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Zeitschrift für Palliativmedizin 2016; 17(02): 83-93
DOI: 10.1055/s-0042-103068
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© Georg Thieme Verlag KG Stuttgart · New York

Frühzeitige spezialisierte palliativmedizinische Mitbehandlung[*]

Ein herausfordernder GoldstandardEarly Specialized Palliative CareA Challenging Gold Standard
J. Gärtner
1   Klinik für Palliativmedizin, Universitätsklinikum Freiburg
,
U. Wedding
2   Abteilung für Palliativmedizin, Klinik für Innere Medizin II, Universitätsklinikum Jena
,
B. Alt-Epping
3   Klinik für Palliativmedizin, Universitätsmedizin Göttingen
› Author Affiliations
Further Information

Publication History

Publication Date:
16 March 2016 (online)

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Zusammenfassung

Hintergrund: Zunehmende Evidenz belegt die Möglichkeit, durch strukturierte und frühzeitige Integration der spezialisierten Palliativmedizin die Versorgung von Patienten mit inkurablen Grunderkrankungen zu verbessern.

Ziel: Es soll ein aktueller Überblick zur sogenannten frühen Integration spezialisierter palliativmedizinischer Angebote bei Patienten mit inkurablen Grunderkrankungen, insbesondere Krebserkrankungen, vermittelt werden.

Material und Methode: Es erfolgten eine selektive Literaturrecherche und die Darstellung des aktuellen Wissenstands und neuer Entwicklungen.

Ergebnisse: Zahlreiche Studien zur Ergänzung der onkologischen Behandlung durch die Mitbehandlung bzw. Beratung durch Teams der spezialisierten Palliativmedizin sind in einer frühen palliativen Behandlungssituation durchgeführt worden. Eine Verbesserung zeigte sich unter anderem in folgenden Bereichen: bessere Lebensqualität, weniger depressive Symptome, längere Zeit zwischen letzter Chemotherapie und Tod, weniger Chemotherapie in den letzten 60 Lebenstagen, weniger Notaufnahmen, häufigere hospizliche Mitbetreuung, besseres Krankheitsverständnis und verlängertes Überleben.

Die Versorgungsstrukturen in Deutschland sind auf diese meist ambulant geleistete frühzeitige spezialisierte Palliativversorgung nicht eingestellt. Die spezialisierte ambulante Palliativversorgung beschränkt sich bisher auf die Betreuung in häuslicher oder stationär-pflegerischer Umgebung und die letzten Lebenstage, -wochen oder -monate.

Schlussfolgerungen: Die Evidenz zugunsten einer frühzeitigen palliativmedizinischen Mitbehandlung ist in den vergangenen Jahren stetig gewachsen. Die Schaffung der für diese Behandlung nötigen strukturellen Voraussetzungen verbleibt als wichtige Aufgabe für die Zukunft.

Abstract

Background: Increasing evidence demonstrates an improvement in the quality of care of patients when specialist palliative care services are integrated into the care of cancer patients at an early stage.

Aim: This article provides an up to date review on early integration concepts of specialist palliative care, focussing on cancer patients.

Material and methods: A selective search of the literature was performed, the currently available evidence is reported and suggestions regarding future developments are being provided.

Results: Many studies have investigated the benefits for cancer patients when specialist palliative care is provided at an early stage in the course of the disease in addition to active oncological treatment. The data demonstrate an improvement in the following areas: improved quality of life, less depressive symptoms, longer time periods between last chemotherapy and death, less chemotherapy within the last 60 days of life, less admissions to emergency units, higher rates of hospice care, improved understanding of the disease and prognosis, and prolonged survival.

In Germany, the current structures of medical care are not prepared to so as to provide specialized palliative care in an outpatient setting (SAPV). Current SAPV structures provide home care predominantly in the last days, weeks or months of life.

Conclusion: The evidence for early integration of specialist palliative care into the treatment of cancer patients is high but the implementation of feasible and effective structures of care remains a future task.

Kernaussagen

  • Palliativmedizinische Aufgaben wie z. B. die Symptomkontrolle, psychische und sozialdienstliche Unterstützung, Klärung ethischer Fragestellungen am Lebensende u. a. sind schon früh im Verlauf der Erkrankung Bestandteil einer umfassenden Behandlung von inkurabel erkrankten Patienten.

  • Im Sinne einer APV sollten diese Aufgaben durch die primär betreuenden Fachbereiche (z. B. Kardiologie, Onkologie) in Zusammenarbeit mit den Hausärzten wahrgenommen werden.

  • Eine umfassende und erfolgreiche Betreuung der Patienten setzt auch in der APV die routinemäßige, strukturierte Erfassung der Belastungen der Patienten voraus. Für davon abgeleitete basale Maßnahmen der Symptomkontrolle sind einfache, effektive Algorithmen verfügbar.

  • In komplexen Behandlungssituationen und bei belasteten Patienten sollten auch schon im frühen Erkrankungsverlauf spezialisierte palliativmedizinische Versorgungsstrukturen mit ihren multiprofessionell ausgerichteten, bedürfnisorientierten Behandlungsangeboten einbezogen werden.

Schlüsselwörter

Palliativmedizin - Palliativversorgung - Hospizarbeit - patientenzentrierte Versorgung - frühe Integration

Keywords

palliative care - hospice care - terminal care - comprehensive health care - patient centered care

* Dieser Beitrag ist bereits in leicht abgewandelter Form in der Zeitschrift Der Onkologe, Heft 12/2015 erschienen, DOI: s00761-015-3072-4. Mit freundlicher Genehmigung des Springer Verlags, Heidelberg.


 

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