Eine retrospektive Studie über den Einfluss einer Notfallinformation auf den Sterbeort von Palliativpatienten

A retrospective study about the influence of an emergency information form on the place of death of palliative care patients

Zusammenfassung

In der Palliativmedizin ist eine vorherschauende Planung wichtig, auch um sinnvolle und vom Patienten und seinen Angehörigen gewünschte Entscheidungen über den Transfer in Krisensituationen sowie ein mögliches Versterben zu Hause zu treffen.

In der vorliegenden Arbeit wurde die Wirkung einer neu implementierten Notfallinformation auf den Sterbeort untersucht. Diese Notfallinformation ermöglichte vorab einen Wunsch hinsichtlich des Transfers in einer Krisensituation festzuhalten und dem Notfallsystem mitzuteilen.

Insgesamt wurden 858 vom mobilen Palliativteam Hartberg/Weiz/Vorau im Zeitraum 2010 bis 2015 betreute Palliativpatienten in die Studie eingeschlossen. Die Interventionsgruppe, für die eine Notfallinformation errichtet wurde, umfasste 38 Patienten. Die Datenauswertung erfolgte retrospektiv, pseudoanonymisiert und extern.

Die 4 wichtigsten Ergebnisse waren:

1) Die Notfallinformation erhöhte die Wahrscheinlichkeit für die Interventionsgruppe zu Hause zu versterben deutlich (Interventionsgruppe: 72,2 %, Kontrollgruppe 1: 53,0 %, Kontrollgruppe 2: 56,6 %).

2) Wesentlich bei dieser Änderung war die Berücksichtigung des Patientenwillens. Die in der Notfallinformation getroffene Entscheidung hinsichtlich des Transports korrelierte hoch signifikant (p = 0,01) mit dem tatsächlichen Sterbeort.

3) Die Notfallinformation war ein sinnvolles Steuerungsinstrument für die Auslastung von Spezialeinrichtungen, da innerhalb der Interventionsgruppe junge Patienten (mit eher großer Symptomenlast) häufiger in einer Spezialeinrichtung (=Palliativstation) und alte (eher geriatrische) Patienten in einem allgemeinen Krankenhaus verstarben.

4) Es ließ sich kein signifikanter Zusammenhang zwischen der Betreuungsdauer und der Wahrscheinlichkeit, dass eine Notfallinformation verfasst wurde, nachweisen (p = 0,63). Allerdings bestand eine hohe Signifikanz zwischen der Anzahl der Hausbesuche und der Wahrscheinlichkeit, dass eine Notfallinformation errichtet wurde (p = 0,02).

Bei insgesamt kleiner Interventionsgruppe, die auf ein einziges Palliativteam begrenzt war, könnten sich aus weiteren Studien konkrete Handlungsanweisungen für die Arbeitsweise von mobilen Palliativteams hinsichtlich Umfang, Dauer und Frequenz von Hausbesuchen ergeben. So könnte der Begriff der „Betreuungskontinuität“ in den Leitlinien konkretisiert werden. Die vorliegende Studie selbst erbrachte Hinweise, dass häufigere (und kurze) Hausbesuche besser geeignet waren, um den Patientenwunsch hinsichtlich seines Sterbeorts umzusetzen, als längere aber seltene Patientenkontakte.

Summary

In palliative medicine planning in advance is important for critical care situations. It is highly significant to make useful and by the patient and his relatives desired decisions. These concern transport in a situation of crisis and the venue of death (either death at home or transfer to a hospital).

In this study the effect of a new Emergency Information Form about the place of death was examined. The used Emergency Information Form enabled the patient to express a wish on transfer in the case of crisis in advance and communicate this wish to the Emergency system.

A total of 858 patients, taken care of by the mobile palliative-team Hartberg/Weiz/Vorau in the period from 2010 to 2015, were included in the study. The Intervention group—the patients for whom an Emergency Information Form was established—counted 38 patients. Data analysis was retrospective, pseudo anonymized and external.

The 4 most important results were:

1) The Emergency Information Form increased the probability for the intervention group to die at home (intervention group: 72.2%, controll group 1: 53.0%, controll group 2: 56.6%).

2) Important in this change was, that the opinion of the patients was considered. The decision made in the Emergency Information Form correlated with a high significance (p = 0.01) with the actual place of death.

3) Furthermore, it came clear that the Emergency Information Form was a useful tool to handle the utilization of special facilities. Within the intervention group young patients (with a lot of symptoms) died in a special facility more often than old patients. These, rather geriatric people, were mostly brought to a general hospital.

4) There was no significant relation between the duration of care and the probability that an Emergency Information Form was established (p = 0.63). However, there was a high significance between the number of home visits and the probability that an Emergency Information Form was written (p = 0.02).

Due to the fact that there was a small intervention group restricted to only one palliative team further studies could help to make clear advises for palliative teams regarding scope, duration and frequency of home-visits. Thus the term “care continuity” could be concretized in the guidelines.

The study brought forward that numerous (and short) contacts with the patient were more convenient than less but long home-visits in order to fulfil the patients wish concerning his place of death.

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Correspondence to Mag. rer. nat. Mag. phil. Dr. med. univ. Günter Polt MSc.

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G. Polt, D. Weixler und N. Bauer geben an, dass kein Interessenkonflikt besteht.

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Any underlying research materials related to the paper (for example data, samples or models) can be accessed by corresponding the author.

This manuscript describes original work and is not under consideration by any other journal. All authors approved the manuscript and this submission. The study is supported by the ethics committee of the Medical University of Graz.

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Polt, G., Weixler, D. & Bauer, N. Eine retrospektive Studie über den Einfluss einer Notfallinformation auf den Sterbeort von Palliativpatienten. Wien Med Wochenschr 169, 356–363 (2019). https://doi.org/10.1007/s10354-019-0681-3

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Schlüsselwörter

  • Palliativmedizin
  • Sterbeort
  • Notfallinformation
  • Vorherschauende Planung
  • Betreuungskontinuität

Keywords

  • Palliative Care
  • Place of death
  • Emergency information form
  • Advance care planning
  • Continuity of care