Detecting Distress in Cognitively Impaired People to Prevent Suffering: Protocol for an Observational Feasibility...

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 (≥18 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.