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Stiel S, Ernst A, Apolinarski B, Röwer HAA, de Jong L, Burger B, Schütte S, Schneider N, Damm K, Stahmeyer JT, Herbst FA. Consensus-based recommendations for the development and expansion of palliative day care clinics in Germany: results of a Delphi study. BMC Palliat Care 2024; 23:116. [PMID: 38702653 PMCID: PMC11067173 DOI: 10.1186/s12904-024-01441-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/23/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Needs-based, patient-oriented palliative care includes palliative day care clinics as a specialized semi-inpatient care offer. However, the establishment and development of these facilities has been unsystematic. Research is needed to strengthen their transparency and ensure their accessibility, quality, and structural adequacy. A national Delphi study was conducted to generate appropriate recommendations for the establishment and development of palliative day care clinics in Germany. METHODS Recommendations were formulated from focus group data on the development and expansion of palliative day care clinics in Germany. Experts on in- and outpatient palliative care rated 28 recommendations for relevance and feasibility, respectively, using a 4-point Likert-type scale. Suggestions for improvement were captured via free text comments. Items were considered consented when more than 80% of the experts scored them 4 (strongly agree) or 3 (somewhat agree), regarding both relevance and feasibility. RESULTS A total of 23 experts (32% response rate) completed three Delphi rounds. Following the first round, 10 of 28 recommendations were revised according to participants' comments; 1 recommendation was rejected. After the second round, 3 of these 10 recommendations were revised, while 3 were rejected. Consensus was achieved after the third round for 22 of the initial recommendations. CONCLUSIONS The Delphi-consented recommendations provide a basis for the targeted evidence- and needs-based development of palliative day care clinics. The findings show a need for standards setting and the meaningful integration of these clinics into existing structures. TRIAL REGISTRATION The present study was prospectively registered on April 20, 2020, with the German Clinical Trials Register (DRKS00021446).
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Affiliation(s)
- Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Alexandra Ernst
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Beate Apolinarski
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Hanna A A Röwer
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Lea de Jong
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Strasse 7, 30159, Hannover, Germany
| | - Birte Burger
- Health Services Research Unit, AOK Niedersachsen, Hildesheimer Strasse 273, 30519, Hannover, Germany
| | - Sabrina Schütte
- Health Services Research Unit, AOK Niedersachsen, Hildesheimer Strasse 273, 30519, Hannover, Germany
| | - Nils Schneider
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Kathrin Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Strasse 7, 30159, Hannover, Germany
| | - Jona T Stahmeyer
- Health Services Research Unit, AOK Niedersachsen, Hildesheimer Strasse 273, 30519, Hannover, Germany
| | - Franziska A Herbst
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
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Stiel S, Ernst A, Röwer HAA, de Jong L, Burger B, Schneider N, Damm K, Stahmeyer JT, Apolinarski B, Herbst FA. [Empirically derived recommendations for the development and expansion of day hospices in Germany - Results of a Delphi expert panel]. Z Evid Fortbild Qual Gesundhwes 2024; 185:72-82. [PMID: 38431457 DOI: 10.1016/j.zefq.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION A needs-based and patient-oriented hospice and palliative care also includes day hospices as a specialised semi-inpatient care offer. The establishment and development of these facilities in Germany has been rather unsystematic. In order to ensure quality and adequacy of these structures, research is needed. METHODS A Delphi consensus study was conducted online from November 2022 to February 2023 aiming at generating recommendations for the development and expansion of day hospices in Germany. For each recommendation, the participants indicated on a four-point verbal rating scale how much they agreed upon a) the relevance and b) the feasibility of the recommendation. Items were considered consented when 80% of the participants (strongly) agreed with the recommendation regarding both criteria. If no consensus was reached, the recommendations were revised according to the participants' free text comments and presented in the next Delphi round. Descriptive analyses were applied. RESULTS A total of 64 experts participated in the first Delphi round and 44 in the second. In round 1, 34 recommendations and in round 2 six recommendations were consented. The final set contains a total of 40 recommendations: 18 on the tasks of day hospices, 13 on cooperation, 7 on funding, and 2 on public relations. DISCUSSION Recommendations for the development and expansion of day hospices in Germany were developed. Due to their highly rated feasibility, the recommendations should be directly transferable into care practice. It remains to be seen to what extent they will be taken into account in the renegotiation of the framework agreement for day hospices. CONCLUSION The Delphi-consented recommendations provide a basis to guide action in the currently very dynamic development of hospice work and palliative care in Germany.
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Affiliation(s)
- Stephanie Stiel
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland.
| | - Alexandra Ernst
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Hanna A A Röwer
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Lea de Jong
- Institut für Versicherungsbetriebslehre, Leibniz Universität Hannover, Hannover, Deutschland
| | - Birte Burger
- Stabsbereich Versorgungsforschung, AOK - Die Gesundheitskasse für Niedersachsen, Hannover, Deutschland
| | - Nils Schneider
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Kathrin Damm
- Institut für Versicherungsbetriebslehre, Leibniz Universität Hannover, Hannover, Deutschland
| | - Jona T Stahmeyer
- Stabsbereich Versorgungsforschung, AOK - Die Gesundheitskasse für Niedersachsen, Hannover, Deutschland
| | - Beate Apolinarski
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Franziska A Herbst
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
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Apolinarski B, de Jong L, Herbst FA, Huperz C, Röwer HAA, Schneider N, Damm K, Stiel S. Patients' and Relatives' Preferences for Outpatient and Day Care Services Within End-of-Life Care in Germany - A Discrete Choice Experiment. Patient Prefer Adherence 2024; 18:519-529. [PMID: 38440285 PMCID: PMC10910970 DOI: 10.2147/ppa.s442047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/08/2024] [Indexed: 03/06/2024] Open
Abstract
Purpose In Germany, patients with incurable chronic diseases living at home increasingly have the option of using outpatient and day care hospice and specialized palliative care services. The present study examined and compared patients' and their relatives' preferences for end-of-life outpatient and day care services. Patients and Methods The study used a questionnaire integrating a discrete choice experiment. For six scenarios, participants chose between two hypothetical end-of-life care offers, described by seven attributes. The model compared place of care, frequency and duration of care and support, specialized medical palliative care, accompanied activities, and relieving patient counselling. The model also included optional overnight care and willingness to pay. Patients and the relatives of patients suffering from incurable, chronic diseases who were not yet receiving palliative care were recruited via hospitals and self-help groups (06/2021-07/2022). Results The results were based on data from 436 questionnaires (patients: n=263, relatives: n=173). All attributes had a statistically significant impact on choice decisions, with place of care showing the greatest importance. All respondents highly preferred care in the patient's home over out-of-home care. Patients stressed the importance of special medical (palliative) care and valued accompanied activities, often facilitated by hospice volunteers. Relatives, but not patients, considered the frequency and duration of care highly relevant. Conclusion The results suggest a higher demand for care in the patient's home than for out-of-home care. Patients' and relatives' high preference for special medical care and the relief of family caregiver burden should be considered in the design of day care services.
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Affiliation(s)
- Beate Apolinarski
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Lea de Jong
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
| | - Franziska A Herbst
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Carolin Huperz
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
- Faculty of Engineering and Mathematics, Bielefeld University of Applied Sciences, Bielefeld, Germany
| | - Hanna A A Röwer
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Nils Schneider
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Kathrin Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
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Apolinarski B, Huperz C, Röwer HAA, Schneider N, Stiel S, Herbst FA. Expert Perspectives on the Additional Benefit of Day Hospices and Palliative Day Care Clinics in Germany: A Qualitative Approach. Am J Hosp Palliat Care 2024; 41:167-172. [PMID: 37019844 PMCID: PMC10751967 DOI: 10.1177/10499091231168574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Background: In Germany, hospice and palliative care is well covered through inpatient, outpatient, and home-based care services. It is unknown if, and to what extent, there is a need for additional day care services to meet the specific needs of patients and caregivers. Methods: Two day hospices and two palliative day care clinics were selected. In the first step, two managers from each facility (n = 8) were interviewed by telephone, using a semi-structured interview guide. In the second step, four focus groups were conducted, each with three to seven representatives of hospice and palliative care from the facilities' hospice and palliative care networks. Interviews and focus groups were audio recorded, transcribed verbatim and analyzed using qualitative content analysis. Results: The interviewed experts perceived day care services as providing additional patient and caregiver benefits. Specifically, the services were perceived to meet patient needs for social interaction and bundled treatments, especially for patients who did not fit into inpatient settings (due to, e.g., their young age or a lack of desire for inpatient admission). The services were also perceived to meet caregiver needs for support, providing short-term relief for the home care situation. Conclusions: The results suggest that inpatient, outpatient, and home-based hospice and palliative care services do not meet the palliative care needs of all patients. Although the population that is most likely to benefit from day care services is assumed to be relatively small, such services may meet the needs of certain patient groups more effectively than other forms of care.
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Affiliation(s)
- Beate Apolinarski
- Hannover Medical School, Institute for General Practice and Palliative Care, Hannover, Germany
| | - Carolin Huperz
- Hannover Medical School, Institute for General Practice and Palliative Care, Hannover, Germany
- Bielefeld University of Applied Sciences, Faculty of Engineering and Mathematics, Bielefeld, Germany
| | - Hanna A. A. Röwer
- Hannover Medical School, Institute for General Practice and Palliative Care, Hannover, Germany
| | - Nils Schneider
- Hannover Medical School, Institute for General Practice and Palliative Care, Hannover, Germany
| | - Stephanie Stiel
- Hannover Medical School, Institute for General Practice and Palliative Care, Hannover, Germany
| | - Franziska A. Herbst
- Hannover Medical School, Institute for General Practice and Palliative Care, Hannover, Germany
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Apolinarski B, Herbst FA, Röwer HAA, Schneider N, Stiel S. Status quo palliativmedizinischer Tageskliniken und Tageshospize in Deutschland: Ergebnisse einer gemischt-methodischen Studie. Zeitschrift für Palliativmedizin 2021. [DOI: 10.1055/a-1514-8871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Ziel der Studie Der Bestand von Tageshospizen und palliativmedizinischen Tageskliniken in Deutschland soll erstmals systematisch erhoben und analysiert werden.
Methodik In dieser gemischt-methodischen Studie wurden Einrichtungsleitungen in leitfadengestützten Interviews (06.–07.2020) und standardisierter Fragebogenerhebung (08.–10.2020) zu einrichtungsbezogenen Kriterien befragt. Interviewdaten wurden qualitativ inhaltsanalytisch, quantitative Daten deskriptiv ausgewertet.
Ergebnisse Die Interviews (n = 7) liefern einen Überblick über Organisation und Versorgungsangebot hospizlich-palliativer Tageseinrichtungen. Von 28 standardisiert befragten Einrichtungen waren 13 bereits in Betrieb. Die zumeist an andere Versorger angebundenen Einrichtungen bieten in der Regel zwischen 2 und 8 Tagesplätze an.
Schlussfolgerung Aufgrund der gezeigten Entstehungsdynamik scheint eine systematische Integration der neuen Strukturen in die bestehende Hospiz- und Palliativversorgung sinnvoll.
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Affiliation(s)
- Beate Apolinarski
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Franziska A. Herbst
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Hanna A. A. Röwer
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Nils Schneider
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Stephanie Stiel
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
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