{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T10:16:35Z","timestamp":1787912195392,"version":"build-2784847793"},"reference-count":20,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T00:00:00Z","timestamp":1737331200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"German Federal Joint Committee","award":["01VSF18018"],"award-info":[{"award-number":["01VSF18018"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Support Palliat Care"],"accepted":{"date-parts":[[2024,12,24]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Palliative care phases (stable, unstable, deteriorating, terminal and bereavement) are useful in describing the palliative care situation of patients\/relatives and their care needs as well as the suitability of care plans. Little is known about care setting-specific differences of the phases and their association with burden of symptoms\/problems and functional status. We aimed to describe the presence and association of symptom\/problem burden and functional status with the palliative care phase at the beginning of care episodes in specialist palliative care units, specialist home care teams and advisory services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study is a secondary analysis of a prospective, cross-sectional, multicentre study collecting data on patients\u2019 complexity in Germany. Analyses using the palliative care phase, symptom\/problem burden measured by the Integrated Palliative care Outcome Scale (IPOS), functional status measured by the Australian-modified Karnofsky Performance Status (AKPS), severity of confusion and agitation, age and gender were conducted, including descriptive statistics, non-parametric tests and multinomial logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>3115 phases from three settings were included, with an average age of 72 years (SD\u00b113.3) and 49% male. The distribution of phases at episode start varied among settings: data showed in palliative care units 20.3% stable, 43.4% unstable, 31.5% deteriorating and 4.8% terminal; in palliative care advisory, 26% stable, 33.9% unstable, 32.8% deteriorating and 7.3% terminal; and in specialist palliative home care, 42.4% stable, 21.3% unstable, 29.1% deteriorating and 7.2% terminal phases. Multinomial logistic regression showed that besides functional status, in palliative care units and specialist palliative home care, high physical symptom burden and palliative care advisory, high emotional burden increased the odds of being in an unstable phase.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Setting-specific differences in patient characteristics and symptom and problem burden associated with palliative care phases lead towards different demands on the teams providing patient care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/spcare-2024-005017","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T03:55:17Z","timestamp":1737431717000},"page":"1151-1160","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Symptom and problem burden, performance status and palliative care phases in specialist palliative care: cross-sectional analysis of care episodes"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1466-8779","authenticated-orcid":false,"given":"Eva","family":"Lehmann-Emele","sequence":"first","affiliation":[{"name":"Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany"},{"name":"Department of Palliative Medicine, University Medical Center Goettingen, Goettingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1930-8745","authenticated-orcid":false,"given":"Daniela","family":"Gesell","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7351-7092","authenticated-orcid":false,"given":"Farina","family":"Hodiamont","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7622-9923","authenticated-orcid":false,"given":"Julia","family":"Wikert","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0958-3041","authenticated-orcid":false,"given":"Claudia","family":"Bausewein","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,1,20]]},"reference":[{"key":"2026082802200678000_16.5.1151.1","unstructured":"World Health Organization . National cancer control programmes: policies and managerial guidelines. 2002."},{"key":"2026082802200678000_16.5.1151.2","first-page":"278","article-title":"White Paper on standards and norms for hospice and palliative care in Europe: Part 1","volume":"16","author":"Radbruch","year":"2009","journal-title":"Eur J Palliat Care"},{"key":"2026082802200678000_16.5.1151.3","doi-asserted-by":"publisher","DOI":"10.1177\/0269216315589898"},{"key":"2026082802200678000_16.5.1151.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2014.07.010"},{"key":"2026082802200678000_16.5.1151.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-014-2351-8"},{"key":"2026082802200678000_16.5.1151.6","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1177\/0269216319854154","article-title":"Which outcome domains are important in palliative care and when? An international expert consensus workshop, using the nominal group technique","volume":"33","author":"de Wolf-Linder","year":"2019","journal-title":"Palliat Med"},{"key":"2026082802200678000_16.5.1151.7","doi-asserted-by":"publisher","DOI":"10.1177\/0269216314551814"},{"key":"2026082802200678000_16.5.1151.8","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1177\/0269216317727157","article-title":"Phase of Illness in palliative care: Cross-sectional analysis of clinical data from community, hospital and hospice patients","volume":"32","author":"Mather","year":"2018","journal-title":"Palliat Med"},{"key":"2026082802200678000_16.5.1151.9","doi-asserted-by":"publisher","DOI":"10.1136\/spcare-2022-003806"},{"key":"2026082802200678000_16.5.1151.10","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010"},{"key":"2026082802200678000_16.5.1151.11","doi-asserted-by":"crossref","DOI":"10.1186\/s12904-021-00897-x","article-title":"COMPANION: development of a patient-centred complexity and casemix classification for adult palliative care patients based on needs and resource use - a protocol for a cross-sectional multi-centre study","volume":"21","author":"Hodiamont","year":"2022","journal-title":"BMC Palliat Care"},{"key":"2026082802200678000_16.5.1151.12","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1177\/0269216319854264","article-title":"A brief, patient- and proxy-reported outcome measure in advanced illness: Validity, reliability and responsiveness of the Integrated Palliative care Outcome Scale (IPOS)","volume":"33","author":"Murtagh","year":"2019","journal-title":"Palliat Med"},{"key":"2026082802200678000_16.5.1151.13","doi-asserted-by":"publisher","DOI":"10.1177\/0269216315608348"},{"key":"2026082802200678000_16.5.1151.14","doi-asserted-by":"publisher","DOI":"10.1186\/1472-684X-4-1"},{"key":"2026082802200678000_16.5.1151.15","doi-asserted-by":"publisher","DOI":"10.1191\/0269216304pm875oa"},{"key":"2026082802200678000_16.5.1151.16","doi-asserted-by":"crossref","DOI":"10.1186\/s12904-021-00825-z","article-title":"Adaptation of the Australian Palliative Care Phase concept to the German palliative care context: a mixed-methods approach using cognitive interviews and cross-sectional data","volume":"20","author":"Lehmann","year":"2021","journal-title":"BMC Palliat Care"},{"key":"2026082802200678000_16.5.1151.17","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1055\/s-0031-1276957","article-title":"Standards und Richtlinien f\u00fcr Hospiz- und Palliativversorgung in Europa: Teil 2","volume":"12","author":"Radbruch","year":"2011","journal-title":"Palliativmedizin"},{"key":"2026082802200678000_16.5.1151.18","doi-asserted-by":"crossref","DOI":"10.1186\/s12904-023-01329-8","article-title":"Using normalization process theory to evaluate the use of patient-centred outcome measures in specialist palliative home care-a qualitative interview study","volume":"23","author":"Lehmann-Emele","year":"2024","journal-title":"BMC Palliat Care"},{"key":"2026082802200678000_16.5.1151.19","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph19137747","article-title":"Strengthening Community End-of-Life Care through Implementing Measurement-Based Palliative Care","volume":"19","author":"Sandham","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2026082802200678000_16.5.1151.20","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1089\/jpm.2019.0295","article-title":"Is Inpatient Hospice Care Clinically Effective? Using Phase of Illness to Evaluate Care Outcomes for Patients Admitted to a Specialist Palliative Care Unit in Ireland","volume":"23","author":"Lucey","year":"2020","journal-title":"J Palliat Med"}],"container-title":["BMJ Supportive &amp; Palliative Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/spcare-2024-005017","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T09:20:43Z","timestamp":1787908843000},"score":1,"resource":{"primary":{"URL":"https:\/\/spcare.bmj.com\/lookup\/doi\/10.1136\/spcare-2024-005017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,20]]},"references-count":20,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,8,28]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/spcare-2024-005017"],"URL":"https:\/\/doi.org\/10.1136\/spcare-2024-005017","relation":{},"ISSN":["2045-435X","2045-4368"],"issn-type":[{"value":"2045-435X","type":"print"},{"value":"2045-4368","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,20]]}}}