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UNASSIGNED: In 2009, Palliative care was incorporated into the medical curriculum as Cross-Sectional Subject 13 (QB13) by means of the revision of the Medical Licensing Regulations for Physicians. The aim of this study was to determine the strengths and deficits of QB13 student education for palliative care in clinical practice in a multi-centre setting and to identify potential for improvement.
UNASSIGNED: Online questionnaires filled out by medical students during their Practical Year (PY) and resident physicians from the university hospitals in Aachen, Düsseldorf, and Cologne were descriptively analyzed using SPSS; free-text responses were categorized and quantified. Semi-structured interviews with the resident physicians (using a mixed-methods design) were analyzed through content analysis. Emerging categories were quantified.
UNASSIGNED: Analysis of 130 fully completed questionnaires and 23 interviews revealed that participants particularly benefited from patient- and practice-oriented small-group sessions for their clinical work. Despite some university-specific differences, the PY students identified a need for training in end-of-life-care, while resident physicians saw a need for training primarily in dealing with patients and their relatives. They also reported deficits in transferability.
UNASSIGNED: QB13 should be organised in cross-university curricula and provide sufficient resources for practical-oriented small-group teaching. Based on the \"unit of care\", besides caring for palliative patients, dealing with patients\' families should also be an education focus. To improve transferability into clinical practice, students should be actively involved in the care of palliative patients.
UNASSIGNED: Im Jahr 2009 wurde Palliativmedizin nach Vorgabe der ärztlichen Approbationsordnung als Querschnittsbereich 13 (QB13) in das Curriculum Humanmedizin aufgenommen. Ziel dieser Studie war es, Stärken und Defizite der studentischen Lehre des QB13 für die palliativmedizinische Versorgung im klinischen Alltag multizentrisch zu ermitteln und Verbesserungspotenzial abzuleiten.
UNASSIGNED: Die von Studierenden im Praktischen Jahr (PJ) und Ärzt*innen in Weiterbildung (ÄiW) der Unikliniken Aachen, Düsseldorf, Köln ausgefüllten online-Fragebögen wurden mittels SPSS deskriptiv statistisch ausgewertet; Freitextantworten wurden kategorisiert und quantifiziert Die leitfadengestützten Interviews mit den ÄiW (Mixed-Method-Design) wurden inhaltsanalytisch ausgewertet. Entstehende Kategorien wurden quantifiziert.
UNASSIGNED: Die Auswertung der 130 vollständig ausgefüllten Fragebögen und der 23 Interviews ergab, dass die Teilnehmenden für ihre klinische Tätigkeit insbesondere von patient*innen- und praxisnahen Kleingruppenveranstaltungen profitierten. Bei z.T. universitätsspezifischen Unterschieden wurde ein Hauptschulungsbedarf von den PJ-Studierenden für die Terminalphase, von den ÄiW vor allem im Umgang mit An- und Zugehörigen gesehen. Letztere beklagten zudem Defizite in der Transferleistung.
UNASSIGNED: Der QB13 sollte in universitätsübergreifenden Curricula organisiert werden und hierbei genügend Ressourcen für praxisnahen Kleingruppenunterricht vorhalten. Angelehnt an die „unit of care“ sollte neben der Versorgung von Palliativpatient*innen auch der Umgang mit An- und Zugehörigen einen Lehrschwerpunkt darstellen. Zur Verbesserung der Transferleistung in den klinischen Alltag sollten Studierende aktiv in die Versorgung von Palliativpatient*innen einbezogen werden.

BACKGROUND: Behavioral health disorders are common among patients and caregivers in the hospice setting. Yet, limited data exist regarding what hospice providers perceive as the most common and challenging behavioral health disorders they encounter and how they manage these issues in practice.
OBJECTIVE: To characterize the perspectives of hospice medical directors (HMDs) on addressing the behavioral health challenges when caring for patients enrolled in home hospice care and their family caregivers.
METHODS: Semistructured interviews with seventeen certified HMDs were conducted. Data were analyzed using thematic analysis.
RESULTS: Many HMDs agreed that delivering high-quality behavioral health care is a tenet for good end-of-life (EoL) care. HMDs shared that depression and anxiety were the most common behavioral health challenges they encountered, while among caregivers, substance use disorder was the most challenging. Participants mentioned that nurses and social workers played a vital role in detecting and managing behavioral health problems. HMDs also stated that providing additional training for frontline staff and incorporating behavioral health experts are potential solutions to help address current challenges.
CONCLUSIONS: HMDs emphasized the importance of addressing behavioral health challenges among patients and caregivers to provide effective end-of-life care. Future studies should examine the viewpoints of additional key stakeholder groups (e.g., hospice interdisciplinary team members, family caregivers) and confirm them in quantitative studies. Designing and implementing evidence-based assessments and interventions to improve behavioral health care by addressing anxiety, depression, and caregiver substance use disorders is essential to improving care and care outcomes in the hospice setting.

BACKGROUND: Pain is a common symptom for patients with cancer. Hospice and Palliative Medicine (HPM) physicians are expected to be experts in both pharmacologic and non-pharmacologic treatment of pain for this patient population. Insufficient knowledge of non-pharmacologic, interventional approaches to pain management is a barrier to providing optimal care. This study assesses the feasibility and effectiveness of an interventional pain management curriculum on HPM fellow knowledge at a single institution.
OBJECTIVE: The primary objective was to implement an interventional pain management curriculum for HPM fellows\' and secondly to measure its effects on their knowledge and confidence in interventional pain management approaches.
METHODS: We executed an interventional pain management curriculum for HPM fellows. The curriculum consisted of 6 fifty-minute virtual lectures. Anonymous pre- and post-curriculum surveys were used to assess curricular impact.
RESULTS: Post-course surveys showed a significant increase in HPM fellows\' knowledge and confidence in interventional pain management techniques.
CONCLUSIONS: An interventional pain management curriculum for HPM fellows is a feasible and promising intervention to significantly impact fellows\' knowledge and confidence in non-pharmacologic treatment of cancer pain.

Despite sparse evidence and limited guidance on indications, use, and dosing, midazolam is widely used in palliative care. We aimed to describe and compare the use of midazolam in three different countries to improve clinical practice in palliative care. We performed an online survey among palliative care physicians in Norway, Denmark, and the United Kingdom (UK). The focus was indications, dosing, administration, and concomitant drugs. A web-based questionnaire was distributed to members of the respective national palliative medicine associations. The total response rate was 9.4%. Practices in the UK, Norway, and Denmark were overall similar regarding the indications of midazolam for anxiety, dyspnoea, and pain treatment in combination with opioids. However, physicians in the UK used a higher starting dose for anxiety, dyspnoea, and pain treatment compared to Norway and Denmark, as well as a higher maximum dose. Danish physicians preferred, to a higher degree, on-demand midazolam administration. Despite practice similarities in the UK, Norway, and Denmark, differences exist for midazolam dosing and administration in palliative medicine. We demonstrated a lack of consensus on how midazolam should be used in palliative care, setting the stage for future studies on the topic.

BACKGROUND: People with dementia are less in focus of palliative care research than other patient groups even though the awareness of their palliative and end-of-life care needs is rising. Empirical data analyses on people with dementia in palliative care services are lacking.
OBJECTIVE: To explore the prevalence of dementia diagnoses as per the ICD criteria among users of various palliative care settings and to compare use of palliative services, care pathways, and outcomes in people with and without a dementia diagnosis.
METHODS: We conducted retrospective analysis of dementia diagnoses as per ICD (F00-F03/G30) in the German National Hospice and Palliative Care Register between 2009 and 2021. The analysis used methods of descriptive and inferential statistics, including the Bonferroni correction for alpha error inflation.
METHODS: We limited the analysis to the subsample of people aged over 64.
RESULTS: The prevalence of dementia in the different settings of palliative care was lower than in the age-comparable population: Of the 69,116 data sets included in the analysis, a small minority (3.3%) was coded with dementia as the principal diagnosis. Among patients on inpatient palliative care wards, 0.8% (148 of 19,161) had a dementia diagnosis, as did 2.2% (52 of 2,380) of those under hospital palliative care support teams and 4.3% (2,014 of 46,803) of those receiving specialized palliative care at home.
CONCLUSIONS: The records of the German National Hospice and Palliative Care Register suggest that the prevalence of dementia is lower than one might expect from general population data, though numbers are in line with international studies on proportion of dementia patients receiving palliative care. Future research could usefully examine whether this discrepancy stems either from omissions in coding dementia as patients\' principal diagnosis respectively from lapses in documentation of a dementia diagnosis previously made, or from barriers to accessing palliative care services or even displays being excluded from palliative care when trying to access it.
BACKGROUND: No registration.

Community cooperation pharmacies are equipped to prepare narcotics and sterile injectable drugs for palliative medicine at home for cancer pain and end-of-life care; however, to the best of our knowledge, the actual status of the system to provide palliative medicine at home has not yet been examined. Therefore, in this study, given that home palliative medicine is one of the accreditation criteria for community cooperation pharmacies, a questionnaire survey was conducted among managing pharmacists engaged in community cooperation pharmacies to investigate the actual status of the system to provide appropriate services, mainly pain management, to patients who need home palliative medicine. An analysis of responses to the questionnaire showed that pharmacists working in community cooperation pharmacies had a high level of understanding of the proper use of rescue doses of medical narcotics and patient guidance. Pharmacists with experience in sterile and injection preparations also had a high level of understanding of palliative medicine. On the other hand, they had a low level of understanding of the WHO method for cancer pain treatment and appropriate suggestions for opioid switching. These results indicate that the creation of learning opportunities, such as training on injectables and prescription designs, for pharmacists in community cooperation pharmacies is one of the measures that may improve their understanding of palliative medicine.

This study provides prevalence and mortality data for 0- to 19-year-old children and adolescents with medically documented life-threatening and life-shortening diagnoses in Germany. A secondary data analysis of more than 12 million insured persons documented by the statutory health insurance funds in Germany from 2014 to 2019 was conducted in collaboration with the German Association of Statutory Health Insurance Funds (GKV-SV) and the Institute for Applied Health Research Berlin (InGef), whose data sets vary in collection methods. Diagnosis prevalence and mortality were calculated based on selected International Classification of Diseases, 10th Revision (ICD-10) codes reported in inpatient and outpatient care settings. In Germany, the diagnosis prevalence of life-threatening and life-shortening diseases in children and adolescents ranges between 319 948 (InGef-adapted Fraser list) and 402 058 (GKV-SV). These diagnoses can be differentiated into different disease groups (Together-for-Short-Lives [TfSL] 1-4). The TfSL-1 group in which curative treatment can be feasible represents the largest one, with 190 865 persons. In 2019, approximately 1458 children and adolescents with life-threatening and life-shortening diseases died. The current diagnostic and mortality data of affected children and adolescents in Germany serve as the essential foundation for further research into the health care of the target group.

BACKGROUND: Children are a uniquely vulnerable patient population with restricted abilities for self-advocacy and autonomy, risking infringement upon their dignity. Yet the concept of dignity in pediatrics remains underexplored relative to the adult literature and other outcome measures.
OBJECTIVE: To characterize how dignity is defined, evaluated, and/or measured in pediatrics.
METHODS: We conducted a systematic review following PRISMA guidelines across the following databases: MEDLINE, Embase, Cumulative Index of Nursing and Allied Health, PsycINFO, Global Health, Social Science Premium Collection, and Dissertation and Theses. We included publications from database inception through April 2023, in English, involving children aged 0-18 years, and prioritizing dignity as a central theme with a focus on defining, evaluating, or measuring dignity. Study descriptions and pertinent characteristics were extracted and synthesized using a predefined form.
RESULTS: Forty-four articles met inclusion criteria; fewer than half comprised original research (20/44, 45%). Most studies (38/44, 86%) included description of the meaning of dignity, with emergence of salient themes around respect, communication, agency/autonomy, and privacy. Less than half (19/44, 43%) included a measurement or evaluation of dignity; approximately one-third described dignity therapy. More than one-third of publications focused on dignity at end of life (17/44, 39%) and included discussions of palliative medicine and hospice (15/44, 34%).
CONCLUSIONS: Relatively few published studies describe dignity in pediatrics. Opportunities exist to broaden scholarship on this topic in partnership with patients, families, and clinicians, with the goal of assessing and strengthening dignity-centered care across the illness course and at the end of life.

Palliative medicine represents the holistic multiprofessional treatment of severely and incurably ill people and their relatives, addressing their complex physical, psychological, social and spiritual needs. The central therapeutic goals are the quality of life and alleviation of suffering. In the course of many neurological diseases, high symptom burden, long and variable trajectories and unfavorable prognosis at times create a need for palliative care even at an early stage, which is currently still inadequately met. This can be countered by qualified neuropalliative care. In addition to intensifying interdisciplinary collaboration, this requires neurologists to have core competencies in palliative care. These include a team-oriented attitude, communication skills, expertise in symptom control and knowledge of biomedical ethics including palliative options at the end of life.
UNASSIGNED: Palliativmedizin steht für die ganzheitliche, multiprofessionelle Behandlung schwer und unheilbar erkrankter Menschen und ihrer Zugehörigen mit ihren komplexen physischen, psychischen, sozialen und spirituellen Bedürfnissen. Zentrale Therapieziele sind Lebensqualität und Leidenslinderung. Im Verlauf vieler neurologischer Erkrankungen entsteht durch hohe Symptomlast, lange und variable Krankheitsdauer und ungünstige Prognose mitunter schon frühzeitig palliativmedizinischer Versorgungsbedarf, der aber aktuell noch unzureichend gedeckt ist. Dem kann eine qualifizierte palliativneurologische Betreuung entgegenwirken. Diese erfordert neben einer Intensivierung der interdisziplinären Kollaboration palliativmedizinische Kernkompetenzen bei Neurolog:innen. Hierzu zählen eine teamorientierte Grundhaltung, kommunikative Fähigkeiten, Expertise bei der Symptomkontrolle sowie medizinethische Kenntnisse auch zu palliativen Optionen am Lebensende.