Palliativmedizin bei nicht malignen Erkrankungen: Herzinsuffizienz, COPD, Leberversagen, terminale Niereninsuffizienz

 

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Zusammenfassung

Die komplexen, multidimensionalen Bedürfnisse von Patienten mit fortgeschrittenen nicht malignen Erkrankungen sind zunehmend in den Fokus der palliativmedizinischen Forschung geraten. Häufig übertrifft die Symptomlast diejenige von Krebspatienten. Eine palliative, symptomorientierte Versorgung ist jedoch für viele dieser Patienten wegen eines fehlenden Konsensus über den adäquaten Zeitpunkt der Integration von Palliativmedizin, sehr variabler Verläufe, Informationsdefiziten und prognoseorientierter Einschlusskriterien (z. B. in der stationären Hospizversorgung) schwerer zugänglich als für Patienten mit Krebserkrankungen. Im Folgenden werden klinische Verläufe, Indikatoren für eine spezialisierte palliative Versorgung und mögliche Therapieoptionen für die weit fortgeschrittene Phase der Erkrankung an den Beispielen der Herzinsuffizienz, der chronisch obstruktiven Lungenerkrankung (COPD) und der Leber- und Niereninsuffizienz dargestellt.

Abstract

The complex, multi-dimensional needs of patients with advanced non-malignant diseases have recently gained increasing attention by palliative care research. Symptom burden may be higher than that seen in cancer patients. However, for many of these patients, barriers to palliative care services are harder to overcome due to a missing consensus on when to initiate palliative care, widely variable disease trajectories, lack of information, and eligibility criteria linked to prognosis (as seen in some hospice services). In this review, clinical characteristics, indicators for specialized palliative care integration, and management strategies in far advanced stages of the diseases are outlined using the examples of cardiac failure, chronic obstructive pulmonary disease (COPD) and end-stage liver and kidney disease.

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