[Palliative medicine and inpatient palliative care unit--functions, organisation forms and significance of surgery].

About 160  palliative care units with 1228 beds or 15  beds / 1  million inhabitants were available in German hospitals in the year 2008. Demand analyses consider 35  beds / 1  million inhabitants as necessary. Whether the additional demand could be reduced by a greater use of home- and hospice-based end-of-life care is discussed. For general hospitals the establishment of an acute palliative care unit within a medical (oncology) ward is recommended due to costs, organisation facilities and attitudes of physicians toward referral. The establishment of an acute palliative care unit may be costly for the hospital, nevertheless, outpatient palliative medicine and hospices are a cost-effective health service from a socioeconomic point of view, avoiding unnecessary hospital admissions and freeing up hospital beds by early discharge. An analysis of consultants demonstrates a minor interest of surgeons in specialisation in palliative medicine. However, data suggest that prior experience in palliative care alters the selection of treatment recommendations by surgeons with respect to more supportive or aggressive interventions in patients with advanced cancer. Ethical decision-making regarding therapy and counselling of patients at the end of life and discussing the prognosis with patients and their families require education in palliative medicine. A core curriculum to teach palliative care for surgical residents therefore has been presented.