Informing Severely III Patients: Needs, Shortcomings and Strategies for Improvement.

SUMMARY: The scope of palliative care has expanded gradually over the last decade. Provision of palliative care is not restricted to the last months of life as in some out-dated concepts. It addresses the needs of severely ill patients in all care settings (in- and outpatients, home care, hospices). Particularly in the last years, the value of integrating palliative care early in the disease trajectory of life-threatening and incurable diseases has become increasingly acknowledged. In order for patients to fully benefit from the concept of early integration of palliative care, they need to be provided with information tailored to their disease trajectory. For example, patients and relatives need to know how symptoms such as pain, depression, fatigue, breathlessness, or anxiety can be alleviated. The patients' knowledge and understanding will support the coping process, improve comfort and enhance patient participation and autonomy. Since information needs are highly individual and vary throughout the course of the disease, an interactive approach of assessing the patients' needs and responding to them adequately is mandatory. In this article, the information needs of advanced cancer patients and their families are explained, shortcomings of the present information concepts are discussed, and an integrative approach to responding to patients' information needs throughout the care pathway is advocated.

Palliative care needs of chronically ill nursing home residents in Germany: focusing on living, not dying.

OBJECTIVES: To explore the palliative care needs of nursing home residents in Germany who had not yet entered the dying phase. METHODS: Semi-structured interviews were conducted with a sample of nine residents suffering from chronic disease or frailty. The interviews were audio-recorded, transcribed, and analysed using a grounded theory approach. FINDINGS: The residents described multidimensional needs, which were categorized as 'being recognized as a person', 'having a choice and being in control', 'being connected to family and the world outside', 'being spiritually connected', and 'physical comfort'. They emphasized their desire to control everyday matters. Physical impairment was a problem, especially when independence was threatened, e.g. by immobility or a reliance on pain killers. CONCLUSION: The desire for self-determination is key when designing and evaluating primary and palliative care programmes for nursing homes. Early integration of palliative care can improve the quality of life of chronically ill residents.

Pain prevalence in hospitalized patients in a German university teaching hospital.

Forty-eight units were enrolled in a descriptive, cross-sectional study to identify strengths and weaknesses of pain management in a German university teaching hospital. Patients had to be > or =18 years old and able to speak German; intensive care, psychiatric, obstetric and pediatric units were excluded. Structured interviews were conducted by an independent researcher not involved in patient care. Patients were asked about prevalence of pain during the interview at rest, on movement, and during the 24 hours before the interview; patients rated pain intensity at rest and on movement as well as the worst pain 24 hours before the interview by using a 10 cm visual analogue scale (VAS). In addition, patients indicated localization, duration, and causes of pain. Chart analysis was carried out to check for pain medication, ICD-10 diagnoses, and demographic data. To evaluate the adequacy of pain management, the Pain Management Index (PMI) was assessed. A total of 561 of the 825 inpatients who were contacted participated in the study. Fifty percent experienced pain during the interview and 63% reported pain during the preceding 24 hours. Fifty-eight percent had moderate or severe pain (VAS > or = 45 mm) and 36% reported severe pain (VAS > or = 65 mm). Thirty-three percent had pain for more than six months. The most prevalent localization of the strongest pain was in the lower extremities (20%). Fifty percent of patients with pain received pain medication. Patients on the surgical wards (P = 0.002) and those having severe pain (P < 0.001) were more likely to get analgesics. However, 30% of those with VAS> or =65 mm received no analgesic and only 24% had adequate medication. A negative PMI, indicating inadequate pain therapy, was found in 44% (246/559) of the sample. Sex and age did not influence pain prevalence, pain intensity, or pain therapy. Pain prevalence and intensity in this German university hospital were high and pain therapy was inadequate in many cases. Pain management needs to be improved by continuous assessment and adequate pain medication.