National strategy for palliative care of severely ill and dying people and their relatives in pandemics (PallPan) in Germany - study protocol of a mixed-methods project.

BACKGROUND: In the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program 'Palliative care in Pandemics' (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliative care in pandemics for the national pandemic cohort network (NAPKON). METHODS: Mixed-methods project including ten work packages conducting (online) surveys and qualitative interviews to explore and describe i) experiences and burden of patients (with/without SARS-CoV-2 infection) and their relatives, ii) experiences, challenges and potential solutions of health care professionals, stakeholders and decision makers during the SARS-CoV-2 pandemic. The work package results inform the development of a consensus-based guidance. In addition, best practice examples and relevant literature will be collected and variables for data collection identified. DISCUSSION: For a future "pandemic preparedness" national and international recommendations and concepts for the care of severely ill and dying people are necessary considering both generalist and specialist palliative care in the home care and inpatient setting.

[Depression, anxiety, delirium and desire to die in palliative care : Recommendations of the S3 guideline on palliative care for patients with incurable cancer]. / Depression, Angst, Delir und Todeswunsch in der Palliativversorgung : Empfehlungen der S3-Leitlinie Palliativmedizin für Patienten mit einer nichtheilbaren Krebserkrankung.

BACKGROUND: The aim of palliative care is to optimize the quality of life of patients with incurable advanced diseases. Adequate psychotherapeutic and psychiatric care is essential in this context. OBJECTIVE: This article presents the recommendations of the S3 guideline on palliative care for patients with incurable cancer with regard to psychotherapeutic and psychiatric contents. MATERIAL AND METHODS: The guideline was developed under the leadership of the German Society for Palliative Medicine (DGP) within the methodological framework of the German Guideline Program in Oncology. Systematic literature reviews were carried out to identify relevant publications in the databases Medline, Cochrane Library, PsycInfo and Embase. Based on the publications included and clinical experience, representatives of 61 professional associations developed and agreed on evidence-based and consensus-based recommendations. RESULTS: Out of the total of 15 chapters in the guidelines, four have a special reference to psychiatry or psychotherapy; they cover the topics depression, anxiety, delirium in the dying phase and dealing with the desire to die. These chapters contain a total of 71 recommendations, almost one third of which are evidence-based. In view of the regularly undetected psychological symptoms in patients with incurable cancer, an early assessment is recommended. Optimal control of physical symptoms and support in social and existential matters are general measures that should be provided in addition to non-pharmacological and pharmacological procedures. CONCLUSION: The guideline on palliative care deals with important mental issues that should be considered by all disciplines and professions. The need for research in palliative care remains high.

[Healthcare structures in palliative care medicine : Flowchart for patients with incurable cancer]. / Versorgungsstrukturen in der Palliativmedizin : Behandlungspfad für Patienten mit einer nichtheilbaren Krebserkrankung.

BACKGROUND: In Germany the structures of generalized and specialized palliative care services have considerably increased over the last decade with respect to the number, quality and differentiation. The goal is to improve or to maintain the quality of life for patients with life-threatening illnesses. AIM: The current structures of generalized and specialized palliative care services in Germany are presented. MATERIAL AND METHODS: The structures of healthcare services are presented primarily based on the S3 guidelines on palliative care for patients with incurable cancer. An extrapolation to all patients with incurable illnesses and limited life-expectancy has been carried out. RESULTS: Palliative care in Germany can be differentiated into two sectors. Generalized palliative care provides care for patients with a low or moderately complex situation on general hospital and oncology wards, in long-term care facilities and in the domestic environment. Specialized palliative care services manage patients with a highly complex situation in palliative care units, by a palliative care support team in hospitals or in palliative medical day care centers and as outpatients in specialized outpatient palliative home care, in specialized palliative outpatient clinics or day care hospices. Inpatient hospices and the outpatient hospice services are overlapping sectors and can be assigned to both generalized and specialized palliative care. CONCLUSION: Despite a good development in recent years, a nationwide and sufficient provision of palliative care services has still not been achieved and some services have hardly been developed, e. g. palliative outpatient clinics. Hospital palliative care support teams should soon be available in all hospitals caring for patients with life-threatening illnesses, due to the requirements of the Hospice and Palliative Care Act from 2015.