R Voltz

Universitätsklinikum Tübingen, Tübingen, Baden-Württemberg, Germany

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Publications (205)594.64 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: In Germany, patients severely affected by Multiple Sclerosis (MS) do not routinely come into contact with palliative care, even if possibly beneficial. This study was aimed at investigating how severely affected MS patients and their health professionals perceive palliative care to determine how to better approach these patients in Germany about this topic. 15 patients feeling severely affected by MS and 23 health professionals experienced with MS patients (3 social workers, 7 nurses, and 13 physicians) in both in-/outpatient and rural/ urban settings participated in this qualitative study in Germany. Semi-structured interviews (patients, health professionals) and focus groups (health professionals) were conducted, transcribed verbatim and analyzed via qualitative content analysis. MS patients were mostly unfamiliar with the term "palliative care" or were aware of it only in relation to cancer and dying. They did not view it as relevant to themselves. Health professionals predominantly associated palliative care with dying cancer patients, if familiar with it at all. Most physicians doubted its relevance for neurological patients and denied MS as a cause of death. Nevertheless, most felt they already offered their patients sufficient palliative care, or thought that it could not meet MS patients' complex needs. Most nurses and social workers recognized deficits in existing care structures and regarded palliative care as an opportunity for MS patients. MS patients', and health professionals' restricted, death-associated awareness of palliative care leads to discomfort, fear or rejection of this idea. Therefore, a defined concept of palliative care emphasizing opportunities for severely affected MS patients and considering early integration should be spread throughout the German MS community as an additional layer of support for this patient group.
    BMC Palliative Care 03/2014; 13(1):11. · 1.12 Impact Factor
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    ABSTRACT: Breathlessness is a common and distressing symptom in patients with advanced disease. Patients' self-report is deemed to be the most valid method of symptom assessment. When patients are not capable of self-assessment, professionals' assessment is often used as alternative but evidence on the validity is conflicting. The aim of this study was to compare self- and professionals' assessment of breathlessness regarding presence and severity in patients with advanced disease. Secondary analysis of a cross-sectional, multi-centre and nationwide register (HOspice and Palliative Care Evaluation (HOPE)). Documented inpatients from hospices and palliative care units from 2006 to 2008 who completed the self-assessed MInimal DOcumentation System (MIDOS) were included. Professionals' assessment were based on the integrated symptom and problem checklist (symptom scores, 0-3). Cohen's kappa (κ) was used to estimate the 'level of agreement' (LoA). Two thousand six hundred twenty-three patients (mean age, 66.9 (SD, 12.8); 54.4 % female; median Eastern Cooperative Oncology Group score, 3; 95.9 % with malignant disease) were analysed. Prevalence of breathlessness was 53.4 % (1,398 patients) by professionals' and 53.1 % (1,410 patients) by self-assessment. Presence was correctly evaluated by professionals in 80.9 % of cases (sensitivity, 81.8 %; specificity, 79.8 %). Severity of breathlessness was correctly estimated in 65.7 % of cases. LoA was good (κ = 0.62) for the evaluation of presence of breathlessness and moderate (κ = 0.5) for the estimation of severity. The proportion of over- or underestimated scores was similar. If patient's self-rating, the gold standard of symptom assessment, is not possible, professionals' assessment might be a valid alternative, at least for assessing the presence of breathlessness.
    Supportive Care in Cancer 02/2014; · 2.09 Impact Factor
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    ABSTRACT: Abstract Background: The needs of patients feeling severely affected by multiple sclerosis (MS) have rarely been investigated. However this is essential information to know before care can be improved, including adding palliative care (PC) services where helpful. Since it remains unclear at what point specialized palliative care should begin for this patient group, this study focuses on needs in general. Objective: The objective was to explore the subjectively unmet needs of patients feeling severely affected by MS. Methods: The study used a qualitative cross-sectional approach for needs assessment. Fifteen patients self-reporting feeling severely affected by MS were recruited and interviewed using a combination of purposive and convenience sampling (five were accompanied by a caregiver relative). Interviews were recorded and transcribed verbatim, followed by qualitative content analysis. Results: Unmet needs were identified in the main categories "support of family and friends," "health care services," "managing everyday life," and "maintaining biographical continuity." Patients expressed the desire for more support from their families and to be viewed as distinct individuals. They see a substantial deficit in the physician-patient relationship and in the coordination of services. A decrease in expressed unmet needs was found for patients more severely affected and less socially integrated. Conclusions: To address the unmet needs of severely affected MS patients, health care services need to be improved and linked with existing PC services. Special attention is required to form supporting professional-patient relationships. Multiprofessional services should be accessible for patients, while integrating relatives. All services should have an individual approach to provide needs-tailored support.
    Journal of palliative medicine 02/2014; · 1.84 Impact Factor
  • Annals of the American Thoracic Society. 02/2014; 11(2):274.
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    ABSTRACT: Context. Breathlessness is a distressing symptom in advanced disease. Understanding its patterns, burden and palliative care (PC) needs over time is important to improve patients` quality of life. Objectives To describe and compare the courses of refractory breathlessness, functional status, distress and PC needs in patients with advanced chronic obstructive pulmonary disease (COPD) or lung cancer (LC) over time. Methods This was a cohort study of patients with COPD (stage III/IV) or LC. Data were assessed monthly with up to 12 telephone interviews, using the modified Borg Scale, Karnofsky Performance Status Scale, Distress Thermometer and Palliative care Outcome Scale as outcomes measures. Descriptive analysis compared all outcomes between COPD and LC at baseline and over time (forward from study entry and backward from death). Results Eighty-two patients (50 COPD, 32 LC), mean (SD) age 67.2 (7.8) and 36% female were included (8 COPD, 23 LC deceased). COPD patients perceived higher levels of breathlessness and distress at lower functional status steadily over time. LC patients’ breathlessness, distress and PC needs increased while functional status decreased towards death. PC needs were similar between disease groups. Breathlessness was negatively correlated with functional status (COPD -0.20, P=0.012; LC -0.277, P=0.029) AU: SHOULD, E.G., -0.20, HAVE AN r = IN FRONT OF IT? and positively correlated with PC needs in COPD patients (0.343, P<0.001). Death was significantly predicted by diagnosis (LC: HR=7.84, P<0.001) and functional status (10% decline: HR=1.52, P=0.001). Conclusion PC needs of patients with advanced COPD are comparable to LC patients and breathlessness severity and distress are even higher. PC for COPD patients needs further improvement to address symptom burden and needs.
    Journal of pain and symptom management 01/2014; · 2.42 Impact Factor
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    ABSTRACT: Context: Episodic breathlessness is a common and distressing symptom in patients with advanced disease. Still, it is not yet clearly defined. Objectives: The aim of this work was to develop an international definition, categorization, and terminology of episodic breathlessness. Methods: An online Delphi survey was conducted with international breathlessness experts. We used a structured questionnaire to identify specific aspects and reach agreement on a definition, categorization, and terminology (five-point Likert scale). Consensus was defined in advance as ≥70% agreement. Results: Thirty-one of 68 (45.6%), 29 of 67 (43.3%), and 33 of 67 (49.3%) experts responded in the first, second, and third rounds, respectively. Participants were 20–79 years old, about 60% male, and more than 75% rated their own breathlessness expertise as moderate to high. After three rounds, consensus was reached on a definition, categorization, and terminology (84.4%, 96.3%, and 92.9% agreement). The final definition includes general and qualitative aspects of the symptom, for example, time-limited severe worsening of intensity or unpleasantness of breathlessness in the patient's perception. Categories are predictable or unpredictable, depending on whether any triggers can be identified. Conclusion: There is high agreement on clinical and operational aspects of episodic breathlessness in advanced disease among international experts. The consented definition and categorization may serve as a catalyst for clinical and basic research to improve symptom control and patients' quality of life.
    Journal of Pain and Symptom Management 10/2013; · 2.60 Impact Factor
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    ABSTRACT: Abstract Background: Episodic breathlessness is a common and distressing symptom in advanced cancer and nonmalignant diseases but there is a lack of evidence on the characteristics of the symptom. Objective: The aim of this study was to determine the duration, severity, frequency and timing of breathlessness episodes in patients with advanced diseases. Methods: Explorative analysis of pooled cross-sectional data on episodic breathlessness collected in personal interviews with patients suffering from chronic obstructive pulmonary disease, lung cancer, chronic heart failure, or motor neuron disease. Interviews were conducted as part of two studies in the UK and in Germany that included the same questions on duration, frequency, timing, and peak severity of breathlessness episodes. Severity was measured on the modified Borg scale (0-10). Results: One hundred and twenty-nine patients, 61% male, mean age of 67 years (SD 9.8), were included. The episodes described were mainly short (75%≤10 min), severe (mean 6.5 (SD 2.4), and occurred mostly daily. Frequency of episodes triggered by exertion could hardly be determined as these varied depending on patients' activity. Conclusion: Our study reveals clinically important information on the characteristics of episodic breathlessness in patients with advanced diseases. Findings have implications for the treatment of episodic breathlessness since most short-acting drugs in use have a longer onset of action compared to the duration of episodes. We need to determine patient-relevant therapeutic targets for future evaluation of adequate pharmacological and nonpharmacological management options that are urgently warranted.
    Journal of palliative medicine 09/2013; · 1.84 Impact Factor
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    Journal der Deutschen Dermatologischen Gesellschaft 08/2013; 11 Suppl 6:1-116. · 1.40 Impact Factor
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    Journal der Deutschen Dermatologischen Gesellschaft 08/2013; 11 Suppl 6:1-126. · 1.40 Impact Factor
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    ABSTRACT: CONTEXT: Fentanyl is a potent opioid that has been proven to provide effective treatment for breakthrough cancer pain. Although opioids are the only drug group with evidence for the symptomatic treatment of breathlessness, evidence about the efficacy of fentanyl for the relief of breathlessness is unknown. OBJECTIVES: We performed a systematic review to evaluate the current evidence for the use of fentanyl for the relief of breathlessness. METHODS: The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendation for systematic reviews. Four databases (MEDLINE, EMBASE, Cochrane Library, International Pharmaceutical Abstracts) were screened using "fentanyl" and "dyspnoea" (and synonyms) as search terms. Hand search and contact with relevant authors completed the search. RESULTS: A total of 622 references were retrieved, 13 of which met the inclusion criteria for this review. Two randomized controlled trials (RCTs) evaluated fentanyl for breathlessness, but one only included two patients. The other studies were before-after (n = 2) and case studies (n = 9). All studies reported successful relief of breathlessness after fentanyl application, but the only (pilot-) RCT failed to demonstrate a statistically significant difference compared with placebo. The nature and incidence of adverse events were comparable with other opioids, and no respiratory depression was observed. CONCLUSION: Descriptive studies yielded promising results for the use of fentanyl for the relief of breathlessness; however, efficacy trials are lacking. Fully powered RCTs are warranted to determine the efficacy of fentanyl for breathlessness relief, but these require pilot studies to evaluate effective size, study procedures, and outcome measures.
    Journal of pain and symptom management 06/2013; · 2.42 Impact Factor
  • 13th World Congress of the European Association for Palliative Care, 30 May - 2 June 2013, “Palliative Care – the right way forward” [FC 13.6, oral presentation], Prague, Czech Republic; 06/2013
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    Journal der Deutschen Dermatologischen Gesellschaft 06/2013; 11(6):563-94. · 1.40 Impact Factor
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    Journal der Deutschen Dermatologischen Gesellschaft 06/2013; 11(6):563-602. · 1.40 Impact Factor
  • K M Perrar, H Golla, R Voltz
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    ABSTRACT: This systematic literature review aims to collect and analyse relevant clinical trials for the drug treatment of delirium in palliative care. The search was conducted including July 2012 in Medline (from 1966) and Embase (from 1974). The search retrieved 448 studies, of which 3 studies could be included in the analysis. Treatment with the antipsychotic drug haloperidol can be recommended, which is also true to a somewhat lower extent for the antipsychotics olanzapine and aripiprazole. Treatment with lorazepam only should be avoided. This literature analysis reflects the positive clinical experience, especially when using haloperidol. To confirm these recommendations, further substantial clinical studies are needed.The English full-text version of this article can be found at SpringerLink (under "Supplemental").
    Der Schmerz 03/2013; · 1.02 Impact Factor
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    ABSTRACT: Background: By law in 2013, palliative medicine will be integrated into the undergraduate curriculum as part of a mandatory training program and examinations at German medical schools. For this reason a national curriculum in palliative medicine has to be developed. Aim: The aim of this study was to analyze international undergraduate curricula in palliative medicine, and thus support further curriculum development in Germany. Design: Available international curricula were sought through general search engines (Google, Medline/Pubmed) in German and/or the English language. We used the palliative care education assessment tool (PEAT) for analysis of available curricula. The PEAT comprises 7 domains, and 83 objectives. Results: We identified 17 international undergraduate curricula on palliative medicine. There was a wide variation in curricular design. Mapping the curricula, the results showed that five of the seven PEAT domains were represented in the curricula retrieved. Sixteen objectives were included in more than 75% and 46 objectives in up to 50% of the curricula, respectively. Eighteen objectives were included in less than 25% of the curricula. Three PEAT objectives were absent in all curricula examined. Conclusion: There is an overlap between objectives presented in the PEAT and in the curricula, suggesting that there are "core objectives" such as "respect for differing values," "bereavement process," and "use of opioids" which might be mandatory for undergraduate palliative medical education.
    Journal of palliative medicine 01/2013; 16(1):20-30. · 1.84 Impact Factor
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    ABSTRACT: BACKGROUND: In Germany, case management in a palliative care unit was first implemented in 2005 at the Department of Palliative Medicine at the University Hospital Cologne. One of the purposes of this case management is to deal with enquiries from patients and their relatives as well as medical professionals. Using the Case Management Process Model of the Case Management Society of America as a reference, this study analysed (a) how this case management was used by different enquiring groups and (b) how patients were identified for case management and for palliative care services. The first thousand enquiries were analysed considering patient variables, properties of the enquiring persons and the content of the consultations. RESULTS: Most enquiries to the case management were made by telephone. The majority of requests regarded patients with oncological disease (84.3 %). The largest enquiring group was composed of patients and relatives (40.8 %), followed by internal professionals of the hospital (36.1 %). Most of the enquiring persons asked for a patient's admission to the palliative care ward (46.4 %). The second most frequent request was for consultation and advice (30.9 %), followed by requests for the palliative home care service (13.3 %). Frequent reasons for actual admissions were the need for the treatment of pain, the presence of symptoms and the need for nursing care. More than half of the enquiries concerning admission to the palliative care ward were followed by an admission. CONCLUSIONS: Case management has been made public among the relevant target groups. Case management as described by the Case Management Process Model helps to identify patients likely to benefit from case management and palliative care services. In addition, with the help of case management palliative patients may be allocated to particular health care services.
    BMC Research Notes 11/2012; 5(1):611.
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    ABSTRACT: Abstract Background: Opioids are the drugs of choice for management of breathlessness in advanced disease, but acute episodic breathlessness remains difficult to manage. New routes of opioid applications with quicker onset of action seem attractive for the management of episodic breathlessness. Objective: This study aimed to determine the acceptability and preference of different routes of opioid applications in patients suffering from breathlessness due to advanced disease. Design: The study consisted of structured face-to-face interviews with patients suffering from breathlessness due to lung cancer (LC), chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), and motor neurone disease (MND). Images and explanation were used to illustrate six application forms (oral, inhaled, sublingual, intranasal, buccal, transmucosal). Results: Participants numbered 119 (UK n=48, Germany n=71), 60% male, mean age 67.7 years (SD 9.9); 50% suffered from COPD. Inhaled was the most accepted (87%) and preferred (68%) route of application, followed by sublingual (45%/13%) and intranasal (42%/8%). The oral was least accepted (24%) and least preferred (9%) although nearly all participants had previous experiences with it (97%). Ratings were similar in both countries but different for preferences of sublingual (UK>Germany) and intranasal (Germany>UK). In general, participants from the UK rated more often "yes" for acceptability of all routes compared to Germany. Conclusion: Inhaled was the most accepted and preferred route of application, but no route seemed to be acceptable to all patients. Therefore, individual patient preferences should be explored before drug prescription to enhance compliance and convenience.
    Journal of palliative medicine 10/2012; · 1.84 Impact Factor
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    ABSTRACT: OBJECTIVE: The implementation of palliative care (PC) is an important challenge for health policy makers. The primary aim of this study was to analyze the effects of inpatient PC for cancer patients in the last six months of life. METHODS: Based on routine data of a nationwide sickness fund, a retrospective matched-pair analysis was performed to assess the care of cancer patients who were treated at least once on an inpatient PC unit and compare the results to cancer patients who where not treated on an inpatient PC unit. The main categories that were assessed included place of death, cost of health care and surrogates for quality of symptom control, aggressiveness of care, and end of life decisions. RESULTS: Of 11,355 patients, 841 received PC. Compared with other patients they were more likely to receive opioids (66.8% vs. 55.3%; p<0.0001) and chemotherapy in an outpatient setting (25.5% vs. 19.9%; p=0.004). Provision of artificial nutrition and surgery was similar in both groups. Total costs were higher for PC patients compared to routine care (21,879€ (±14,351€) vs. 17,885€ (±14,326€); difference 3994€ (95%-CI: [2648€; 18,973€]; p<0.0001) and PC patients were more likely to die in hospital (69.9% vs. 55.3%; p<0.0001). CONCLUSION: Cancer patients treated on a PC inpatient unit where more likely to receive opioids (a surrogate for quality of end-of-life care) but where less likely to die at home and the cost of care for these patients was higher. The results can be interpreted both from (i) a methodological standpoint that assumes confounding due to the fact that the PC patients might have been suffering from more complex symptoms and (ii) a health policy view. For the latter it is important to recognize that the whole potential of PC can only be achieved if PC (a) is provided as a cross-sectoral network, (b) is integrated early in the disease (c) assures specialized PC expertise.
    Health Policy 08/2012; · 1.51 Impact Factor
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    ABSTRACT: The purpose of this review is to give an overview of challenges that have been addressed in recent research in end-of-life communication. Diversity of difficulties that may occur in communication about end-of-life issues has been showed. The emotional quality of this communication requires special skills from professionals involved. Studies showed that physicians and medical students are often overstrained and avoid end-of-life discussions. Health professionals and patients are often ambivalent about end-of-life discussions. Nevertheless, professionals are expected to initiate these in an honest, needs-oriented way. Patient preferences are difficult to infer and have to be assessed explicitly and regularly. Studies showed that the emotional impact of end-of-life discussions can lead to a high burden or avoidance of professionals. Interdisciplinary, multi-professional work can support health professionals in end-of-life care but often structural barriers obstruct possible benefits. Health professionals need to initiate end-of-life communication in a sensitive way. Specific demands for health professionals in end-of-life communication are to differentiate own emotions and life events from those of patients and to deal with both adequately. Moreover, structural aspects can lead to difficulties between different specialties, professions and sectors, which can have a negative impact on adequate care for patient and relatives. Special efforts for improvement are needed.
    Current opinion in supportive and palliative care 08/2012; 6(3):355-64.

Publication Stats

2k Citations
594.64 Total Impact Points


  • 2013
    • Universitätsklinikum Tübingen
      Tübingen, Baden-Württemberg, Germany
  • 2006–2012
    • University of Cologne
      • Zentrum für Palliativmedizin
      Köln, North Rhine-Westphalia, Germany
    • MediaPark Klinik Köln
      Köln, North Rhine-Westphalia, Germany
    • Haukeland University Hospital
      • Department of Neurology
      Bergen, Hordaland Fylke, Norway
    • Max Planck Institute for Human Cognitive and Brain Sciences
      Leipzig, Saxony, Germany
  • 2011
    • Centrum für Integrierte Onkologie
      Köln, North Rhine-Westphalia, Germany
    • University of Padova
      • Department of Neurosciences
      Padova, Veneto, Italy
  • 2010–2011
    • Universitätsklinikum Erlangen
      • Department of Palliative Medicine
      Erlangen, Bavaria, Germany
  • 2009
    • University of Tuebingen
      Tübingen, Baden-Württemberg, Germany
  • 2008–2009
    • Universität Heidelberg
      • Neurological Clinic
      Heidelberg, Baden-Wuerttemberg, Germany
    • University of Bonn
      • Department of Neurobiology
      Bonn, North Rhine-Westphalia, Germany
  • 1993–2008
    • Ludwig-Maximilian-University of Munich
      • • Institute for Clinical Neuroimmunology
      • • Department of Urology
      • • Institute of Clinical Neuroimmunology
      • • Department of Neurology
      München, Bavaria, Germany
  • 2007
    • Hospital Havelhoehe
      Berlín, Berlin, Germany
  • 2003–2005
    • University of Leipzig
      • Department für Nuklearmedizin
      Leipzig, Saxony, Germany
  • 2004
    • Universität Regensburg
      Ratisbon, Bavaria, Germany
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
  • 1990–2001
    • University Hospital München
      München, Bavaria, Germany
  • 2000
    • Weill Cornell Medical College
      • Division of Neurobiology
      New York City, New York, United States
  • 1997–1999
    • Memorial Sloan-Kettering Cancer Center
      • Department of Neurology
      New York City, NY, United States
  • 1996–1997
    • University of Milan
      • Department of Neurological Sciences
      Milano, Lombardy, Italy
    • San Raffaele Scientific Institute
      Milano, Lombardy, Italy