Patienten als Partner in der letzten Lebensphase

Abstract

Between March 2002 and August 2003 as part of the research project "Patients as partners -- tumour patients and their participation in medical decisions" tumour patients undergoing palliative therapy (n=272) were interviewed and asked about their level of information, their desired place to die and whether they had prepared an advance directive. Furthermore, 72 relatives of deceased patients who had been looked after by the project's palliative care team were given a similar questionnaire including questions concerning their knowledge about disease and prognosis, the actual place of death and the relevance of advance directives. According to patients and relatives, information particularly about prognosis is unsatisfactory. Of the inter-viewed patients, 75% said they wanted to die at home and 15% in a hospital. According to their relatives, 36% of the patients looked after by the palliative care team had an advance directive. The survey of the relatives showed a significant relation between the preparation of an advance directive and dying at the desired place. According to the relatives, medical and health reasons, hope for an improvement up to the very end,acute worsening of the condition and deficits in medical care were important reasons for dying in hospital against the patient'swish. In future, advance directives should be used as an aid for communication and the planning of care. Therefore, cooperation between doctors and patients based on a partnership is necessary. The required competence in communication should be improved.

Cancer Patients and Advance Directives: A Survey of Patients in a Hematology and Oncology Outpatient Clinic

“…There is a growing awareness of ADs. In a survey published in 2004, 29% of tumor patients were not familiar with ADs [13]. In our survey, the number of uninformed respondents was only 2% compared to 5% in a comparable survey carried out from 2007 to 2010 among cancer patients receiving radiotherapy [10].…”

“…The study population comprised a representative population of 503 patients with different stages various oncological and hematological diseases, who were receiving a whole spectrum of treatments at an outpatient department of a University Hospital. The prevalence of ADs was 31%, indicating an increasing number of ADs compared to the 14-24% found in other German surveys among different cancer patient populations between 2002 and 2010 [9,10,13]. There is a growing awareness of ADs.…”

Spezialisierte ambulante Palliativversorgung aus Sicht ambulanter Pflegedienste – Eine empirische Untersuchung in Sachsen-Anhalt Ost

“…Seit 2007 haben gemäß § 37b SGB V schwerst-und sterbenskranke Versicherte gesetzlichen Anspruch auf eine optimierte Versorgung im häuslichen Umfeld [1]. Ein hohes Maß an Selbst-und Mitbestimmung aufrechtzuerhalten, möglichst durch Privatheit und Gewohnheiten im täglichen Leben, erklärt unter anderem den Wunsch vieler unheilbar kranker Menschen die letzte Lebensphase in vertrauter Umgebung zu verbringen [2,3]. Das verlangt nach einer ebenso medizinisch wie pflegerisch adäquaten Versorgung entsprechend der Behandlung im stationären Bereich.…”

Stand der spezialisierten ambulanten Palliativversorgung (SAPV) in Deutschland – Verträge und Erfahrungen

“…Conclusion SAPV contracts may influence care provision and differences complicate compari-Einleitung ! 75 % der Palliativpatienten wollen am Lebensende zu Hause versorgt werden [1]. Ein Teil von ihnen benötigt beispielsweise aufgrund einer komplizierten Schmerz-und Symptomsituation eine besonders aufwendige Betreuung.…”