Eychmüller Steffen
Palliativzentrum, Kantonsspital St.Gallen.
Ther Umsch. 2012 Feb;69(2):87-90. doi: 10.1024/0040-5930/a000256.
Assessment in Palliative Care is a broad field trying to integrate various dimensions from physical, psychological, social and spiritual problems and suffering. Medical diagnosis alone may not successfully reflect this multidimensional aspects, as it may be true for nursing diagnosis. In addition, any assessment procedures in palliative care needs a) to be performed in an interprofessional way, i.e. integrating various perspectives, b) to avoid additional burden for the patient, and c) to allow repetitive longitudinal follow up in order to assess the outcomes of interventions. Derived from WHO definition of Palliative Care from 2002 we developed at our centre the problem- rather than diagnosis based SENS-Model and started its clinical implementation. This new tool to structure narratives from patients may facilitate not only to prioritize the various problems, but also to define tasks and responsibilities within the team including the evaluation of the intended benefit. Apart, SENS may help to avoid medicalisation and focus on pathological rather then salutogenetic interpretation. By this, SENS may develop towards a first problem - based ";classification and assessment system" in palliative care, possibly valuable for other chronic diseases and its multidimensional problems, too.
姑息治疗中的评估是一个广泛的领域，旨在整合身体、心理、社会和精神问题及痛苦的各个维度。仅靠医学诊断可能无法成功反映这一多维度的情况，护理诊断可能也是如此。此外，姑息治疗中的任何评估程序都需要：a）以跨专业的方式进行，即整合各种观点；b）避免给患者增加额外负担；c）允许进行重复性的纵向随访，以便评估干预措施的效果。根据世界卫生组织2002年对姑息治疗的定义，我们在中心开发了基于问题而非诊断的SENS模型，并开始在临床中实施。这个用于构建患者叙述的新工具不仅可能有助于对各种问题进行优先级排序，还能明确团队内部的任务和职责，包括对预期益处的评估。此外，SENS可能有助于避免医学化，将重点放在病理而非健康成因的解释上。通过这种方式，SENS可能会发展成为姑息治疗中首个基于问题的“分类和评估系统”，这对其他慢性病及其多维度问题可能也有价值。
