Advance Care Planning in Zeiten der Corona-Pandemie – eine Chance für die Patientenautonomie in der Akutsituation

Hartog, Christiane S.; Spies, Claudia; Michl, Susanne; Janssens, Uwe

doi:10.1007/s00063-020-00717-9

Cited by 8 publications

(9 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Schwierigkeiten mit konventionellen Patientenverfügungen und deren Anwendung auf der Intensivstation sind durch zahlreiche empirische Untersuchungen aufgedeckt worden [ 32 ]. Das Konzept des Advance Care Planning (ACP), das die vorhandenen Schwachstellen adressiert [ 23 , 83 ], ist jedoch bislang nicht flächendeckend und auf allen relevanten Ebenen realisiert. Auch die Voraussetzungen für die Kostenübernahme für ACP sind gesetzlich nur für ausgewählte Bereiche geklärt (vgl.…”

Section: Allgemeine Forderungen Zur Vermeidung Einer üBerversorgungunclassified

Überversorgung in der Intensivmedizin: erkennen, benennen, vermeiden

Michalsen

Neitzke

Dutzmann

et al. 2021

Med Klin Intensivmed Notfmed

Self Cite

View full text Add to dashboard Cite

ZusammenfassungUngeachtet der sozialgesetzlichen Vorgaben existieren im deutschen Gesundheitssystem in der Patientenversorgung nebeneinander Unter‑, Fehl- und Überversorgung. Überversorgung bezeichnet diagnostische und therapeutische Maßnahmen, die nicht angemessen sind, da sie die Lebensdauer oder Lebensqualität der Patienten nicht verbessern, mehr Schaden als Nutzen verursachen und/oder von den Patienten nicht gewollt werden. Daraus können hohe Belastungen für die Patienten, deren Familien, die Behandlungsteams und die Gesellschaft resultieren. Dieses Positionspapier erläutert Ursachen von Überversorgung in der Intensivmedizin und gibt differenzierte Empfehlungen zu ihrer Erkennung und Vermeidung. Zur Erkennung und Vermeidung von Überversorgung in der Intensivmedizin erfordert es Maßnahmen auf der Mikro‑, Meso- und Makroebene, insbesondere die folgenden: 1) regelmäßige Evaluierung des Therapieziels im Behandlungsteam unter Berücksichtigung des Patientenwillens und unter Begleitung von Patienten und Angehörigen; 2) Förderung einer patientenzentrierten Unternehmenskultur im Krankenhaus mit Vorrang einer qualitativ hochwertigen Patientenversorgung; 3) Minimierung von Fehlanreizen im Krankenhausfinanzierungssystem gestützt auf die notwendige Reformierung des fallpauschalbasierten Vergütungssystems; 4) Stärkung der interdisziplinären/interprofessionellen Zusammenarbeit in Aus‑, Fort- und Weiterbildung; 5) Initiierung und Begleitung eines gesellschaftlichen Diskurses zur Überversorgung.

show abstract

Section: Allgemeine Forderungen Zur Vermeidung Einer üBerversorgungunclassified

Überversorgung in der Intensivmedizin: erkennen, benennen, vermeiden

Michalsen

Neitzke

Dutzmann

et al. 2021

Med Klin Intensivmed Notfmed

Self Cite

View full text Add to dashboard Cite

show abstract

“…In an emergency situation, not only the family, but also the medical team needs to know what the patient's choices are when an indication for interventions such as intubation, intensive care treatment or reanimation in the case of a cardiac arrest arises. Experiences during the first and the second wave of COVID-19 reinforce the importance of these reflections, independently of the necessity of triage [17].…”

mentioning

confidence: 90%

Strong second COVID-19 wave calls for a second look at ICU triage guidelines

Suter

Pargger

2020

Swiss Med Wkly

View full text Add to dashboard Cite

“…Thus, it is essential to sufficiently train health care providers in palliative medicine and end-of-life care [ 7 , 8 ], identify patients’ needs in a standardized manner [ 1 , 4 , 9 ], and communicate their wishes efficiently and as concretely as possible– for example by means of DPW [ 10 ]. Available DPW upon presentation to the ED could preserve patient autonomy once decision-making capacity is lost, reduce the occurrence of procedures not in line with patient wishes and distribute ED resources more efficiently.…”

Section: Introductionmentioning

confidence: 99%

“…Health Care Proxy or Power of Attorney documents, which delegate decisions in certain areas of life to other persons, are not included [ 5 ]. Furthermore, differences between AD and ACP [ 10 ], consideration of DPW by health care providers and its impact [ 11 , 12 ] or initiation of palliative measures in the ED [ 12 – 15 ] are not explored in this paper.…”

Section: Introductionmentioning

confidence: 99%

Advance directives in the emergency department–a systematic review of the status quo

Weber,

Hübner,

Pflock

et al. 2024

BMC Health Serv Res

View full text Add to dashboard Cite

Background Providing individualised healthcare in line with patient wishes is a particular challenge for emergency healthcare professionals. Documentation of patient wishes (DPW), e.g. as advance directives, can guide clinicians in making end-of-life decisions that respect the patient’s wishes and autonomy. However, patient centered decisions are hindered by limited availability of DPWs in emergency settings. Objective This systematic review aims to congregate present data on recorded rates for DPW existence and availability in the emergency department (ED) as well as contributing factors for these rates. Methods We searched MEDLINE, Google Scholar, Embase and Web of Science databases in September 2023. Publications providing primary quantitative data on DPW in the ED were assessed. Publications referring only to a subset of ED patients (other than geriatric) and investigating DPW issued after admission were excluded. Results A total of 22 studies from 1996 to 2021 were included in the analysis. Most were from the US (n = 12), followed by Australia (n = 4), Canada (n = 2), South Korea, Germany, the United Kingdom and Switzerland (n = 1 each). In the general adult population presenting to the ED, 19.9–27.8% of patients reported having some form of DPW, but only in 6.8% or less it was available on presentation. In the geriatric population, DPW rates (2.6–79%) as well as their availability (1.1–48.8%) varied widely. The following variables were identified as positive predictors of having DPW, among others: higher age, poorer overall health, as well as sociodemographic factors, such as female gender, having children, being in a relationship, higher level of education or a recent previous presentation to hospital. Conclusions Existence and availability of a recorded DPW among ED patients was low in general and even in geriatric populations mostly well below 50%. While we were able to gather data on prevalence and predictors, this was limited by heterogeneous data. We believe further research is needed to explore the quality of DPW and measures to increase both rates of existence and availability of DPW in the ED.

show abstract

Advance Care Planning in Zeiten der Corona-Pandemie – eine Chance für die Patientenautonomie in der Akutsituation

Cited by 8 publications

References 9 publications

Überversorgung in der Intensivmedizin: erkennen, benennen, vermeiden

Überversorgung in der Intensivmedizin: erkennen, benennen, vermeiden

Strong second COVID-19 wave calls for a second look at ICU triage guidelines

Advance directives in the emergency department–a systematic review of the status quo

Contact Info

Product

Resources

About