46 results on '"Eychmüller, Steffen"'
Search Results
2. Facilitators and barriers of implementing end-of-life care volunteering in a hospital in five European countries: the iLIVE study.
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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
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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]
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- 2024
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3. Prevalence and characteristics of patients with heart failure needing palliative care
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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
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- 2021
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4. Validation of the German version of the needs assessment tool: progressive disease-heart failure
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Gonzalez-Jaramillo, Valentina, Guyer, Jelena, Luethi, Nora, Sobanski, Piotr, Zbinden, Rut, Rodriguez, Eveline, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
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- 2021
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5. 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
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Hagemann, Monika, Zambrano, Sofia C., Bütikofer, Lukas, Bergmann, Antje, Voigt, Karen, and Eychmüller, Steffen
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- 2020
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6. Applications of Machine Learning in Palliative Care: A Systematic Review
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Vu, Erwin, primary, Steinmann, Nina, additional, Schröder, Christina, additional, Förster, Robert, additional, Aebersold, Daniel M., additional, Eychmüller, Steffen, additional, Cihoric, Nikola, additional, Hertler, Caroline, additional, Windisch, Paul, additional, and Zwahlen, Daniel R., additional
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- 2023
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7. Correction to: An online international comparison of thresholds for triggering a negative response to the “Surprise Question”: a study protocol
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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
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- 2020
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8. Compassionate communities: How to assess their benefit? A protocol of a collaborative study between different countries
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González-Jaramillo, Valentina, primary, Krikorian, Alicia, additional, Tripodoro, Vilma, additional, Jorge, Margarita, additional, Zambrano, Sofia C., additional, López, Francy, additional, Vélez, Maria Clara, additional, Noguera, Tatiana, additional, Orellana, Sebastián, additional, Montilla, Silvina, additional, Christen-Cevallos Rosero, Andri, additional, and Eychmüller, Steffen, additional
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- 2023
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9. Applications of Machine Learning in Palliative Care: A Systematic Review
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Vu, Erwin, Steinmann, Nina, Schröder, Christina, Förster, Robert, Aebersold, Daniel M, Eychmüller, Steffen, Cihoric, Nikola, Hertler, Caroline, Windisch, Paul, Zwahlen, Daniel R, University of Zurich, and Windisch, Paul
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Cancer Research ,Oncology ,2730 Oncology ,1306 Cancer Research ,610 Medicine & health ,10044 Clinic for Radiation Oncology - Abstract
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.
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- 2023
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10. An online international comparison of thresholds for triggering a negative response to the “Surprise Question”: a study protocol
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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
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- 2019
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11. Live well, die well – an international cohort study on experiences, concerns and preferences of patients in the last phase of life: the research protocol of the iLIVE study
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Yildiz, Berivan, primary, Allan, Simon, additional, Bakan, Misa, additional, Barnestein-Fonseca, Pilar, additional, Berger, Michael, additional, Boughey, Mark, additional, Christen, Andri, additional, De Simone, Gustavo G, additional, Egloff, Martina, additional, Ellershaw, John, additional, Elsten, Eline E C M, additional, Eychmüller, Steffen, additional, Fischer, Claudia, additional, Fürst, Carl Johan, additional, Geijteman, Eric C T, additional, Goldraij, Gabriel, additional, Goossensen, Anne, additional, Halfdanardottir, Svandis Iris, additional, Haugen, Dagny Faksvåg, additional, Hedman, Christel, additional, Hoppe, Tanja, additional, Hughes, Rosemary, additional, Iversen, Grethe Skorpen, additional, Joshi, Melanie, additional, Kodba-Ceh, Hana, additional, Korfage, Ida J, additional, Lunder, Urska, additional, Lüthi, Nora, additional, Martín-Roselló, Maria Luisa, additional, Mason, Stephen, additional, McGlinchey, Tamsin, additional, Montilla, Silvi, additional, Rasmussen, Birgit H, additional, Ruiz-Torreras, Inmaculada, additional, Schelin, Maria E C, additional, Sigurdardottir, Katrin Ruth, additional, Sigurdardottir, Valgerdur, additional, Simon, Judit, additional, Smeding, Ruthmarijke, additional, Solvåg, Kjersti, additional, Strupp, Julia, additional, Tripodoro, Vilma, additional, van der Kuy, Hugo M, additional, van der Rijt, Carin C D, additional, van Zuylen, Lia, additional, Veloso, Verónica I, additional, Vibora-Martin, Eva, additional, Voltz, Raymond, additional, Zambrano, Sofia C, additional, and van der Heide, Agnes, additional
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- 2022
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12. Quality of care as an individual concept: Proposition of a three-level concept for clinical practice
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Ebneter, Andreas Samuel, Vonlanthen, Ronald, and Eychmüller, Steffen
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Health Policy ,Germany ,Health Personnel ,education ,Medicine (miscellaneous) ,Humans ,610 Medicine & health ,Patient Safety ,Education - Abstract
BACKGROUND Quality in health care is a complex framework with many components. The word "quality" is used in different official settings and different contexts (public health, certification, patient safety). On individual and team levels, the perception of quality is heterogenous, and the term is often used beyond the theoretical framework. Therefore, it remains a challenge to describe the perceived quality of care in the clinical setting. The aim of this paper is to present a simple concept that can be used to visually define the perceived quality of care for the individual health care professional. METHODS/CONCEPT An experience-based concept that uses different levels of "quality of care" individually to guide the supervision of health care professionals (residents) and quality goal setting in teams is presented, with the assumption that the ambition of any health care professional is to provide excellence in care. Three perceived levels of quality of care are defined, described, and visualized, namely, a) security, b) comfort, and c) perfection. The "comfort level" defines a sustainable level of care where the optimal balance between good patient care and resource use is achieved. Excellence of care is located between the comfort and the perfection level. The practical application of this proposed concept is described in three settings, namely, 1) the threshold for asking advice from the supervisor (resident physicians), 2) in supervision/coaching discussions between residents and supervisors, and 3) in the analysis of perceived quality of care and goals setting within the team. CONCLUSION A simplified, purpose-built but well-defined concept to visually depict the perception of quality of care by clinicians can be useful in clinical practice, for the supervision of residents and for team dynamics.
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- 2022
13. Unmet Needs in Patients With Heart Failure: The Importance of Palliative Care in a Heart Failure Clinic
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Gonzalez-Jaramillo, Valentina, primary, Maessen, Maud, additional, Luethi, Nora, additional, Guyer, Jelena, additional, Hunziker, Lukas, additional, Eychmüller, Steffen, additional, and Zambrano, Sofia C., additional
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- 2022
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14. Biopsychosoziale Intensivmedizin am Lebensende
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Eychmüller, Steffen and Pautex, Sophie
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610 Medicine & health - Published
- 2022
15. Additional file 5 of Validation of the German version of the needs assessment tool: progressive disease-heart failure
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Gonzalez-Jaramillo, Valentina, Guyer, Jelena, Luethi, Nora, Sobanski, Piotr, Zbinden, Rut, Rodriguez, Eveline, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
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endocrine system ,fungi - Abstract
Additional file 5. Original version (English) of the “Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF)”.
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- 2021
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16. Additional file 6 of Validation of the German version of the needs assessment tool: progressive disease-heart failure
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Gonzalez-Jaramillo, Valentina, Guyer, Jelena, Luethi, Nora, Sobanski, Piotr, Zbinden, Rut, Rodriguez, Eveline, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
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Additional file 6. Changes made for the cultural adaptation.
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- 2021
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17. Additional file 8 of Validation of the German version of the needs assessment tool: progressive disease-heart failure
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Gonzalez-Jaramillo, Valentina, Guyer, Jelena, Luethi, Nora, Sobanski, Piotr, Zbinden, Rut, Rodriguez, Eveline, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
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Additional file 8. Table 2. Frequency of answers from the first application of the tool.
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- 2021
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18. Additional file 7 of Validation of the German version of the needs assessment tool: progressive disease-heart failure
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Gonzalez-Jaramillo, Valentina, Guyer, Jelena, Luethi, Nora, Sobanski, Piotr, Zbinden, Rut, Rodriguez, Eveline, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
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education ,behavioral disciplines and activities ,humanities - Abstract
Additional file 7. Table 1. Matrix of the weights used to assess inter-rater reliability and test-retest reliability.
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- 2021
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19. Additional file 9 of Validation of the German version of the needs assessment tool: progressive disease-heart failure
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Gonzalez-Jaramillo, Valentina, Guyer, Jelena, Luethi, Nora, Sobanski, Piotr, Zbinden, Rut, Rodriguez, Eveline, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
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Additional file 9. Table 3. Sensitivity analysis to assess the inter-rater reliability for each one of second evaluators.
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- 2021
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20. Clinically significant bleeding in incurable cancer patients: effectiveness of hemostatic radiotherapy
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Cihoric Nikola, Crowe Susanne, Eychmüller Steffen, Aebersold Daniel M, and Ghadjar Pirus
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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.
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- 2012
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21. Demands on interprofessional collaboration
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Fliedner, M. C. and Eychmüller, Steffen
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610 Medicine & health - Published
- 2016
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22. Betreuung sterbender Menschen und ihrer Angehörigen
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Eychmüller, Steffen, primary and Grossenbacher-Gschwend, Babara, additional
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- 2017
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23. Accompagnement des personnes mourantes et de leurs proches
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Eychmüller, Steffen, primary and Grossenbacher-Gschwend, Babara, additional
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- 2017
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24. Sinn und Unsinn der WHO-Stufen bei der Behandlung von Tumorschmerzen
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Siegenthaler, Andreas, primary, Eychmüller, Steffen, additional, Pfander, Grégoire, additional, and Streitberger, Konrad, additional
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- 2014
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25. Sens et non-sens des paliers de l’OMS dans le traitement des douleurs cancéreuses
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Siegenthaler, Andreas, primary, Eychmüller, Steffen, additional, Pfander, Grégoire, additional, and Streitberger, Konrad, additional
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- 2014
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26. Stand der Entwicklung von Palliative Care in der Schweiz : Bestandesaufnahme 2008
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Eychmüller, Steffen, Schmid, Margareta, and Müller, Marianne
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Palliative care ,Survey ,616: Innere Medizin und Krankheiten - Abstract
Anhand einer schriftlichen Befragung sollten folgende Fragen beantwortet werden: Stand der Integration von Palliative Care als Konzept in Institutionen der Krankenversorgung und der Betreuung von alten Menschen in der Schweiz (Spitäler, Alters- und Pflegeheime, ambulanter Sektor und Spezialeinrichtungen), Identifizierung des Angebotes der Grundversorgung in Palliative Care sowie von Angeboten der spezialisierten Versorgung in Palliative Care. Dies auch im Hinblick auf ein internationales Benchmarking und die Weiterentwicklung eines regelmässigen nationalen Monitoring-Instruments.
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- 2008
27. Palliative Care in der Schweiz Bestandesaufnahme 2008 : erste Ergebnisse
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Eychmüller, Steffen, Schmid, Margareta, and Müller, Marianne
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Palliative Care ,Survey ,616: Innere Medizin und Krankheiten - Published
- 2008
28. «Keine Zeit mehr zum Sterben»
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Eychmüller, Steffen, primary
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- 2014
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29. Palliativmedizinische Fallbeispiele
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Traichel, Birgit, primary, Nef, Petra, additional, and Eychmüller, Steffen, additional
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- 2013
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30. Trois cas choisis de médecine palliative
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Traichel, Birgit, primary, Nef, Petra, additional, and Eychmüller, Steffen, additional
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- 2013
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31. Additional file 3 of Validation of the German version of the needs assessment tool: progressive disease-heart failure
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Gonzalez-Jaramillo, Valentina, Guyer, Jelena, Luethi, Nora, Sobanski, Piotr, Zbinden, Rut, Rodriguez, Eveline, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
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3. Good health - Abstract
Additional file 3. Template of the survey to health care personnel.
32. Additional file 2 of Validation of the German version of the needs assessment tool: progressive disease-heart failure
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Gonzalez-Jaramillo, Valentina, Guyer, Jelena, Luethi, Nora, Sobanski, Piotr, Zbinden, Rut, Rodriguez, Eveline, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
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3. Good health - Abstract
Additional file 2. Template of the survey to patients.
33. Prevalence and characteristics of patients with heart failure needing palliative care
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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
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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.
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34. Additional file 4 of Validation of the German version of the needs assessment tool: progressive disease-heart failure
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Gonzalez-Jaramillo, Valentina, Guyer, Jelena, Luethi, Nora, Sobanski, Piotr, Zbinden, Rut, Rodriguez, Eveline, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
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3. Good health - Abstract
Additional file 4. Template of the interview to assess face validity, applicability, relevance and acceptability of the tool among health care personnel.
35. The 'Surprise question' in heart failure: a prospective cohort study
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Gonzalez-Jaramillo, Valentina, Arenas Ochoa, Luisa Fernanda, Saldarriaga, Clara, Krikorian, Alicia, Vargas, John Jairo, Gonzalez-Jaramillo, Nathalia, Eychmüller, Steffen, and Maessen, Maud
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610 Medicine & health ,360 Social problems & social services ,3. Good health - Abstract
OBJECTIVE The Surprise Question (SQ) is a prognostic screening tool used to identify patients with limited life expectancy. We assessed the SQ's performance predicting 1-year mortality among patients in ambulatory heart failure (HF) clinics. We determined that the SQ's performance changes according to sex and other demographic (age) and clinical characteristics, mainly left ventricular ejection fraction (LVEF) and the New York Heart Association (NYHA) functional classifications. METHODS We conducted a prospective cohort study in two HF clinics. To assess the performance of the SQ in predicting 1-year mortality, we calculated the sensitivity, specificity, positive and negative likelihood ratios, and the positive and negative predictive values. To illustrate if the results of the SQ changes the probability that a patient dies within 1 year, we created Fagan's nomograms. We report the results from the overall sample and for subgroups according to sex, age, LVEF and NYHA functional class. RESULTS We observed that the SQ showed a sensitivity of 85% identifying ambulatory patients with HF who are in the last year of life. We determined that the SQ's performance predicting 1-year mortality was similar among women and men. The SQ performed better for patients aged under 70 years, for patients with reduced or mildly reduced ejection fraction, and for patients NYHA class III/IV. CONCLUSIONS We consider the tool an easy and fast first step to identify patients with HF who might benefit from an advance care planning discussion or a referral to palliative care due to limited life expectancy.
36. Validation of the German version of the needs assessment tool: progressive disease-heart failure
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Gonzalez-Jaramillo, Valentina, Guyer, Jelena, Luethi, Nora, Sobanski, Piotr, Zbinden, Rut, Rodriguez, Eveline, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
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610 Medicine & health ,360 Social problems & social services ,3. Good health - 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.
37. Additional file 2 of Validation of the German version of the needs assessment tool: progressive disease-heart failure
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Gonzalez-Jaramillo, Valentina, Guyer, Jelena, Luethi, Nora, Sobanski, Piotr, Zbinden, Rut, Rodriguez, Eveline, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
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3. Good health - Abstract
Additional file 2. Template of the survey to patients.
38. Additional file 3 of Validation of the German version of the needs assessment tool: progressive disease-heart failure
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Gonzalez-Jaramillo, Valentina, Guyer, Jelena, Luethi, Nora, Sobanski, Piotr, Zbinden, Rut, Rodriguez, Eveline, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
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3. Good health - Abstract
Additional file 3. Template of the survey to health care personnel.
39. Additional file 4 of Validation of the German version of the needs assessment tool: progressive disease-heart failure
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Gonzalez-Jaramillo, Valentina, Guyer, Jelena, Luethi, Nora, Sobanski, Piotr, Zbinden, Rut, Rodriguez, Eveline, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
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3. Good health - Abstract
Additional file 4. Template of the interview to assess face validity, applicability, relevance and acceptability of the tool among health care personnel.
40. Validation of the German version of the needs assessment tool: progressive disease-heart failure
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Gonzalez Jaramillo, Valentina, Guyer, Jelena, Luethi, Nora, Sobanski, Piotr, Zbinden, Rut, Rodriguez, Eveline, Hunziker, Lukas, Eychmüller, Steffen, and Maessen, Maud
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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.
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41. Challenges and gaps delivering palliative care to patients with heart failure
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Gonz��lez Jaramillo, Valentina, Eychmüller, Steffen, and Bosshard, Georg
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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.
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- 2021
42. Cost Impact of Palliative Care: An Empirical Analysis of a Swiss University Hospital
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Hagemann, Monika, Bergmann, Antje, Eychmüller, Steffen, and Technische Universität Dresden
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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
43. An online international comparison of thresholds for triggering a negative response to the 'Surprise Question': a study protocol
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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
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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.
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- 2019
44. An economic evaluation of an early palliative care intervention among patients with advanced cancer.
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Maessen M, Fliedner MC, Gahl B, Maier M, Aebersold DM, Zwahlen S, and Eychmüller S
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- 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.
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- 2024
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45. Palliative sedation - revised recommendations.
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Beauverd M, Mazzoli M, Pralong J, Tomczyk M, Eychmüller S, and Gaertner J
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- 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.
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- 2024
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46. Development of an international Core Outcome Set (COS) for best care for the dying person: study protocol.
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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
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- 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
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