Barrieren für Gespräche über Tod und Sterben in der Medizin

Zusammenfassung

Für viele Menschen sind Tod und Sterben etwas Schmerzliches (in vielerlei Hinsicht), dessen Vorstellung tiefgründige, starke Ängste berührt oder auslöst. Häufig wird versucht, das Thema zu vermeiden und von sich weg zu schieben. In der Medizin aber lässt sich das Thema nicht aussparen – und es gibt gute Gründe, gerade darüber zu sprechen.

Abstract

Conversations about death, dying and the end of life are usually difficult. They can turn out to be both a burden and a challenge for those engaging in these talks. There is evidence that talking early about end-of-life-topics shows positive effects concerning medical and psychological conditions of patients. Open communication addressing these topics can be part of family- and patient-centered talks in an intensive care department, known as a quality indicator of intensive care medicine. Further, these conversations are important and necessary in palliative care for providing a “good death”. Nevertheless, these conversations are delayed or do not take place due to communication barriers of doctors, patients and caregivers. Barriers to end of life communication of physicians contain individual, personal or role-specific factors, lack of medical knowledge, including insecurities of prognosis, professional attitudes, clinical routines and the worry of harming patients with these talks. Regarding barriers to communication of patients and their family members, it could be differentiated between emotional, cognitive, relationship-related and external factors. It could be valuable to recognize these barriers to increase the possibility of end of life conversations in the near future.

In daily medical routine end of life topics should be addressed early and actively. Especially the readiness for these conversations should be tested repeatedly and talks should be offered regularly. Critical events such as relapse, modulating therapy concepts and knowledge of unrealistic treatment expectations should be regarded as prompts to offer conversations about dying and end-of-life care actively.

Kernaussagen

• Das Sprechen über Tod und Sterben ist schwierig und wird wegen vielfältiger Barrieren bei Ärzten, Patienten und Angehörigen häufig vermieden.

• Eine frühzeitige Kommunikation über Sterben und die letzte Lebensphase kann positive medizinische und psychologische Effekte haben und sollte im medizinischen Kontext nicht ausgespart werden.

• Barrieren auf ärztlicher Seite lassen sich neben persönlichen und rollenspezifischen den Bereichen (klinisches) Wissen, prognostische Unsicherheit, (berufliche) Einstellungen, klinische Routinen sowie der Sorge um die Auswirkungen auf Patienten zuordnen.

• Auf Patienten- und Angehörigenseite gibt es emotionale, kognitive, kommunikative, beziehungsbezogene und externe Barrieren.

• Gespräche sollten immer wieder angeboten und die Gesprächsbereitschaft geprüft werden. Klinisch kritische Ereignisse, Rezidive, Umstellung auf ein palliativmedizinisches Therapiekonzept und das Wissen um unrealistische Erwartungen sollten Anlässe sein, ein Gespräch über Sterben und die Versorgung am Lebensende anzubieten.

Schlüsselwörter

Kommunikation - Lebensende - Tod - Therapiezielfindung - Gesprächsführung

Key words

end-of-life - end-of-life discussion - dying - communication - advance care planning

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