Hubert Jocham | Fachhochschule Vorarlberg (original) (raw)
Papers by Hubert Jocham
Palliative Care: Research and Treatment
The purpose of this article was to investigate the outcome measures developed and used in palliat... more The purpose of this article was to investigate the outcome measures developed and used in palliative care. The paper involved a literature review of published research. Many of the reviewed papers concluded similarly that there was lack of good quality evidence on which to base conclusions. More high quality evidence is needed to compare the relative merits of the differences in models of palliative care services, so that we can learn from other appropriate systems of care at end of life. It follows that quality of life is the main outcome of palliative care, in which the patient instead of the disease represents the target of the clinical approach. Patients struggling with serious illness have other concerns, including managing pain and other symptoms, coordinating care among multiple providers and settings, ensuring that treatments refl ect preferences and balance benefi ts and harms as well as clinical appropriateness, achieving empathic communication and care, fostering well-being, maintaining function and practically supporting family and caregivers through illness and bereavement.
Pflege Zeitschrift, Jun 1, 2006
The aim of palliative care for seriously ill and dying patients suffering from oncological diseas... more The aim of palliative care for seriously ill and dying patients suffering from oncological diseases is to obtain or enhance the quality of their lifes. It will become more and more necessary to evaluate and record the efficiency of different kinds of medical care with reliable and validated instruments. Professional home care will gain in importance for various political and economic reasons. The central question asked of palliative care will be how outpatient and inpatient care affects quality of life and if differences can be detected between both kinds of care. A representative group of 121 patients was chosen from a group of 250 terminally ill cancer patients who were either in ambulant or inpatient palliative care (outpatients n = 57, inpatients n = 64). Within the first 24 hours after either admission into the palliative sector of a hospital or first contact with the ambulant "Palliative Home Care Team" at home the patient's quality of life was estimated. After one week another estimation followed. The questionnaire EORTC-QLQ-C30, developed by the European Organisation for Research and Treatment of Cancer and translated into German, was used for this. Both groups of patients were homogeneous in their demographic parameters. In both groups improvements in nearly every dimension of quality of life were achieved between the first and the second assessment. The dimensions of symptom control (pain, fatigue, vomiting, and breathlessness) improved most distinctively in the outpatient care group. The German EORTC-QLQ-C30 turned out to be a reliable evaluation instrument for measuring patients' quality of life in out-patient or inpatient palliative care. Ambulant care always has to be considered as an alternative to inpatient care without leading to any quality deficits.
Pflege Zeitschrift, 2006
The aim of palliative care for seriously ill and dying patients suffering from oncological diseas... more The aim of palliative care for seriously ill and dying patients suffering from oncological diseases is to obtain or enhance the quality of their lifes. It will become more and more necessary to evaluate and record the efficiency of different kinds of medical care with reliable and validated instruments. Professional home care will gain in importance for various political and economic reasons. The central question asked of palliative care will be how outpatient and inpatient care affects quality of life and if differences can be detected between both kinds of care. A representative group of 121 patients was chosen from a group of 250 terminally ill cancer patients who were either in ambulant or inpatient palliative care (outpatients n = 57, inpatients n = 64). Within the first 24 hours after either admission into the palliative sector of a hospital or first contact with the ambulant "Palliative Home Care Team" at home the patient's quality of life was estimated. After o...
Nursing management (Harrow, London, England : 1994)
International journal of palliative nursing, 2009
Quality-of-life (QoL) assessment is crucial for the evaluation of a palliative care outcome. This... more Quality-of-life (QoL) assessment is crucial for the evaluation of a palliative care outcome. This article investigates the applicability of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) on a German sample of terminally ill cancer patients receiving palliative care in different settings. Patients were randomly selected in 10 palliative homecare services and one palliative care unit in a general hospital and 'evaluated' among the consecutively 'registered' patients. The random sample of patients (n-121) was representative of the general patient population cared for by the palliative care services in Germany. The EORTC QLQ-C30 was administered to the terminally ill cancer patients on their first day in hospital or upon their first contact with the specialized palliative homecare team. The clinical variable assessed was the Karnofsky performance status. The questionnaire was well accepted in the present patie...
Central European Journal of Medicine, 2009
Palliative care aims at improving the patient’s quality of life. The assessment of this quality o... more Palliative care aims at improving the patient’s quality of life. The assessment of this quality of life (QoL) is crucial for the evaluation of palliative care outcome. Many patients require hospital admissions for symptom control during their cancer journey and most of them die in hospitals, although they would like to stay at home until the end of their lives. In 1986, the European Organization for Research and Treatment (EORTC) initiated a research programme to develop an integrated, modular approach for evaluating the quality of life of patients participating in international clinical trials. This questionnaire measures cancer patients’ physical, psychological and social functions and was used in a wide range of clinical cancer trials with large numbers of research groups and also in various other non-trial studies. The aim of this study was to evaluate the psychometric properties, especially the reliability, validity and applicability of the EORTC QLQ-C30 in a German sample of t...
Journal of Hospice & Palliative Nursing, 2009
... Guy Widdershoven, PhD, is Professor of Ethics of Healthcare, Faculty of Health Sciences and S... more ... Guy Widdershoven, PhD, is Professor of Ethics of Healthcare, Faculty of Health Sciences and Scientific, Director of the Care and Public Health Research Institute ... The aims of this study were to assess in two different settings and at two different points of time the quality of life of ...
Journal of Clinical Nursing, 2006
variable of interest. This article also describes conceptual and operational definitions of quali... more variable of interest. This article also describes conceptual and operational definitions of quality of life and explores the implicit and explicit goals of research. Results. Quality of life is a concept relevant to the discipline of nursing. Nurses, especially oncology and palliative care nurses, actively contributed to the development of the quality of life concept through instrument development and population description. Conclusion. Nurses working in German palliative care settings do change the quality of life of patients they care for, but there are no systematic standards of assessing these outcomes. Relevance to clinical practice. There are challenges related to measuring quality of life in patient-focused palliative care and research. Systematic quality of life assessment in all palliative care settings will establish quality assurance and the further development of this very young discipline in Germany.
European Journal of Cancer, 1999
Cancer Treatment Reviews, 1996
Patient-controlled analgesia (PCA) was administered in the domiciliary environment in 143 pre-ter... more Patient-controlled analgesia (PCA) was administered in the domiciliary environment in 143 pre-terminally and terminally ill tumour patients suffering either from excruciating chronic pain or severe chronic/acute complex pain that could not be relieved adequately by oral analgesia. Morphine solutions were infused subcutaneously in concentrations between 1% and 3%. The intravenous route was preferred in patients with indwelling catheters or those susceptible to inflammatory skin reactions at the infusion site. After initial dose adjustment, lasting 2-3 days, the morphine amounts infused by PCA reached a median of 93mg day-' (range 12-464 mg day-'). The median was 28% lower than the median dose administered orally. A total of 84% of patients utilized the option of bolus self-administration. The median percentage administered via the bolus mode amounted to 5.3% of the total requirements. During the course of treatment, morphine requirements increased by a median of 2.3mg day-' (range-29 +52 mg day-'). Most patients were treated continuously in the home care setting until death, the median duration being 27 days (range l-437 days). The terminal morphine demands reached a median of 188mg day-' (range 15-1008 mg day-'). PCA turned out to be safe and effective, attaining excellent results in 95 (66%) patients and satisfactory pain relief in 43 (30%). PCA proved to be insufficient in five (4%) cases. Side-effects were mild: constipation, fatigue, nausea and local inflammatory skin reactions occurred in 9%. Thus, with support from an experienced mobile nursing team, PCA can be safely administered in the terminal domiciliary care of tumour patients. PCA is superior to oral analgesia, especially in the treatment of severe oscillating pain. PCA provides adequate pain control in about 96% of patients who are poorly responsive to oral opioids.
Journal of clinical …, 2006
variable of interest. This article also describes conceptual and operational definitions of quali... more variable of interest. This article also describes conceptual and operational definitions of quality of life and explores the implicit and explicit goals of research. Results. Quality of life is a concept relevant to the discipline of nursing. Nurses, especially oncology and palliative care nurses, actively contributed to the development of the quality of life concept through instrument development and population description. Conclusion. Nurses working in German palliative care settings do change the quality of life of patients they care for, but there are no systematic standards of assessing these outcomes. Relevance to clinical practice. There are challenges related to measuring quality of life in patient-focused palliative care and research. Systematic quality of life assessment in all palliative care settings will establish quality assurance and the further development of this very young discipline in Germany.
Palliative Care: Research and Treatment
The purpose of this article was to investigate the outcome measures developed and used in palliat... more The purpose of this article was to investigate the outcome measures developed and used in palliative care. The paper involved a literature review of published research. Many of the reviewed papers concluded similarly that there was lack of good quality evidence on which to base conclusions. More high quality evidence is needed to compare the relative merits of the differences in models of palliative care services, so that we can learn from other appropriate systems of care at end of life. It follows that quality of life is the main outcome of palliative care, in which the patient instead of the disease represents the target of the clinical approach. Patients struggling with serious illness have other concerns, including managing pain and other symptoms, coordinating care among multiple providers and settings, ensuring that treatments refl ect preferences and balance benefi ts and harms as well as clinical appropriateness, achieving empathic communication and care, fostering well-being, maintaining function and practically supporting family and caregivers through illness and bereavement.
Pflege Zeitschrift, Jun 1, 2006
The aim of palliative care for seriously ill and dying patients suffering from oncological diseas... more The aim of palliative care for seriously ill and dying patients suffering from oncological diseases is to obtain or enhance the quality of their lifes. It will become more and more necessary to evaluate and record the efficiency of different kinds of medical care with reliable and validated instruments. Professional home care will gain in importance for various political and economic reasons. The central question asked of palliative care will be how outpatient and inpatient care affects quality of life and if differences can be detected between both kinds of care. A representative group of 121 patients was chosen from a group of 250 terminally ill cancer patients who were either in ambulant or inpatient palliative care (outpatients n = 57, inpatients n = 64). Within the first 24 hours after either admission into the palliative sector of a hospital or first contact with the ambulant "Palliative Home Care Team" at home the patient's quality of life was estimated. After one week another estimation followed. The questionnaire EORTC-QLQ-C30, developed by the European Organisation for Research and Treatment of Cancer and translated into German, was used for this. Both groups of patients were homogeneous in their demographic parameters. In both groups improvements in nearly every dimension of quality of life were achieved between the first and the second assessment. The dimensions of symptom control (pain, fatigue, vomiting, and breathlessness) improved most distinctively in the outpatient care group. The German EORTC-QLQ-C30 turned out to be a reliable evaluation instrument for measuring patients' quality of life in out-patient or inpatient palliative care. Ambulant care always has to be considered as an alternative to inpatient care without leading to any quality deficits.
Pflege Zeitschrift, 2006
The aim of palliative care for seriously ill and dying patients suffering from oncological diseas... more The aim of palliative care for seriously ill and dying patients suffering from oncological diseases is to obtain or enhance the quality of their lifes. It will become more and more necessary to evaluate and record the efficiency of different kinds of medical care with reliable and validated instruments. Professional home care will gain in importance for various political and economic reasons. The central question asked of palliative care will be how outpatient and inpatient care affects quality of life and if differences can be detected between both kinds of care. A representative group of 121 patients was chosen from a group of 250 terminally ill cancer patients who were either in ambulant or inpatient palliative care (outpatients n = 57, inpatients n = 64). Within the first 24 hours after either admission into the palliative sector of a hospital or first contact with the ambulant "Palliative Home Care Team" at home the patient's quality of life was estimated. After o...
Nursing management (Harrow, London, England : 1994)
International journal of palliative nursing, 2009
Quality-of-life (QoL) assessment is crucial for the evaluation of a palliative care outcome. This... more Quality-of-life (QoL) assessment is crucial for the evaluation of a palliative care outcome. This article investigates the applicability of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) on a German sample of terminally ill cancer patients receiving palliative care in different settings. Patients were randomly selected in 10 palliative homecare services and one palliative care unit in a general hospital and 'evaluated' among the consecutively 'registered' patients. The random sample of patients (n-121) was representative of the general patient population cared for by the palliative care services in Germany. The EORTC QLQ-C30 was administered to the terminally ill cancer patients on their first day in hospital or upon their first contact with the specialized palliative homecare team. The clinical variable assessed was the Karnofsky performance status. The questionnaire was well accepted in the present patie...
Central European Journal of Medicine, 2009
Palliative care aims at improving the patient’s quality of life. The assessment of this quality o... more Palliative care aims at improving the patient’s quality of life. The assessment of this quality of life (QoL) is crucial for the evaluation of palliative care outcome. Many patients require hospital admissions for symptom control during their cancer journey and most of them die in hospitals, although they would like to stay at home until the end of their lives. In 1986, the European Organization for Research and Treatment (EORTC) initiated a research programme to develop an integrated, modular approach for evaluating the quality of life of patients participating in international clinical trials. This questionnaire measures cancer patients’ physical, psychological and social functions and was used in a wide range of clinical cancer trials with large numbers of research groups and also in various other non-trial studies. The aim of this study was to evaluate the psychometric properties, especially the reliability, validity and applicability of the EORTC QLQ-C30 in a German sample of t...
Journal of Hospice & Palliative Nursing, 2009
... Guy Widdershoven, PhD, is Professor of Ethics of Healthcare, Faculty of Health Sciences and S... more ... Guy Widdershoven, PhD, is Professor of Ethics of Healthcare, Faculty of Health Sciences and Scientific, Director of the Care and Public Health Research Institute ... The aims of this study were to assess in two different settings and at two different points of time the quality of life of ...
Journal of Clinical Nursing, 2006
variable of interest. This article also describes conceptual and operational definitions of quali... more variable of interest. This article also describes conceptual and operational definitions of quality of life and explores the implicit and explicit goals of research. Results. Quality of life is a concept relevant to the discipline of nursing. Nurses, especially oncology and palliative care nurses, actively contributed to the development of the quality of life concept through instrument development and population description. Conclusion. Nurses working in German palliative care settings do change the quality of life of patients they care for, but there are no systematic standards of assessing these outcomes. Relevance to clinical practice. There are challenges related to measuring quality of life in patient-focused palliative care and research. Systematic quality of life assessment in all palliative care settings will establish quality assurance and the further development of this very young discipline in Germany.
European Journal of Cancer, 1999
Cancer Treatment Reviews, 1996
Patient-controlled analgesia (PCA) was administered in the domiciliary environment in 143 pre-ter... more Patient-controlled analgesia (PCA) was administered in the domiciliary environment in 143 pre-terminally and terminally ill tumour patients suffering either from excruciating chronic pain or severe chronic/acute complex pain that could not be relieved adequately by oral analgesia. Morphine solutions were infused subcutaneously in concentrations between 1% and 3%. The intravenous route was preferred in patients with indwelling catheters or those susceptible to inflammatory skin reactions at the infusion site. After initial dose adjustment, lasting 2-3 days, the morphine amounts infused by PCA reached a median of 93mg day-' (range 12-464 mg day-'). The median was 28% lower than the median dose administered orally. A total of 84% of patients utilized the option of bolus self-administration. The median percentage administered via the bolus mode amounted to 5.3% of the total requirements. During the course of treatment, morphine requirements increased by a median of 2.3mg day-' (range-29 +52 mg day-'). Most patients were treated continuously in the home care setting until death, the median duration being 27 days (range l-437 days). The terminal morphine demands reached a median of 188mg day-' (range 15-1008 mg day-'). PCA turned out to be safe and effective, attaining excellent results in 95 (66%) patients and satisfactory pain relief in 43 (30%). PCA proved to be insufficient in five (4%) cases. Side-effects were mild: constipation, fatigue, nausea and local inflammatory skin reactions occurred in 9%. Thus, with support from an experienced mobile nursing team, PCA can be safely administered in the terminal domiciliary care of tumour patients. PCA is superior to oral analgesia, especially in the treatment of severe oscillating pain. PCA provides adequate pain control in about 96% of patients who are poorly responsive to oral opioids.
Journal of clinical …, 2006
variable of interest. This article also describes conceptual and operational definitions of quali... more variable of interest. This article also describes conceptual and operational definitions of quality of life and explores the implicit and explicit goals of research. Results. Quality of life is a concept relevant to the discipline of nursing. Nurses, especially oncology and palliative care nurses, actively contributed to the development of the quality of life concept through instrument development and population description. Conclusion. Nurses working in German palliative care settings do change the quality of life of patients they care for, but there are no systematic standards of assessing these outcomes. Relevance to clinical practice. There are challenges related to measuring quality of life in patient-focused palliative care and research. Systematic quality of life assessment in all palliative care settings will establish quality assurance and the further development of this very young discipline in Germany.