Steffen Eychmüller

Steffen Eychmüller
Inselspital, Universitätsspital Bern · Center for palliative care

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93
Publications
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Publications

Publications (93)
Article
https://www.medinfo-verlag.ch/digitale-hilfsmittel-in-der-palliative-care-quo-vadis/
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Introduction Adequately addressing the needs of patients at the end of life and their relatives is pivotal in preventing unnecessary suffering and optimising their quality of life. The purpose of the iLIVE study is to contribute to high-quality personalised care at the end of life in different countries and cultures, by investigating the experience...
Article
Purpose To develop and validate an electronic poor outcome screening (ePOS) score to identify critically ill patients with potentially unmet palliative care (PC) needs at 48 hours after ICU admission. Materials and Methods Retrospective single-centre cohort study of 1’772 critically ill adult patients admitted to a tertiary academic ICU in Switzer...
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Background There are increasing calls to establish heart failure (HF) clinics due to their effectiveness in the interdisciplinary management of people living with HF. However, although a recommendation exists for palliative care (PC) providers to be part of the interdisciplinary team, few of the established HF clinics include them in their teams. T...
Article
Background Quality in health care is a complex framework with many components. The word “quality” is used in different official settings and different contexts (public health, certification, patient safety). On individual and team levels, the perception of quality is heterogenous, and the term is often used beyond the theoretical framework. Therefo...
Article
BACKGROUND: Telemedicine in palliative care was initially developed in countries where geography or resources limit access to care services. Recently, largely owing to the COVID-19 pandemic, this technology is being increasingly used in highly urbanised countries such as Switzerland. However, there is still scepticism regarding whether these tools...
Article
Wir leben in einer komplexen Welt mit komplexen gesundheitlichen Situationen, welche nur mit der Hilfe von interprofessioneller Koordination bewältigt werden können. Die Telemedizin als digitale Kommunikationsform kann helfen, die interprofessionelle Zusammenarbeit zu verbessern. Sie vereinfacht den Austausch im Team sowie mit den Patientinnen und...
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Background Few hospitals and heart failure (HF) clinics offer concurrent palliative care (PC) together with life-prolonging therapies. To know the prevalence of patients in HF clinics needing PC and useful tools to recognize them are the first steps to extending PC in those settings. However, it is still unknown whether tools commonly used to ident...
Article
Telemedicine in palliative care is established especially in countries with large geographical distances. Digital forms of communication (virtual consultations) are most frequently used and well-accepted by patients and caregivers. The main benefit lies in the reduction of the access barrier in the outpatient setting. Advantages are stress reductio...
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Zusammenfassung. Das Lebensende vorzubereiten, wichtige Dinge zu planen, die verbleibende Lebenszeit nicht nur mit medizinischen Behandlungen zu verbringen, sondern zu leben, dies sind häufig geäusserte Wünsche von Menschen mit fortschreitenden Krankheiten. Bei Fachpersonen sind prognostische Aussagen gefürchtet. Gleichzeitig kommt es bei Gespräche...
Article
Uncertainty, fear to harm the patient, discomfort handling the discussion and lack of time are the most cited barriers to prognostic disclosure. Physicians can be reassured that patients desire the truth about prognosis and can manage the discussion without harm, including the uncertainty of the information, if approached in a sensitive manner. Con...
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Zusammenfassung. Häufig haben Menschen am Lebensende den Wunsch, möglichst lange zuhause zu bleiben. Um dies vermehrt zu ermöglichen, benötigt es neben Gesundheitsfachpersonen, die Betroffene und ihre Angehörigen begleiten, auch Bildungsangebote zur Stärkung der Ressourcen im Umgang mit dem Lebensende. Im Rahmen des Projektes «Compassionate City La...
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Background The Surprise Question (‘Would I be surprised if this patient died within 12 months?’) identifies patients in the last year of life. It is unclear if ‘surprised’ means the same for each clinician, and whether their responses are internally consistent. Aim To determine the consistency with which the Surprise Question is used. Design A cr...
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Background The Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF) is a tool created to assess the needs of people living with heart failure and their informal caregivers to assist delivering care in a more comprehensive way that addresses actual needs that are unmet, and to improve quality of life. In this study, we aimed to (1)...
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Objective The Surprise Question (SQ) is a prognostic screening tool used to identify patients with limited life expectancy. We assessed the SQ’s performance predicting 1-year mortality among patients in ambulatory heart failure (HF) clinics. We determined that the SQ’s performance changes according to sex and other demographic (age) and clinical ch...
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Background The public’s view of palliative care often involves its potential to improve of quality-of-life as well as its use as a last resource prior to death. Objective To obtain an idea of the image of palliative care held by the public in the German-speaking part of Switzerland, the authors sought to understand (1) the perceptions of palliativ...
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Background: International oncology societies recommend early palliative care. Specific models to integrate early palliative care efficiently into clinical practice are debated. The authors designed a study to look at the quantitative and qualitative outcomes of an early palliative care intervention in oncological care to decrease stress and improv...
Preprint
Full-text available
Background The Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF) is a tool created to assess the needs of people living with heart failure and their informal caregivers to assist delivering care in a more comprehensive way that addresses actual needs that are unmet, and to improve quality of life. In this study we aimed to 1) Tr...
Article
Objectives Evidence for the positive impact of the early integration of palliative care (EPC) continues to grow. Less is known about how EPC improves patient and family outcomes, including the content of EPC consultations. Therefore, we aimed to better understand the content of EPC consultations including areas addressed, percentage covered per are...
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Objective To assess the effectiveness of home-based palliative care (HBPC) on reducing hospital visits and whether HBPC lowered health care cost. Method We searched six bibliographic databases (Embase (Ovid); Cochrane Central Register of Controlled Trials; Medline (Ovid); PubMed; Web of Science Core Collection; and, CINAHL) until February 2019 and...
Article
Palliative care focuses on symptom management, discussion of treatment and care decisions, network organization, and support of the family. As part of the advance care planning (ACP) process, staff nurses in the acute care setting are often involved in all of the above areas. It is yet unclear what nurses' roles and responsibilities are and what sk...
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Background In contrast to typical measures employed to assess outcomes in healthcare such as mortality or recovery rates, it is difficult to define which specific outcomes of care are the most important in caring for dying individuals. Despite a variety of tools employed to assess different dimensions of palliative care, there is no consensus on a...
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Background Use of implantable cardioverter defibrillators is increasingly common. As patients approach the end of life, it is appropriate to deactivate the shock function. Aim To assess the prevalence of implantable cardioverter defibrillator reprogramming to deactivate the shock function at the end of life and the prevalence of advance directives...
Article
Background Nurses’ end of life (EoL) care focuses on direct (eg, physical) and indirect (e,g, coordination) care. Little is known about how much time nurses actually devote to these activities and if activities change due to support by specialized palliative care (SPC) in hospitalized patients. Aims (1) Comparing care time for EoL patients receivi...
Article
Context: Although the number of studies on the economic impact of palliative care (PC) is growing, the great majority report costs from North America. Objectives: We aimed to provide a comprehensive overview of PC hospital cost components from the perspective of a European mixed funded health care system by identifying cost drivers of PC and qua...
Article
Background: The term "palliative care" (PC) has often been found to have a negative connotation leading some to suggest rebranding and some services to change their name. Perceptions of the PC community about the term remain largely unexplored. Objective: To explore how PC researchers/academics perceive the term is the objective of this study. De...
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Background: Intervention trials confirm that patients with advanced cancer receiving early palliative care experience a better quality of life and show improved knowledge about and use of palliative care services. To involve patients in future health-care decisions, health professionals should understand patients' perspectives. However, little is...
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Delirium is a frequent condition in patients in a palliative care situation and most often associated with substantial burden or even danger for the persons concerned as well as caregivers and health-care-professionals. Despite the lack of randomized-controlled-trials (RCTs) benzodiazepines and neuroleptic agents are used extensively in palliative...
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Anticipatory planning for end of life requires a common language for discussion among patients, families, and professionals. Studies show that early Palliative Care (PC) interventions based on a problem-oriented approach can improve quality of life, support decision-making, and optimize the timing of medical treatment and transition to hospice serv...
Article
Anticipation at the end of life - a critical appraisal for the clinical practice Abstract. Advance planning or anticipation in health care is based on prognosis, and that is no more (and no less) than dealing with probabilities. Knowledge about prognostic factors in medicine is needed here, and competencies how to communicate it. In medicine, advan...
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Chapter
Palliative care approaches patients and their suffering with a bio-psycho-social-spiritual model. Thus, it is the strength of palliative care to complement the diagnosis driven approach of medical cancer care by a problem and resources-based assessment, participatory care plan and person-directed interventions. Interventions need to reflect timely...
Article
140 Background: Reasons why clinical trials of early palliative care (ePC) interventions have prolonged patient recruitment time frames have been researched mainly qualitatively. Our objective was to identify major recruitment barriers encountered in our ePC trial, as well as to implement actions to overcome them. The impact of these changes on rec...
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Background: Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. Aim: To assess national models and method...
Article
Hintergrund Optimale Ergebnisse wie geringere Morbidität, höhere Patienten- und Mitarbeiterzufriedenheit sowie niedrigere Versorgungskosten im heutigen diagnosefokussierten Gesundheitssystem können durch eine effektive interprofessionelle Zusammenarbeit erreicht werden. Ziel Basierend auf der Literatur und eigenen klinischen Erfahrungen wird erfol...
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Purpose of review: The aim of this review is to critically appraise the existing evidence on 'early palliative care' (EPC), discuss its relationship with advance care planning, and to reflect on the impact of EPC on the quality of care provided during the last days of life. Recent findings: There are indicators that EPC may help to avoid aggress...
Article
Background Optimal outcomes such as lower mortality, greater satisfaction of patients and health care professionals, and lower health care costs within the current diagnosis-oriented health care system, can be achieved by effective interprofessional collaboration. Aim Based on the literature and our own clinical experiences, we reflect on successfu...
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Background: In 2007, a first survey on undergraduate palliative care teaching in Switzerland has revealed major heterogeneity of palliative care content, allocation of hours and distribution throughout the 6 year curriculum in Swiss medical faculties. This second survey in 2012/13 has been initiated as part of the current Swiss national strategy i...
Article
Background To test the benefit of an early patient-driven Advance Care Planning (ACP) intervention using the “SENS”-structure we are conducting a multi-centre mixed methods trial in patients with cancer. Because difficulties recruiting patients for studies in early PC are documented the process needs distinct attention because of their often vulner...
Article
Background Advance care planning (ACP) structures complex situations and offers pragmatic support. Early integration of Palliative Care into care pathways of any chronic life-limiting disease necessitates the early definition of a patient/family driven care plan. Aim The authors developed a person-centred, needs-driven ACP framework helping patient...
Article
Background: As the demand for palliative care (PC) in emergency wards continues to increase, emergency medicine is increasingly focusing on the care of extremely ill patients with incurable, chronic and/or advanced diseases. There is no consistent definition of the profile of PC or understanding of what PC involves. The mistake is often made of co...
Chapter
Imagine you suffer from an advanced malignant lymphoma, and waking up one morning, you feel a stabbing pain that does not go away even when you change your position. There was no discomfort in this place before; after the last checkup at the oncologist’s, you were told that “everything is under control.” This early-morning pain has huge consequence...
Article
Palliative care approaches the patient and his or her suffering with a biopsychosocial-spiritual model. Thus, it is the strength of palliative care to complement the diagnosis driven approach of medical cancer care by a problem and resources-based assessment, participatory care plan, and patient-directed interventions. Interventions need to reflect...
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Present the activities of the European Association for Palliative Care (EAPC) in the area of medical education including projects as Undergraduate and Postgraduate Curricula, Mapping Medical Education, Physician's Specialization and International Medical Education in Palliative Care (iMEP): a research on undergraduates. We outline also future proje...
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Schweizerische Ärztezeitung | Bulletin des médecins suisses | Bollettino dei medici svizzeri | 2010;91: 10 409 Palliative Care in der Schweiz 2008 – eine Bestandesaufnahme Hintergrund Die Veränderung der demographischen Entwicklung mit einem immer grösseren Anteil alter Menschen, der Zunahme von chronischen Erkrankungen und dem raschen Anstieg der...
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Background: Providing the highest quality care for dying patients should be a core clinical proficiency and an integral part of comprehensive management, as fundamental as diagnosis and treatment. The aim of this study was to provide expert consensus on phenomena for identification and prediction of the last hours or days of a patient's life. This...
Chapter
This chapter presents an account of a regional initiative undertaken in north eastern Switzerland to develop community-based palliative care. The Kerala (India) Neighbourhood Network in Palliative Care (KNNPC) was identified as an excellent example of a model of community palliative care that effectively addresses some of the difficulties experienc...
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This study was performed to evaluate the outcome after hemostatic radiotherapy (RT) of significant bleeding in incurable cancer patients. Patients treated by hemostatic RT between November 2006 and February 2010 were retrospectively analyzed. Bleeding was assessed according to the World Health Organization (WHO) scale (grade 0 = no bleeding, 1 = pe...
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Assessment in Palliative Care is a broad field trying to integrate various dimensions from physical, psychological, social and spiritual problems and suffering. Medical diagnosis alone may not successfully reflect this multidimensional aspects, as it may be true for nursing diagnosis. In addition, any assessment procedures in palliative care needs...
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In the last few years public interest in the care of severely ill and dying patients has been growing. The aim of palliative medicine is to improve the care of the dying. However, this is still not achieved in many general hospitals. The Liverpool Care Pathway (LCP) for the care of the dying intends to change this situation. The aim of this study w...
Article
In clinical practice, assessment and adequate treatment of depression in the last month of life remain a difficult task. Although assessment instruments and criteria for depression are available for use in the palliative care population, few have been applied for the last weeks of life. The same is true for clinical management including antidepress...
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Auch für die professionellen Begleiter eines Schwerkranken ist die Sterbephase eine Herausforderung, da dies oft ihre Kompetenz überschreiten kann. Im Jahr 2005 wurde am Kantonsspital St. Gallen vonseiten der Spitalleitung entschieden, der Kompetenz der Betreuung am Lebensende durch die Erarbeitung eines multiprofessionellen Qualitätsstandards eine...
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To offer evidence-based clinical recommendations concerning prognosis in advanced cancer patients. A Working Group of the Research Network of the European Association for Palliative Care identified clinically significant topics, reviewed the studies, and assigned the level of evidence. A formal meta-analysis was not feasible because of the heteroge...
Article
To evaluate the predictive accuracy of the Palliative Prognostic (PaP) score in patients with advanced cancer under the care of an oncologist. The PaP score was calculated in 100 consecutive patients with advanced cancer hospitalized under the care of a medical or radiation oncologist at a university teaching hospital in Australia. The attending on...