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Introduction: Palliative sedation (PS) is an intrusive measure to relieve patients at the end of their life from otherwise untreatable symptoms. Intensive discussion of the advantages and limitations of palliative care with the patients and their relatives should precede the initiation of PS since PS is terminated by the patient's death in most cases. Drugs for PS are usually administered intravenously. Midazolam is widely used, either alone or in combination with other substances. PS can be conducted in both inpatient and outpatient settings; however, a quality analysis comparing both modalities was missing so far.Patients and Methods: This prospective observational study collected data from patients undergoing PS inpatient at the palliative care unit (PCU, n = 26) or outpatient at a hospice (n = 2) or at home (specialized outpatient palliative care [SAPV], n = 31) between July 2017 and June 2018. Demographical data, indications for PS, and drug protocols were analyzed. The depth of sedation according to the Richmond Agitation Sedation Scale (RASS) and the degree of satisfaction of staff members and patient's relatives were included as parameters for quality assessment.Results: Patients undergoing PS at the PCU were slightly younger compared to outpatients (hospice and SAPV combined). Most patients suffered from malignant diseases, and midazolam was the backbone of sedation for inpatients and outpatients. The median depth of sedation was between +1 and -3 according to the RASS with a trend to deeper sedation prior to death. The median degree of satisfaction was "good," scored by staff members and by patient's relatives. Significant differences between inpatients and outpatients were not seen in protocols, depth of sedation, and degree of satisfaction.Conclusion: The data support the thesis that PS is possible for inpatients and outpatients with comparable results. For choosing the best place for PS, other aspects such as patient's and relative's wishes, stress, and medical reasons should be considered. [ABSTRACT FROM AUTHOR]

Background: The basis for adequate psycho-oncological care is the identification of patients with psychosocial support needs. The German Working Group for Psychooncology also recommends the Hornheider Screening Instrument (HSI) for this purpose. The question, "Is anyone in your family particularly burdened by the hospital stay?" is intended to capture disease-related family stress. But is this item equally suitable for outpatients and inpatients? The study objective was to examine how replacing the original item affects the test performance of this modified version of the HSI and the frequency of psychosocial stress., Patients and Methods: 92 outpatients and 98 inpatients with skin tumors assessed their psychosocial situation using different questionnaires., Results: Compared to inpatients, less than half as many outpatients answered the item in the affirmative. If the question was replaced by: "Is someone in your family particularly burdened by your disease or the course of the disease?" this setting-related difference did not arise. The "Alternative item" and the "Modified version of the HIS" (HSI-MV) proved to be superior to the original item and the original HSI with regard to all examined criteria., Conclusions: The HSI-MV can be used as a reliable and valid instrument for the systematic assessment of psychosocial care needs in outpatient and inpatient settings. Depending on care capacity, a threshold of ≥ 5 or ≥ 4 is appropriate. In addition to screening, the desire for support should be enquired., (© 2022 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.)

Background: In the clinical treatment pathways of certified oncological centers, psychotherapeutic services are mandatory. Although patients with somatic, non-oncological illnesses show an equally high prevalence of psychosocial stress, these guidelines do not exist for the general hospital sector. Are these patients really less burdened and is psychological support only needed in individual cases? The example of dermatological patients will be used to show whether the need for psychosocial care and the desire for support vary between individuals with and without malignant disease., Patients and Methods: Using the Hornheider screening instrument and distress thermometer, 216 dermatological inpatients assessed their psychosocial stress and that of a close relative. In addition, they were asked about their desire for support and preferred support provider., Results: i) Patients without skin cancer were more frequently and more severely distressed than cancer patients. ii) Patients of both groups assessed their relatives to be approximately equally distressed. Compared with their own distress, cancer patients assessed their relatives as more frequently and on average more severely distressed. More than 50 % of all patients regarded their own disease as the cause of their relatives' distress. iii) The desire for support in both groups was about 18 %. iv) Doctors and psychologists were usually named as potential contact persons., Conclusions: The expansion of psychosocial support services for non-tumor patients and their relatives seems necessary. The establishment of appropriate screening methods should be considered. Further studies in other clinical areas are required., (© 2020 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.)

Background: Diagnosis and treatment of malignancies are frequently associated with a variety of problems for affected individuals and their relatives. In order to ensure adequate psycho-oncological and social care, it is recommended to routinely assess patients' psychosocial distress. While psychosocial services for inpatients have been expanded in recent years, the outpatient care structure in terms of psycho-oncological support is far from satisfactory, especially in Mecklenburg-Western Pomerania. We therefore set out to investigate the following questions: Does the need for psychosocial care vary in relation to (a) the treatment setting (inpatients vs. outpatients) and (b) the diagnosis? (c) Do patients experiencing psychological distress desire support?, Patients and Methods: We asked both inpatients and outpatients to rate their psychosocial situation using the Hornheide Questionnaire. Patients were also asked about their desire for psychological support and the preferred contact person., Results: (a) The treatment setting had no impact on the need for psychosocial care and the desire for support. (b) Depending on the type of skin cancer, there were significant differences in the need for such care among the 251 patients surveyed. (c) Despite a certain discrepancy, there was a significant correlation between psychosocial distress (39.0 %; n = 98/251) and desire for support (14.3 %; n = 35/245). (d) Patients experiencing distress primarily chose physicians (n = 21) and psychologists (n = 20) as potential contact persons., Conclusions: (1) In addition to the level of distress, the desire for support should be inquired. (2) Recommendations by physicians represent an important means of access to psycho-oncological services. (3) Services for outpatient support should be expanded., (© 2018 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)

Background: Regular assessment of psychosocial distress is an important component of adequate psycho-oncological and social support in cancer patients. To date, relevant studies on skin cancer patients have primarily included individuals with melanoma., Objectives: (1) Does the need for psychosocial support vary with the type of skin cancer? (2) Do mentally distressed patients desire support? (3) From the various individuals in the treatment team, whom do patients choose as potential contact person?, Patients Und Methods: Inpatients with skin cancer were asked to self-assess their psychosocial situation using the Hornheide questionnaire. In addition, they were asked about their desire for psychosocial support and the preferred potential contact person., Results: The need for support among the 116 patients surveyed varied significantly depending on the diagnosis (p = 0.007). However, the direct comparison between patients with melanoma (n = 38; 32.8 %) and squamous cell carcinoma (n = 9; 7.8 %) (p = 0.724) or other types of skin cancer (n = 20; 17.2 %) (p = 0.366) revealed no such difference. The prevalence of psychosocial distress (n = 49; 42.2 %) and the desire for support (n = 20; 17.4 %) showed considerable differences. Patients primarily chose a physician (n = 14/35) or a psychologist (n = 13/35) as potential "go-to" person for their mental distress., Conclusions: Apart from psychosocial distress, the desire for support should be assessed, and patients should be provided access to additional psychosocial care options. With respect to the need for psychosocial support, it does not seem to be justified to preferentially - or even exclusively - consider melanoma patients in clinical practice and research., (© 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)