What are the problems in palliative care? Results from a representative survey

Abstract

The development of a standardised core documentation for palliative care was initiated in Germany in 1996. Results from previous evaluations have shown the wide variability of the documentation in participating units. A different documentation form was used in 2001 using free text entries to find out what problems palliative care specialists perceive in their patients. Fifty-five of the 83 palliative inpatient units in Germany (66% of the units) as well as one unit each from Austria and Switzerland, documented 1304 patients in the core documentation in 2001. Inpatient care was continued until death for 531 patients, 604 patients were discharged home and 169 patients were transferred to other places of care. Palliative care treatment effectively reduced mean physical symptom intensity. Mean intensities of psychological and social problems also were reduced although not as much as physical symptom load. Nursing problems were reduced for those patients discharged but not for those who died in the unit. Anxiety and depression were the most frequent psychological problems. Nursing problems were focussed on impairment of mobility and other activities of daily living such as washing, nutrition and drinking. Excessive distress on caregivers and the organisation of home care were the predominant social problems. In conclusion, this representative prospective survey with the majority of palliative care units in Germany showed the high effectiveness of symptom relief. Using the categories identified in this study, checklists were constructed and included in the documentation forms that are currently used for the core documentation project.

Evaluation of Terminal-Stage Cancer Patients Needing Palliative Care in the Emergency Department

“…In advanced-stage cancer patients, pain, nausea, vomiting, loss of appetite, and shortness of breath are the main causes for presentation to the ED (11)(12)(13)(14). In our study, nausea-vomiting and pain were particularly common among these patients.…”

Validity, reliability and clinical feasibility of a Needs Assessment Tool for people with progressive cancer

“…However, this item encompassed potential physical symptoms including fatigue, pain, dyspnoea, loss of appetite, nausea, constipation, diarrhoea, drowsiness and sleep problems. It is possible that some health professionals considered a number of these symptoms in making their assessment, while others focussed predominately on pain, the most prevalent physical symptom reported by patients with advanced cancer [32][33][34][35][36][37][38][39]. Given the importance of accurate assessment of physical concerns, the results suggest a need for greater specificity in this item.…”

Non-cancer patients in specialized palliative care in Germany: What are the problems?

“…Detailed information on the development of the documentation tool has been published previously. 10,11 HOPE was used in several epidemiological surveys in Germany. 10,[12][13][14][15] Further evaluation of the psychometric properties is currently being performed.…”