Gastroenterologische Palliativmedizin

Zusammenfassung

Die Palliativmedizin gewinnt in Deutschland aus gesellschaftlichen, medizinischen und ökonomischen Gründen zunehmend an Bedeutung. Durch die Gründung der Arbeitsgemeinschaft „Gastroenterologische Palliativmedizin” hat die DGVS 2007 dieser Entwicklung Rechnung getragen. Patienten mit gastrointestinalen Tumoren oder fortgeschrittenen nichtmalignen Lebererkrankungen stellen ein wichtiges Klientel dar. Ca. 80 % aller palliativmedizinischen Patienten haben gastrointestinale Symptome. Endoskopische Verfahren spielen in der Symptomlinderung eine wichtige Rolle. In dem folgenden Beitrag soll eine Standortbestimmung der gastroenterologischen Palliativmedizin versucht werden. Neben einer Begriffsklärung, einem kurzen geschichtlichen Abriss und den aktuellen gesetzlichen Rahmenbedingungen palliativmedizinischer Arbeit soll auf besondere Aspekte von Ethik, Entscheidungsfindung und Forschung in der Palliativmedizin eingegangen werden. Im Zusammenhang mit der aktuellen Datenlage zu palliativen endoskopischen Eingriffen soll deutlich werden, dass die Rolle des Gastroenterologen über die handwerkliche Durchführung dieser Maßnahmen hinausgeht. Er ist wichtiger Partner in der dialogischen Entscheidungsfindung mit dem Patienten und dem interdisziplinären Team. Am Beispiel eines deutschen Universitätsklinikums soll erläutert werden, wie palliativmedizinische Versorgungsstrukturen unter den Rahmenbedingungen einer universitären Akutklinik implementiert werden können.

Abstract

On consideration of current medical and socio-economical factors, palliative care is becoming an increasingly important aspect of modern medicine in Germany. The German Society for Digestive and Metabolic Disorders (DGVS) has taken this into account by founding the working group “Palliative Gastroenterology”. Patients with gastrointestinal malignancies or advanced non-malignant liver disease represent an important group that benefits from palliative care. Approximately 80 % of all palliative care patients suffer from gastrointestinal symptoms and endoscopic procedures performed by gastroenterologists play an important role in relieving symptoms such as obstruction. It is the object of this paper to evaluate the role of gastroenterologists in palliative medicine. It will give a brief definition, a historical review and the current legal background for palliative care in Germany and examine special aspects of ethics, decision making and research. Considering the current evidence on palliative endoscopic procedures this paper wants to establish the role of the gastroenterologist in palliative care far beyond the mere practicalities of endoscopy. The gastroenterologist is a crucial element of the interdisciplinary palliative care team and a partner to the patient in the process of decision-making. Finally, it is demonstrated how palliative care structures can be implemented in the setting of a university acute-care hospital.

Schlüsselwörter

Palliativmedizin - Gastroenterologie - universitäre Akutklinik

Key words

palliative medicine - gastroenterology - university acute-care hospital

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