Claudia Bausewein

Ludwig-Maximilians-Universität in Munich | LMU · Department for Palliative Medicine

Background: The option of intentional sedation to relieve intolerable suffering from treatment-refractory symptoms may elicit a feeling of safety for patients and informal caregivers as a last resort if the situation becomes unbearable. Many health care professionals feel uncomfortable and insecure in conducting intentional sedation due to specific...

Background People living with serious respiratory illness experience a high burden of symptoms. This review aimed to determine whether multicomponent services reduce symptoms in people with serious illness related to respiratory disease. Methods Electronic databases were searched to identify randomised controlled trials (RCTs) evaluating multicomp...

Zusammenfassung Hintergrund Im Februar 2020 erklärte das Bundesverfassungsgericht § 217 StGB für nichtig. Seitdem ist die geschäftsmäßige Förderung der Selbsttötung straffrei. Ziel dieser Studie ist die Beschreibung von Kenntnissen, Einstellungen und Erfahrungen von Mitgliedern der Deutschen Gesellschaft für Palliativmedizin (DGP) im Umgang mit To...

Background Severe and refractory chronic breathlessness is a common and burdensome symptom in patients with advanced life-limiting disease. Its clinical management is challenging because of the lack of effective interventions. Aim To provide practice recommendations on the safe use of pharmacological therapies for severe chronic breathlessness. D...

Background: In 2020, the German Constitutional Court stopped the prohibition of repeated or businesslike assisted suicide for all residents, regardless of their health status (1). Medical societies are encouraged to take a position towards this topic (2). Therefore, we aimed to describe the attitudes and experiences of members of the German Associ...

Respiratory symptoms are ubiquitous and impair health-related quality of life in people with respiratory disease. This European Respiratory Society (ERS) task force aimed to provide recommendations for symptomatic treatment in people with serious respiratory illness. The ERS task force comprised 16 members, including representatives of people with...

Background: Terminological problems concerning sedation in palliative care and consequences for research and clinical decision making have been reported frequently. Objectives: To gather data on the application of definitions of sedation practices in palliative care to clinical cases and to analyze implications for high-quality definitions. Design:...

Background The COVID pandemic is an example of a crisis challenging healthcare systems worldwide. The impact of the pandemic on providing high-quality palliative care calls for a deeper understanding of specialist services during crises. This is essential in preparation for further crises. Aim To develop a conceptual understanding of the impact of...

Background Standardised use of patient-centred outcome measures (PCOMs) improves aspects of quality of care. Normalization Process Theory (NPT) considers the social (inter-)actions of implementation processes operationalised through four constructs: coherence-building, cognitive participation, collective action and reflexive monitoring. The aim of...

In 2020, the German Federal Constitutional Court overturned § 217 of the criminal code und emphasized the right for self-determined dying and the right for assistance with suicide. Recently, two bills aiming to regulate suicide assistance were rejected by the German parliament and a proposal for a law on suicide prevention was supported. Reactions...

Background Specialist palliative home care (SPHC) aims to maintain and improve patients’ quality of life in the community setting. Symptom burden may differ between oncological and non-oncological patients. However, little is known about diagnosis-related differences of SPHC patients. This study aims to describe the prevalence of physical symptom b...

Background The hospice movement has provided an excellent model of specialist palliative care for those with advanced illness approaching the end of life. However, there are marked inequities in provision of this care, and major geographical variations in the resourcing of palliative care, often resulting in a poor match between the needs of a pati...

Background: Despite the development of patient-centred or patient-reported outcome measures (PCOMs or PROMs) in palliative and end-of-life care over recent years, their routine use in practice faces continuing challenges. Objective: To update a highly cited literature review, identify and synthesise new evidence on facilitators, barriers, lessons l...

Pharmacotherapy plays a crucial role in symptom management in palliative care and is associated with risks potentially leading to drug-related problems (DRP). Pharmacists can identify DRPs and advise prescribers on optimizing drug therapy. The aim of this study was to identify DRP in a palliative care unit (PCU) and evaluate corresponding pharmaceu...

Background The timely integration of palliative care is important for patients suffering from various advanced diseases with limited prognosis. While a German S-3-guideline on palliative care exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for integration of palliative care into intensive care...

Background The use of sedative drugs and intentional sedation in end-of-life care is associated with clinical, ethical and legal challenges. In view of these and of the issue’s great importance to patients undergoing intolerable suffering, we conducted a project titled SedPall (“From anxiolysis to deep continuous sedation – Development of recommend...

Background Over the last decades, patient-reported outcome measures (PROM) have been developed for a better understanding of patient needs. The Integrated Palliative Care Outcome Scale (IPOS) is an internationally recommended PROM in palliative care. The validated electronic version of IPOS (eIPOS) was implemented in four German specialist palliati...

Background The need for palliative care will increase over the next years because of the rise in deaths from chronic illness and demographic changes. The provision of specialist palliative care (SPC) in Germany (palliative care units (PCU), specialist palliative home care (SPHC) teams and palliative care advisory (PCA) teams) has been expanded in r...

The timely integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S‑3-guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive...

The timely integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S‑3-guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive...

The timely integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S‑3-guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive...

The timely integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S‑3-guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive...

Zusammenfassung Die zeitgerechte Integration der Palliativmedizin ist ein wichtiger Bestandteil in der medizinischen Behandlung von verschiedenen Erkrankungen im fortgeschrittenen Stadium. Während eine erweiterte S3-Leitlinie zur Palliativmedizin für Patienten mit einer nicht heilbaren Krebserkrankung existiert, fehlt bis dato eine Leitlinie für ni...

Background/aims: In Germany, specialist palliative care (SPC) is provided by palliative care units (PCU), palliative care advisory teams in hospitals and specialist palliative home care (SPHC) teams. Palliative care needs are considered a major factor in determining in which SPC setting patients are treated. Systematic comparisons are lacking, so w...

The integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S3 guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive care un...

Objective: To identify and describe requirements, recommendations, and templates for the documentation of sedation in adult palliative care. Introduction: International literature shows inconsistency in clinical practice regarding sedation in palliative care accompanied by legal, ethical, and medical uncertainties. Documentation in general serves a...

A specialized drug information service can assist professionals in collating relevant information and hereby help to increase medication safety. It is only helpful if the information provided can also be put into practice, though. The aim of this study was to evaluate the benefits of a specialized palliative care drug information service AMInfoPall...

Zusammenfassung Die zeitgerechte Integration der Palliativmedizin ist ein wichtiger Bestandteil in der medizinischen Behandlung von verschiedenen Erkrankungen im fortgeschrittenen Stadium. Während eine erweiterte S3-Leitlinie zur Palliativmedizin für Patienten mit einer nicht heilbaren Krebserkrankung existiert, fehlt bis dato eine Leitlinie für ni...

Background The COVID-19 pandemic impacts on working routines and workload of palliative care (PC) teams but information is lacking how resource use and associated hospital costs for PC changed at patient-level during the pandemic. We aim to describe differences in patient characteristics, care processes and resource use in specialist PC (PC unit an...

Purpose: Symptom control for patients who were severely ill or dying from COVID-19 was paramount while resources were strained and infection control measures were in place. We aimed to describe the characteristics of SARS-CoV-2 infected patients who received specialized palliative care (SPC) and the type of SPC provided in a larger cohort. Method...

Background: The Integrated Palliative Care Outcome Scale (IPOS) validly and reliably measures symptoms and concerns of those receiving palliative care. Aim: To determine the equivalence of the paper version with an electronic version of the IPOS (eIPOS). Design: Multicentre randomised crossover trial (NCT03879668) with a within-subject compari...

Background: Despite the development of patient-centred or patient-reported outcome measures (PCOMs or PROMs) in palliative and end-of-life care over recent years, their routine use in practice faces continuing challenges. Objective: To update a highly cited literature review, identify and synthesise new evidence on facilitators, barriers, lessons l...

Background Patient-reported outcome measures have the potential to improve outcomes, quality, and effectiveness of care. Digital use of patient-reported outcome measures could be an option to foster implementation in palliative care. The Palli-MONITOR study focused on developing and testing an electronic patient-reported outcome measure in speciali...

Warum ein Memorandum zur Versorgungsforschung im letzten Lebensjahr? Mit den Fortschritten der Medizin und dem demographischen Wandel wird nicht nur die Lebensspanne in der Bevölkerung verlängert, sondern bei dem zunehmenden Anteil von alten und hochaltrigen Menschen auch immer häufiger die letzte Lebenszeit mit Multimorbidität, Demenz oder mit sch...

Zusammenfassung Einleitung Im Forschungsverbund deutscher universitärer Palliativzentren (PallPan) im Netzwerk Universitätsmedizin (NUM) wurden Handlungsempfehlungen für die Versorgung von Schwerkranken und Sterbenden in Pandemiezeiten erarbeitet. Dazu wurden auch die Erfahrungen und Bedürfnisse von patientennah tätigen Mitarbeitenden im Krankenhau...

Background: Existing data on sedation at the end of life indicate challenges in the home care setting, leading to deviations from guidelines or non-provision of sedation. Aim: As part of the "SedPall" study, we aimed to explore circumstances in specialist palliative home care, which influence the practice of sedation. Design: Semi-structured q...

Zusammenfassung Versorgungsforschung im letzten Lebensjahr beschäftigt sich mit der wissenschaftlichen Erfassung der Begleitung und Betreuung von schwerstkranken und sterbenden Menschen sowie ihrer An- und Zugehörigen. Patientinnen und Patienten in der letzten Lebensphase können unterschiedlichen Erkrankungsgruppen angehören, besondere Charakterist...

Hintergrund und Stand (inter)nationaler Forschung: Multiprofessionell arbeitende Palliativdienste etablieren sich zunehmend in Deutschland. In nicht auf Palliativversorgung spezialisierten Bereichen im Krankenhaus unterstützen sie Primärversorgende bei der Behandlung von Patient:innen mit nicht heilbaren Erkrankung und deren Angehörigen. Im Vorderg...

Background According to recent legislation, facilitated advance care planning (ACP) for nursing home (NH) residents is covered by German sickness funds. However, the effects of ACP on patient-relevant outcomes have not been studied in Germany yet. This study investigates whether implementing a complex regional ACP intervention improves care consis...

Objectives The Munich Breathlessness Service (MBS) significantly improved control of breathlessness measured by the Chronic Respiratory Questionnaire (CRQ) Mastery in a randomized controlled fast track trial with waitlist group design spanning 8 weeks in Germany. This study aimed to assess the within-trial cost-effectiveness of MBS from a societal...

Hintergrund Die Sicherstellung einer effektiven Palliativversorgung ist im Kontext der aktuellen COVID-19-Pandemie von großer Bedeutung, aber besonders herausfordernd. Einzelpersonen, Gesellschaft, Politik und auch die spezialisierte Palliativversorgung (SPV) sind von der schnellen Ausbreitung des Virus und den umfangreichen Gegenmaßnahmen betroffe...

Hintergrund Eine systematische, standardisierte Dokumentation in der spezialisierten Palliativversorgung (SPV) wird derzeit in Deutschland nur bedingt realisiert. Der limitierte Einsatz validierter Assessments zur Symptomerfassung und Erhebung von Palliativbedürfnissen sowie das Fehlen bundesweiter Standards schränken nicht nur die kontinuierliche...

Background The SARS-CoV-2 pandemic is a constant challenge for health care systems, also in Germany. Care of seriously ill and dying people and their relatives is often neglected and suffering increased due to sub-optimal symptom management, visiting restrictions and lonely dying. The project “Palliative Care in Pandemics (PallPan)” intended to dev...

Background COVID-19 is a severe disease with a high need for intensive care treatment and a high mortality rate in hospitalized patients. The objective of this study was to describe and compare the clinical characteristics and the management of patients dying with SARS-CoV-2 infection in the acute medical and intensive care setting. Methods Descri...

Purpose The effect of the duration of an educational rotation presented at a palliative care unit on the palliative care knowledge gain and the increase of palliative care self-efficacy expectations are unclear. Methods This national prospective multicenter pre–post survey conducted at twelve German University Comprehensive Cancer Centers prospect...

During humanitarian crises, such as a pandemic, healthcare systems worldwide face unknown challenges. This study aimed to explore and describe the effect of the SARS-CoV-2 pandemic on the needs of non-infected patients and family caregivers in specialist palliative care, using qualitative, semi-structured interviews. Data were analyzed using induct...

Background: Data on sedation at the end of life (eol) in different medical disciplines are scarce and mostly based on subjective reports. We aimed to assess the use of sedatives with continuous effect in the last week of life and associated factors in different hospital departments, with the aid of objectifiable criteria. Methods: We conducted a...

Background The SARS-CoV-2 pandemic has presented major challenges to the health system. Despite high acute case numbers, patients without Covid-19 still need to be cared for. Due to the severity of the disease and a possible stressful overall situation, patients with palliative care needs also require comprehensive care during pandemic times. In ad...

With knowledge, skills, and attitudes to treatment goal establishment and treatment decisions, palliative care can contribute to appropriate use of scare resources during the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic. Palliative medicine also delivers recommendations on management of symptoms of breathlessness, anxi...

Background Since the onset of the SARS CoV2 pandemic, protective and isolation measures had a strong impact on the care and support provided to seriously ill and dying people at the end-of-life. Aim Exploring bereaved relatives’ experiences of end-of-life care during the SARS-CoV2 pandemic. Design Qualitative interview study with bereaved relativ...

Background During the COVID-19 pandemic, it has become apparent that palliative care has dynamically adapted to the care of dying patients with and without COVID-19 and has developed new forms of collaboration. Evaluation is needed to assess which innovations should be integrated into future pandemic management. Aim To explore the experiences of s...

Objectives The heterogeneity of specialist palliative care services requires a classification to enable a clear description and comparison. In Germany, specialist palliative care is provided by palliative care units, palliative care advisory teams in hospitals and palliative home care teams. The differentiation between the three care settings can s...

Background A casemix classification based on patients’ needs can serve to better describe the patient group in palliative care and thus help to develop adequate future care structures and enable national benchmarking and quality control. However, in Germany, there is no such an evidence-based system to differentiate the complexity of patients’ need...

Zusammenfassung. Patient_innen in fortgeschrittenen Krankheitsstadien leiden unter vielfältigen physischen und psychischen Beschwerden. Dazu gehören Schmerzen, Schwäche, Energielosigkeit, Gewichtsverlust, Atemnot, Übelkeit, Erbrechen, Verstopfung und Depression. In der Sterbephase können Rasselatmung, Delir und / oder terminale Unruhe hinzukommen....

The German Association of Palliative Care developed an evidence-based guideline about the management of malignant wounds in adult patients with incurable cancer. There is a lack of evidence-based guidelines about fungating wounds and a confusing wide range of available wound dressings. The goal of the guideline is to reduce the suffering of patient...