Orient palliative care to the patient
22.02.2018 17:33
The topic of patient orientation at the end of life concerns doctors, nursing staff and patients alike. In order to meet the needs and wishes of cancer patients, structural changes are necessary - both in palliative care and in oncological care. Experts came to this conclusion at a press conference on the occasion of the German Cancer Congress in Berlin.
Most terminally ill people wish they could die at home without pain and in dignity. However, studies show that patients are more likely to be overtreated at the end of their lives and that their wish to die at home is often not taken into account, says Prof. Birgitt van Oorschot, a palliative care physician from Würzburg. The decision about which treatments should be carried out at the end of life is usually made very late, in the last week before death. There is hardly any time left for comprehensive “advanced care planning”.
The causes are manifold. Many patients are ambivalent at the end of life, explained Dr. Bernd Oliver Maier, Vice President of the German Society for Palliative Medicine: The desire for life-prolonging measures meets the need to deal with the approaching end. “Both are authentic, but make treatment decisions at the end of life complex. Our care structures are not equipped for this.” It is therefore important to include palliative medicine at an early stage in the care of terminally ill patients and an assessment that records a patient’s individual palliative care and oncological care needs in order to be able to optimally support him in decision-making and therapy planning.
The lack of nursing staff is also having a negative impact in this context. The need for additional nursing staff in the hospital alone is estimated at at least 70,000. From 2019 there will be binding minimum nursing staff limits in care-sensitive areas. But the term “care-sensitive” is problematic, complained Torsten Rantzsch, nursing director at the University Hospital Düsseldorf: “Care must be based on the needs of the patient. Minimum staffing levels that assume that the care needs of all patients are the same will not improve the nursing shortage.
This applies particularly to oncological patients - at the end of life, the amount of care required increases, both in the inpatient and outpatient sectors, confirmed Kerstin Paradies, board spokeswoman for the Conference on Oncological Nursing and Pediatric Nursing in the German Cancer Society. It's not just about basic care; specialist knowledge in dealing with side effects, supportive measures and sensitive communication is required. Oncology specialist nurses are qualified for these tasks through two years of additional training.
However, due to the nursing shortage and for economic reasons, they are often not used for the tasks for which they are actually trained. Paradies: “We need new forms of division of labor in care that are based on the needs of patients. Oncological nursing can and would like to take on more responsibility here, but it is reaching the limits of the system,” says Paradies. In many health systems abroad, such as in Scandinavia, nursing staff are entitled to take on more extensive competencies than in Germany. There, nursing is an academic profession with a higher status than in Germany.