Der Klinikarzt 2013; 42(12): 564-569
DOI: 10.1055/s-0034-1368112
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Begleitung am Lebensende – Konzept einer haus- und palliativärztlichen ambulanten Betreuung

End of life care – A concept for home and palliative outpatient management
Alfons Gersmann
1  Palliativärztlicher Konsiliardienst Dortmund, Dortmund
› Author Affiliations
Further Information

Publication History

Publication Date:
20 January 2014 (online)

Zusammenfassung

Begleitung der Menschen mit unheilbaren Krankheiten an deren Lebensende, Behandlung der krankheitsbedingten Symptome, Bearbeitung ethischer Fragestellungen bei der Gestaltung des Lebensendes und Lösung psychosozialer Probleme – das sind Aufgaben der Palliativmedizin. Die Strukturen der ambulanten Palliativversorgung mit einem Palliativmedizinischen Konsiliardienst (PKD) ermöglichen in Westfalen-Lippe diese Arbeit, die in 30 Palliativnetzen regional in Kooperation mit vorhandenen Einrichtungen gestaltet wird. Die Palliativnetze gewährleisten die erforderliche Begleitung und die palliativmedizinische Behandlung der Patienten – überwiegend mit Krebserkrankungen, aber auch mit internistischen und neurologischen Erkrankungen im Endstadium. Am Beispiel des PKD Dortmund wird die Organisation der palliativen Betreuung beschrieben.

Summary

When there is no cure for an illness our attention turns to treating the unpleasant symptoms that our patients experience. This involves a broad spectrum of care with the terminal care often being called hospice and palliative care.

The primary focus is controlling the patient's symptoms such as pain and shortness of breath. We also address ethical questions while dealing with psychosocial problems. This work is possible because of the cooperative structures of palliative care with their palliative care teams [Palliativer Konsiliardienst (PKD)]. There are 30 regionally organized palliative nets. The situation in Dortmund provides an example for these structures.

The palliative nets provide the necessary support and palliative care for the patients. Most patients predominantly suffer from late stage malignancies. Those patients with other terminal medical diseases, such as chronic heart failure, end stage renal disease, cirrhosis, COPD and stroke, benefit tremendously when their symptoms are addressed. People can choose to die at home surrounded by those they love when the patient and family receive this type of palliative support. The established structures support general palliative care and enable a specialized ambulant palliative care. Ethical questions are resolved together with the patient, their caregivers and the palliative team. Informed decisions are made to discontinue certain treatments or to waive life-prolonging procedures. Hospital admissions are minimized in this way.