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Berner-Sharma, J.M.* ; Berner-Sharma, A.  ; Arnold, T.* ; Bausewein, C.* ; Rémi, C.*

Impact of a structured pathway on nausea and vomiting treatment in palliative care: A before-after study.

J. Palliat. Med, DOI: 10.1177/10966218261462313 (2026)
DOI PMC
Open Access Green möglich sobald Postprint bei der ZB eingereicht worden ist.
BACKGROUND: Nausea and vomiting are distressing symptoms in palliative care. Due to a heterogeneous population and limited evidence, clinical management remains challenging. Guidelines often recommend an etiology-based treatment approach, but supporting evidence is scarce, particularly for noncancer patients. OBJECTIVES: Evaluating the impact of a structured, etiology-based treatment pathway on nausea and vomiting burden and treatment quality in palliative care patients. SETTING/SUBJECTS: Single-center, before-after study in adult patients on a German tertiary palliative care unit, comparing symptom burden and treatment quality before (Phase 1, 15 months) and after (Phase 2, 12 months) implementation of the pathway. MEASUREMENTS: Outcome measures were change in symptom burden score on day 3 (Integrated Palliative Care Outcome Scale ([IPOS]), treatment quality (quality indicator [QI]; burden reduction on IPOS), and duration of symptoms (days). Significance level was set at α < 0.01. RESULTS: In Phase 1, 172/330 patients (52.1%) experienced 230 episodes of nausea/vomiting, versus 139/280 patients (49.6%) with 178 episodes in Phase 2. On day 3, symptom burden scores for nausea decreased to a greater extent in Phase 2 (p = 0.007); vomiting showed a nonsignificant reduction (p = 0.021). The QI (nausea) was met in 124/178 (69.7%) versus 129/156 (82.7%) (p = 0.0056), and the QI (vomiting) was met in 66/93 (71.0%) versus 81/95 (85.3%) (p = 0.0176) episodes. Symptom duration decreased from 3 (0-25) to 2 (0-23) days (p < 0.001). CONCLUSIONS: The systematic etiology-based pathway significantly improved cause identification and treatment quality. While benefits were more pronounced in cancer patients, this structured approach provides a robust framework for enhancing antiemetic management in the palliative care setting. Further studies should investigate antiemetic treatment in noncancer patients.
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Publikationstyp Artikel: Journalartikel
Dokumenttyp Wissenschaftlicher Artikel
Schlagwörter Antiemetics ; End-of-life ; Nausea ; Palliative Care ; Symptom Management ; Vomiting; Symptom Prevalence; Advanced Cancer; Management; Disease
ISSN (print) / ISBN 1096-6218
e-ISSN 1557-7740
Zeitschrift Journal of Palliative Medicine
Verlag Mary Ann Liebert
Verlagsort Larchmont, NY
Begutachtungsstatus Peer reviewed
Institut(e) Core Facility Bioinformatics and Statistics (CF-BIOS)