[Pitfalls in communicating with patients with chronic pain in urology-from pain games to loss of authority]. / Tücken in der Kommunikation mit chronischen Schmerzpatienten in der Urologie ­ von "pain games" bis Koryphäenkillern.

Patients with chronic pain syndromes are often referred to as "difficult" patients. In addition to positive expectations of the physicians' competence, pain patients often express understandable doubts about the appropriateness and efficiency of new treatment options and are afraid of rejection and devaluation. Hope and disappointment, idealization and devaluation alternate in a characteristic way. This article demonstrates the pitfalls of communicating with patients suffering from chronic pain and provides recommendations for improving physician-patient interaction based on acceptance, honesty and empathy.

Relatives Experience More Psychological Distress Due to COVID-19 Pandemic-Related Visitation Restrictions Than In-Patients.

Background: The COVID-19 pandemic led to visiting restrictions (VRs) of patients in hospitals. Social contacts between patients' relatives play an important role in convalescence. Isolation may cause new psychological comorbidity. The present study investigated the psychological distress of VR in in-patients and their relatives. Methods: From April 1, 2020 to May 20, 2020, 313 in-patients (≥14 years) of the University Medical Center Rostock were interviewed by questionnaires and 51 relatives by phone. Subjective psychological distress was assessed by a distress thermometer [0 (not at all)-100 (extreme)]. The study also investigated stressors due to VR, psychological distress in dependence on demographic or disease-related data, currently used communication channels and desired alternatives and support. Results: Relatives were more psychologically distressed by VR than in-patients (59 ± 34 vs. 38 ± 30, p = 0.002). Loss of direct physical contact and facial expressions/gestures resulted in the most distress. Psychological distress due to VR was independent of demographics and indicates small positive correlations with the severity of physical restriction and the general psychological distress of in-patients. The most frequent ways of communication were via phone and social media. Frequently requested alternatives for patients were other interlocutors and free phone/tablet use, for relatives visiting rooms with partitions. Conclusion: VRs are a stressor for patients and their relatives. The establishment of visiting rooms with partitions and the free use of phones/tablets could reduce the additional distress.

COVID-19: Challenges and solutions for the provision of care to seriously ill and dying people and their relatives during SARS-CoV-2 pandemic - perspectives of pandemic response team members: A qualitative study on the basis of expert interviews (part of PallPan).

BACKGROUND: During the SARS-CoV-2 pandemic's initial waves, bans on visiting and isolation measures placed limits on providing services for seriously ill and dying people and their relatives. Pandemic response teams at governmental level (macro), at federal state and municipal level (meso) and in healthcare facilities (micro) played their role in pandemic management procedures. AIM: To explore pandemic-related challenges and solutions of pandemic response teams regarding the provision of care to seriously ill and dying people and their relatives. Findings were to be integrated into a national strategy (PallPan). DESIGN: Semi-structured expert interviews (10/2020-2/2021) analysed via structured content analysis. SETTINGPARTICIPANTS: We interviewed 41 members, who discussed the work of 43 German pandemic response teams (micro n = 23; meso n = 20; no members were available at macro level) from 14 German federal states. RESULTS: Twenty-nine of 43 teams took account of the needs of seriously ill and dying. Their main challenges resulted from pandemic-related legal requirements in hospitals and long-term care facilities. The implementation of such was in the remits of the meso level. Dysfunctional or non-existent communication between the levels was reported to be challenging. To foster patient-related solutions the micro level pandemic response teams supported individual decisions to enable patient-relative contact for example, visiting and saying goodbye outside, meeting via digital solutions. CONCLUSIONS: Pandemic response teams evidently struggled to find appropriate solutions to ease pandemic-related impact on the care of seriously ill and dying patients and their relatives. We recommend bringing palliative care expertise on board.

Longitudinal observation of anxiety and depression among palliative care cancer patients.

BACKGROUND: Anxiety and depressive symptoms are commonly reported to have a high prevalence in advanced cancer patients. However, whether the severity of the symptoms change during a stay in a palliative care unit (PCU) and after discharge home has not been studied thus far. This prospective, longitudinal, single-center study screened for anxiety and depression as measured on the German version of Hospital Anxiety and Depression Scale (HADS-D) in a palliative care (PC) cancer cohort at three different time points. METHODS: Consecutive patients (N=206) admitted to a PCU were evaluated of whom N=102 could be enrolled. Patients were screened for anxiety and depression using the HADS-D questionnaire: 24 h after admittance (P1), within 24 h before discharge (P2) and 2 weeks after discharge (P3). Longitudinal changes and influencing factors were determined. RESULTS: Nearly 80% of all patients had at least at one time point a HADS score ≥8 indicating a clinically meaningful symptom burden. The P1 mean scores were 7.1±3.3 (anxiety) and 8.9±4.6 (depression). Depression was associated with underlying cancer type (P<0.05). Anxiety and depression stabilized during hospitalization (P2). However, a significant deterioration after discharge (P3) was observed (anxiety P=0.046; depression P=0.003), in particular in older patients (>65 years) and higher ECOG status (≥3). Patients with a short time since first diagnosis (<1 year) had significantly higher symptom burden compared to patients with a longer disease course. Participation was 50% emphasizing the difficulty to study PC patients. Most patients had advanced cancers (99%). Underlying cancer types consisted of a broad variety of solid tumors including 15% hematological cases. Median survival was 1.1 months. CONCLUSIONS: The high prevalence of anxiety and depressive symptoms points to the need for psychological support. All PC patients should be screened for psychological distress to identify those in need of further assessment and treatment. The deterioration at home suggests the need for improved outpatient management, including home-based psychological support. Caregivers should be aware of the psychological vulnerability of newly diagnosed cancer patients, patients with lower functional status and higher age.

Perception of bedside teaching within the palliative care setting-views from patients, students and staff members.

BACKGROUND: Bedside teaching is an essential part of medical education. However, within the setting of palliative care at a university hospital, different needs and interests may collide. On the one hand students need to be prepared for the care for critically ill patients yet on the other, patients require particular tranquility and protection. An analysis of potential harm and benefits resulting from bedside teaching in palliative care is a crucial prerequisite for the organization of bedside teaching in this sensitive setting. METHODS: We performed a qualitative study researching the perception and challenges of bedside teaching on the palliative care ward at the Rostock University Medical Center. To that extent, elective courses "Intensive Practical Training in Palliative Care" were held during the summer and winter terms of 2016 and 2016/2017, respectively. Students and team members answered a self-developed questionnaire on the perception of bedside teaching on the palliative care ward. Patients were lead through semi structured interviews later analyzed according to the thematic framework approach. RESULTS: A group of 21 students in their clinical years, 20 patients and 19 members of the palliative care team participated in this study. The experience of working with patients in the palliative care setting was very valuable for almost all students. Most patients enjoyed the presence of students on the ward. However, some missed clear cutoff criteria for termination. Students mostly felt comfortable with palliative care patients and did not request professional help for coping with experienced aspects of dying and death. In contrast, members of the palliative care team though were concerned about patients' safety and comfort and requested strict guidance of students during the course. CONCLUSIONS: Bedside teaching within the palliative care setting classified a valuable tool for specialized palliative care skills. However, in order to protect the critically ill, students need structured guidance and strict behavioral instructions for presence at the bed side.

Questionnaires measuring quality of life and satisfaction of patients and their relatives in a palliative care setting-German translation of FAMCARE-2 and the palliative care subscale of FACIT-Pal.

BACKGROUND: The evaluation of quality of life (QoL) and satisfaction with care in palliative care patients and their relatives is an important aspect of palliative care research, likewise important to get a direct feedback for the success of treatment. Here, questionnaires are important tools for measuring outcomes of care in medicine. Several validated, predominantly English, questionnaires already exist. These have been translated in different languages but German. The Functional Assessment of Chronic Illness Therapy (FACIT) is an established tool for the evaluation of QoL in cancer patients. The FACIT-Pal, a 46-itemquestionnaire of this group of questionnaires, measures the QoL in palliative care patients. It includes a new palliative care subscale which is not yet available in German. The FAMCARE-2, a 17-item-questionnaire, evaluates the relatives' satisfaction with the care and support they received from palliative care team. METHODS: The translation process followed a protocol including multiple independent translators as well as a forth and back translation. RESULTS: A German version of FAMCARE-2 and FACIT-Pal was translated based on the original questionnaire. Relevant differences between the English original versions and the back translations weren't revealed by the original scale developers. CONCLUSIONS: The final versions of the German translations have been authorized by the scale developers. The FAMCARE-2 and the FACIT-Pal are now available in German and can be used for research and quality control purposes.

[Central venous cannulation--the important things, you should know!]. / Der zentrale Venenkatheter--eine Literaturanalyse--Indikationen, Nutzen und Risiken.

Central venous cannulation is essential for management of patients who are critically ill or require major surgery. Based on approximately 90 studies, the use and maintainance of catheters, typical complications, most common puncture sites and techniques were sighted to give an overview over the state-of-the-art concerning central venous catheters.

[Persistent intractable hiccup in the perioperative period]. / Kasuistik--Unstillbarer Schluckauf beim Patienten in der perioperativen Phase.

We describe a case of hiccup in an awakening patient. Since there was no success in stopping the hiccup by deepening anaesthesia with Desflurane, we used Propofol 1.3 mg/kg BW as a short acting i.v. anaesthetic with a fast onset to provide early recovery after eliminating hiccup in the awakening patient. Recommendations for the therapy of hiccup range from breathing exercises to the implantation of a phrenic nerve stimulator. The small number of comparable patients and the lack of controlled studies prevent evidence-based recommendations for therapy. Currently patients profit mostly from the exchange of personal experiences.