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Überbringen schlechter Nachrichten – eine Herausforderung für jeden Arzt

Breaking bad news—a challenge for every physician

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Zusammenfassung

Das Überbringen schlechter Nachrichten ist eine der wichtigsten Aufgaben und eine der größten Herausforderungen im ärztlichen Berufsalltag. Nicht selten steht ein solches Gespräch am Anfang einer Arzt-Patienten-Beziehung und bestimmt deren weiteren Verlauf. Auf Intensivstationen und in Notfallsituationen findet die Interaktion meist mit Familienmitgliedern statt, die nicht nur mit der Verantwortung, für ihre Angehörigen Entscheidungen treffen zu müssen, sondern auch mit ihren eigenen Belastungen und Ängsten belastet sind. Nachweislich können durch eine gute Kommunikation die Krankheitsbewältigung der Patienten und ihre Compliance sowie die Entscheidungsfähigkeit Angehöriger von Schwerstkranken verbessert werden. Besondere Schwierigkeiten liegen darin, dass der Arzt sein Gegenüber und dessen soziales Umfeld häufig kaum oder gar nicht kennt, nicht einschätzen kann, wie Patient oder Angehörige auf die negative Botschaft reagieren und mit der Erwartungshaltung konfrontiert ist, als Arzt zu heilen. Trotz meist ungenügender zeitlicher Ressourcen soll ein Vertrauensverhältnis aufgebaut werden, um gemeinsam Therapieentscheidungen zu treffen.

Abstract

Breaking bad news is one of the most important and challenging physician’s duties in routine daily work. It is not unusual that such dialogues take place at the very beginning of a doctor-patient relationship and positively or negatively influence the further course. In cases of critically ill patients or in emergency situations clinicians mostly interact with family members who have to cope with their own distress and with uncertainties of their loved one’s disease. It is well accepted that good communication can significantly improve coping with the disease and promote patient compliance as well as better fulfilling family needs. Particular difficulties are the often minimal or lacking information on the counterpart and the family network, the expectations of patients and their families and the inability to predict their reactions. It is always a challenge to honestly deliver bad news to a patient and relatives without destroying their hope. Despite often limited time resources a bond of trust should be built up and the patient should be empowered to participate in shared decision making.

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Schilling, G., Mehnert, A. Überbringen schlechter Nachrichten – eine Herausforderung für jeden Arzt. Med Klin Intensivmed Notfmed 109, 609–613 (2014). https://doi.org/10.1007/s00063-013-0250-2

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  • DOI: https://doi.org/10.1007/s00063-013-0250-2

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