Schneider Nils, Schwartz Friedrich Wilhelm
Medizinische Hochschule Hannover, Abteilung für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Carl-Neuberg-Strasse 1, 30627 Hannover.
Med Klin (Munich). 2006 Jul 15;101(7):552-7. doi: 10.1007/s00063-006-1077-x.
The health care for patients with incurable, advanced diseases is increasingly attended to in Germany. Among other things, this is enforced by the debate on euthanasia and by the criticism of the inadequate structure of services and processes of care. The palliative care approach refers to cancer as well as to non-cancer patients; due to demographic changes, it becomes more and more important for an increasing number of old and very old patients with particular complex needs (e. g., caused by multimorbidity, dementia and chronic pain). Therefore, the need for improving palliative care is immense. However, the statements on the current situation and the recommendations for improvement are based only slightly on valid scientific data. This article (written from the perspective of health services research) provides an overview on the topic with particular respect to the structure of specialized palliative care services (such as palliative care teams and palliative care units) and to the political framework. Open questions on diverse levels are picked out as a central theme, and the need for interdisciplinary, application-oriented research is pointed out.
在德国,针对身患不治之症的晚期患者的医疗保健正日益受到关注。这在一定程度上是由关于安乐死的辩论以及对护理服务和流程结构不完善的批评所推动的。姑息治疗方法适用于癌症患者以及非癌症患者;由于人口结构的变化,对于越来越多有特殊复杂需求(例如由多种疾病、痴呆症和慢性疼痛引起)的老年和高龄患者而言,姑息治疗变得越来越重要。因此,改善姑息治疗的需求极为迫切。然而,关于当前状况的陈述以及改进建议仅在很小程度上基于有效的科学数据。本文(从卫生服务研究的角度撰写)对该主题进行了概述,特别关注了专业姑息治疗服务的结构(如姑息治疗团队和姑息治疗病房)以及政治框架。将不同层面的开放性问题作为核心主题提出,并指出了开展跨学科、应用型研究的必要性。