Patientenverfügung bei Patienten mit Nierenerkrankungen im Vergleich zu allgemein-internistischen Patienten

Driehorst, Florian; Keller, Frieder

doi:10.1055/s-0034-1369881

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…Since September 2009, German law regulates that advance directives - if applicable - must be respected in any decision concerning medical treatment [ 34 ]. In our series, the prevalence of a living will was low, however similar to reports in other medical specialties [ 35 , 36 ]. Their presence had no obvious influence on transition to palliative care.…”

Section: Discussionsupporting

confidence: 90%

End-of-life decisions in acute stroke patients: an observational cohort study

et al. 2016

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BackgroundCrucial issues of modern stroke care include best practice end-of-life-decision (EOLD)-making procedures and the provision of high-quality palliative care for dying stroke patients.MethodsWe retrospectively analyzed records of those patients who died over a 4-year period (2011–2014) on our Stroke Unit concerning EOLD, focusing on the factors that most probably guided decisions to induce limitation of life-sustaining therapy and subsequently end-of-life-care procedures thereafter.ResultsOf all patients treated at our Stroke Unit, 120 (2.71 %) died. In 101 (86.3 %), a do-not-resuscitate-order (DNRO) was made during early treatment. A decision to withdraw/withhold further life supportive therapy was made in 40 patients (34.2 %) after a mean of 5.0 days (range 0–29). Overall patient death occurred after a mean time of 7.0 days (range 1–30) and 2.6 days after therapy restrictions. Disturbance of consciousness at presentation, dysphagia on day 1 and large supratentorial stroke were possible indicators of decisions to therapeutic withdrawing/withholding. Proceedings of EOL care in these patients were heterogeneous; in most cases monitoring (95 %), medical procedures (90 %), oral medication (88 %), parenteral nutrition (98 %) and antibiotic therapy (86 %) were either not ordered or withdrawn, however IV fluids were continued in all patients.ConclusionsA high percentage of stroke patients were rated as terminally ill and died in the course of caregiving. Disturbance of consciousness at presentation, dysphagia on day 1 and large supratentorial stroke facilitated decisions to change therapeutic goals thus initiating end-of-life-care. However, there is further need to foster research on this field in order to ameliorate outcome prognostication, to understand the dynamics of EOLD-making procedures and to educate staff to provide high-quality patient-centred palliative care in stroke medicine.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0113-8) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 90%

End-of-life decisions in acute stroke patients: an observational cohort study

et al. 2016

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“…In the present study, "more advanced age" was independently associated with the existence of one of the documents under study. This has already been confirmed in a variety of studies (13,14). In old age the need is greater for patients to be involved in decisions about the nature and extent of medical interventions (15,16).…”

Section: Discussionmentioning

confidence: 78%

“…A more probable explanation is that not all patients knew exactly what had happened to their documents; it may be that more of the documents should have been presented by relatives. Other studies have also found a relatively low rate of powers of attorney or advance directives either deposited with the hospital or brought into it by the patient or a relative (11,14,20).…”

Section: Discussionmentioning

confidence: 99%

Advance Directives and Powers of Attorney in Intensive Care Patients

Heer¹,

Saugel²,

Sensen³

et al. 2017

Deutsches Ärzteblatt International

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For patients hospitalized in intensive care units, there should be early discussion about the presence or absence of documents of these kinds and early evaluation of the patient's concrete wishes in critical situations. Future studies are needed to determine how best to assure that these documents will be correctly prepared and then given over to hospital staff so that they can take their place in the patient's record.

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“…Insgesamt 14 Studien konnten keinen statistisch signifikanten Einfluss des Geschlechts bei der tatsächlichen Inanspruchnahme von Vorsorgedokumenten ausweisen [16, 20, 21, 24, 29, 30, 32-34, 36, 40, 41, 44, 47, 53-55]. Zwei der Studien [16,36] fanden zunächst Hinweise auf signifikante Geschlechterdifferenzen, die sich jedoch in anschließenden Regressionsanalysen relativierten, da andere Einflussfaktoren (z. B. das Alter der Befragten) für die Effekte verantwortlich zeichneten.…”

Section: Verbreitung Von Vorsorgedokumenten Bei Frauen Und Männernunclassified

“…mit Geschlecht zu interagieren. So zeigt sich, dass ein höheres Alter [16,24,33,34,36,44,55], ein höherer Sozialstatus [29,30], persönliche Verlusterfahrungen [32][33][34], eigene Kinder [53,54], der Familienstand (verheiratet bzw. in einer Partnerschaft lebend) [24,29,30], eine gefestigte Erwerbssituation [24], das Vorliegen einer (chronischen) Erkrankung [36,44] [29,30,33,34,53,54].…”

Section: Verbreitung Von Vorsorgedokumenten Bei Frauen Und Männernunclassified

Behandlung im Voraus Planen (BVP): Eine Übersichtsarbeit über das Vorsorgeverhalten von Frauen und Männern in Deutschland

et al. 2018

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Patientenverfügung bei Patienten mit Nierenerkrankungen im Vergleich zu allgemein-internistischen Patienten

Abstract: Age was found the more impacting variable than the renal diagnosis on the prevalence of advance directives. Patients with a renal diagnosis should be encouraged to make a statement on dialysis in their living will.

Cited by 5 publications

References 24 publications

End-of-life decisions in acute stroke patients: an observational cohort study

End-of-life decisions in acute stroke patients: an observational cohort study

Advance Directives and Powers of Attorney in Intensive Care Patients

Behandlung im Voraus Planen (BVP): Eine Übersichtsarbeit über das Vorsorgeverhalten von Frauen und Männern in Deutschland

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