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The PC program of the Italian speaking part of Switzerland (Ticino) has been developed bottom up since 1990. It was started with a palliative homecare service, called Hospice Ticino. Six years later PC consultant teams were introduced in... more
The PC program of the Italian speaking part of Switzerland (Ticino) has been developed bottom up since 1990. It was started with a palliative homecare service, called Hospice Ticino. Six years later PC consultant teams were introduced in the public hospitals. Finally in 2003 an acute palliative care unit was opened. Few resources are still lacking to ensure a comprehensive network, especially in the private clinics and in the elderly homes. Through the newly implemented National Strategy in PC 2010 - 12, the government of Canton Ticino has been charged with promoting a comprehensive, strategic and operative program in PC in order to guarantee access to high quality PC to every patient wherever he choses to be cared for. The article describes the history of Ticino's palliative care program, highlighting some of its controversial issues.
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In light of the increasing number of people living into advanced age and the intensification of migration flows, care provision to multi-cultural and religious patient populations has become an important concern for many palliative care... more
In light of the increasing number of people living into advanced age and the intensification of migration flows, care provision to multi-cultural and religious patient populations has become an important concern for many palliative care professionals. The current scoping review aims to explore the main barriers to spiritual care provision for minority groups and identify some strategies to overcome such obstacles. The review draws some general recommendations for researchers, policymakers and clinicians. First, more empirical research on different patient groups is needed; studies should target not only nurses, but also other healthcare providers, to ensure that practice adequately reflects the multidisciplinary nature of palliative care. Secondly, training and education should be offered in various forms and at different levels, as well as go beyond factual knowledge about the beliefs and practices of various religions.
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Background: Palliative care (PC) for patients with advanced cancer improves symptom management and quality of life and may promote home deaths. Limited data are available regarding PC in advanced head and neck cancer (HNC) patients. The... more
Background: Palliative care (PC) for patients with advanced cancer improves symptom management and quality of life and may promote home deaths. Limited data are available regarding PC in advanced head and neck cancer (HNC) patients. The aim of this study was to describe the type of care and modalities of integration of specialized PC in a population of relapsed and/or metastatic head and neck cancer patients, followed in a single institution over 4 years.Methods: Between January 2016 and December 2019, data on patients with relapsed and/or metastatic head and neck cancer not suitable for curative treatment diagnosed at the Oncology Institute of Southern Switzerland were reviewed retrospectively. Site, type and lines of treatment, treatment response, referral to specialist palliative care (yes or no), type of symptoms, tracheostomy and/or feeding-tube presence, and site of death were documented. Comparisons were made between patients benefitting from PC integration versus standard ca...
Background Cultural and linguistic diversity in patients and their relatives represents a challenge for clinical practice in palliative care around the world. Cross-cultural training for palliative care professionals is still scarce, and... more
Background Cultural and linguistic diversity in patients and their relatives represents a challenge for clinical practice in palliative care around the world. Cross-cultural training for palliative care professionals is still scarce, and research can help determine and support the implementation of appropriate training. In Switzerland, health policies address diversity and equity issues, and there is a need for educational research on cross-cultural training in palliative care. The aim of this study was to investigate the clinical challenges faced by Swiss palliative care professionals when working with migrant patients and their relatives. We also documented professionals’ interests in cross-cultural training. Methods A web survey of professionals working in specialized palliative care in the French- and Italian-speaking areas of Switzerland investigated clinical challenges with migrant populations and interests in various training opportunities. Results A total of 204 individuals ...
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Palliative care is frequently associated with end of life and cancer, both in the general population and among healthcare professionals. ID-PALL is a new, short, easy-to-use instrument to help professionals to identify general or... more
Palliative care is frequently associated with end of life and cancer, both in the general population and among healthcare professionals. ID-PALL is a new, short, easy-to-use instrument to help professionals to identify general or specialized palliative care needs in adult inpatients in different care settings. ID-PALL has already been validated in internal medicine units. ID-PALL should help professionals to discuss a suitable palliative care project, in order to maintain the best quality of life for patients and their relatives, and to involve palliative care specialists at the appropriate time. Recommendations for clinical practice are also proposed to guide professionals after the identification phase.
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Additional file 3. Delphi questionnaire round 3. This questionnaire was send to the participants to assess the relevance and the comprehensibility of the final items, and also the name of the instrument. This questionnaire was originally... more
Additional file 3. Delphi questionnaire round 3. This questionnaire was send to the participants to assess the relevance and the comprehensibility of the final items, and also the name of the instrument. This questionnaire was originally in French. We present a literal translation in this article.
Additional file 1. Delphi questionnaire round 1. This questionnaire was send to the participants to choose the most relevant items for the instrument and the best formulation for each item. This questionnaire was originally in French. We... more
Additional file 1. Delphi questionnaire round 1. This questionnaire was send to the participants to choose the most relevant items for the instrument and the best formulation for each item. This questionnaire was originally in French. We present a literal translation in this article.
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This article follows on from part 1 published in the previous issue of the European Journal of Palliative Care and looks at the ten core interdisciplinary competencies in palliative care in more detail. For each competency, a short... more
This article follows on from part 1 published in the previous issue of the European Journal of Palliative Care and looks at the ten core interdisciplinary competencies in palliative care in more detail. For each competency, a short description of its rationale and focus is followed by a list of its constituents.
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Title: IDentification of patients in need of general and specialised PALLiative care (IDPALL©): item generation, content and face validity of a new interprofessional screening instrument. Authors: Fabienne Teike Lüthi... more
Title: IDentification of patients in need of general and specialised PALLiative care (IDPALL©): item generation, content and face validity of a new interprofessional screening instrument. Authors: Fabienne Teike Lüthi (Fabienne.Teike-luethi@chuv.ch) Mathieu Bernard (Mathieu.Bernard@chuv.ch) Michel Beauverd (Michel.Beauverd@chuv.ch) Claudia Gamondi (Claudia.Gamondi@eoc.ch) Anne-Sylvie Ramelet (Anne-Sylvie.Ramelet@chuv.ch) Gian Domenico Borasio (Gian.Borasio@chuv.ch) Version: 2 Date: 11 Jan 2020 Author’s response to reviews: Dear Ms Zalm, Please find attached our revised manuscript entitled "Identification of patients in need of general and specialised palliative care (ID PALL©): item generation, content and face validity of a new interprofessional screening instrument”. Below is a list of the changes made in response to the reviewers' feedback. We thank the reviewers for their constructive comments, which we believe have strengthened the quality of the manuscript. We hope th...
. Palliative care is frequently associated with the end of life and cancer. However, other patients may need palliative care, and this need may be present earlier in the disease trajectory. It is therefore essential to identify at the... more
. Palliative care is frequently associated with the end of life and cancer. However, other patients may need palliative care, and this need may be present earlier in the disease trajectory. It is therefore essential to identify at the right time patients who need palliative care and to distinguish between those in need of general palliative care and those for whom a referral to specialists is required. ID-PALL has been developed as an instrument to support professionals in this identification and to discuss a suitable palliative care project, in order to maintain the best quality of life for patients and their relatives. Recommendations for clinical practice are also proposed to guide professionals after the identification phase.
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. The provision of high-quality palliative care in nursing homes (NHs) requires specific knowledge and skills among health professionals. The aims of the study were to assess quality of care during the dying process and quality of... more
. The provision of high-quality palliative care in nursing homes (NHs) requires specific knowledge and skills among health professionals. The aims of the study were to assess quality of care during the dying process and quality of end-of-life of NH residents in the French and Italian parts of Switzerland. 90 residents died during the study period (mean age 88.7 years). Mean of the “End-of-Life in Dementia Scales – Comfort Assessment while Dying” score was 35.7 (theoretical range 14–42). Mean of the “Quality of Dying in LongTerm Care” score was 38.3 (theoretical range 11–55). In conclusion, the quality of dying and quality of end-of-life care in NH studied can be improved improved, in particular on the anticipation level. Die Bereitstellung einer qualitativ hochwertigen Palliativversorgung in Pflegeheimen erfordert spezifische Fähigkeiten. Ziel der Studie war es, die Qualität der Sterbebegleitung von Bewohnern, die in der französisch- und italienischsprachigen Schweiz in Pflegeheimen sterben, zu bewerten. 90 Bewohner starben während der Studiendauer (Durchschnittsalter 88,7 Jahre). Der mittlere Wert der «End-of-Life in Dementia Scales – Comfort Assessment while Dying» lag bei 35,7 (theoretischer Bereich 14–42). Der Mittelwert der Skala «the Quality of Dying in LongTerm Care» lag bei 38,3 (theoretischer Bereich 11–55). Zusammenfassend lässt sich sagen, dass die Qualität der Versorgung am Lebensende in den untersuchten Pflegeheimen verbessert werden kann, insbesondere im Hinblick auf die Antizipation.
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Background and objectivesMeaning in life (MIL) represent a key topic in palliative care. The aims of this study were to explore (1) the differences in perceived MIL and in the meaning-relevant life areas between a representative sample of... more
Background and objectivesMeaning in life (MIL) represent a key topic in palliative care. The aims of this study were to explore (1) the differences in perceived MIL and in the meaning-relevant life areas between a representative sample of the Swiss population and palliative care patients, and (2) to what extent MIL can be considered as a significant predictor of quality of life (QOL).MethodsA cross-sectional study was conducted separately for the patients (face-to-face interviews) and the general population (telephone survey). MIL was measured with the Schedule for Meaning in Life Evaluation (SMILE) and QOL with a single-item visual analogue scale (0–10). Sociodemographic variables were controlled for in the analyses.Results206 patients and 1015 participants from the Swiss population completed the protocol. Results indicated high MIL scores in both populations even if the difference was significant (patients 81.9 vs general population 87, p<0.001). Patients were more likely to ci...
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As life expectancy has increased, a growing number of people experience conditions, including cancers, that carry complex health and social needs. Palliative care services have the potential to address these needs but face significant... more
As life expectancy has increased, a growing number of people experience conditions, including cancers, that carry complex health and social needs. Palliative care services have the potential to address these needs but face significant obstacles. One major obstacle is suboptimal interprofessional collaboration. This study’s goal was an in-depth exploration of interactional and organizational barriers and supports of collaboration in palliative care in Switzerland. We sought the perspectives of health care professionals, patients’ family members and leaders and experts in oncology/palliative care delivery (key informants) through interviews and focus groups with fifty HPs and key informants and ten patients’ family members. Qualitative analyses of interviews and focus groups used framework analysis. We identified three major themes of interaction: personal characteristics, communication, and connectedness with other health care professionals; and three major organizational themes: ser...
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Background Despite the high potential to improve the quality of life of patients and families, palliative care services face significant obstacles to their use. In countries with high-resource health systems, the nonfinancial and... more
Background Despite the high potential to improve the quality of life of patients and families, palliative care services face significant obstacles to their use. In countries with high-resource health systems, the nonfinancial and nonstructural obstacles to palliative care services are particularly prominent. These are the cognitive barriers -knowledge and communication barriers- to the use of palliative care. To date no systematic review has given the deserved attention to the cognitive barriers and facilitators to palliative care services utilization. This study aims to synthesize knowledge on cognitive barriers and facilitators to palliative care use in oncology and hemato-oncology from the experiences of health professionals, patients, and their families. Methods A systematic review was conducted. PubMed, PsycINFO, International Association for Hospice and Palliative Care/Cumulative Index of Nursing and Allied Health Literature (IAHPC/CINAHL), and Communication & Mass Media Compl...
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Switzerland is the only country in the world where assisted suicide (AS) is performed without a specific legislation, within the law, mostly without medical participation. Assisted suicide involves enabling the patient to obtain a lethal... more
Switzerland is the only country in the world where assisted suicide (AS) is performed without a specific legislation, within the law, mostly without medical participation. Assisted suicide involves enabling the patient to obtain a lethal substance, which the person wishing to commit suicide then takes without any external assistance. In Switzerland, active euthanasia is against the law, but if certain conditions are met, AS is not prosecuted.
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Background and objectives Existential areas, and in particular the concept of meaning in life, represent a key topic in palliative care. The aims of this study are to explore (i) the differences in perceived meaning in life (MIL) and in... more
Background and objectives Existential areas, and in particular the concept of meaning in life, represent a key topic in palliative care. The aims of this study are to explore (i) the differences in perceived meaning in life (MIL) and in the meaning-relevant life areas between a representative sample of the Swiss population and palliative care patients, and (ii) to what extent MIL can be considered as a significant predictor of quality of life (QOL) in the two populations. Methods A cross sectional study was conducted separately for the patients (face-to-face interviews) and the representative sample of the Swiss population (telephone survey). MIL was measured with the Schedule for Meaning in Life Evaluation (SMILE) and QOL with a with a single item visual analogue scale (0-10). Socio-demographic variables were controlled for in the analyses. Results 206 palliative care patients and 1015 participants from the Swiss population completed the protocol. Results indicated high MIL scores ...
Background: Families’ experiences of assisted dying are under-investigated and families are rarely considered in clinical guidelines concerning assisted dying. Aim: To systematically review family experiences of assisted dying. Design: A... more
Background: Families’ experiences of assisted dying are under-investigated and families are rarely considered in clinical guidelines concerning assisted dying. Aim: To systematically review family experiences of assisted dying. Design: A systematic literature review using thematic synthesis. Data sources: MEDLINE, Embase, CINAHL, AMED (Allied and Complementary Medicine) and PsycINFO databases (January 1992 to February 2019). Studies investigating families’ experiences on the practice of legalised assisted dying were included. We excluded studies prior to legalisation within the jurisdiction, secondary data analysis and opinion papers. Results: Nineteen articles met the inclusion criteria. Publications were derived from four countries: The Netherlands, United States (Oregon, Washington and Vermont), Canada and Switzerland. Dutch studies predominately investigated family involvement in euthanasia, while Swiss and American studies only reported on assisted suicide. Eleven studies had a...
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e17503 Background: early palliative care (PC) for patients with advanced cancer improves quality of life, promotes home deaths and can improve survival. Limited data are available regarding PC in advanced head and neck cancer (HNC)... more
e17503 Background: early palliative care (PC) for patients with advanced cancer improves quality of life, promotes home deaths and can improve survival. Limited data are available regarding PC in advanced head and neck cancer (HNC) patients. To investigate the effect of introducing specialized PC in patients with relapsed and/or metastatic head and neck cancer. Methods: between October 2010 and December 2018, the medical charts of all patients treated in the Oncology Institute of Southern Switzerland with relapsed and/or metastatic HNC were reviewed. Site, status of disease (metastatic at diagnosis, locally or metastatic relapsed), type and lines of treatment, treatment response and referral to specialist palliative care (yes or no) were documented. Comparisons were made between patients referred and non-referred to PC. Results: sixty-two patients with relapsed/metastatic HNC were identified, 32 (51.6%) of which were referred to specialized PC. Patients were mainly men (47, 75.8%), ...
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The objectives of this study were to trace, monitor, and assess for clinical effectiveness, visual compatibility, and stability of commonly used combinations of drugs for patients hospitalized in a Swiss palliative care unit, over a... more
The objectives of this study were to trace, monitor, and assess for clinical effectiveness, visual compatibility, and stability of commonly used combinations of drugs for patients hospitalized in a Swiss palliative care unit, over a 12-month period. In this longitudinal analysis, commonly used multidrug combinations were monitored with a duly created data collection sheet for healthcare professionals. Assessment of visual changes of the mixtures and the evaluation of major changes in the overall symptom control over time were recorded. The clinical changes were classified according to reasonable correlation to the modality of drug administration and not to clinical evolution of the underlying disease. Over a 12-month period, a total of 48 multidrug infusions were recorded and monitored. The infusions were composed of two, three, four, or five active principles. Infusions were given over a 24-h period, mainly intravenously, either through an implantable venous access port or a periph...
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ObjectivesAssisted suicide in Switzerland is mainly performed by right-to-die societies. Medical involvement is limited to the prescription of the drug and certification of eligibility. Palliative care has traditionally been perceived as... more
ObjectivesAssisted suicide in Switzerland is mainly performed by right-to-die societies. Medical involvement is limited to the prescription of the drug and certification of eligibility. Palliative care has traditionally been perceived as generally opposed to assisted suicide, but little is known about palliative care physicians’ involvement in assisted suicide practices. This paper aims to describe their perspectives and involvement in assisted suicide practices.MethodsA qualitative interview study was conducted with 23 palliative care physicians across Switzerland. Thematic analysis was used to interpret data.ResultsSwiss palliative care physicians regularly receive assisted suicide requests while none reported having received specific training in managing these requests. Participants reported being involved in assisted suicide decision making most were not willing to prescribe the lethal drug. After advising patients of the limits on their involvement in assisted suicide, the majo...
Spiritual, existential, and psychological issues represent central components of quality of life (QOL) in palliative care. A better understanding of the dynamic underlying these components is essential for the development of interventions... more
Spiritual, existential, and psychological issues represent central components of quality of life (QOL) in palliative care. A better understanding of the dynamic underlying these components is essential for the development of interventions tailored to the palliative context. The aims were to explore (i) the relationship between spirituality, meaning in life, wishes for hastened death and psychological distress in palliative patients, and (ii) the extent to which these non-physical determinants influence QOL. A cross-sectional study involving face-to-face interviews with Swiss palliative patients was performed, including the Schedule for Meaning in Life Evaluation (SMILE), the Spiritual Subscale of the Functional Assessment of Chronic Illness Therapy (FACIT-Sp), the Idler Index of Religiosity (IIR), the Hospital Anxiety and Depression Scale (HADS) and the Schedule of Attitudes toward Hastened Death (SAHD). QOL was measured with a single item visual analogue scale (0-10). 206 patients ...
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In somatic medicine, diagnostic terms often refer to the disease processes that are the causes of patients' symptoms. The language used in some clinical textbooks and health information resources suggests that this is also sometimes... more
In somatic medicine, diagnostic terms often refer to the disease processes that are the causes of patients' symptoms. The language used in some clinical textbooks and health information resources suggests that this is also sometimes assumed to be the case with diagnoses in psychiatry. However, this seems to be in tension with the ways in which psychiatric diagnoses are defined in diagnostic manuals, according to which they refer solely to clusters of symptoms. This paper explores how theories of reference in the philosophy of language can help to resolve this tension. After the evaluation of descriptive and causal theories of reference, I put forward a conceptual framework based on two-dimensional semantics that allows the causal analysis of diagnostic terms in psychiatry, while taking seriously their descriptive definitions in diagnostic manuals. While the framework is presented as a solution to a problem regarding the semantics of psychiatric diagnoses, it can also accommodate the analysis of diagnostic terms in other medical disciplines.
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BackgroundLittle is known in Europe about end-of-life (EOL) decisions and advance directives (AD), particularly in patients with severe advanced disease. Switzerland is a multicultural and multilingual federal country and has the... more
BackgroundLittle is known in Europe about end-of-life (EOL) decisions and advance directives (AD), particularly in patients with severe advanced disease. Switzerland is a multicultural and multilingual federal country and has the particularity of being divided into four linguistic and cultural regionsObjectiveTo understand better in different regions of Switzerland which specific patient's characteristics could have an impact on their decision to complete AD or not.Design/setting/participantsProspective study conducted in four palliative care units. Patients with an advanced oncological disease, fluent in French, German or Italian and with a Mini-Mental State Examination >20 were included. Demographic data, symptom burden (Edmonton Symptom Assessment System, ESAS; Hospital Anxiety and Depression Scale, HADS) and spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual well-being, FACIT-sp) have been assessed. A structured questionnaire has been complet...
L’assistance au suicide en Suisse est surtout accessible aux membres d’associations militant pour le droit de mourir dans la dignite. Elle s’est developpee dans un contexte legal particulier. Les modalites de participation des proches a... more
L’assistance au suicide en Suisse est surtout accessible aux membres d’associations militant pour le droit de mourir dans la dignite. Elle s’est developpee dans un contexte legal particulier. Les modalites de participation des proches a l’ensemble du processus sont peu connues. Cet article analyse ces accompagnements de fin de vie singuliers qui s’elaborent dans le cadre de trajectoires de maladies, articulees a une procedure d’assistance au suicide. Entre partage de souffrances, soins, negociations de delais et recherche de certificats, le quotidien des proches impliques est occupe par de multiples tâches, dont la moindre n’est pas de choisir a qui annoncer la date et les conditions de la mort.
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The PC program of the Italian speaking part of Switzerland (Ticino) has been developed bottom up since 1990. It was started with a palliative homecare service, called Hospice Ticino. Six years later PC consultant teams were introduced in... more
The PC program of the Italian speaking part of Switzerland (Ticino) has been developed bottom up since 1990. It was started with a palliative homecare service, called Hospice Ticino. Six years later PC consultant teams were introduced in the public hospitals. Finally in 2003 an acute palliative care unit was opened. Few resources are still lacking to ensure a comprehensive network, especially in the private clinics and in the elderly homes. Through the newly implemented National Strategy in PC 2010 - 12, the government of Canton Ticino has been charged with promoting a comprehensive, strategic and operative program in PC in order to guarantee access to high quality PC to every patient wherever he choses to be cared for. The article describes the history of Ticino's palliative care program, highlighting some of its controversial issues.