Frühe Integration von Palliativversorgung - was wirklich diskutiert werden sollte

Abstract

By definition, palliative care (PC) is applicable already in early stages of incurable and life-threatening diseases, in conjunction with therapies that are intended to prolong life, such as for example chemo- or radiotherapy. Many patients suffer from distressing symptoms or problems in early phases of such illness. Therefore, it is not a question of «if» PC should be integrated early into oncology, but «how». General PC is defined as an approach that should be delivered by healthcare professionals regardless of their discipline. This is often referred to as «general» or «primary» PC. For this, routine symptom assessment, expertise concerning basic symptom management and communication skills are basic requirements. Communication skills include the willingness to engage in discussions concerning patients' fears, worries and end-of-life issues without the fear of destroying hope. Specialist PC is provided by specialist teams regardless of the patients' disease, be it cancer or non-cancer. Such teams should be integrated in the care of PC patients depending on the availability of these services and the patients' needs. Key messages: «Early PC» must not be used synonymously with «early specialist PC» because much of the PC is delivered as basic oncology PC. For the integration of specialist PC, the identification of triggers is warranted in different institutions to facilitate a meaningful and effective cooperation. Such cooperations should be based on patients' needs, but must also account for questions of availability and resources.