Skip to main content
SpringerLink
Log in

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

  • originalarbeit
  • Published:
Wiener Medizinische Wochenschrift Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. der Schmitten J, Rothärmel S, Rixen S, Marckmann G. beizeiten begleiten® – Gesundheitliche Vorausplanung (Advance Care Planing) in den Senioreneinrichtungen einer Modellregion: zukunftsträchtige Alternative zur traditionellen Patientenverfügung? In: Höfling W, Hrsg. Das neue Patientenverfügungsgesetz in der Praxis. Baden-Baden: Nomos; 2011. S. S81–121.

    Google Scholar 

  2. Hickman SE, Nelson CA, Perrin NA. A comparison of methods to communicate treatment preferences in nursing facilities: traditional practices versus the physician orders for life-sustaining treatment (POLST) program. J Am Geriatr Soc. 2010;58:1241–8.

    Article  PubMed Central  Google Scholar 

  3. Kretschmer B. Der „rote Umschlag“ für den Notarzt. Möglichkeiten und Chancen eines Notfallbogens als komprimierter Patientenverfügung im Rettungseinsatz. In: May AT, Hrsg. Passive Sterbehilfe: Besteht gesetzlicher Regelungsbedarf? Münster: LIT; 2002. S. S141–72.

    Google Scholar 

  4. Wiese Ch, Bartels U, Geyer A. Göttinger Palliativkrisenbogen: Verbesserung der notfallmedizinischen Versorgung von ambulanten Palliativpatienten.„Die Gelbe Karte für den Rettungsdienst“. Dtsch Med Wochenschr. 2008;133:972–6.

    Article  CAS  Google Scholar 

  5. Higginson IJ, Sen-Gupta GJ. Place of care in advanced cancer: a qualitative sastemic literature review of patient preferences. J Palliat Med. 2000;3(3):287–300.

    Article  CAS  Google Scholar 

  6. Boulton S, Smith C, Abel J. Quality end of life care for all (qelca) implementation and evaluation. BMJ Support Palliat Care. 2014;4(Suppl 1):A80–A1.

    Article  Google Scholar 

  7. Brogaard T, Neergaard MA, Sololowski I, Olesen F, Jensen AB. Congruence between preferred and actual place of care and death among Danish cancer patients. Palliat Med. 2013;27(2):155–64.

    Article  Google Scholar 

  8. Gomes B, Higginson IJ, Calanzani N, Cohen J, Deliens L, Daveson BA, Bechinger-English D, Bausewein C, Ferreira PL, Toscani F, Menaca A, Gysels M, Ceulemans L, Simon ST, Pasman HR, Albers G, Hall S, Murtagh FE, Haugen DF, Downing J, Koffman J, Pettenati F, Finetti S, Antunes B, Harding R. Preferences for place of death in faces with advances cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. Ann Oncol. 2012;23(8):2006–15.

    Article  CAS  Google Scholar 

  9. Neergaard MA, Jensen AB, Sondergaard J, Sokolowski I, Olesen F, Vedsted P. Preference for place-of-death among terminally ill cancer patients in Denmark. Scand J Caring Sci. 2011;25(4):627–36.

    Article  Google Scholar 

  10. Damanhuri G. What factors influence the terminally ill patient refferred to the hospital specialist palliative care team in a NHS hospital, not achieving their preferred place of death? A critical evaluation. BMJ Support Palliat Care. 2014;4(Suppl 1):A54–A5.

    Article  Google Scholar 

  11. Escobar Pinzon LC, Claus M, Zepf KI, Letzel S, Fischbeck S, Weber M. Preference for place of death in Germany. J Palliat Med. 2011;14(10):1097–103.

    Article  Google Scholar 

  12. Fukui S, Yoshiuchi K, Fujita J, Sawai M, Watanabe M. Japanese people’s preference for place of end-of-life care and death: a population-based nationwide survey. J Pain Symptom Manage. 2011;42(6):882–92.

    Article  Google Scholar 

  13. Billingham MJ, Billingham SJ. Congruence between preferred and actual place of death according to the presence of malignant or non-malignant disease: a systematic review and meta-analysis. BMJ Support Palliat Care. 2013;3(2):144–54.

    Article  Google Scholar 

  14. Than T, Adam Z, Wadhhwa P, Ayubi M. Deciding right: right care, right plan, right patient; an individualised approach to palliative care. BMJ Support Palliat Care. 2014;4(Suppl 1):A80–A1.

    Google Scholar 

  15. Pollock K, Caswell G, Harwood R, Porock D. Caring for frail or seriously ill older people dying on acute hospital wards. BMJ Support Palliat Care. 2014;4(Suppl 1):A20.

    Article  Google Scholar 

  16. Gomes B, Calanzani N, Gysels M, Hall S, Higginson IJ. Heterogeneity ans changes in preferences for dying at home: a systematic review. BMC Palliat Care. 2013;12:7.

    Article  PubMed Central  Google Scholar 

  17. Aoun SM, Skett K. A longitudinal study of end-of-life preferences of terminally-ill people who live alone. Health Soc Care Community. 2013;21(5):530–5.

    Article  Google Scholar 

  18. Barclay JS, Kuchibhatla M, Tulsky JA, Johnson KS. Association of hospice patients’ income and care level with place of death. JAMA Intern Med. 2013;173(6):450–6.

    Article  PubMed Central  Google Scholar 

  19. Neergaard MA, Jensen AB, Sokolowski I, Olesen F, Vedsted P. Socioeconomic position and place of death of cancer patients. BMJ Support Palliat Care. 2012;2(2):133–9.

    Article  Google Scholar 

  20. Alshemmari SH, Elbasmi AA, Alsirafy SA. The place of death of patients with cancer in Kuwait. BMJ Support Palliat Care. 2013;5(5):510. https://doi.org/10.1136/bmjspcare-2012-000433.

    Article  Google Scholar 

  21. Houttekier D, Cohen J, Pepersack T, Deliens L. Dying in hospital: a study of incidence and factors related to hospital death using death certificate data. Eur J Public Health. 2013;23:751–6.

    Article  Google Scholar 

  22. Khan SA, Gomes B, Higginson IJ. End-of-life care—what do caner patients want? Nat Rev Clin Oncol. 2014;11(2):100–8.

    Article  Google Scholar 

  23. Jayaraman J, Joseph K. Determinants of place of death: a population-based retrospective chohort study. BMC Palliat Care. 2013;12:19.

    Article  PubMed Central  Google Scholar 

  24. Jeurkar N, Farrington S, Craig TR, Slattery J, Harrold JK, Oldanie B, Teno JM, Casarett DJ. Which hospice patients with cancer are able to die in the setting of their choice? Results of a retrospective cohort study. J Clin Oncol. 2012;30(22):2783–7.

    Article  PubMed Central  Google Scholar 

  25. Neergaard MA, Vedsted P, Olesen F, Sokolowski I, Jensen AB, Sondergaard J. Associations between home death and GP involvement in palliative cancer care. Br J Gen Pract. 2009;59(566):671–7.

    Article  PubMed Central  Google Scholar 

  26. Escobar Pinzón LC, Weber M, Claus M, Fischbeck S, Unrath M, Martini T, Münster E. Factors influencing place of death in Germany. J Pain Symptom Manage. 2011;41(5):893–903.

    Article  Google Scholar 

  27. Howell DA, Wang HI, Smith AG, Howard MR, Patmore RD, Roman E. Place of death in haematological malignancy: variations by disease sub-type and time from diagnosis to death. BMC Palliat Care. 2013;12(1):42.

    Article  PubMed Central  Google Scholar 

  28. Gao W, Verne J, Davies J, Peacock J, Gordon E, Morris C, Greenough A, Higginson I. Home deaths are more common at weekends and holiday periods among children and young people (CYP) who die from cancer. BMJ Support Palliat Care. 2014;4(1):113–4.

    Article  Google Scholar 

  29. Arnold E, Finucane AM, Oxenham D. Preferred place of death for patients referred to a specialist palliative care service. BMJ Support Palliat Care. 2015 Sep;5(3):294–6. https://doi.org/10.1136/bmjspcare-2012-000338. Epub 2013 May 27. PMID: 24644165.

    Article  PubMed  Google Scholar 

  30. Ahlner-Elmqvist M, Jordhoy MS, Jannert M, Fayers P, Kaasa S. Place of death: hospital-based advanced home care versus conventional care. A prospective study in palliative cancer care. Palliat Med. 2004;18(7):585–93.

    Article  Google Scholar 

  31. Alonso-Babarro A, Astray-Mochales J, Dominquez-Berjon F, Genova-Maleras R, Bruera E, Diaz-Mayordomo A, Cortes CC. The association between in-patient death, utilization of hospital resources and availability of palliative home care for cancer patients. Palliat Med. 2013;27(1):68–75.

    Article  Google Scholar 

  32. Pensionsversicherungsanstalt. Pflegestufen in Österreich. http://www.pensionsversicherung.at/portal27/pvaportal/content?contentid=10007.707701&viewmode=content. Zugegriffen: 8. Mai 2018.

  33. Schur S, Weixler D, Gabl C, Kreye G, Likar R, Masel EK, Mayrhofer M, Reiner F, Schmidmayr B, Kirchheiner K, Watzke HH; AUPACS (Austrian Palliative Care Study) Group. Sedation at the end of life – a nation-wide study in palliative care units in Austria. BMC Palliat Care. 2016 May 14;15:50. https://doi.org/10.1186/s12904-016-0121-8. PMID: 27180238.

  34. Poulose JV, Do YK, Neo PS. Association between referral-to-death interval and location of death of patients referred to a hospital-based specialist palliative care service. J Pain Symptom Manage. 2013;46(2):173–81.

    Article  Google Scholar 

  35. Kimura T, Imanaga T, Matsuzaki M, Akahshi T. Home death is associated with frequency of physician home medical care visits: a questionnaire survey on communications in home medical care settings. Geriatr Gerontol Int. 2015;15(4):465–71.

    Article  Google Scholar 

  36. Wiese Ch, Lassen Ch, Bartels U, Taghavi M, Elhabash S, Grafand B, Hanekop G. International recommendations for outpatient palliatve care and prehospital palliative emergencies—a prospective questionnaire-based investigation. BMC Palliat Care. 2013;12:10.

    Article  PubMed Central  Google Scholar 

  37. Shalowitz DI, Garrett-Mayer E, Wendler D. The accuracy of surrogate decision makers. Arch Intern Med. 2006;166:493–7.

    Article  Google Scholar 

  38. Gerrard R, Campbell J, Minton O, Moback B, Skinner C, McGowan C, Stone PC. Achieving the preferred place of care for hospitalized patients at the end of life. Palliat Med. 2011;25(4):333–6.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. LKH Hartberg, Rotkreuzplatz 2, 8230, Hartberg, Österreich

    Günter Polt MSc

  2. LKH Horn, Horn, Österreich

    Dietmar Weixler MSc

  3. LKH Hartberg, Hartberg, Österreich

    Norbert Bauer MBA

Authors
  1. Günter Polt MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dietmar Weixler MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Norbert Bauer MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Günter Polt MSc.

Ethics declarations

Interessenkonflikt

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

Additional information

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10354-019-0681-3

Schlüsselwörter

Keywords

Search

Navigation