For 50 years, palliative care seeks to relieve the agony of dying. Slowly makes also paid.
"If I had only learned to know you sooner!" Sighs the 60-year-old patient Franziska Gerhard (name changed) and is hard to understand. Many years ago, has been diagnosed with multiple sclerosis, a progressive incurable nerve disease in spurts. Meanwhile, the patient can only swallow hard and speak. Because they can not cough up enough saliva and respiratory secretions, it barely gets air. At least now the time has come for physicians from neurology to include the mobile team of palliative care unit at the University Hospital in Freiburg in the treatment. It must have been such an inspiration for the woman: "For years fought alone against my disease Now also something is done for me.". If it goes to Gerhild Becker, palliative care should no longer be subject solely to the whiff of impending death. The Freiburg professor, first in Baden-Württemberg holds a chair for this specialist field, vehemently pleaded for "early integration": "Palliative care should not at the end of life are used, but as soon as an incurable disease has been diagnosed."
for cancer patients
As in that 39-year-old family man. He had just built a house that was the center of life, since he was diagnosed with Metastatic lung cancer. "He was so fit at the time that he had with the bike can come to the clinic," says senior physician in January gardener. In addition to the oncologist he learned as a normal part of the treatment, immediately know the palliative care team - as a kind of "double bookkeeping".
Maybe he would never need the help, it was at the beginning. Unfortunately, that was a mistake. 18 months later the tumor had yet won. "The hope changes in the disease process," Jan Weiss gardener. Eventually it will not go more for more time, but to the best possible remaining time.
An insight that slow development also from colleagues in other disciplines. Too long has the high-performance medicine is laid out to nourish the mere hope of more time. But "we can not send them into a fight they can not win the patient," the palliative say.
Tailwind provides them with research. International attention in 2010 in a renowned journal, The New England Journal of Medicine study published in the American Harvard University. The scientists compared two groups of lung cancer patients still physically fit. One got the usual top oncological treatment, the second additional palliative accompaniment. It turned out that the participants in the second group not only had less anxiety and - feel less stressed - as well as their families. They lived longer - on average two months with a life expectancy of one year.
Even the patients themselves have given a resounding vote of confidence: At the 10 000 are in a random sample were interviewed across Europe. Only six per cent said they, if they were terminally ill and had to live only one more year, taking the fight to a longer life at any price. 60 percent preferred to the amazement of the professional world a higher quality of life in the time remaining.
The Freiburg University Hospital has drawn conclusions from it: since September 2012 is a mobile team of specialist palliative care doctors and nurses ready. It is associated by all departments once be appreciated that a patient may not be the only curing of importance. "Eventually the chemo is only stressful, and it's about to relieve symptoms such as pain, shortness of breath, nausea," says Werner of the specialist nurse Beatrix palliative Konsildienst. "And so, out with the patient and his family, how it works and what is good for them."
The elderly heart patient with a chronic progressive heart failure as the team with morphine can take the breath. They not only anxiolytic, but also relaxes the respiratory muscles. With psychologists, counselors and social services of the clinic is considering how it can go after discharge home, in a nursing home or hospice. There are "narrow interfaces" have been established.
Franciscan Gerhard is an outpatient palliative care from the Freiburg network founded in 2010. Eleven partners have joined together in the non-profit organization under the Department of Tumor Biology, practicing palliative care, hospice and social service group. The University of Freiburg has rejected the regret of the other partners to participate.
Around the clock, seven days a week, a team of doctors and nurses in the region between garbage home and Emmendingen is ready for the "specialized outpatient palliative care" (SOPC). Leaving the Rhine, however, says Michael Binkert, the head of pain management and palliative care in the clinic for tumor biology, it will be difficult to find appropriate help. Except for the area Titisee and Neustadt, is lacking in the Black Forest of personnel to provide such care.
In general, however, the use of such a doctor / nurse teams must be covered by health insurance since 2007. Provided it is prescribed by a doctor, because a chronic and life-threatening disease is far advanced and the medical and nursing care is particularly complex.
The teams advise doctors and patients, to provide support and stand in emergencies - severe pain or similar symptoms - even 24 hours a day. Approximately 250 patients per year is given that help. In the majority of cases, if they were people in the last days, says Martin Ehmer, the managing director of palliative care network.
Nine out of ten terminally ill people still go empty handed - they do not meet the conditions required for the use of specialized palliative care SAPV. You must be content with the so-called general outpatient palliative care AAPV. In general, the Freiburg doctor Heike Lenzer, who collaborated in the palliative care network, it states that it is nothing new. "This is just a new word created for what the GPs always do." But still: Thanks to dedicated medical professionals like Harald Rönz many terminally ill patients can live at home until the end. "I need to feel what I can expect for the relatives yet," says the 66-year-old from Schluchseewerk.
However, as critics claim there is a lack of AAPV still on clearly defined structures. Therefore it succeed her more bad than good to fill the promising name of life. Is stingy on the part of health insurance is also in accordance with contracts paid for the doctors. Currently there is more than "lousy paid" home visit so Binkert when a general practitioner approaches his dying patients at home sick bed to help.
Many doctor still missing the necessary expertise
Life with the General outpatient palliative care fills currently especially the idealism and commitment of primary care physicians. The Palliative thought had arrived in the minds of certified palliative Binkert his colleagues. For most, it now counts some of the obvious ethical obligations, not only to cure disease, but also to alleviate incurable diseases. "But you really have to want to deal with it," says Martin Ehmer, who has observed that some of his colleagues still is struggling with the new self-understanding. Many a family doctor, experts say, also lacked the appropriate knowledge about pain medication and other treatment options to care for seriously ill patients palliative care.
Nevertheless, the past is the specialist palliative care sought in vain for the appropriate curricula, today, assured Becker, leaving no budding doctors more the Freiburg University without proper knowledge. Its own specialist title as in England there are in palliative care although still not, but the Bezirksärztekammer Südbaden made in collaboration with the University Hospital palliative care in their training program anyway to a focus. General and other specialists who demonstrate 160 training hours may result in the additional title palliative care. We have the 200 in South Baden. The training could not be rewarded only professionally: As of October, it is said, can the palliative care physicians in addition to standard care bill - but only if they have the appropriate training.
Event tip: "Where is the palliative care today," with lectures by Prof. Gerhild Becker, Ernst White, Chairman Hospizgruppe Freiburg, nursing scientist Johanna Feuchtinger and education planner Bettina COUNE. Wednesday, 5 June 19 to 22 clock, lecture hall (ENT / Ophthalmology), Killianstrasse 5, University Hospital Freiburg
