Survey on German Palliative Care Specialists’ Experiences with Advance Directives

Abstract

IntroductionAdvance directives (AD) play a central role in end-of-life treatments, intensive care, and palliative care. However, little is known about the experiences of healthcare professionals with ADs. This study reports on palliative care professionals’ views on advance directives (AD).MethodsA questionnaire was handed out to attendants of a palliative care symposium.ResultsComplete answers were obtained from 126 physicians and 276 nurses. Almost all physicians and nurses had treated patients with an AD, and the majority more than 10 patients. The most frequent refusal by the patients was resuscitation (87.8%) followed by intensive care (79.1%), artificial ventilation, and nutrition. The most frequent wish was pain therapy (92.3%) followed by allowing the natural course of the illness (64.4%). The wish for hospice treatment (44.8%) or spiritual care (39.3%) was less frequent.DiscussionThe results hint at fears and deficits in the care of patients at the end of life. Often the quality of life and not the quantity of days remaining is in the center of a patient’s will and points to the growing importance of palliative care.ConclusionADs are well established among palliative care professionals and regarded as helpful for patients at the end of life.

Spiritual Care in Palliative Care: A Systematic Review of the Recent European Literature

“…Fifty-three articles were included [33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85]. Seventeen were quantitative studies [33,34,36,37,40,43,50,51,54,61,66,67,69,71,74,81,82], of which the majority ( n = 11) were survey studies, 27 qualitative studies […”

“…Seventeen were quantitative studies [33,34,36,37,40,43,50,51,54,61,66,67,69,71,74,81,82], of which the majority ( n = 11) were survey studies, 27 qualitative studies [38,39,41,42,44,45,46,48,49,53,55,56,57,58,59,60,63,64,68,73,76,78,79,80,83,84,85], most of which were interview studies ( n = 13), and nine mixed-methods studies [35,47,52,62,65,70,72,75,77]. Most studies were conducted in Western Europe ( n = 37), especially in the UK ( n = 10), Germany ( n = 8), and the Netherlands ( n = 13).…”

“…Fifty-three articles were included [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ]. Seventeen were quantitative studies [ 33 , 34 , ...…”

Was wissen Fachkräfte im Gesundheitswesen über Vorsorgedokumente?

“…Instrumente zur Vorausplanung für Situationen, in denen eine Person ihren Willen rechtlich nicht mehr erklären kann, existieren in Deutschland in Form der Patientenverfügung, Vorsorgevollmacht und Betreuungsverfügung. Der Bekanntheitsgrad dieser Vorsorgedokumente und deren Verbreitung in der Allgemeinbevölkerung nehmen seit Jahren stetig zu [1,2] und gewinnen im medizinisch-pflegerischen Berufsalltag immer mehr an Bedeutung [3,4,5]. Vorsorgedokumente bieten bei der Behandlung einwilligungsunfähiger Patienten eine Hilfe zur Ermittlung des Patientenwillens, ob durch Beschreibung der (nicht) gewünschten Behandlungsmaßnahmen in bestimmten Lebens-und Krankheitssituationen wie bei der Patientenverfügung oder Benennung eines Bevollmächtigten in der Vorsorgevollmacht bzw.…”

“…eines rechtlichen Betreuers in einer Betreuungsverfügung [6]. Viele Ärztinnen und Ärzte erleben das Vorhandensein von Vorsorgedokumenten als hilfreich, auch wenn sie sich in der praktischen Umsetzung immer wieder mit Problemen durch pauschale oder nicht zutreffende Formulierungen oder den Herausforderungen der Anwendung in Notfallsituationen sowie mit ethischen Konflikten unwiderruflicher Behandlungsentscheidungen konfrontiert sehen [5,7].…”