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Zeitschrift für Palliativmedizin 2004; 5(1): 19-27
DOI: 10.1055/s-2003-814874
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Die Bewertung der palliativmedizinischen Patientenversorgung mithilfe der Palliative Care Outcome Scale (POS) in verschiedenen Versorgungsformen

Die Anwendung eines palliativmedizinischen Messinstruments bei Krebspatienten im St. Columba's Hospiz, Edinburgh, und bei Patienten mit Lungenkrebs oder Herzinsuffizienz in häuslicher VersorgungAn Assessment of the Ability of the Palliative Care Outcome Scale (POS) to Measure Palliative Care Outcomes in Different SettingsThe Use of a Palliative Care Outcome Measure in Cancer Patients Attending St. Columba's Day-Hospice, Edinburgh, and in Patients with Lung Cancer or Heart Failure in Primary CareG.  A.  Lerzynski1 , A.  Allan2 , S.  A.  Murray3
  • 1Heinrich-Heine-Universität Düsseldorf
  • 2St. Columba's Hospice, Edinburgh, Schottland
  • 3Department of General Practice, The University of Edinburgh, Schottland
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Publication History

Publication Date:
14 April 2004 (online)

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Zusammenfassung

Hintergrund: Patienten, die eine palliativmedizinische Betreuung benötigen, leiden an Erkrankungen, die die Lebenszeit limitieren und die Lebensqualität beeinträchtigen. Die Verbesserung der Lebensqualität ist das Hauptziel in der Betreuung dieser Patienten. Die Lebensqualität eines Patienten objektiv zu erfassen ist schwierig, weil sie von jedem Patienten individuell definiert wird. Trotz dieser Problematik sind eine Reihe von Instrumenten zur Erfassung der individuellen Lebensqualität erstellt worden. Eines dieser Instrumente ist die „Palliative Care Outcome Scale” (POS), die 1999 von der Palliative Care Core Audit Project Advisory Group entwickelt wurde und an acht Zentren für Palliativmedizin innerhalb Großbritanniens validiert wurde. Patienten und Methoden: In diese Arbeit gingen Daten von insgesamt 71 Patienten ein, die mithilfe der POS ihre Lebensqualität bewertet haben. Die Patienten stammten aus unterschiedlichen palliativmedizinischen Versorgungsformen in Edinburgh, zum einem aus dem Tageshospiz des St. Columba's Hospiz (43 Krebspatienten) und zum anderen aus der häuslichen Primärversorgung einer Allgemeinarztpraxis (14 Lungenkrebspatienten und 14 Herzinsuffizienzpatienten). Die Patientendaten wurden gesammelt und in einer Datenbank (SPSS) verwaltet. Ergebnisse: In der statistischen Analyse fanden sich Unterschiede in der Auswertung einzelner Fragen zwischen den verschiedenen palliativmedizinischen Versorgungsformen. Dazu zählten die Fragen nach der Angst der Patienten, der Sorge der Angehörigen um die Patienten sowie die Einschätzung der Patienten ein lebenswertes Leben zu führen. Darüber hinaus unterschied sich die Liste der Beschwerden, durch die die Patienten in der letzten Zeit beeinträchtigt wurden, sowohl in den unterschiedlichen Einrichtungen als auch unter den Patienten mit malignen und nicht malignen Erkrankungen. Statistisch relevante Unterschiede im Design und in der Anwendung der Fragebogen in den verschiedenen Versorgungsformen wurden analysiert und berücksichtigt. Aufgrund der geringen Patientenzahl und einer ungleichen Patientenverteilung ist jedoch eine vorsichtige Bewertung der Ergebnisse notwendig. Schlussfolgerungen: Diese Studie zeigt Unterschiede auf zwischen Palliativpatienten in häuslicher Versorgung und Palliativpatienten, die ein Tageshospiz besuchen. In den verschiedenen Versorgungsformen innerhalb der Palliativmedizin ist die POS in der Lage, Unterschiede im Ergebnis der palliativmedizinischen Therapie sowie im Wohlbefinden der Patienten anzuzeigen.

Abstract

Background: Quality of life (QoL) is the main goal in palliative care as all patients are diagnosed with life-limiting diseases. Measuring QoL is difficult, as it must be individually defined by the patient. However, a number of measures are being developed to help evaluate individual care outcomes. The Palliative Care Outcome Scale (POS) is one such instrument, developed in 1999 by the Palliative Care Core Audit Project Advisory Group and validated in eight centers providing Palliative Care within the UK. Patients and methods: For the purpose of this project, data from 71 patients were available relating to this instrument used innovatively in two settings in Edinburgh: hospice day care (43 patients), and primary care research (28 patients). Questionnaire data from home care and day hospice patients were collected and entered into a database (SPSS). Results: Statistical analyses revealed differences between the various settings for POS items such as anxiety, worry expressed by the family and patient's attitude towards a worthwhile life. Moreover, the list of problems by which the patient was affected in the past differed not only between the settings but also between malignant and non-malignant diseases. Differences in design and measurement properties of the POS in home care and day hospice patients were analysed and evaluated. However, with only 71 participants and an unbalanced distribution of participants in this study, careful interpretation and evaluation of statistical results is important. A larger sample of patients and greater standardisation of assessments may permit the POS to clarify the relationship between quality of life in home care and day hospice settings. Conclusions: This study indicates that palliative care patients attending a day hospice differ in some points from palliative care patients treated in a home care environment. Within various palliative care settings, the POS is able to investigate differences in outcomes and patient's well being.

Schlüsselwörter

Palliative Care Outcome Scale (POS) - Lebensqualität - Tageshospiz - häusliche Versorgung - Krebspatienten - Herzinsuffizienzpatienten

Key words

Palliative Care Outcome Scale (POS) - quality of life (QoL) - day hospice - home care - cancer patients - heart failure patients

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Guido Lerzynski

Gudrunstraße 5

40764 Langenfeld

Email: lerzynsk@uni-duesseldorf.de

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