Simon S T, Pralong A, Welling U, Voltz R
Zentrum für Palliativmedizin, Uniklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland.
Centrum für Integrierte Onkologie (CIO), Köln/Bonn, Deutschland.
Internist (Berl). 2016 Oct;57(10):953-958. doi: 10.1007/s00108-016-0127-6.
In Germany the structures of generalized and specialized palliative care services have considerably increased over the last decade with respect to the number, quality and differentiation. The goal is to improve or to maintain the quality of life for patients with life-threatening illnesses.
The current structures of generalized and specialized palliative care services in Germany are presented.
The structures of healthcare services are presented primarily based on the S3 guidelines on palliative care for patients with incurable cancer. An extrapolation to all patients with incurable illnesses and limited life-expectancy has been carried out.
Palliative care in Germany can be differentiated into two sectors. Generalized palliative care provides care for patients with a low or moderately complex situation on general hospital and oncology wards, in long-term care facilities and in the domestic environment. Specialized palliative care services manage patients with a highly complex situation in palliative care units, by a palliative care support team in hospitals or in palliative medical day care centers and as outpatients in specialized outpatient palliative home care, in specialized palliative outpatient clinics or day care hospices. Inpatient hospices and the outpatient hospice services are overlapping sectors and can be assigned to both generalized and specialized palliative care.
Despite a good development in recent years, a nationwide and sufficient provision of palliative care services has still not been achieved and some services have hardly been developed, e. g. palliative outpatient clinics. Hospital palliative care support teams should soon be available in all hospitals caring for patients with life-threatening illnesses, due to the requirements of the Hospice and Palliative Care Act from 2015.
在德国，过去十年中，姑息治疗服务的综合和专科结构在数量、质量和差异化方面都有了显著增长。目标是改善或维持危及生命疾病患者的生活质量。
介绍德国当前姑息治疗服务的综合和专科结构。
医疗服务结构主要依据针对无法治愈癌症患者的姑息治疗S3指南呈现。已对所有无法治愈疾病且预期寿命有限的患者进行了推断。
德国的姑息治疗可分为两个部门。综合姑息治疗为综合医院和肿瘤病房、长期护理机构及家庭环境中情况简单或中等复杂的患者提供护理。专科姑息治疗服务在姑息治疗病房、医院的姑息治疗支持团队、姑息医疗日间护理中心以及专科姑息家庭护理门诊、专科姑息门诊或日间护理临终关怀机构中，管理情况高度复杂的患者。住院临终关怀和门诊临终关怀服务是重叠部门，可归为综合和专科姑息治疗。
尽管近年来发展良好，但仍未实现全国范围内充分提供姑息治疗服务的目标，一些服务几乎未得到发展，例如姑息门诊。根据2015年《临终关怀和姑息治疗法》的要求，医院姑息治疗支持团队应尽快在所有照料危及生命疾病患者的医院中配备。
