Zusammenarbeit von Intensivmedizin und Palliativmedizin

Berendt, Julia; Ostgathe, Christoph; Simon, Steffen T.; Tewes, Mitra; Schlieper, Daniel; Schallenburger, Manuela; Meier, Stefan; Gahr, Susanne; Schwartz, Jacqueline; Neukirchen, Martin

doi:10.1007/s00063-020-00712-0

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…Such underlying diseases may facilitate the involvement of sPC. Here the tasks of palliative care lie in recovery and maintenance of quality of life [ 5 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Triggers of intensive care patients with palliative care needs from nurses’ perspective: a mixed methods study

Schallenburger,

Schwartz,

Icks

et al. 2024

Crit Care

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Purpose Triggers have been developed internationally to identify intensive care patients with palliative care needs. Due to their work, nurses are close to the patient and their perspective should therefore be included. In this study, potential triggers were first identified and then a questionnaire was developed to analyse their acceptance among German intensive care nurses. Methods For the qualitative part of this mixed methods study, focus groups were conducted with intensive care nurses from different disciplines (surgery, neurosurgery, internal medicine), which were selected by convenience. Data were analysed using the “content-structuring content analysis” according to Kuckartz. For the quantitative study part, the thus identified triggers formed the basis for questionnaire items. The questionnaire was tested for comprehensibility in cognitive pretests and for feasibility in a pilot survey. Results In the qualitative part six focus groups were conducted at four university hospitals. From the data four main categories (prognosis, interprofessional cooperation, relatives, patients) with three to 15 subcategories each could be identified. The nurses described situations requiring palliative care consults that related to the severity of the disease, the therapeutic course, communication within the team and between team and patient/relatives, and typical characteristics of patients and relatives. In addition, a professional conflict between nurses and physicians emerged. The questionnaire, which was developed after six cognitive interviews, consists of 32 items plus one open question. The pilot had a response rate of 76.7% (23/30), whereby 30 triggers were accepted with an agreement of ≥ 50%. Conclusion Intensive care nurses see various triggers, with interprofessional collaboration and the patient's prognosis playing a major role. The questionnaire can be used for further surveys, e.g. interprofessional triggers could be developed.

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“…Such underlying diseases may facilitate the involvement of sPC. Here the tasks of palliative care lie in recovery and maintenance of quality of life [ 5 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Triggers of intensive care patients with palliative care needs from nurses’ perspective: a mixed methods study

Schallenburger,

Schwartz,

Icks

et al. 2024

Crit Care

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“…This makes it clear that interdisciplinary collaboration between intensive medicine and palliative medicine needed to be improved in the study center. A descriptive study from Germany conducted at 16 Comprehensive Cancer Centres (CCC) showed that cooperation between intensive care and palliative care is not only a local but also an overarching problem (49). In 2016, the median of intensive care patients with palliative care consultations was 33 (minimum 0, maximum 100), only nine patients (median) were transferred from an intensive care unit to a palliative care unit (minimum 1, maximum 30).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of therapeutic and diagnostic procedures in the last 14 days of life in hospital patients: a single-center observational study from Germany

Dasch¹,

Zahn²

2021

Ann Palliat Med

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Background: The opportunities available for maintaining and prolonging life in modern medicine give rise to medical-ethical dilemmas in patients at the end of life, raising the question of whether intensified treatment and diagnosis is appropriate in these patients. This affects hospital patients in particular.Methods: This single-center cross-sectional study from Germany analyzed hospital records of all deceased patients of a university hospital who died between October 2016 and September 2017. The prevalence of therapeutic and diagnostic procedures during the last 14 days before death was determined. In-hospital transfer practices shortly before patients' deaths were also examined.Results: A total of 468 hospital patients died. The mean age at death was 76.3±13.7 years; 47.0% [220] were female; 12.0% [56] died on the day of hospital admission, 41.9% [196] 1 to 6 days and 46.1% [216] more than 6 days later; the case mix index (CMI) was 4.6. The majority of patients {57.1% [267]} died on intensive care unit (ICU). Therapeutic and diagnostic procedures within the last 14 days before death: 30.3% [142] resuscitation, 28.6% [134] surgery, 10.9% [51] extracorporeal membrane oxygenation (ECMO), 23.7% [111] renal replacement therapy, 4.3% [20] tracheostomy, 2.8% [13] PTCA/cardiac stenting, 1.9% [9] chemotherapy, 29.3% [137] transfusion of packed red blood cells, 13.7% [64] transfusion of prothrombin complex concentrate, 5.3% [25] cardiac catheter examination, 7.5% [35] upper gastrointestinal endoscopy, 79.1% [370] chest X-ray, 41.9% [196] computed tomography. In-hospital transfer from ICU to PCU before patients' death: 1.5% (4/274 ICU patients).Conclusions: Intensified therapeutic and diagnostic procedures are often performed at the end of life in hospital patients. Closer interdisciplinary cooperation between intensive care and palliative care would be beneficial to improve in-patient care for these patients.

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“…In den letzten Jahren widmeten sich einige Publikationen der Überversorgung und Therapiebegrenzung in der Intensivmedizin [ 18 , 22 ] und erhöhten hier womöglich das Bewusstsein für die Sinnhaftigkeit der Integration palliativmedizinischer Aspekte in die Intensivmedizin [ 3 , 5 , 8 , 18 , 19 , 21 – 23 ]. Der Wechsel von einem kurativen zu einem palliativen Konzept bzw.…”

Section: Hinführung Zum Themaunclassified

Transition from intensive care to palliative care

Lustig,

Elsner,

Krumm

et al. 2023

Anaesthesiologie

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Zusammenfassung Hintergrund Die Verlegung von Patient:innen der Intensivstation (ITS) auf die Palliativstation (PTS) geht meist mit der Festlegung eines palliativen Konzeptes einher. Die Anpassung der Therapieziele mit primärem Fokus auf Lebensqualität und Symptomkontrolle kann für medizinisches Personal, Patient:innen und Angehörige herausfordernd sein. Beschreibungen dieser Transition sind jedoch rar. Fragestellung Ziel der Studie war die Charakterisierung der von den intensivmedizinischen Stationen gestellten Konsile an die Palliativmedizin sowie der Patient:innen durch Beschreibung der Versorgungspfade und Interventionen. Methode Retrospektive, quantitative Analyse aller im Jahr 2019 intensivmedizinisch betreuten Patient:innen der Uniklinik RWTH Aachen, für die ein palliativmedizinisches Konsil angefordert worden war. Ergebnisse Es wurden n = 102 Konsilanfragen der ITS an die Palliativmedizin ausgewertet. Fünf von 32 (16 %) auf die PTS übernommenen Konsilpatient:innen bzw. 35 (34 %) aller 102 Patient:innen konnten in das häusliche Umfeld oder eine stationäre Einrichtung (Pflegeheim, Hospiz, andere) entlassen werden. Die häufigsten Gründe einer Nichtübernahme waren: fehlende Kapazität der PTS (33 %), Versterben auf der Warteliste (20 %) und Ablehnung durch die Patient:innen (20 %). Die durch die Intensivmediziner:innen angefragten konsiliarischen Leistungen „Symptomkontrolle“ (χ2 = 10,17; p < 0,05) und „Beratung“ (χ2 = 12,82; p < 0,001) zeigten einen signifikanten Zusammenhang mit der jeweils durch die Palliativmediziner:innen durchgeführten Intervention. Schlussfolgerung Der Bedarf palliativmedizinischer Unterstützung der ITS überstieg die Aufnahmekapazität der PTS. Zukünftige Studien sollten Versorgungsmodelle palliativmedizinischer Unterstützung in der Intensivmedizin näher untersuchen.

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Zusammenarbeit von Intensivmedizin und Palliativmedizin

Cited by 4 publications

References 28 publications

Triggers of intensive care patients with palliative care needs from nurses’ perspective: a mixed methods study

Triggers of intensive care patients with palliative care needs from nurses’ perspective: a mixed methods study

Prevalence of therapeutic and diagnostic procedures in the last 14 days of life in hospital patients: a single-center observational study from Germany

Transition from intensive care to palliative care

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