Zusammenfassung
Hintergrund
Wenn man an medizinische Grenzen stößt, sind Konflikte manchmal unvermeidbar. Die häufigsten Konflikte auf der Intensivstation treten zwischen dem medizinischen Team und den Angehörigen auf. Dabei sind insbesondere Therapieentscheidungen am Lebensende konfliktbeladen und stellen v. a. für Angehörige eine große Belastung dar.
Ziel
Die Studienlage soll dargestellt werden, zudem werden Handlungsempfehlungen zum Umgang mit potenziell konfliktbeladenen Entscheidungen auf der Intensivstation aufgezeigt.
Material und Methoden
Dieser Beitrag basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed.
Ergebnisse
Es liegen Studienergebnisse zu posttraumatischen Belastungsstörungen von Angehörigen vor, welche die Belastung von Angehörigen durch Konfliktsituationen aufzeigen. Es existieren Empfehlungen zur Haltung des Arztes, zum Gesprächsstil und anderen Kontextfaktoren in Gesprächen über Therapieentscheidungen. Studienergebnisse legen nahe, dass eine sich an diesen Empfehlungen orientierende Gesprächsführung die emotionalen Belastungen der Angehörigen reduziert. Klinische Ethikberatungen können Konflikte auf der Intensivstation vermeiden, haben keinen Einfluss auf die Mortalitätsrate, führen aber zu einer Verkürzung letztendlich frustraner lebenserhaltender Maßnahmen.
Schlussfolgerungen
Um Konfliktsituationen auf der Intensivstation zu vermeiden, ist eine zeitnahe, kongruente und empathische Gesprächsführung in einem angemessenen ruhigen Umfeld mit den Angehörigen essenziell. Zur Deeskalation bei Konflikten werden klinische Ethikberatungen empfohlen.
Abstract
Background
If medicine is coming close to its limits conflicts sometimes occur. Most conflicts in the intensive care unit (ICU) involve the medical team and patients’ relatives. In particular decisions about withholding and withdrawing life-sustaining therapy lead to conflicts. Decisions about limiting life-sustaining treatment are burdened by conflicts and put an enormous strain particularly on relatives.
Aim
Illustration of currently available studies and existing recommendations on how to manage potentially conflict-laden decision-finding discussions on the ICU are presented.
Material and methods
This article is based on a selective literature research in the PubMed database.
Results
Studies have been carried out to evaluate posttraumatic stress disorders in relatives who were involved in life-limiting treatment decisions. Conflicts on the ICU put an emotional strain on relatives. Evidence-based recommendations are available regarding physicians’ attitudes during discussions about therapy decisions, communication style and other contextual factors. Study results show that the emotional stress level relatives have to endure can be reduced if conversations between patients’ families and the clinical personnel were conducted according to these recommendations. The involvement of a clinical ethics committee can prevent conflicts and has been shown to have no impact on the mortality rate but does decrease the time life-sustaining measures were unsuccessfully pursued.
Conclusion
To prevent conflicts between the medical personnel and patients’ relatives on the ICU, a timely, congruent and empathic conversation style in an appropriate, quiet environment is essential. Consultation with clinical ethics committees is recommended to de-escalate disputes.
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M. Ratliff und J.-O. Neumann geben an, dass kein Interessenkonflikt besteht.
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Ratliff, M., Neumann, JO. Entscheidungskonflikte mit Angehörigen auf der Intensivstation. Med Klin Intensivmed Notfmed 111, 638–643 (2016). https://doi.org/10.1007/s00063-015-0109-9
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DOI: https://doi.org/10.1007/s00063-015-0109-9
Schlüsselwörter
- Therapiebegrenzungsentscheidung
- Religion
- Kommunikation
- Posttraumatische Belastungsstörungen
- Klinische Ethikberatung