{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T08:06:41Z","timestamp":1784102801110,"version":"3.55.0"},"reference-count":35,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Background: With the increasing prevalence of multimorbidity, the demand for palliative and end-of-life care is expected to rise substantially in the coming decades. Digital health technologies may enable automated detection of clinically relevant distress, including symptoms such as pain, breathlessness (dyspnea), anxiety\/panic, nausea, and agitation. Remote detection of such distress in cognitively impaired patients who are unable to reliably call for help could enable timely intervention when patients are unattended. Methods: This observational feasibility study will collect multimodal data from a non-invasive sensor system consisting of 3D radar, a photoplethysmographic sensor (wearable), and a microphone. Sensor data will be linked to distress events identified by nurses or physicians during routine clinical care using structured proxy assessments. Adults (\u226518 years) admitted to the Palliative Care Center Basel who are unable to reliably call for help due to cognitive impairment will be included based on written informed consent provided by a legal proxy. Aim: The aim of this study is to evaluate the feasibility of multimodal sensor-based monitoring for detecting clinician-identified distress events and to explore associations between sensor-derived variables and distress, informing future validation studies and the development of automated detection approaches in palliative care.<\/jats:p>","DOI":"10.3390\/s26144484","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T07:29:39Z","timestamp":1784100579000},"page":"4484","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Detecting Distress in Cognitively Impaired People to Prevent Suffering: Protocol for an Observational Feasibility Study of a Radar-Based Technology Augmented with Photoplethysmographic Sensors and Audio Signals (SURREAL)"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6985-0201","authenticated-orcid":false,"given":"Christopher","family":"Boehlke","sequence":"first","affiliation":[{"name":"Palliative Care Center, Bethesda Spital AG, 4052 Basel, Switzerland"},{"name":"Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0845-6030","authenticated-orcid":false,"given":"Fabian","family":"Buergi","sequence":"additional","affiliation":[{"name":"Palliative Care Center, Bethesda Spital AG, 4052 Basel, Switzerland"},{"name":"Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1693-9851","authenticated-orcid":false,"given":"Jens","family":"Eckstein","sequence":"additional","affiliation":[{"name":"Department Digitalization & ICT, University Hospital Basel, 4031 Basel, Switzerland"},{"name":"Department of Internal Medicine, University Hospital Basel, 4031 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0902-7801","authenticated-orcid":false,"given":"Marc","family":"Stawiski","sequence":"additional","affiliation":[{"name":"Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, 4132 Muttenz, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5726-6761","authenticated-orcid":false,"given":"Simone","family":"Hemm","sequence":"additional","affiliation":[{"name":"Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, 4132 Muttenz, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2417-3785","authenticated-orcid":false,"given":"Wolfgang","family":"Hasemann","sequence":"additional","affiliation":[{"name":"Institute of Nursing Science, University of Basel, 4031 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1176-3164","authenticated-orcid":false,"given":"Jan","family":"Gaertner","sequence":"additional","affiliation":[{"name":"Palliative Care Center, Bethesda Spital AG, 4052 Basel, Switzerland"},{"name":"Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/j.jpainsymman.2020.04.027","article-title":"Redefining Palliative Care\u2014A New Consensus-Based Definition","volume":"60","author":"Radbruch","year":"2020","journal-title":"J. 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