[Characteristic values and test statistical goodness of the Veterans RAND 12-Item Health Survey (VR-12) in patients with chronic pain : An evaluation based on the KEDOQ pain dataset]. / Kennwerte und teststatistische Güte des Veterans RAND 12-Item Health Survey (VR-12) bei Patienten mit chronischem Schmerz : Eine Auswertung auf Basis des KEDOQ-Schmerz-Datensatzes.

The Veterans RAND 12-Item Health Survey (VR-12) was added to the German Pain Questionnaire (DSF) as a self-report measure of health-related quality of life in 2016, replacing the previously used SF-12, which required a license. Both measures have 12 items and include a physical component summary (PCS) and a mental component summary (MCS). Evaluations with a larger sample on characteristic values and on the test-statistical goodness of the VR-12 in patients with chronic pain are so far missing. Data on the VR-12 and other procedures of the DSF were evaluated from 11,644 patients from 31 centers participating in KEDOQ pain. The patients filled out the DSF before starting a pain therapy treatment. Change sensitivity was determined for 565 patients for whom the VR-12 was available from a follow-up questionnaire of the DSF several months after the initial survey.The reliability (Cronbach's alpha) of the PCS was rtt = 0.78 and for the MCS rtt = 0.84. The MCS had significant relationships with the depression, anxiety and stress scales (r = -0.51 to r = -0.72), and the PCS correlated more highly with areas of pain-related impairment (r = -0.48 to r = -0.52). Patients with higher pain chronicity, those with higher pain severity, and those with evidence of high psychological distress described significantly lower health-related quality of life in PCS and MCS. The effect size (ES) of change in terms of improvement in health-related quality of life was ES = 0.33 in the MCS and ES = 0.51 in the PCS.The results are in agreement with the findings of the SF-36 and SF-12 in patient collectives with chronic pain. In summary, they show that the VR-12 is an adequate substitute for the SF-12 in the German pain questionnaire.

[Pain therapy care in Germany-Do patients receiving day care differ from those receiving outpatient or inpatient care at the start of treatment? : A further evaluation based on the KEDOQ-pain data set]. / Schmerztherapeutische Versorgung in Deutschland ­ unterscheiden sich teilstationär versorgte Patienten von den ambulant oder stationär versorgten bei Behandlungsbeginn? : Eine weitere Auswertung auf Basis des KEDOQ-Schmerz-Datensatzes.

The direct comparison of day care pain patients with patients from other treatment sectors with respect to sociodemographic, pain-related and psychological characteristics has not yet been the subject of systematic analyses. The project core documentation and quality assurance in pain therapy (KEDOQ-pain) of the German Pain Society (Deutsche Schmerzgesellschaft e.V.) makes this comparison possible. This second analysis of the available KEDOQ data was intended to show how patients receiving day care treatment can be characterized using the core data set and whether and to what extent they differ from patients receiving outpatient or inpatient treatment. This is a continuation of the first publication, which showed remarkably small differences between outpatients and inpatients but did not include day care patients.The KEDOQ-pain data from 25 centers with a total of 8953 patients were evaluated. Patients had completed the German pain questionnaire (DSF) between January 2012 and March 2017 and received day care (n = 1264), outpatient (n = 4082) or inpatient (n = 3607) pain therapy treatment. Sociodemographic, pain-related and psychometric data of the DSF reported by patients were evaluated as well as physician information on the pain chronification stage and pain localization. The evaluation was descriptive and compared groups using univariate and multivariate procedures.Day care treated patients were significantly younger, had a higher level of education, were more frequently employed, reported higher impairment values and showed a higher severity index according to von Korff than inpatients and outpatients treated for pain. In addition, they described a shorter pain duration as well as worse habitual well-being (Marburg questionnaire on habitual well-being, MFHW). These predictors explained roughly half of the variance in the prediction of the day care treatment setting. The comparison of outpatients and inpatients showed significant group differences for some variables; however, the effects were very small.The evaluations suggest that pain therapy day care facilities treat a special group of pain patients that significantly differ from patients in other treatment sectors. Cautious conclusions are drawn regarding the systematic allocation of patients to care appropriate to their treatment needs.

[Treatment effects and cost-effectiveness of interdisciplinary multimodal pain treatment of patients with back pain : A controlled observational intervention study based on claims data and survey data of participants]. / Behandlungs- und Kosteneffekte der interdisziplinären multimodalen Schmerztherapie bei Patienten mit Rückenschmerz : Eine kontrollierte, nicht-randomisierte Interventionsstudie mit GKV-Daten und Teilnehmerbefragung.

BACKGROUND: Persons insured by AOK Nordost statutory health insurance (SHI) and on sick leave underwent a 20-day program of interdisciplinary multimodal pain therapy (IMST) following an initial assessment (IA). We evaluated its effectiveness regarding sick leave, utilization/costs of SHI services, and patient-reported characteristics of pain. MATERIALS AND METHODS: Participants with >14 days of IMST in 2013-2015 and with data necessary for comparison (intervention group, IG) were matched 1:1 in 2 steps. From AOK Nordost data, we identified a comparison group (CG) having characteristics matching exactly and by propensity score. Starting on the IA (IG) or a comparable reference day (CG), we analyzed utilization/costs of services related to back pain for 365 days. Participants' characteristics of pain were surveyed on the IA day and within 183-365 days. RESULTS: The 86 IG patients had on average 44.33 (median 12) days of sick leave less than the CG after their initial sick leave starting at the IA (significant, p <0.05). Fewer IG patients had ≥1 hospitalization (OR 0.33; 95%CI 0.12-0.88), ≥1 prescription of physiotherapy (OR 0.35; 95%CI 0.24-0.82), and ≥1 specialist visit (OR 0.39; 95%CI 0.10-0.52) related to back pain. More IG patients had "lasting absence of treatment" (OR 4.06; 95%CI 1.09-15.1). Follow-up interviews were available for 56 IG patients, showing less pain intensity, impairment by pain, and pain severity (significant). Regarding the SHI perspective, cost savings per patient nearly covered the IA and IMST costs. DISCUSSION: For a selected comparable population treated by protocol, IA and IMST was associated with reduction or "lasting absence" of treatment, pain relief, and major savings on sickness benefits. Other than in previous studies we found coverage of IA and IMST costs without consideration of productivity loss.

[Interdisciplinary multimodal assessment and risk-tailored pathways for patients with back pain : Prospective evaluation of an integrated healthcare delivery project]. / Interdisziplinär-multimodales sektorenübergreifendes Assessment und bedarfsorientierte Steuerung für Patienten mit Rückenschmerzen : Prospektive Evaluation eines integrierten Versorgungsprojekts.

BACKGROUND: Back pain is prevalent in the population, sometimes recurrent and may result in everyday and work disabilities. It is often a reason for seeking healthcare support. Analyzing the need of treatment and chronification-risk tailored intervention is a particular demand in healthcare delivery. OBJECTIVES: Reducing downstream consequences of back pain (e. g. pain and disability) by using an interdisciplinary multimodal assessment followed by a risk-tailored intervention. METHODS: Patients with back pain (n = 1638) underwent assessments based on the German Pain Questionnaire (GPQ) and the diagnostic assessment each by a team comprising a physician, a psychologist and a physiotherapist. They were assessed answering a follow-up questionnaire after 6 and/or 12 months (n = 832) for success criteria sensitive to change as pain, everyday and work disability. RESULTS: Patients had on average 62.5 days of work disability and 53.3% had pain up to one year. After assessment, 1447 patients (88.3%) were assigned to receive an intensive interdisciplinary multimodal back pain intervention. Intervention groups were: 120 h of full-time treatment for 4 weeks (n = 1030) or 60 h (n = 224), 48 h part time treatment for 3 months (n = 87), and in-patient hospital treatment for about 17 days (n = 106). The effect sizes of success criteria were large to very large in all treatment groups. CONCLUSIONS: Tailored, interdisciplinary and intensive intervention is effective in reducing downstream consequences of back pain. The treatment assignment was based on patient reports (GPQ score) and multidisciplinary assessments (clinical evidence score). Tailored interventions should include sufficient intensity for highly disabled patients. Care integration such as timely communication between the health insurance system, back pain centers and usual healthcare services as well as patient- and process-related documentation are crucial for this intervention.

[Pain therapy in Germany - what is the difference between initial outpatient and inpatient treatment? : Assessment based on the KEDOQ pain dataset]. / Schmerztherapeutische Versorgung in Deutschland ­ was unterscheidet ambulante und stationäre Patienten zu Behandlungsbeginn? : Eine Auswertung auf Basis des KEDOQ-Schmerz-Datensatzes.

A comparison of chronic pain patients in outpatient and inpatient treatment settings regarding pain-related and psychological characteristics, has not yet been systematically analyzed. The core documentation and quality assurance in pain therapy (KEDOQ-Schmerz) is a quality assurance system for documentation and quality management of pain therapy in different treatment settings. The system was initiated by the German Pain Society. We used KEDOQ-Schmerz data to describe differences between patients being treated in outpatient and inpatient settings with respect to social, pain-related and psychological factors. In total, the set of KEDOQ-Schmerz data analyzed included information from 4705 patients (from 13 clinics) collected between January 2012 and April 2016. Patients received either outpatient (n = 2682) or inpatient (n = 2023) treatment. The data analyzed comprised sociodemographic, pain-related and psychological data collected through the German Pain Questionnaire (DSF) at the beginning of treatment as well as information about pain chronification and pain localization provided by practitioners. The statistical analysis was carried out by descriptive and comparative data analysis using univariate and multivariate statistical methods. Patients with inpatient treatment were significantly older, more often female and more often had multiple pain localizations. They described stronger pain intensity and more frequently had a higher Mainz Pain Staging System (MPSS) score of pain chronification. They described a significantly poorer physical and mental health-related quality of life in the short form (SF-12) health survey, had significantly higher depression, anxiety and stress values (DASS) and a poorer habitual well-being in the Marburg questionnaire on habitual well-being (MFHW). Significant group differences had only small effect sizes. Even though most predictors for the inpatient treatment setting in multivariate analysis were significant, in total they explained less than 5% of the variance. The results indicate that pain therapy in specialized pain settings more and more has to manage patients with higher pain chronification, higher pain-related stress and previous therapy experience. The differences in patient characteristics between treatment settings are mostly clinically unimportant. Differences in clinical features do not declare the allocation to one treatment setting or the other.

[Characteristics of Patients with Breathlessness]. / Charakteristika von Palliativpatienten mit Atemnot.

Background Breathlessness is a common and distressing symptom in patients with advanced life-limiting disease. The aim of this study was to describe demographical and clinical characteristics of patients with breathlessness in Germany. Methods We conducted a secondary analysis of hospice and palliative care inpatient data from 2006 to 2008. The Hospice and Palliative Care Evaluation (HOPE) is an annual prospective German survey, that includes a validated 16-item symptom-and-problem checklist (severity score 0 - 3). Characteristics of patients with or without breathlessness were compared in a pure descriptive manner. Interpretation of given p-values takes the error inflation due to multiple testing into account. Results Breathlessness was recorded in 2860/5320 (53.8 %) patients (mean age 67.2 years (SD 12.4), 51.4 % female, 93.6 % malignant disease (female/male lung cancer 15.7/29.5 %, breast cancer 20.3/0.3 %, colon 10.3/8.7 %). Breathless patients compared with those without breathless ness had a significantly worse functional status (ECOG 3 - 4: 78.4 % vs. 70.8 %, p < 0.001), suffered from a larger number (11.1 vs. 9.5, p < 0.001) of symptoms and the symptoms were of higher intensity (except confusion). Breathless patients had a higher risk to die during inpatient stay (43.5 % vs. 32.4 %, p < 0.001). Conclusion Based on this large sample of hospice and palliative care inpatients, breathlessness is associated with a high symptom burden and shortened survival. Breathless patients need more attention in health care.

[Characteristics of patients with breathlessness - results of the german hospice and palliative care evaluation]. / Charakteristika von Palliativpatienten mit Atemnot.

BACKGROUND: Breathlessness is a common and distressing symptom in patients with advanced life-limiting disease. The aim of this study was to describe demographical and clinical characteristics of patients with breathlessness in Germany. METHODS: We conducted a secondary analysis of hospice and palliative care inpatient data from 2006 to 2008. The Hospice and Palliative Care Evaluation (HOPE) is an annual prospective German survey, that includes a validated 16-item symptom-and-problem checklist (severity score 0-3). Characteristics of patients with or without breathlessness were compared in a pure descriptive manner. Interpretation of given p-values takes the error inflation due to multiple testing into account. RESULTS: Breathlessness was recorded in 2860/5320 (53.8 %) patients (mean age 67.2 years (SD 12.4), 51.4 % female, 93.6 % malignant disease (female / male lung cancer 15.7/29.5 %, breast cancer 20.3/0.3 %, colon 10.3/8.7 %)). Breathless patients compared with those without breathless ness had a significantly worse functional status (ECOG 3-4: 78.4 % vs. 70.8 %, p < 0.001), suffered from a larger number (11.1 vs. 9.5, p < 0.001) of symptoms and the symptoms were of higher intensity (except confusion). Breathless patients had a higher risk to die during inpatient stay (43.5 % vs. 32.4 %, p < 0.001). CONCLUSION: Based on this large sample of hospice and palliative care inpatients, breathlessness is associated with a high symptom burden and shortened survival. Breathless patients need more attention in health care.

Construct and predictive validity of the German Örebro questionnaire short form for psychosocial risk factor screening of patients with low back pain.

PURPOSE: Recognizing patients at risk of developing chronic low back pain is essential for targeted interventions. One of the best researched screening instruments for this purpose is the Örebro Musculoskeletal Pain Questionnaire (ÖMSPQ). This work addresses psychometric properties of the German ÖMSPQ short form and its construct and prognostic validity. METHODS: Analyses are based on a cluster-randomized trial assessing a risk tailored intervention for patients consulting for low back pain in 35 general practices. A total of 360 patients consulting for acute and sub-acute back pain, aged 20-60 years, were included. All patients received a 10-item German short version of the ÖMSPQ, and other generic instruments (Graded Chronic Pain Scale, Patient Health Questionnaire-Depression, Hannover Functional Ability Questionnaire, Fear-Avoidance Beliefs Questionnaire). The construct validity was assessed based on the factorial structure of the items and correlations with generic instruments. The area under the curve (AUC), sensitivity and specificity were calculated as measures of prognostic validity. RESULTS: ÖMSPQ items belonging to the same subscale correlated highest among each other. The internal consistency of the ÖMSPQ items was 0.80 (Cronbach's α). The factorial structure corresponds with theoretic expectations. ÖMSPQ subscales on pain related disability, depression, and fear-avoidance beliefs correlated highest with their counterpart generic scales. The AUC for three ÖMSPQ-based prediction models ranged from 0.77 to 0.81. CONCLUSIONS: Our results support a satisfactory factorial and prognostic validity of the German short ÖMSPQ. The instrument may guide the provision of targeted interventions. Further research should link it to targeted treatments.

[Treatment of elderly with chronic pain in geriatric care and pain therapy facilities in Germany. Survey results]. / Therapie chronischer Schmerzen bei Älteren in schmerztherapeutischen und geriatrischen Einrichtungen in Deutschland. Ergebnisse einer Befragung.

BACKGROUND: Even though there are no satisfactory data available on the prevalence of chronic pain in the elderly, it is certainly a common problem in Germany. The goal of this study is to provide information on the treatment of elderly patients with chronic pain in geriatric care and pain therapy facilities in Germany. METHOD: Throughout Germany geriatric and pain clinics were asked by email about their treatment practice of patients with chronic pain. The questions related to four types of patients sharing the same chronic pain characteristics and comorbidities but differing with respect to cognitive and physical impairment. The questions were divided into the following areas: equipment, staff, patient care, documentation, and cooperation. RESULTS: Replies from a total of 85 institutions were evaluated. The response rates were approximately 5 % for geriatric units and 10 % for pain units. More patients with chronic pain are treated in geriatrics units than in pain therapy facilities due to larger capacities. Although all four types of patients are treated in both types of facilities, the functionally more competent patients are more common in pain therapy facilities. In geriatrics, the inverse relationship was found. Differences exist in the staff structure and qualification, frequency and refinement of individual and group therapies, assessments used, teamwork, documentation, and cooperation with outpatient care. CONCLUSION: Due to the differences between geriatric and pain management departments shown in all investigated areas, an exchange between these two cross-sectional subjects could help to improve inpatient, outpatient and intersectoral treatment of elderly patients with chronic pain.

[Patients with pain in outpatient care. A nationwide cross-sectional survey with path model]. / Schmerz bei Patienten in der ambulanten Pflege. Eine bundesweite Querschnittsstudie mit Pfadmodell.

BACKGROUND: There is limited knowledge on the degree of pain and pain-related impairments in home care clients. This study was carried out to provide data on the prevalence of pain and pain-related impairments in home care patients and to investigate the impact on activities of daily living and on classification into the three levels of care as defined by the statutory German long-term care insurance. MATERIAL AND METHODS: In 2012 a representative cross-sectional multicenter study was conducted among clients of 100 German home care services. The stepwise sampling procedure included a random selection of 9 home care services in each of the 16 federal states and a randomized sampling among the clients of the participating home care services. The total sample consisted of 878 home care clients (inclusion criteria ≥ 18 years). The subjective pain intensity was measured using an 11-step Likert scale ranging from 0 (no pain) to 10 (most severe pain). Pain-related impairments were rated on a 6-step Likert scale (0 = no impairments to 5 = complete impairment) assessing the level of independence in household chores, mobility, personal hygiene, dressing and social participation. Furthermore, multimorbidity (number of diagnoses) and level of care according to the current classification in the German long-term care insurance were registered. The predictive significance of latent variables was determined by structural equation modelling. RESULTS: Of the subjects surveyed 68.5 % (n = 672) reported suffering from pain. The average intensity of pain was 2.9 (standard deviation SD 2.8) and pain-related impairments had the greatest effect on mobility (78.2 %). Path analysis revealed that a higher degree of pain-related impairments (ß = + 0.31) and a higher number of diagnoses (ß = + 0.19) were associated with classification to higher levels of care as defined in the German long-term care insurance. However, stronger pain and higher age were related to a classification to a lower level of care (ß = - 0.21). No relevant gender differences were identified except for the finding that old age in women had no significant effect on the classification to the level of care, whereas in men both old age and pain intensity did have an impact. CONCLUSION: Even though the majority of home care clients in this representative study suffered from pain, the degree of pain intensity only becomes an issue in home care if it concurs with impairments in daily living and a corresponding classification to higher levels of care dependency. These findings suggest that pain and pain management should receive more attention in home care, irrespective of observable impairments in daily living. In practice, nurses in home care services should regularly assess the level of pain intensity among home care clients and the results of these regular pain assessments should be taken into account for the identification of individual care needs.

[Recommendations of the updated LONTS guidelines. Long-term opioid therapy for chronic noncancer pain]. / Empfehlungen der aktualisierten Leitlinie LONTS. Langzeitanwendung von Opioiden bei chronischen nicht-tumorbedingten Schmerzen.

BACKGROUND: The regular update of the German S3 guidelines on long-term opioid therapy for chronic noncancer pain (CNCP), the"LONTS" (AWMF registration number 145/003), began in November 2013. METHODS: The guidelines were developed by 26 scientific societies and two patient self-help organisations under the coordination of the Deutsche Schmerzgesellschaft (German Pain Society). A systematic literature search in the Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Scopus databases (up until October 2013) was performed. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. The strength of the recommendations was established by multistep formal procedures, in order to reach a consensus according to German Association of the Medical Scientific Societies ("Arbeitsgemeinschaft der Wissenschaftlich Medizinischen Fachgesellschaften", AWMF) regulations. The guidelines were reviewed by the Drug Commission of the German Medical Association, the Austrian Pain Society and the Swiss Association for the Study of Pain. RESULTS: Opioids are one drug-based treatment option for short- (4-12 weeks), intermediate- (13-25 weeks) and long-term (≥ 26 weeks) therapy of chronic osteoarthritis, diabetic polyneuropathy, postherpetic neuralgia and low back pain. Contraindications are primary headaches, as well as functional somatic syndromes and mental disorders with the (cardinal) symptom pain. For all other clinical presentations, a short- and long-term therapy with opioid-containing analgesics should be evaluated on an individual basis. Long-term therapy with opioid-containing analgesics is associated with relevant risks (sexual disorders, increased mortality). CONCLUSION: Responsible application of opioid-containing analgesics requires consideration of possible indications and contraindications, as well as regular assessment of efficacy and adverse effects. Neither an uncritical increase in opioid application, nor the global rejection of opioid-containing analgesics is justified in patients with CNCP.

[Comparison of two screening questionnaires for patients with low back pain. Collation of risk factors for chronification]. / Vergleich zweier Screening-Fragebogen für Patienten mit Rückenschmerzen. Erfassung von Risikofaktoren für eine Chronifizierung.

BACKGROUND: Screening for risk factors for chronic low back pain (LBP) (yellow flags) is recommended by clinical guidelines. Various questionnaires to assess yellow flags have been proposed. OBJECTIVES: The aim of this study was to compare the prognostic validity of two screening questionnaires. MATERIAL AND METHODS: This was a prospective observational study with 241 LBP patients from 9 general practitioners, 4 orthopedic surgeons and 2 pain clinics. We compared the Örebro musculoskeletal pain questionnaire (ÖMSPQ) and the Heidelberg short questionnaire (HKF-R10) which were completed by all patients at inclusion before the consultation. Primary outcomes were assessed after 3 months by mail. Clinical endpoints were pain intensity, disability and more than two follow-up consultations. RESULTS: The sensitivity of the HKF-R10 to predict the primary outcome ranged from 81 % to 88 %, while the specificity was much lower (37-47 %). The ÖMSPQ showed an opposite pattern with a low sensitivity ranging from 50 % to 58 % but a higher specificity (77-80 %). In patients initially classified as having chronic LBP (n = 81), using the questionnaires as a diagnostic tool, the sensitivity of both questionnaires increased but specificity decreased. Single items may perform better with regard to primary outcome than the sum scores. CONCLUSION: Both screening questionnaires for chronic LBP have insufficient diagnostic and prognostic validity for routine use in ambulatory care. Further studies are needed to improve diagnostic and prognostic validity and to elaborate criteria for a targeted use of screening questionnaires to guide therapeutic interventions.

[Evaluation of 12 pilot projects to improve outpatient palliative care]. / Evaluation von 12 Pilotprojekten zur Verbesserung der ambulanten Palliativversorgung.

BACKGROUND: With a priority programme the German Cancer Aid supported the development of quality-assured outpatient palliative care to cover the whole country. The 12 regional pilot projects funded with the aim to improve outpatient palliative care in different models and different frameworks were concurrently monitored and evaluated. METHODS: The supported projects, starting and ending individually, documented all patients who were cared for using HOPE (Hospice and palliative care evaluation) and MIDOS (Minimal documentation system for palliative patients). Total data were analyzed for 3239 patients decriptively. In addition to the quantitative data the experiences of the projects were recorded in a number of workshops (2008, 2009, 2010, and 2012). In particular, the experiences reported in the final meeting in July 2012 were considered for this article as well as the final reports for the German Cancer Aid. RESULTS: In the quantitative evaluation 85.6% of 3239 palliative care patients had a cancer diagnosis. In all model projects the goal of a network with close cooperation of primary providers, social support, and outpatient and inpatient specialist services has been achieved. For all projects, the initial financing of the German Cancer Aid was extremely important, because contracts with health insurance funds were negotiated slowly, and could then be built on the experiences with the projects. CONCLUSION: The participants of the project-completion meeting emphasized the need to carry out a market analysis before starting palliative care organizations considering the different regional structures and target groups of patients. Education, training and continuing education programs contribute significantly to the network. A reliably funded coordination center/case management across all institutions is extremely important.

["Back pain coach". A project for patients with back pain]. / "Rücken-Coach". Ein Projekt für Patienten mit Rückenschmerzen.

QUESTION: Back pain is a challenge for case management but is a health insurance fund (HIF) that identifies high risk patients and includes them in a back pain assessment and a multimodal program cost-effective? METHODS: Case managers of a HIF contacted selected patients and requested information on pain and current perspectives. Patients in the intervention group were offered a multimodal assessment and, if applicable, a multimodal treatment program. Control group patients received verbal or written (back book) information. Cost data were evaluated with respect to the interview data 1 year prior and 1 year afterwards. FINDINGS: Of the 800 insured persons contacted 621 were nationwide, 88 were regional controls and 91 were intervention patients. Inability to work was still rising in all groups but less in the intervention group versus both control groups. Drugs, hospital as well as cure/adjuvant costs were less for intervention patients than in both control groups. The investment for the program was thus more than refinanced. INTERPRETATION: Case management was well accepted but the intervention was in need of training for case managers and the specific diagnostic and treatment option regionally. FUNDING: The HIF was responsible for the study investment and project partners shared the training of the HIF regional case managers.

[German pain questionnaire and standardised documentation with the KEDOQ-Schmerz. A way for quality management in pain therapy]. / Deutscher Schmerzfragebogen (DSF) und standardisierte Dokumentation mit KEDOQ-Schmerz. Auf dem Weg zur gemeinsamen Qualitätsentwicklung der Schmerztherapie.

KEDOQ-Schmerz was developed by the German Pain Society (formerly DGSS) as a basic tool for documentation and quality management of pain therapy. It is planned to use KEDOQ-Schmerz as the data basis for nationwide, cross-sectional and independent scientific research in health services in Germany. With comparatively little effort, each participating institution (practices, pain clinics) will be able to provide quality control of their own diagnostic procedures and therapeutic effects by using benchmarking. In future KEDOQ-Schmerz will also be used as a method for external quality management in pain therapy in Germany.

[Well-being of patients receiving specialized palliative care at home or in hospital]. / Befinden von Palliativpatienten im Verlauf einer spezialisierten ambulanten oder stationären Versorgung.

BACKGROUND: A major goal of palliative care is sustaining quality of life (QoL) for patients suffering from severe symptoms, which is determined by physical and psychological consequences of an illness as well as other factors, such as the meaning of life and family support. Patients have reported high levels of QoL despite worsening symptoms. The self-estimated QoL of patients receiving outpatient and inpatient palliative care was analyzed using retrospective data from the German Hospice and Palliative Care Evaluation (HOPE). MATERIALS AND METHODS: A descriptive analysis of questionnaires given to 2,030 patients (1,616 inpatients, 414 outpatients) and their professional care takers was carried out assessing symptoms, well-being and care-related information. RESULTS: At the beginning of treatment inpatients had a higher symptom burden than outpatients. Reduced pain, tiredness and weakness and improved well-being allowed inpatients to be discharged. Outpatients suffering from severe dyspnea, constipation and anxiety were more likely to be admitted to hospital. Well-being was associated with symptom burden, weakness and tiredness in both self-evaluation and care-taker assessment particularly for outpatients. CONCLUSIONS: While tiredness and weakness influenced QoL especially for outpatients, patient-specific factors may surpass them in patient perception. To improve the QoL of palliative care patients, individual factors must be assessed in addition to symptom control.

Anticancer therapies in specialized palliative care--a multicenter survey.

INTRODUCTION: Anticancer therapies gain increasing attention and discussion in specialized palliative care institutions. Frequency, indication, attitude of team members, and modes of these therapies implemented in specialized palliative care settings are still under investigation. METHODS: Descriptive analysis of the nationwide Hospice and Palliative Care Evaluation 2007 that collected data from palliative medicine, hospice care, and oncology institutions concerning the use of anticancer therapies. RESULTS: Three thousand one hundred eighty-four patients from 67 palliative care units, eight oncology wards, and other in- and outpatient institutions were registered. Two hundred eleven therapeutic interventions, mostly i.v. chemotherapy (28.9%), have been documented in all institutions except from inpatient hospices. Although all institutions were asked to keep records from "palliative patients", those patients treated in oncology services differed from patients on palliative care units with respect to prognosis, therapeutic intention (symptom control versus tumor remission), and team attitude. DISCUSSION: Anticancer therapies are incorporated into palliative care concepts. The described differences in palliative patients that are treated in specialized palliative care as compared to oncology services will have to be discussed with regard to selection of patients for specialized palliative care and the range of suitable treatment modalities in palliative care concepts.

[How much diagnostics is required in palliative care? Results from a representative survey and own experiences]. / Wieviel Diagnostik braucht die Palliativmedizin? Ergebnisse einer multizentrischen Studie und Fallserie.

BACKGROUND: Applying diagnostic techniques in palliative care (PC) requires a thorough balance between a physical, psychosocial (and financial) burden and its therapeutic relevance in far advanced diseases. The extent of diagnostic employment in PC, preferred techniques, application problems, its informative value and therapeutic significance still have to be described. METHODS: The Hospice and Palliative Care Evaluation (HOPE) 2007 collected data from the application of microbiological and imaging techniques in German PC institutions. Furthermore, 70 consecutive ultrasound scans in our PC unit have been retrospectively analyzed.In 691 PC patients (from a total of 3184 in HOPE), diagnostic techniques (DIA) were applied and documented. RESULTS: In-patients with DIA (86,1 %) and the HOPE collective showed a comparable age and duration of hospital stay. Microbiological techniques contributed to 26,1 % of all documented in-patient investigations, imaging techniques 69,1 %. Ultrasound was the preferred imaging technique on PC units (67,1 %), whilst radiography, CT or MRI scans were rather employed on oncology wards. Nuclear imaging was rarely documented. In 80,8 %, imaging diagnostics were considered relevant for further treatment decisions (in-patients only); transportation problems and pain during imaging were relevant obstacles. In our own patient cohort, ultrasound was applied rather for general prognostic purposes, less often resulting in immediate therapeutic actions. Transportation problems could be almost entirely avoided by using a mobile ultrasound device. CONCLUSION: DIA in PC are applied independently of age or duration of hospital stay; its therapeutic significance is considered to be high; procedural problems may be resolvable. Therefore, this survey might challenge the tradition of low technology in PC.

[Accompanying evalution of funded projects in palliative medicine of the German Cancer Aid]. / Begleitevaluation des Förderschwerpunkts Palliativmedizin der Deutschen Krebshilfe.

INTRODUCTION: The German Cancer Aid funded 12 regional projects which developed different models of palliative home care. The realization of the projects were concurrently monitored and evaluated. MATERIAL AND METHODS: The funded projects were asked to document all patients who were cared for beginning in January 2009 using HOPE (Hospice and palliative survey), MIDOS (Minimal documentation system for palliative patients) and the Barthel index. Documentation was mandatory at the beginning and the end of care as well as when patients changed settings, for example when patients were transferred from a palliative care unit to a palliative home care service. Additionally the projects were visited by an independent observer. RESULTS: Overall the 12 projects documented 2,663 patients. Analysis revealed differences between the projects mainly concerning target groups and interventions. DISCUSSION: The results of this evaluation can support the discussion about the development of palliative home care in Germany with particular focus on possible interrelations between structures, target groups and possible outcomes of care.

Psychological distress in cancer patients assessed with an expert rating scale.

The purpose of this study was to investigate psychosocial stress in a large sample of cancer patients using an expert rating scale. Specific aims were to analyse the relevance of setting variables (type of clinic, contact initiative, therapy) and gender. A total of 6365 patients were assessed in 105 institutions. Univariate and multivariate statistical analysis of setting variables indicated that patients treated in palliative care settings showed highest distress scores compared to patients recruited from hospitals and outpatient clinics (P<0.001). Significant differences were also found for contact initiative (P<0.001); lowest distress was found in patients who were recruited by routine contact. Patients who asked for psychosocial support or who were recruited by the medical staff showed the highest distress scores. The analysis of therapy groups showed that patients receiving radiotherapy or surgery were not more distressed than patients without therapy. The most distressing treatment was chemotherapy. Gender had differential effects on clinic type (P<0.001) and contact initiative (P<0.001) but not on treatment and diagnosis. Expert rating scales are an important complement for self-assessment questionnaires to evaluate psychological distress of cancer patients in psychosocial studies as well as in routine medical care.