Hausärztliche Palliativversorgung bei nichtonkologischen Patienten

Zusammenfassung

Hintergrund

Die meisten Patienten können in ihrer letzten Lebensphase im Rahmen der allgemeinen Palliativversorgung v. a. durch Hausärzte betreut werden. Dabei überwiegen – im Gegensatz zur spezialisierten Palliativmedizin – Patienten mit nichtonkologischen Erkrankungen.

Ziel der Arbeit

Basierend auf einer Literaturanalyse präsentiert dieser Beitrag aktuelle Themen der Forschungsliteratur zur hausärztlichen Versorgung dieser Patientengruppe am Lebensende.

Material und Methoden

Es erfolgten eine Literaturrecherche in den Datenbanken PubMed und Scopus für den Zeitraum 2008 bis 2013 sowie formale und inhaltsanalytische Auswertungen entlang der Kriterien des PRISMA-Statements.

Ergebnisse

Es wurden 127 Artikel in die inhaltliche Analyse und den finalen Review eingeschlossen. Vier thematische Schwerpunkte wurden herausgearbeitet: 1) spezifische Zielgruppen (z. B. hochaltrige Patienten, Patienten mit fortgeschrittener Herzinsuffizienz, Schmerzpatienten), 2) Zusammenarbeit von Hausärzten mit anderen Ärzten und Gesundheitsprofessionen, 3) palliativmedizinische Qualifizierung sowie 4) Betreuung von Palliativpatienten in der Praxis. Zum vierten Themenkomplex und insbesondere der Untergruppe „Barrieren und fördernde Aspekte der Palliativversorgung“ fanden sich die meisten Arbeiten. Eine zentrale Barriere besteht in einer ungenügenden Koordination der beteiligten Akteure. Förderlich ist eine frühzeitige, vorausschauende Versorgungsplanung, in der konkrete Aspekte einer späteren Palliativversorgung thematisiert werden.

Schlussfolgerungen

Die aktuelle Forschungsliteratur verdeutlicht die Wichtigkeit einer Optimierung von Versorgungsstrukturen und -prozessen sowie einer frühzeitigen Auseinandersetzung mit Themen des Lebensendes in der hausärztlichen Praxis. Hierfür ist eine strukturierte Identifikation des palliativen Versorgungsbedarfs unter Einsatz von geeigneten Erhebungsinstrumenten zielführend.

Abstract

Background

Most patients in the last phase of life can be treated in the context of generalist palliative care, especially by general practitioners. In contrast to specialized palliative care, non-cancer patients predominate in this setting.

Objective

The aim of this article is to review the literature and elaborate current topics for non-cancer patients at the end of life in primary palliative care.

Material and methods

A literature search was carried out in the databases PubMed and Scopus from 2008 to 2013 followed by a qualitative content analysis according to the PRISMA statement.

Results

A total of 127 articles could be included in the qualitative content analysis and the final review whereby four core topics were identified: (1) specific target groups (e.g. elderly patients, patients with advanced heart failure and pain), (2) collaboration of general practitioners with other physicians and health professions, (3) qualifications in palliative care and (4) provision of primary palliative care. Most articles found were related to the fourth topic and the subtopic of barriers and facilitators of palliative care. Insufficient coordination of the persons involved was a barrier often discussed. Advanced care planning including concrete aspects of palliative care at an early stage can be beneficial for both patients and professionals.

Conclusion

The current literature search elucidates the importance of optimizing the processes and structures in providing palliative care and the discussion of end of life issues at an early stage in general practice. Therefore, a structured identification of palliative care needs identified by appropriate assessment instruments is crucial.

Eingeschlossene Artikel

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