicians (48%), and had a postgraduate degree (90%). For 40%, the term hindered the positioning of PC, 28% worried about using the term, and 55% did not discuss these difficulties. We found significant differences between responses and several demographics (e.g., younger age and higher likelihood of worrying about the term). Through open responses, we identified that the term is widely in use, and that its limitations are seen as a cultural by-product, and not as something that a name change would solve. Conclusions: Senior PC academics, researchers, and clinicians have an onus to ensure that colleagues with limited PC experience have the opportunity to discuss and explore the impact of the term on the practice of research. Regarding the term itself, the community's views are conclusive: although using the term will remain a difficult task, the field's identity is in the name. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
25. Compassion training: Towards a better understanding of patients through self‐exposure.
- Author
-
Felber, Sibylle Jeanine, Lerch, Seraina Petra, Bauer, Daniel, Liaudet, Florence, Eychmüller, Steffen, and Lörwald, Andrea
- Subjects
MINDFULNESS ,SELF-perception ,MOTIVATIONAL interviewing ,MEDICAL students ,PHYSICIAN-patient relations ,SIMULATION methods in education ,COMMUNICATION ,MEDICAL education - Abstract
The article provides information on an elective blended course designed and piloted by an interdisciplinary team at the University of Bern with one day of classroom training to improve sixth-year medical students' compassion in patient-physician communication. Topics discussed include the learning goals of the pilot, preparatory reading made, and lessons learned from the course.
- Published
- 2023
- Full Text
- View/download PDF
26. Demands on interprofessional collaboration
- Author
-
Fliedner, M. C. and Eychmüller, Steffen
- Subjects
610 Medicine & health - Published
- 2016
- Full Text
- View/download PDF
27. An early palliative care intervention can be confronting but reassuring: A qualitative study on the experiences of patients with advanced cancer.
- Author
-
Fliedner, Monica, Zambrano, Sofia, Schols, Jos MGA, Bakitas, Marie, Lohrmann, Christa, Halfens, Ruud JG, and Eychmüller, Steffen
- Subjects
TUMOR diagnosis ,TUMOR treatment ,CANCER patient psychology ,COGNITION ,CONTENT analysis ,CONVERSATION ,DECISION making ,EMOTIONS ,INTERVIEWING ,RESEARCH methodology ,PATIENT-family relations ,HEALTH outcome assessment ,PALLIATIVE treatment ,SOCIAL networks ,PSYCHOLOGICAL stress ,TUMOR classification ,ADVANCE directives (Medical care) ,QUALITATIVE research ,SOCIAL support ,EARLY medical intervention - Abstract
Background: Intervention trials confirm that patients with advanced cancer receiving early palliative care experience a better quality of life and show improved knowledge about and use of palliative care services. To involve patients in future health-care decisions, health professionals should understand patients' perspectives. However, little is known about how patients' experience such interventions. Aim: To explore advanced cancer patients' experiences with a structured early palliative care intervention, its acceptability and impact on the patients' life including influencing factors. Design: Qualitative content analysis of in-depth, semi-structured interviews. Setting/participants: Patients with various advanced cancer diagnoses were enrolled in a multicenter randomized controlled trial (NCT01983956), which investigated the impact of "Symptoms, End-of-life decisions, Network, Support," a structured early palliative care intervention, on distress. Of these, 20 patients who underwent the intervention participated in this study. Results: Participants received the intervention well and gained a better understanding of their personal situation. Patients reported that the intervention can feel "confronting" but with the right timing it can be confirming and facilitate family conversations. Patients' personal background and the intervention timing within their personal disease trajectory influenced their emotional and cognitive experiences; it also impacted their understanding of palliative care and triggered actions toward future care planning. Conclusion: Early palliative care interventions like "Symptoms, End-of-life decisions, Network, Support" may provoke emotions and feel "confrontational" often because this is the first time when issues about one's end of life are openly discussed; yet, advanced cancer patients found it beneficial and felt it should be incorporated into routine care. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
28. Endstation Notfallstation: Perzeption und Rezeption des Begriffs «palliativer Patient» sowie Ansätze zur Verbesserung der interdisziplinären Zusammenarbeit – ein Survey unter notfallmedizinischem Personal auf einer Schweizer Notfallstation
- Author
-
Eychmüller, Steffen, Stähli Klenk, Laurence, Exadaktylos, Aristomenis, Iucolano, Nicoletta Milena, and Braun, Christian Tasso
- Subjects
610 Medicine & health - Abstract
Hintergrund: Wegen sich verändernder Strukturen im Spitalbereich sowie im Bereich der Hausarztabdeckung als auch infolge zunehmenden Drucks auf das Gesundheitssystem kommen mehr Patienten auf die Notfallstationen, die aufgrund ihrer Grunderkrankung und des fortgeschrittenen Krankheitsstadiums von einem palliativen Behandlungskonzept profitieren. Eine wesentliche Herausforderung ist hierbei bereits die Definition von «Palliative Care» (PC), sowie die Klärung, was genau die palliative Versorgung beinhaltet. Häufig vermischt wird der Terminus «Palliative Care» mit «End of life care». Die vorliegende Studie ist eine Standortbestimmung im Universitären Notfallzentrum des Inselspitals Bern (UNZ), das jährlich rund 32 400 Patienten versorgt. Ziel ist es, mehr über den Wissensstand und die persönliche Einstellung der Mitarbeiter zu palliativen Fragestellungen und speziell zum Begriff «Palliative Care» zu erhalten. Methodik: Die Mitarbeiter des Universitären Notfallzentrums des Inselspitals Bern (UNZ) wurden mittels einer Online-Umfrage durch eine spitalexterne Fachinstitution interviewt. Diese Befragung basiert auf einem Instrument [1], das in einer vergleichbaren Studie auf einer Notfallstation in den USA entwickelt und validiert wurde. Resultate: Von 154 Mitarbeitenden (Pflege und Ärzte) füllten 60 Mitarbeitende die Befragung vollständig aus, entsprechend einer Antwortrate von 39%. Die Definition von Palliative Care (von n=60) war sehr heterogen und konnte in sechs Themenbereiche eingeteilt werden. Bei den Fragen nach spezifischen Leistungsangeboten äusserten die Mitarbeitenden den Wunsch nach einem erleichterten Zugang zu bestehenden Patientendaten, nach einem 24-Stunden-Palliative-Care-Konsiliardienst und nach mehr Besprechungszeit für Fragestellungen der PC im klinischen Alltag. Schlussfolgerungen: Die heterogene Begriffsdefinition von «Palliative Care» bestätigt sich. Es besteht kein klares Vorgehen, und zudem lässt sich ein Zeitmangel für ausführliche Patientengespräche in palliativen Situationen im UNZ feststellen. Der Patientenwunsch oder Patientenverfügungen mit DNR/DNI-Prozedere stehen nicht im Widerspruch zu den persönlichen Wertvorstellungen der meisten Mitarbeitenden. Die 24-Stunden-Verfügbarkeit eines spezialisierten PC-Teams, das Erarbeiten von Guidelines und vermehrtes Training für PC würde von den UNZ-Mitarbeitenden begrüsst., Background: As the demand for palliative care (PC) in emergency wards continues to increase, emergency medicine is increasingly focusing on the care of extremely ill patients with incurable, chronic and/or advanced diseases. There is no consistent definition of the profile of PC or understanding of what PC involves. The mistake is often made of confusing PC with end-of-life or terminal care. The present study was intended to assess the situation at the Department of Emergency Medicine, Inselspital, Bern University Hospital (UNZ), which cares for about 32 400 patients annually. The plan was to find out how much staff members knew about PC and to survey their personal attitudes. Methods: The employees of the UNZ were surveyed with an online questionnaire by a special institution outside the hospital. This is based on an instrument [1] developed in a comparative study in an emergency ward in the USA and used for physicians. Results: 60 of 154 staff members (physicians and nurses) completed the questionnaire, corresponding to a response rate of 39%. The definition of palliative care (n=60) was very mixed and could be classified into 6 areas. In response to questions about specific services, the staff members mentioned that their access to existing patient data should be facilitated. They also expressed the wish for a 24 h palliative consultation service and thought that, during normal working days, more time should be allotted to discussing issues related to palliative care. Conclusions: It has been confirmed that the definition of palliative care is not consistent. Within the UNZ, there is no clear procedure, but lack of time for detailed discussions with patients needing palliative care. Patient wishes or living wills with the DNR/DNI procedure do not contradict the personal ethics of most staff members. UNZ staff members would welcome the 24 h availability of a specialized PC team, as well as the development of guidelines and increased training in PC.
- Published
- 2014
- Full Text
- View/download PDF
29. The impact of early palliative care on the quality of care during the last days of life: what does the evidence say?
- Author
-
Zambrano, Sofia C., Fliedner, Monica C., and Eychmüller, Steffen
- Abstract
Purpose of review The aim of this review is to critically appraise the existing evidence on ‘early palliative care’ (EPC), discuss its relationship with advance care planning, and to reflect on the impact of EPC on the quality of care provided during the last days of life. Recent findings There are indicators that EPC may help to avoid aggressive treatment, shorten hospital stay, improve overall quality of life, and to see more frequently dying and death at the preferred place of care. Summary The evidence from randomized controlled trials supports the integration of palliative care early in the disease trajectory. However, in terms of outcomes and quality indicators for care in the last days of life, evidence is still lacking. Predominantly, when it comes to the outcomes which may be more difficult to assess, such as spiritual aspects, or the social network, for which more comprehensive information is needed. These outcomes should not be neglected in palliative care studies, particularly when they can provide meaningful information about patient and family adjustment, and focus on psychosocial aspects rather than physical symptom control. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
30. Definition, Pathophysiology, and Assessment of Pain.
- Author
-
Eychmüller, Steffen
- Published
- 2015
- Full Text
- View/download PDF
31. 'Diagnosing dying' in cancer patients -- a systematic literature review.
- Author
-
Eychmüller, Steffen, Domeisen Benedetti, Franzisca, Latten, Richard, Tal, Kali, Walker, Jochen, and Costantini, Massimo
- Published
- 2013
32. Care of the dying and the LCP in England: an international perspective.
- Author
-
Ellershaw, John, Fürst, Carl Johan, Lunder, Urska, Boughey, Mark, Eychmüller, Steffen, Hodgson, Susan Hannam, Haugen, Dagny Faksväg, Marshall, Bridget, Walker, Helen M., Wilkinson, Susie, Voltz, Raymond, and van Zuylen, Lia
- Published
- 2013
33. Introducing the EAPC Steering Group on Medical Education and Training.
- Author
-
Eisner, Frank, Mason, Stephen, Blumhuber, Heidi, Centeno, Carlos, Cetto, Gianluigi, De Conno, Franco, Ellershaw, John E., Eychmüller, Steffen, Filbet, Marilène, and Larkin, Philip
- Published
- 2014
34. Prevalence and characteristics of patients with heart failure needing palliative care
- Author
-
Arenas Ochoa, Luisa Fernanda, González-Jaramillo, Valentina, Saldarriaga, Clara, Lemos, Mariantonia, Krikorian, Alicia, Vargas, John Jairo, Gómez-Batiste, Xavier, Gonzalez-Jaramillo, Nathalia, and Eychmüller, Steffen
- Subjects
Patient-centered care ,Research ,RC952-1245 ,610 Medicine & health ,Heart failure ,Prognosis ,Needs assessment ,Cross-Sectional Studies ,Special situations and conditions ,360 Social problems & social services ,Prevalence ,Quality of Life ,Palliative care ,Humans ,Health services needs and demands ,Aged - Abstract
Background Few hospitals and heart failure (HF) clinics offer concurrent palliative care (PC) together with life-prolonging therapies. To know the prevalence of patients in HF clinics needing PC and useful tools to recognize them are the first steps to extending PC in those settings. However, it is still unknown whether tools commonly used to identify patients with HF needing PC can correctly distinguish them. Two systematic reviews found that the NECesidades PALiativas (NECPAL) tool was one of the two most commonly used tools to asses PC needs in HF patients. Therefore, we assessed 1) the prevalence of PC needs in HF clinics according to the NECPAL tool, and 2) the characteristics of the patients identified as having PC; mainly, their quality of life (QoL), symptom burden, and psychosocial problems. Methods This cross-sectional study was conducted at two HF clinics in Colombia. We assessed the prevalence of PC in the overall sample and in subgroups according to clinical and demographic variables. We assessed QoL, symptom burden, and psychosocial problems using the 12-Item Short-Form Health Survey (SF-12), the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Edmonton Symptom Assessment System (ESAS). We compared the results of these tools between patients identified as having PC needs (+NECPAL) and patients identified as not having PC needs (–NECPAL). Results Among the 178 patients, 78 (44%) had PC needs. The prevalence of PC needs was twice as nigh in patients NYHA III/IV as in patients NYHA I/II and almost twice as high in patients older than 70 years as in patients younger than 70 years. Compared to –NECPAL patients, +NECPAL patients had worse QoL, more severe shortness of breath, tiredness, drowsiness, and pain, and more psychosocial problems. Conclusion The prevalence of PC needs in outpatient HF clinics is high and is even higher in older patients and in patients at more advanced NYHA stages. Compared to patients identified as not having PC needs, patients identified as having PC needs have worse QoL, more severe symptoms, and greater psychosocial problems. Including a PC provider in the multidisciplinary team of HF clinics may help to assess and cover these needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00850-y.
- Full Text
- View/download PDF
35. Validation of the German version of the needs assessment tool: progressive disease-heart failure
- Author
-
Gonzalez Jaramillo, Valentina, Guyer, Jelena, Luethi, Nora, Sobanski, Piotr, Zbinden, Rut, Rodriguez, Eveline, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
- Subjects
Heart Failure ,Male ,Patient-centered care ,Research ,Computer applications to medicine. Medical informatics ,Palliative Care ,R858-859.7 ,Reproducibility of Results ,610 Medicine & health ,Stroke Volume ,Middle Aged ,Translating ,Needs assessment ,NAT: PD-HF ,360 Social problems & social services ,Germany ,Surveys and Questionnaires ,Disease Progression ,Quality of Life ,Humans ,Female ,Aged - Abstract
Background The Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF) is a tool created to assess the needs of people living with heart failure and their informal caregivers to assist delivering care in a more comprehensive way that addresses actual needs that are unmet, and to improve quality of life. In this study, we aimed to (1) Translate the tool into German and culturally adapt it. (2) Assess internal consistency, inter-rater reliability, and test–retest reliability of the German NAT: PD-HF. (3) Evaluate whether and how patients and health care personnel understand the tool and its utility. (4) Assess the tool’s face validity, applicability, relevance, and acceptability among health care personnel. Methods Single-center validation study. The tool was translated from English into German using a forward–backward translation. To assess internal consistency, we used Cronbach´s alpha. To assess inter-rater reliability and test–retest reliability, we used Cohen´s kappa, and to assess validity we used face validity. Results The translated tool showed good internal consistency. Raters were in substantial agreement on a majority of the questions, and agreement was almost perfect for all the questions in the test–retest analysis. Face validity was rated high by health care personnel. Conclusion The German NAT: PD-HF is a reliable, valid, and internally consistent tool that is well accepted by both patients and health care personnel. However, it is important to keep in mind that effective use of the tool requires training of health care personnel. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01817-6.
- Full Text
- View/download PDF
36. Unmet device reprogramming needs at the end of life among patients with implantable cardioverter defibrillator: A systematic review and meta-analysis
- Author
-
Gonzalez-Jaramillo, Valentina, Sobanski, Piotr, Calvache, Jose A, Arenas-Ochoa, Luisa F, Franco, Oscar H, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
- Subjects
610 Medicine & health ,360 Social problems & social services ,3. Good health - Abstract
BACKGROUND Use of implantable cardioverter defibrillators is increasingly common. As patients approach the end of life, it is appropriate to deactivate the shock function. AIM To assess the prevalence of implantable cardioverter defibrillator reprogramming to deactivate the shock function at the end of life and the prevalence of advance directives among this population. DESIGN Following a previously established protocol available in PROSPERO, we performed a narrative synthesis of our findings and used the logit transformation method to perform our quantitative synthesis. DATA SOURCES We searched seven bibliographic databases (Embase, Cochrane Central register of controlled Trials, Medline-Ovid, Web-of-Science, Scopus, PsychInfo, and CINAHL) and additional sources until April 2019. RESULTS Of the references we identified, 14 were included. We found a pooled prevalence of implantable cardioverter defibrillator reprogramming at the end of life of 28% (95% confidence interval, 22%-36%) with higher reprogramming rates after the recommendations for managing the device at the end of life were published. Among patients with advance directives, the pooled prevalence of advance directives that explicitly mentioned the device was 1% (95% confidence interval, 1%-3%). CONCLUSIONS The prevalence of implantable cardioverter defibrillator reprogramming and advance directives that explicitly mentioned the device was very low. Study data suggested reprogramming decisions were made very late, after the patient experienced multiple shocks. Patient suffering could be ameliorated if physicians and other healthcare professionals adhere to clinical guidelines for the good management of the device at the end of life and include deactivating the shock function in the discussion that leads to the advance directive.
37. Challenges and gaps delivering palliative care to patients with heart failure
- Author
-
Gonz��lez Jaramillo, Valentina, Eychmüller, Steffen, and Bosshard, Georg
- Subjects
360 Social problems & social services ,610 Medicine & health - Abstract
Background: People living with heart failure (HF) have a wide range of physical and psychological symptoms and comorbidities. These affect their quality of life throughout the HF trajectory. Therefore, patients with HF, especially in advanced stages of this disease, may benefit from palliative care (PC). However, despite PC being widely recommended, few hospitals and HF clinics offer concurrent PC along with life���prolonging therapies. Due to the unpredictability of the HF disease trajectory, prognostication is challenging, as well as identifying patients who might benefit from PC or have unmet needs. Additionally, patients with HF and implantable cardioverter efibrillators (ICD) have specific end���of���life (EoL) device management needs. Aims: In this thesis, I contribute knowledge about the challenges and gaps in the delivery of PC to patients with HF. Through the 4 articles that form my thesis, I provide knowledge about the challenges of identifying patients who might benefit from PC or those who have unmet PC needs. I evaluate the performance of the surprise question (SQ) predicting 1���year mortality in ambulatory HF clinics, in article 1. In article 2, I assess the prevalence of patients with PC needs in outpatient HF clinics with the NECesidades PALiativas (NECPAL) or Palliative Needs tool. Additionally, I use the NECPAL tool to identify patients with HF who might benefit from PC. For article 3, I evaluated the psychometric characteristics of the German Needs Assessment Tool: Progressive Disease ��� Heart Failure (NAT: PD���HF). Finally, I quantify gaps from anticipatory care planning and EoL care of patients with ICD in article 4. Methods: I used a cohort of 178 patients from 2 ambulatory HF clinics in Colombia for articles 1 and 2. To assess the performance of the SQ to predict 1���year mortality (article 1), I consulted Colombia���s national mortality register for participants��� 1���year vital status. To assess the NECPAL tool���s identification of patients with HF who might benefit from PC (article 2), I conducted a cross���sectional analysis that compared health���related quality of life and physical and psychosocial problems, between patients needing (+NECPAL group) and not needing (���NECPAL group) PC. To validate the German NAT: PD���HF, I used a singlecenter study at Inselspital���s Heart Failure Clinic in Bern, Switzerland (article 3). The tool was translated from English into German using a forward���backward translation. I assessed the German NAT: PD���HF���s psychometric characteristics, including internal onsistency, inter���rater reliability, test���retest reliability, and face validity. I conducted a systematic review and meta���analysis for article 4. Results: These studies��� results are presented in 4 articles. Article 1 shows the SQ���s sensitivity to predict 1���year mortality is 85% and its specificity is 57%. The SQ���s positive and negative likelihood ratios were 1.98 and 0.26, respectively. Its performance was similar among women and men, yet performed better in patients younger than 70 years, in patients with reduced or mildly reduced ejection fraction, and in patients at the New York Heart Association class III or IV. Article 2 shows that among patients under optimal medical 8 treatment in outpatient HF clinics, 44% met the NECPAL tool criteria to receive concurrent PC (+NECPAL). Compared to ���NECPAL patients, +NECPAL patients had worse quality of life; more severe shortness of breath, tiredness, drowsiness, and pain; and greater psychosocial problems. Article 3 shows that the German NAT: PD���HF validation had good internal consistency, substantial inter���rater agreement for most of the items, and an almost perfect test���retest reliability. Moreover, patients thought well of the tool, and they agreed that it could help to improve their quality of care. Article 4 shows that nearly 3 out of 4 patients (pooled estimate 28%, 95% CI 22���36%) died with their ICD���s shock function active, despite guidelines recommending deactivation of this function at the EoL. For those with advance directives, few directives mentioned what to do with ICD devices at the EoL; the pooled prevalence estimate was only 1% (95% CI 1���3%). Conclusion: In this thesis, I contribute knowledge about gaps and challenges delivering palliative care to patients with heart failure. I show gaps regarding anticipatory care planning and end���of���life care for patients with implantable cardioverter defibrillators and offer strategies to address these gaps. Additionally, I provide knowledge and suggestions to overcome identifying patients��� palliative care needs. I assessed 3 tools to support the identification of palliative care needs; 2 of them, to support the identification of the needs due to limited life expectancy (the SQ and the NECPAL), and 1 to identify palliative care needs regardless of prognosis (the NAT: PD���HF). The best screening tool depends on the situation, and whatever tool we use, it is better to screen and think about the palliative care needs of the patients using any tool than no screening at all.
- Published
- 2021
38. Cost Impact of Palliative Care: An Empirical Analysis of a Swiss University Hospital
- Author
-
Hagemann, Monika, Bergmann, Antje, Eychmüller, Steffen, and Technische Universität Dresden
- Subjects
Palliative care, hospitals, financial impact, cost components ,ddc:610 ,Palliativpflege, Krankenhäuser, finanzielle Auswirkungen, Kostenkomponenten - Abstract
Context: Prior research widely reaches the consensus that Palliative Care (PC) has proven clinical benefits. However, far less is known about the economic impact of PC. This thesis contributes to the existing literature by providing a comprehensive overview of PC costs oc-curring in individual organizational units and cost types from the perspective of a European mixed funded health care system. The objective of this thesis is to identify cost drivers of PC and to quantify their effects on hospital costs. Research Question: Does PC reduce hospital costs for adult patients with a non-accidental death? Methodology: The research design of the retrospective, observational cost analysis is based on administrative and medical patient data for all inhospitalised deaths in 2015 in a large aca-demic University hospital in Switzerland. The thesis consists of three separate cost analyses, of which the first compares hospital costs for patients receiving PC to costs for usual care (UC) patients using the propensity score, i.e. inverse probability weighting. The second and third analyses focus on PC patients only. These sub-studies compare the costs of a patient’s pre- and post-intervention hospital stay as well as investigate the role of the timing of PC in-terventions. Hereby, the costs for patients who receive a PC intervention during the first three days of their hospital stay (early PC patients) and patients who receive a PC intervention after three days of their hospital stay (late PC patients) are compared using the bootstrap method. Results: The first cost analysis provides heterogeneous results regarding the hospital costs for PC and UC patients. Average daily costs are lower for PC patients compared to UC pa-tients. However, due to the on average significantly longer hospital stays of PC patients, total costs are on a similar level for the two groups. Considering total ward costs only, costs are significantly higher for PC than for UC patients. Therefore, no unambiguous statement can be made, whether PC patients indeed have lower hospital costs as compared to UC patients. The second analysis reveals that hospital costs increase after a patient receives a PC inter-vention. The results of the third analysis show that late PC patients have higher hospital costs than early PC patients. Therefore, the timing of a PC intervention is of major importance pur-suing a cost avoidance strategy. Conclusion: The thesis provides empirical evidence supporting decision-makers and management accountants of the cost avoidance potential of PC interventions from different cost perspectives. The results contribute to the literature comprehensive information on hospi-tal cost drivers by shedding light on costs from different organizational units as well as individ-ual cost types of a hospital. This enhances transparency for internal and external stakeholders and can serve as a potential controlling instrument.:Content Index of Figures Index of Tables Index of Abbreviations Abstract 1 Introduction 1.1 Motivation 1.2 Research Objective 1.3 Outline of the Study 2 Conceptual Foundation 2.1 Palliative Care 2.2 Economic Evaluation Approach 2.3 Stationary Accounting 2.4 Ambulatory Accounting 3 Literature Review 3.1 Review Method 3.2 Results 3.3 Implications for this Study 4 Hypotheses Development 5 Research Design 5.1 Sample Selection 5.2 Clinical and Financial Data 5.3 Methods of Analysis 5.3.1 Cluster Code 5.3.2 Statistical Analysis 6 Empirical Results 6.1 Sample Characteristics 6.1.1 Baseline Table 6.1.2 Activity Records 6.2 Financial Analysis 6.2.1 Cost Allocation 6.2.2 Palliative Care vs. Usual Care 6.2.2.1 Total Costs 6.2.2.2 Costs per Day 6.2.2.3 Interim Conclusion 6.2.3 Palliative Care Intervention 6.2.3.1 Total Costs 6.2.3.2 Costs per Day 6.2.3.3 Interim Conclusion 6.2.4 Timing of PC Interventions 6.2.4.1 Total Costs 6.2.4.2 Costs per Day 6.2.4.3 Interim Conclusion 7 Conclusion 7.1 Main Findings and Discussion 7.2 Implications 7.3 Limitations and Outlook Bibliography Appendix Appendix I: Literature Review – Search String Appendix II: Baseline Table – Early vs. Late PC Patients Appendix III: Crude Data – PC vs. UC Patients Acknowledgment Affirmation on Oath Kontext: Bisherige Forschungsergebnisse stimmen weitgehend überein, dass «Palliative Care» (PC) einen erheblichen klinischen Nutzen bieten kann. Über die wirtschaftlichen Auswirkungen von PC ist indes wenig bekannt. Diese Dissertation trägt zur bestehenden Literatur bei, indem sie eine umfassende Analyse der Kosten von PC unter den Rahmenbedingungen eines europäischen gemischt finanzierten Gesundheitssystems liefert. Dabei werden die Kosten einzelner Organisationseinheiten sowie die Kostenarten eines Spitals untersucht. Die Arbeit zielt darauf ab, Kostentreiber von PC zu identifizieren und deren Auswirkungen auf die Spitalkosten zu quantifizieren. Forschungsfrage: Senkt PC die Spitalkosten für erwachsene Patienten, welche an einem nicht-unfallbedingten Tod verstorben sind? Methodik: Das Forschungsdesign der retrospektiven Kostenanalyse basiert auf administrativen und medizinischen Patientendaten für das Jahr 2015 bezüglich inhospitalisierter Todesfälle eines grossen akademischen Universitätsspitals in der Schweiz. Die Dissertation besteht aus drei separaten Kostenanalysen. Mithilfe der Propensity Score-Methode (inverse probability weighting) vergleicht die erste Analyse die Spitalkosten von PC Patienten mit den Kosten von «usual care» (UC) Patienten. In der zweiten und dritten Analyse werden ausschliesslich PC Patienten unter Anwendung der Bootstrap-Methode untersucht. Dabei werden einerseits die Kosten eines Spitalaufenthalts vor und nach einer PC Intervention verglichen. Zum anderen wird die Bedeutung des Zeitpunkts einer PC Intervention untersucht, indem die Spitalkos-ten von Patienten mit einer frühen PC Intervention den Kosten von Patienten mit einer späten PC Intervention gegenübergestellt werden. Ergebnisse: Die erste Kostenanalyse liefert heterogene Ergebnisse bezüglich der Spitalkosten für PC und UC Patienten. Die durchschnittlichen Kosten pro Tag sind geringer für PC Patienten als für UC Patienten. Aufgrund des im Durchschnitt deutlich längeren Spitalaufenthaltes von PC Patienten sind die Gesamtkosten beider Gruppen jedoch auf ähnlichem Niveau. Der Teil der Gesamtkosten, welcher auf der Normalstation entsteht, ist für PC Patienten signifikant höher als für UC Patienten. Daher kann keine allgemeingültige Aussage getroffen werden, ob PC Patienten im Vergleich zu UC Patienten tatsächlich geringere Spitalkosten verursachen. Die zweite Analyse zeigt, dass die Spitalkosten steigen, nachdem ein Patient eine PC Intervention erhalten hat. Die Ergebnisse der dritten Analyse verdeutlichen, dass Pa-tienten, welche nach drei Tagen Spitalaufenthalt eine PC Intervention empfangen («late PC-Patienten») höhere Kosten verursachen als «early PC-Patienten», die während der ersten drei Tage ihres Spitalaufenthalts eine PC Intervention erhalten. Demzufolge ist der Zeitpunkt einer PC Intervention von grosser Bedeutung für die Implementierung einer Kostenvermei-dungsstrategie. Schlussfolgerung: Die empirischen Ergebnisse der Arbeit sind bedeutsam für Entscheidungsträger und Controller im Spital, da das Kostenvermeidungspotenzial von PC Interven-tionen aus verschiedenen Kostenperspektiven diskutiert wird. Der Beitrag der Dissertation zur bestehenden Literatur besteht darin, dass die Studie auf Basis detaillierter Kostendaten um-fassende Erkenntnisse über die Kostentreiber eines Spitals liefert, indem sie verschiedene Organisationseinheiten sowie einzelne Spitalkostenarten berücksichtigt. Die Arbeit erhöht die Transparenz für interne und externe Stakeholder und kann als potenzielles Steuerungsinstrument dienen.:Content Index of Figures Index of Tables Index of Abbreviations Abstract 1 Introduction 1.1 Motivation 1.2 Research Objective 1.3 Outline of the Study 2 Conceptual Foundation 2.1 Palliative Care 2.2 Economic Evaluation Approach 2.3 Stationary Accounting 2.4 Ambulatory Accounting 3 Literature Review 3.1 Review Method 3.2 Results 3.3 Implications for this Study 4 Hypotheses Development 5 Research Design 5.1 Sample Selection 5.2 Clinical and Financial Data 5.3 Methods of Analysis 5.3.1 Cluster Code 5.3.2 Statistical Analysis 6 Empirical Results 6.1 Sample Characteristics 6.1.1 Baseline Table 6.1.2 Activity Records 6.2 Financial Analysis 6.2.1 Cost Allocation 6.2.2 Palliative Care vs. Usual Care 6.2.2.1 Total Costs 6.2.2.2 Costs per Day 6.2.2.3 Interim Conclusion 6.2.3 Palliative Care Intervention 6.2.3.1 Total Costs 6.2.3.2 Costs per Day 6.2.3.3 Interim Conclusion 6.2.4 Timing of PC Interventions 6.2.4.1 Total Costs 6.2.4.2 Costs per Day 6.2.4.3 Interim Conclusion 7 Conclusion 7.1 Main Findings and Discussion 7.2 Implications 7.3 Limitations and Outlook Bibliography Appendix Appendix I: Literature Review – Search String Appendix II: Baseline Table – Early vs. Late PC Patients Appendix III: Crude Data – PC vs. UC Patients Acknowledgment Affirmation on Oath
- Published
- 2019
39. An online international comparison of thresholds for triggering a negative response to the 'Surprise Question': a study protocol
- Author
-
Yvonne Engels, Johan Wens, Linda J. M. Oostendorp, Maud Maessen, Patrick Stone, Christina Gerlach, Bert Leysen, Nicola White, Carel Veldhoven, Christina Avgerinou, Guido Biasco, Steffen Eychmüller, Rabih Chattat, Giovanni Ottoboni, Christopher Tomlinson, Sofia C. Zambrano, Victoria Vickerstaff, White, Nicola, Oostendorp, Linda, Vickerstaff, Victoria, Gerlach, Christina, Engels, Yvonne, Maessen, Maud, Tomlinson, Christopher, Wens, Johan, Leysen, Bert, Biasco, Guido, Zambrano, Sofia, Eychmüller, Steffen, Avgerinou, Christina, Chattat, Rabih, Ottoboni, Giovanni, Veldhoven, Carel, and Stone, Patrick
- Subjects
Palliative care ,Survival ,Study Protocol ,0302 clinical medicine ,Belgium ,Germany ,Surveys and Questionnaires ,610 Medicine & health ,Netherlands ,Multiple choice ,media_common ,lcsh:RC952-1245 ,General Medicine ,Prognosis ,Death ,Surprise ,Italy ,Negative response ,030220 oncology & carcinogenesis ,0305 other medical science ,Psychology ,Switzerland ,medicine.medical_specialty ,Attitude to Death ,Attitude of Health Personnel ,Prognosi ,media_common.quotation_subject ,education ,lcsh:Special situations and conditions ,1117 Public Health and Health Services ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,03 medical and health sciences ,Surprise question ,All institutes and research themes of the Radboud University Medical Center ,General Practitioners ,030502 gerontology ,medicine ,Humans ,National level ,Protocol (science) ,Internet ,Correction ,Certificate ,United Kingdom ,Vignette ,Family medicine ,Human medicine ,Gerontology - Abstract
Background The Surprise Question (SQ) “would I be surprised if this patient were to die in the next 12 months?” has been suggested to help clinicians, and especially General Practitioners (GPs), identify people who might benefit from palliative care. The prognostic accuracy of this approach is unclear and little is known about how GPs use this tool in practice. Are GPs consistent, individually and as a group? Are there international differences in the use of the tool? Does including the alternative Surprise Question (“Would I be surprised if the patient were still alive after 12 months?”) alter the response? What is the impact on the treatment plan in response to the SQ? This study aims to address these questions. Methods An online study will be completed by 600 (100 per country) registered GPs. They will be asked to review 20 hypothetical patient vignettes. For each vignette they will be asked to provide a response to the following four questions: (1) the SQ [Yes/No]; (2) the alternative SQ [Yes/No]; (3) the percentage probability of dying [0% no chance – 100% certain death]; and (4) the proposed treatment plan [multiple choice]. A “surprise threshold” for each participant will be calculated by comparing the responses to the SQ with the probability estimates of death. We will use linear regression to explore any differences in thresholds between countries and other clinician-related factors, such as years of experience. We will describe the actions taken by the clinicians and explore the differences between groups. We will also investigate the relationship between the alternative SQ and the other responses. Participants will receive a certificate of completion and the option to receive feedback on their performance. Discussion This study explores the extent to which the SQ is consistently used at an individual, group, and national level. The findings of this study will help to understand the clinical value of using the SQ in routine practice. Trial registration Clinicaltrials.gov NCT03697213 (05/10/2018). Prospectively registered. Electronic supplementary material The online version of this article (10.1186/s12904-019-0413-x) contains supplementary material, which is available to authorized users.
- Published
- 2019
40. Outcomes of care during the last month of life: a systematic review to inform the development of a core outcome set.
- Author
-
González-Jaramillo V, Luethi N, Egloff M, Roa-Díaz ZM, González-Jaramillo N, Díaz-Ríos C, Christen-Cevallos Rosero A, Dodd S, Eychmüller S, and Zambrano SC
- Subjects
- Humans, Palliative Care, Terminal Care standards, Outcome Assessment, Health Care
- Abstract
Background: To date, there is a lack of standardization and consensus on which outcomes are central to assess the care provided to patients in the last month of life. Therefore, we aimed to conduct a systematic review to identify relevant outcomes to inform the development of a core outcome set for the best care for the dying person., Methods: We conducted a systematic review of outcomes reported in the scientific literature about the care for the dying person in the last month of life. We searched for peer-reviewed studies published before February 2022 in four electronic databases. To categorise the outcomes, we employed the taxonomy developed by the "Core Outcome Measures in Effectiveness Trials" collaboration., Results: Out of the 2,933 articles retrieved, 619 were included for analyses. The majority of studies (71%) were retrospective and with data extracted from chart reviews (71%). We extracted 1,951 outcomes in total, from which, after deletion of repeated outcomes, we identified 256 unique ones. The most frequently assessed outcomes were those related to medication or therapeutic interventions and those to hospital/healthcare use. Outcomes related to psychosocial wellbeing were rarely assessed. The closer to death, the less frequently the outcomes were studied., Conclusions: Most outcomes were related to medical interventions or to hospital use. Only a few studies focused on other components of integrated care such as psychosocial aspects. It remains to be defined which of these outcomes are fundamental to achieve the best care for the dying.
- Published
- 2024
- Full Text
- View/download PDF
41. An economic evaluation of an early palliative care intervention among patients with advanced cancer.
- Author
-
Maessen M, Fliedner MC, Gahl B, Maier M, Aebersold DM, Zwahlen S, and Eychmüller S
- Subjects
- Humans, Cost-Benefit Analysis, Quality of Life, Behavior Therapy, Palliative Care, Neoplasms therapy
- Abstract
Background: Early integration of palliative care into oncology care has shown positive effects on patient symptoms and quality of life. It may also reduce health care costs. However given the heterogeneity of settings and interventions and the lack of information on the minimally effective dose for influencing care utilisation and costs, it remains uncertain whether early palliative care reduces costs., Objectives: We sought to determine whether an early palliative care intervention integrated in usual oncology care in a Swiss hospital setting reduced utilisation and costs of health care in the last month of life when compared with usual oncology care alone., Methods: We performed a cost-consequences analysis alongside a multicentre trial. We extracted costs from administrative health insurance data and health care utilisation from family caregiver surveys to compare two study arms: usual oncology care and usual oncology care plus the palliative care intervention. The intervention consisted of a single-structured, multiprofessional conversation with the patient about symptoms, end-of-life decisions, network building and support for carers (SENS). The early palliative care intervention was performed within 16 weeks of the diagnosis of a tumour stage not amenable or responsive to curative treatment., Results: We included 58 participants with advanced cancer in our economic evaluation study. Median overall health care costs in the last month of life were 7892 Swiss Francs (CHF) (interquartile range: CHF 5637-13,489) in the intervention arm and CHF 8492 [CHF 5411-12,012] in the control arm. The average total intervention treatment cost CHF 380 per patient. Integrating an early palliative care intervention into usual oncology care showed no significant difference in health care utilisation or overall health care costs between intervention and control arms (p = 0.98)., Conclusion: Although early palliative care is often presented as a cost-reducing care service, we could not show a significant effect of the SENS intervention on health care utilisation and costs in the last month of life. However, it may be that the intervention was not intensive enough, the timeframe too short or the study population too small for measurable effects. Patients appreciated the intervention. Single-structured early palliative care interventions are easy to implement in clinical practice and present low treatment costs. Further research about the economic impact of early palliative care should focus on extracting large, detailed cost databases showing potential shifts in cost and cost-effectiveness., Clinical Trials: gov Identifier: NCT01983956.
- Published
- 2024
- Full Text
- View/download PDF
42. Palliative sedation - revised recommendations.
- Author
-
Beauverd M, Mazzoli M, Pralong J, Tomczyk M, Eychmüller S, and Gaertner J
- Subjects
- Humans, Palliative Care methods, Uncertainty, Health Personnel, Communication, Hypnotics and Sedatives therapeutic use, Physicians, Deep Sedation methods, Terminal Care methods
- Abstract
Palliative sedation is defined as the monitored use of medications intended to induce a state of decreased or absent awareness (unconsciousness) to relieve the burden of otherwise intractable suffering in a manner ethically acceptable to the patient, their family, and healthcare providers. In Switzerland, the prevalence of continuous deep sedation until death increased from 4.7% in 2001 to 17.5% of all deceased in 2013, depending on the research method used and on regional variations. Yet, these numbers may be overestimated due to a lack of understanding of the term "continuous deep sedation" by for example respondents of the questionnaire-based study. Inadequately trained and inexperienced healthcare professionals may incorrectly or inappropriately perform palliative sedation due to uncertainties regarding its definitions and practice. Therefore, the expert members of the Bigorio group and the authors of this manuscript believe that national recommendations should be published and made available to healthcare professionals to provide practical, terminological, and ethical guidance. The Bigorio group is the working group of the Swiss Palliative Care Society whose task is to publish clinical recommendations at a national level in Switzerland. These recommendations aim to provide guidance on the most critical questions and issues related to palliative sedation. The Swiss Society of Palliative Care (palliative.ch) mandated a writing board comprising four clinical experts (three physicians and one ethicist) and two national academic experts to revise the 2005 Bigorio guidelines. A first draft was created based on a narrative literature review, which was internally reviewed by five academic institutions (Lausanne, Geneva, Bern, Zürich, and Basel) and the heads of all working groups of the Swiss Society of Palliative Care before finalising the guidelines. The following themes are discussed regarding palliative sedation: (a) definitions and clinical aspects, (b) the decision-making process, (c) communication with patients and families, (d) patient monitoring, (e) pharmacological approaches, and (f) ethical and controversial issues. Palliative sedation must be practised with clinical and ethical accuracy and competence to avoid harm and ethically questionable use. Specialist palliative care teams should be consulted before initiating palliative sedation to avoid overlooking other potential treatment options for the patient's symptoms and suffering.
- Published
- 2024
- Full Text
- View/download PDF
43. Talking about dying and death: Essentials of communicating about approaching death from the perspective of major stakeholders.
- Author
-
Felber SJ, Guffi T, Brem BG, Schmitz FM, Schnabel KP, Guttormsen Schär S, Eychmüller S, and Zambrano SC
- Abstract
Objectives: Although caring for dying patients and their family caregivers (FC) is integral to patient care, training in communication about approaching death is almost inexistent in medical and nursing curricula. Consequently, many health professionals have insufficient knowledge about conducting these conversations. In order to gain a broader insight into essential aspects of this communication from different perspectives, we conducted focus groups with key stakeholders., Methods: Medical specialists, nurses, medical students, bereaved FC and patient representatives participated in five focus groups ( n = 30). Following a focus group schedule, we elicited relevant aspects of communication about approaching death, associated emotions, and appropriate communication frameworks. We analyzed data thematically., Results: Four main themes were central to conversations about approaching death: (1) embracing care within medical expertise, (2) preparing the conversation while remaining open to the unexpected, (3) recognizing and reflecting on own emotions and reactions, and (4) establishing a meaningful connection with others., Significance of Results: Communicating about approaching death with dying patients and their FC can be complex and challenging at a professional and personal level. With the recognition of the dying phase, a process is initiated for which health professionals need solid clinical knowledge about but also effective communication skills, constant self-reflection and self-care strategies. Comprehensive training and supervision while dealing with the challenges of communicating approaching death to dying patients and their FC are key, particularly for trainees, less experienced physicians and nurses. The essential components identified in this study can help health professionals to master these conversations.
- Published
- 2023
- Full Text
- View/download PDF
44. Palliative care and COVID-19: a bibliometric analysis.
- Author
-
Bernardis A, Gonzalez-Jaramillo V, Ebneter AS, and Eychmüller S
- Abstract
Objective: To assess the impact of COVID-19 on the palliative care (PC) publication trend in the last 10 years and the collaboration between countries and main topics that were discussed in the papers., Methods: We used Scopus to identify publications on PC between 2012 and 2021 and publications about PC and COVID-19 between 2020 and 2021. We used VOSviewer to assess the main topics using the keywords from the papers and to assess country collaboration., Results: 1937 publications resulted. An increase in publications about PC was observed during the pandemic, only partially explained by OVID-19-related publications. Cancer-related PC publications were the ones with the most marked increase. We identified six clusters in the distribution of the keywords: bioethics, cancer, nursing home/telemedicine, public health, caring and PC following the WHO definition. The countries with higher number of publications were the United States and England., Conclusion: We showed an increase in the number of PC publications in the last 2 years that was only partially explained by COVID-19-related publications. Most of the publications increase was due to cancer-related publications, since, during the time of the pandemic, publications on cancer and PC increased markedly, while those on heart failure, lung disease and dementia, remained constant., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2023
- Full Text
- View/download PDF
45. Unmet Needs in Patients With Heart Failure: The Importance of Palliative Care in a Heart Failure Clinic.
- Author
-
Gonzalez-Jaramillo V, Maessen M, Luethi N, Guyer J, Hunziker L, Eychmüller S, and Zambrano SC
- Abstract
Background: There are increasing calls to establish heart failure (HF) clinics due to their effectiveness in the interdisciplinary management of people living with HF. However, although a recommendation exists for palliative care (PC) providers to be part of the interdisciplinary team, few of the established HF clinics include them in their teams. Therefore, in this qualitative study, we aimed to understand the unmet PC needs of patients with HF attending an already established HF clinic., Methods: Secondary qualitative analysis of structured interviews undertaken within a larger study to validate the German version of the Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF). The NAT: PD-HF is a tool that aims to assess unmet needs in patients with HF. The interviews took place between January and March 2020 with patients from the ambulatory HF Clinic of a University Hospital in Switzerland. For this analysis, we transcribed and thematically analyzed the longest and most content-rich interviews until we reached data saturation at 31 participants. The interviews lasted 31 min on average (24-48 min)., Results: Participants ( n = 31) had a median age of 64 years (IQR 56-77), the majority had reduced ejection fraction, were men, and were classified as having a New York Heart Association functional class II. Participants were in general satisfied with the treatment and information received at the HF clinic. However, they reported several unmet needs. We therefore identified three ambivalences as main themes: (I) "feeling well-informed but missing essential discussions", (II) "although feeling mostly satisfied with the care, remaining with unmet care needs", and (III) "fearing a referral to palliative care but acknowledging its importance"., Conclusion: Although patients who are receiving multidisciplinary management in ambulatory HF clinics are generally satisfied with the care received, they remain with unmet needs. These unmet needs, such as the need for advance care planning or the need for timely and tactful end-of-life discussions, can be fulfilled by PC providers. Including personnel trained in PC as part of the multidisciplinary team could help to address patients' needs, thus improving the quality of care and the quality of life of people living with HF., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Gonzalez-Jaramillo, Maessen, Luethi, Guyer, Hunziker, Eychmüller and Zambrano.)
- Published
- 2022
- Full Text
- View/download PDF
46. Early palliative care integration trial: consultation content and interaction dynamics.
- Author
-
Kleiner N, Zambrano SC, Eychmüller S, and Zwahlen S
- Abstract
Objectives: Evidence for the positive impact of the early integration of palliative care (EPC) continues to grow. Less is known about how EPC improves patient and family outcomes, including the content of EPC consultations. Therefore, we aimed to better understand the content of EPC consultations including areas addressed, percentage covered per area and interaction style., Methods: As part of a trial in which EPC in addition to oncology care was compared with oncology care alone, we audio recorded 10 interventions. The palliative care team led the interventions using SENS, a conversation structure, which stands for: Symptoms, End-of-life decision-making, Network and Support. We employed two approaches to analysis: the Roter interaction analysis system (RIAS) to analyse interaction dynamics and SENS as a framework for content analysis., Results: Physician-patient communication covered 91% of the interaction. According to RIAS, the consultations were evenly dominated between physicians and patients (ratio=1.04) and highly patient-centred (ratio=1.26). Content wise, rapport was the largest category covering 27% of the consultation, followed by decision-making (21%) and by symptom assessment/management (17%) including 8.1% for physical symptoms and 5.4% for psychosocial aspects. Network discussions covered 17%, and lastly, support for the family 7%., Conclusions: EPC consultations cover a variety of end-of-life topics while putting a high value in establishing rapport, developing a relationship with patients, and on providing reassurance and positive emotional talk. EPC consultations using predefined structures may guarantee that a minimum of important aspects are addressed in a way in which the relationship with the patient remains at the centre., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2021
- Full Text
- View/download PDF
47. Development of an international Core Outcome Set (COS) for best care for the dying person: study protocol.
- Author
-
Zambrano SC, Haugen DF, van der Heide A, Tripodoro VA, Ellershaw J, Fürst CJ, Voltz R, Mason S, Daud ML, De Simone G, Kremeike K, Halfdanardottir SI, Sigurdardottir V, Johnson J, Allan S, Hafeez H, Simões C, Sigurdardottir KR, Rasmussen BH, Williamson P, and Eychmüller S
- Subjects
- Delphi Technique, Humans, Palliative Care methods, Qualitative Research, Systematic Reviews as Topic, Treatment Outcome, Clinical Protocols, Outcome Assessment, Health Care methods, Palliative Care standards
- Abstract
Background: In contrast to typical measures employed to assess outcomes in healthcare such as mortality or recovery rates, it is difficult to define which specific outcomes of care are the most important in caring for dying individuals. Despite a variety of tools employed to assess different dimensions of palliative care, there is no consensus on a set of core outcomes to be measured in the last days of life. In order to optimise decision making in clinical practice and comparability of interventional studies, we aim to identify and propose a set of core outcomes for the care of the dying person., Methods: Following the COMET initiative approach, the proposed study will proceed through four stages to develop a set of core outcomes: In stage 1, a systematic review of the literature will identify outcomes measured in existing peer reviewed literature, as well as outcomes derived through qualitative studies. Grey literature, will also be included. Stage 2 will allow for the identification and determination of patient and proxy defined outcomes of care at the end of life via quantitative and qualitative methods at an international level. In stage 3, from a list of salient outcomes identified through stages 1 and 2, international experts, family members, patients, and patient advocates will be asked to score the importance of the preselected outcomes through a Delphi process. Stage 4 consists of a face-to-face consensus meeting of international experts and patient/family representatives in order to define, endorse, and propose the final Core Outcomes Set., Discussion: Core Outcome Sets aim at promoting uniform assessment of care outcomes in clinical practice as well as research. If consistently employed, a robust set of core outcomes for the end of life, and specifically for the dying phase, defined by relevant stakeholders, can ultimately be translated into best care for the dying person. Patient care will be improved by allowing clinicians to choose effective and meaningful treatments, and research impact will be improved by employing internationally agreed clinically relevant endpoints and enabling accurate comparison between studies in systematic reviews and/or in meta-analyses.
- Published
- 2020
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.