Non-cancer patients in specialized palliative care in Germany: What are the problems?

Christoph Ostgathe,Heidrun Golla,Raymond Voltz,Bernd Alt-Epping,Gabriele Lindena,Jan Gaertner,Lukas Radbruch

doi:10.1177/0269216310385370

Abstract

To determine the role of non-cancer palliative care in inpatient services in Germany, data from the Hospice and Palliative Care Evaluation (HOPE) were analysed. Since 1999, a three-month census has been conducted annually in German palliative care units. Pooled data from 2002–2005 were tested for differences between non-cancer patients (NCs) and cancer patients (Cs). A total of 4182 patients (NC: 3.5%; C: 96.5%) were documented; functional status (using Eastern Cooperative Oncology Group (ECOG) measures) in NCs was lower compared to Cs (p = 0.009). NCs suffered more often from dyspnoea (40%; C: 29%; p = 0.004), weakness (92,3%; C: 84,5%; p = 0.011) and tiredness (75.4%; C: 66.7%; p = 0.03) and less from nausea (17.1%; C: 28.9%; p = 0.002), vomiting (8.2%; C: 19.4%; p = 0.001) or loss of appetite (55.5%; C: 67.9%; p = 0.002). There were no differences in pain and constipation. Other problems (nursing, psychological) were more frequent for NCs, in particular the need for support in the activities of daily life (90.3%; C: 72.8%; p < 0.001) and disorientation/confusion (32.1%; C: 17.2%; p < 0.001). There were no differences in social problems. NCs are still rare in specialized inpatient palliative care institutions in Germany. The palliative care needs in patients with non-malignant disease will challenge the health care system as the workload for these services will grow over proportionally.

Highlights

The integration of palliative care into the health care system has undergone a dynamic development over the last 40 years.[1]
The first palliative care unit linked to a hospital opened in 1983 in Cologne
Since 2005, the census has been repeated annually, as the infrastructure is optimized and the instrument can be used as a standard documentation tool.) The institutions are asked to document up to 30 consecutive palliative care patients at admission to the service and at the time of discharge or death

Summary

Introduction

The integration of palliative care into the health care system has undergone a dynamic development over the last 40 years.[1] Catalysed by the upcoming hospice movement in the late 1960, cancer has emerged as a model[2] to show that a holistic palliative care approach can be beneficial during the non-curative phase of the illness.[3]. The beginning of palliative care in Germany was delayed by almost 20 years. The first palliative care unit linked to a hospital opened in 1983 in Cologne. Since a wide range of services for inpatient and outpatient palliative care has been established. Parallel to the hospital-based palliative care units for acute care (funded exclusively by the health insurances), free standing hospices (funded on a mixed basis – health and nursing insurances, charity) for long-term care developed

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Conclusion