Radbruch L, Ostgathe C, Elsner F, Nauck F, Bausewein C, Fuchs M, Lindena G, Neuwöhner K, Schulenberg D
Klinik für Palliativmedizin, Universitätsklinikum Aachen.
Schmerz. 2004 Jun;18(3):179-88. doi: 10.1007/s00482-003-0276-0.
Since 1996 a working group of palliative care physicians has been developing a core documentation for palliative facilities. The data on a total of 1304 patients were collected in 2001. Treatment in palliative care units was provided for 531 patients until their death (Pat-V), 604 patients could be discharged home, and 169 patients were transferred to other facilities (Pat-E). Infusion therapy, physical therapy, positioning and mobilization, together with counseling and social services were initiated in more than 30% of the patients, while specific measures such as ascites or pleura puncture were instituted in less than 10%. Chemotherapy, radiotherapy, immunotherapy, urinary catheter, physical therapy, mobilization, positioning, psychotherapy, and social services were documented more frequently in the Pat-E group than in the Pat-V group. Chemotherapy was started in only 35 patients and radiotherapy in only 31 patients while they were in the palliative care unit. Parenteral nutrition, infusion therapy, wound management, and counseling were documented more frequently in the Pat-V group. Advanced directives were available for 9,9% of the patients omission or discontinuation of therapies was documented for 28,1%. Specific indications for the quality of palliative care provided could not be identified with the documentation instruments applied. The core documentation does however furnish data from a representative sample of in-patient palliative care in Germany, which can be used as a comparative data pool for other studies and quality assurance measures.
自1996年以来,一个姑息治疗医生工作小组一直在为姑息治疗机构制定核心文档。2001年收集了总共1304例患者的数据。531例患者在姑息治疗病房接受治疗直至死亡(Pat-V),604例患者可以出院回家,169例患者被转至其他机构(Pat-E)。超过30%的患者开始接受输液治疗、物理治疗、体位摆放和活动,而腹水或胸腔穿刺等特定措施的实施率不到10%。与Pat-V组相比,Pat-E组记录化疗、放疗、免疫治疗、导尿、物理治疗、活动、体位摆放、心理治疗和社会服务的频率更高。在姑息治疗病房时,仅35例患者开始化疗,仅31例患者开始放疗。Pat-V组记录肠外营养、输液治疗、伤口处理和咨询的频率更高。9.9%的患者有生前预嘱,28.1%的患者记录了治疗的省略或中止。使用所应用的文档工具无法确定所提供姑息治疗质量的具体指征。然而,核心文档确实提供了来自德国住院姑息治疗代表性样本的数据,这些数据可作为其他研究和质量保证措施的比较数据库。