Dtsch Med Wochenschr 2018; 143(08): 551-557
DOI: 10.1055/s-0043-115631
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© Georg Thieme Verlag KG Stuttgart · New York

(Early) Palliative Care in Rettungsdienst und Notaufnahme

(Early) Palliative Care in Emergency Medicine
Maximilian Spickermann
,
Philipp Lenz
Further Information

Publication History

Publication Date:
12 April 2018 (online)

Abstract

At the end of life patients with a life-limiting disease are often admitted to emergency departments (ED). Mostly, in the setting of an ED there may not be enough time to meet the needs for palliative care (PC) of these patients. Therefore, integration of PC into the ED offers a solution to improve their treatment. In the outpatient setting a cooperation between prehospital emergency services, the patient’s general practitioner and specialized outpatient PC teams may allow the patient to die at home – this is what most patients prefer at the end of life. Furthermore, due to the earlier integration of PC after admission the hospital stay is shortened. Also the number of PC consultations may increase. Additionally, a screening of PC hneeds among all patients visiting the ED may be beneficial: to avoid not meeting existing PC needs and to standardize the need of PC consultation. An example for such a screening tool is the “Palliative Care and Rapid Emergency Screening” (P-CaRES).

Im Zusammenhang mit der alternden Gesellschaft steigt der Bedarf an palliativmedizinischer Versorgung. Vor dem Hintergrund des rasanten medizinischen Fortschritts gestaltet sich jedoch das Abwägen von „Optimum“ und „Maximum“ an Therapie immer schwieriger. Der folgende Beitrag beleuchtet die Einbindung der Palliativmedizin in Notfallmedizin, Rettungsdienst und Notaufnahme.

 
  • Literatur

  • 1 Thoonsen B, Groot M, Engels Y. et al. Early identification of and proactive palliative care for patients in general practice, incentive and methods of a randomized controlled trial. BMC Fam Prac 2011; 12: 123 . doi:10.1186/1471–2296–12–123
  • 2 Temel JS, Greer JA, Muzikansky A. et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363: 733-742 . doi:10.1056/NEJMoa1000678
  • 3 Zimmermann C, Swami N, Krzyzanowska M. et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet 2014; 383: 1721-1730 . doi:10.1016/S0140–6736(13)62416–2
  • 4 Maddocks M, Lovell N, Booth S. et al. Palliative care and management of troublesome symptoms for people with chronic obstructive pulmonary disease. Lancet 2017; 390: 988-1002 . doi:10.1016/S0140–6736(17)32127-X
  • 5 Laufenberg-Feldmann R, Kappis B, Weber M. et al. [Save life--allow death. Collation of emergency missions for terminally ill patients]. Schmerz 2011; 25: 69-76 . doi:10.1007/s00482–010–1000–5
  • 6 Carron PN, Dami F, Diawara F. et al. Palliative care and prehospital emergency medicine: analysis of a case series. Medicine (Baltimore) 2014; 93: e128 . doi:10.1097/MD.0000000000000128
  • 7 Bausewein C, Simon ST, Pralong A. et al. Palliative Care of Adult Patients With Cancer. Deutsches Aerzteblatt international 2015; 112: 863-870 . doi:10.3238/arztebl.2015.0863
  • 8 Smith AK, McCarthy E, Weber E. et al. Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Aff (Millwood) 2012; 31: 1277-1285 . doi:10.1377/hlthaff.2011.0922
  • 9 Elsayem AF, Elzubeir HE, Brock PA. et al. Integrating palliative care in oncologic emergency departments: Challenges and opportunities. World J Clin Oncol 2016; 7: 227-233 . doi:10.5306/wjco.v7.i2.227
  • 10 Kistler EA, Sean MorrisonR, Richardson LD. et al. Emergency department-triggered palliative care in advanced cancer: proof of concept. Acad Emerg Med 2015; 22: 237-239 doi:10.1111/acem.12573
  • 11 McNamara BA, Rosenwax LK, Murray K. et al. Early admission to community-based palliative care reduces use of emergency departments in the ninety days before death. J Palliat Med 2013; 16: 774-779 . doi:10.1089/jpm.2012.0403
  • 12 Delgado-Guay MO, Rodriguez-Nunez A, Shin SH. et al. Characteristics and outcomes of patients with advanced cancer evaluated by a palliative care team at an emergency center. A retrospective study. Support Care Cancer 2016; 24: 2287-2295 . doi:10.1007/s00520–015–3034–9
  • 13 Grudzen CR, Richardson LD, Johnson PN. et al. Emergency Department-Initiated Palliative Care in Advanced Cancer: A Randomized Clinical Trial. JAMA Oncol 2016; 2 (05) 591-598 . doi:10.1001/jamaoncol.2015.5252
  • 14 Nieder C, Tollali T, Haukland E. et al. Impact of early palliative interventions on the outcomes of care for patients with non-small cell lung cancer. Support Care Cancer 2016; 24: 4385-4391 . doi:10.1007/s00520–016–3278-z
  • 15 Scibetta C, Kerr K, McGuire J. et al. The Costs of Waiting: Implications of the Timing of Palliative Care Consultation among a Cohort of Decedents at a Comprehensive Cancer Center. J Palliat Med 2016; 19: 69-75 . doi:10.1089/jpm.2015.0119
  • 16 Rosenberg M, Rosenberg L. Integrated model of palliative care in the emergency department. West J Emerg Med 2013; 14: 633-636 . doi:10.5811/westjem.2013.5.14674
  • 17 Lamba S, Nagurka R, Zielinski A. et al. Palliative care provision in the emergency department: barriers reported by emergency physicians. J Palliat Med 2013; 16: 143-147 . doi:10.1089/jpm.2012.0402
  • 18 George N, Phillips E, Zaurova M. et al. Palliative Care Screening and Assessment in the Emergency Department: A Systematic Review. J Pain Symptom Manage 2016; 51: 108-119 e102. doi:10.1016/j.jpainsymman.2015.07.017
  • 19 George N, Barrett N, McPeake L. et al. Content Validation of a Novel Screening Tool to Identify Emergency Department Patients With Significant Palliative Care Needs. Acad Emerg Med 2015; 22: 823-837 . doi:10.1111/acem.12710
  • 20 Bowman J, George N, Barrett N. et al. Acceptability and Reliability of a Novel Palliative Care Screening Tool Among Emergency Department Providers. Acad Emerg Med 2016; 23: 694-702 . doi:10.1111/acem.12963