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Erschienen in: Zeitschrift für Gerontologie und Geriatrie 3/2022

28.07.2021 | Original Contributions

Integrated renal-palliative care in Germany – Results from a survey on end of life care in a non-profit provider

verfasst von: Dr. med. Wolfgang Pommer

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 3/2022

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Abstract

Background

Palliative care-related problems in end-stage renal patients are similar to those of cancer patients. While the literature on renal palliative care is growing, real-world data on practice patterns of an integrated palliative care approach (IPCA) in Germany are lacking.

Method

An anonymous survey of end of life care (ELC; conservative treatment, dialysis withdrawal, decision making) was mailed to head physicians of adult renal centers (N = 198) including 13 structured questions and 1 open question for more detailed information on the current state of ELC. A free text analysis of the quality of established care and further requirements was provided.

Results

Responses were received from 122 centers (62%) with 14,197 dialysis and 159,652 renal outpatients. Of the 122 centers 86 provided detailed responses to the open question and 4 different thematic patterns could be identified: centers with successfully established ELC (N = 17, 20%, group 1), those where intensified training and education were required (N = 19, 22%, group 2), centers which required structural improvement to establish IPCA (N = 39, 45%, group 3) and those which did not require further supportive measures (N = 11, 13%, group 4). Physician’s age, sex, years of working in renal medicine, center size, and proportion of dialysis withdrawal and conservative treatment were not significantly different between the groups.

Conclusion

Despite equal general conditions, only 20% reported successfully established IPCA. Two out of three centers requested specific measures to establish or improve palliative care. Implementation of IPCA is hampered by educational and structural constraints. These real-world data suggest that structural determinants and soft skills (e.g. team motivation, leadership) can influence ICPA.
Fußnoten
1
von Gersdorff G, Schaller M. QiN-dialysis registry of KfH (personal communication).
 
Literatur
1.
Zurück zum Zitat Alexander S (1962) They decide who lives, who dies. Life Mag 9:102 Alexander S (1962) They decide who lives, who dies. Life Mag 9:102
3.
Zurück zum Zitat Dharmarajan TS, Kaul N, Russell RO (2004) Dialysis in the old: a centenarian nursing home resident with end-stage renal disease. J Am Med Dir Assoc 5:186–191 CrossRefPubMed Dharmarajan TS, Kaul N, Russell RO (2004) Dialysis in the old: a centenarian nursing home resident with end-stage renal disease. J Am Med Dir Assoc 5:186–191 CrossRefPubMed
4.
Zurück zum Zitat Litjens EJR, Mulder WJ, Peppelenbosch NG, Cornelis T (2016) Peritoneal dialysis in centenarian patients: no age limitation? J Vas Access 17(Suppl 1):S53–S55 CrossRef Litjens EJR, Mulder WJ, Peppelenbosch NG, Cornelis T (2016) Peritoneal dialysis in centenarian patients: no age limitation? J Vas Access 17(Suppl 1):S53–S55 CrossRef
5.
Zurück zum Zitat Moens K, Higginson IJ, Harding R (2014) Are there differences in the prevalence of palliative-care related problems in people with advanced cancer and eight non-cancer conditions? A systematic review. J Pain Symptom Manage 48:660–677 CrossRefPubMed Moens K, Higginson IJ, Harding R (2014) Are there differences in the prevalence of palliative-care related problems in people with advanced cancer and eight non-cancer conditions? A systematic review. J Pain Symptom Manage 48:660–677 CrossRefPubMed
6.
Zurück zum Zitat Kelly AS, Morrison RS (2015) Palliative care for the seriously ill. N Engl J Med 373:747–755 CrossRef Kelly AS, Morrison RS (2015) Palliative care for the seriously ill. N Engl J Med 373:747–755 CrossRef
7.
Zurück zum Zitat Quill TE, Abernethy AP (2013) Generalist plus specialist palliative care—creating a more sustainable model. N Engl J Med 368:1173–1174 CrossRefPubMed Quill TE, Abernethy AP (2013) Generalist plus specialist palliative care—creating a more sustainable model. N Engl J Med 368:1173–1174 CrossRefPubMed
8.
Zurück zum Zitat Kurella Tamura M, Cohen LM (2010) Should there be an expanded role for palliative care in end-stage renal disease? Curr Opin Nephrol Hypertens 19:556–560 CrossRefPubMed Kurella Tamura M, Cohen LM (2010) Should there be an expanded role for palliative care in end-stage renal disease? Curr Opin Nephrol Hypertens 19:556–560 CrossRefPubMed
9.
Zurück zum Zitat van de Luijtgaarden MWM, Noordzij M, van Biesen W et al (2013) Conservative care in Europe—nephrologists’ experience with the decision not to start renal replacement therapy. Nephrol Dial Transplant 28:2604–2612 CrossRefPubMed van de Luijtgaarden MWM, Noordzij M, van Biesen W et al (2013) Conservative care in Europe—nephrologists’ experience with the decision not to start renal replacement therapy. Nephrol Dial Transplant 28:2604–2612 CrossRefPubMed
20.
Zurück zum Zitat Swidler MA (2012) Geriatric palliative care. Gerontol A Biol Sci Med Sci 67:1400–1409 CrossRef Swidler MA (2012) Geriatric palliative care. Gerontol A Biol Sci Med Sci 67:1400–1409 CrossRef
21.
Zurück zum Zitat Schell JO, Cohen RA, Green JA et al (2018) NephroTalk: Evaluation of a palliative care communication curriculum for nephrology fellows. J Pain Symptom Manage 56:767–773 CrossRefPubMed Schell JO, Cohen RA, Green JA et al (2018) NephroTalk: Evaluation of a palliative care communication curriculum for nephrology fellows. J Pain Symptom Manage 56:767–773 CrossRefPubMed
22.
Zurück zum Zitat Brown E, Chambers EJ, Eggeling C (2007) End of life care in nephrology. From advanced disease to bereavement. Oxford University Press, Oxford CrossRef Brown E, Chambers EJ, Eggeling C (2007) End of life care in nephrology. From advanced disease to bereavement. Oxford University Press, Oxford CrossRef
23.
24.
Zurück zum Zitat Ladin K, Pandya R, Perrone RD et al (2018) Characterizing approaches to dialysis decision making with older adults. Clin J Am Soc Med 13:1188–1196 Ladin K, Pandya R, Perrone RD et al (2018) Characterizing approaches to dialysis decision making with older adults. Clin J Am Soc Med 13:1188–1196
Metadaten
Titel
Integrated renal-palliative care in Germany – Results from a survey on end of life care in a non-profit provider
verfasst von
Dr. med. Wolfgang Pommer
Publikationsdatum
28.07.2021
Verlag
Springer Medizin
Erschienen in
Zeitschrift für Gerontologie und Geriatrie / Ausgabe 3/2022
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-021-01946-z