Breen Benedict Mathias, Flohr Claudia, Wendt Heike, Chalk Katharina, Haase Ulrike, Hartog Christiane, Tafelski Sascha
Zentrales Pflegecenter (ZPC), Palliativkonsildienst, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin, der Humboldt Universität zu Berlin und dem Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland.
Klinik für Anästhesiologie und Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Charité - Universitätsmedizin Berlin, Corporate Member der Freien Universität Berlin und Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
Med Klin Intensivmed Notfmed. 2025 Apr;120(3):222-229. doi: 10.1007/s00063-024-01149-5. Epub 2024 May 13.
The advance directive and lasting power of attorney are instruments to strengthen patients' autonomy. A hospital-based palliative care consultation service can advise patients and family members about these instruments. This study investigates the need for such consultation among patients with life-limiting illness.
This prospective observational study on intensive and non-intensive care units includes patients with a request for palliative care consultation. Patient-related factors were evaluated for their possible association with the presence or absence of advance directives or power of attorney. In addition, focus group interviews with members of the palliative care consultation team were carried out to identify barriers which prevent patients from drawing up such documents.
A total of 241 oncological and 53 non-oncological patients were included with a median age of 67 years; 69 (23%) patients were treated in the intensive care unit (ICU). Overall, 98 (33%) patients had advance directives, and 133 (45%) had determined a legal health care proxy in advance. A total of 52 patients died in hospital (17.7%). Only age and relationship status were associated with directives. In interviews, the following barriers were identified: information deficit, concern regarding discontinuation of treatment, loss of autonomy and wish to avoid a burden for the family.
The majority in this severely ill patient population lack advance directives. In order to remove barriers, more effective information and counseling is required about such directives. In particular, guidance should include potential clinical situations in which such directives are potentially beneficial.
预先医疗指示和持久授权书是增强患者自主权的工具。医院的姑息治疗咨询服务可为患者及其家属提供有关这些工具的建议。本研究调查了患有危及生命疾病的患者对这种咨询的需求。
这项针对重症监护病房和非重症监护病房的前瞻性观察性研究纳入了请求进行姑息治疗咨询的患者。评估了与预先医疗指示或授权书的有无可能相关的患者相关因素。此外，对姑息治疗咨询团队成员进行了焦点小组访谈，以确定阻碍患者起草此类文件的障碍。
总共纳入了241名肿瘤患者和53名非肿瘤患者，中位年龄为67岁；69名（23%）患者在重症监护病房（ICU）接受治疗。总体而言，98名（33%）患者有预先医疗指示，133名（45%）患者提前指定了法定医疗代理人。共有52名患者在医院死亡（17.7%）。只有年龄和婚姻状况与指示相关。在访谈中，确定了以下障碍：信息不足、对停止治疗的担忧、自主权丧失以及希望避免给家人带来负担。
在这群重症患者中，大多数人缺乏预先医疗指示。为了消除障碍，需要就此类指示提供更有效的信息和咨询。特别是，指导应包括此类指示可能有益的潜在临床情况。
