Wieviel Diagnostik braucht die Palliativmedizin? Ergebnisse einer multizentrischen Studie und Fallserie

Abstract

How much diagnostics is required in palliative care? Results from a representative survey and own experiences Background: Applying diagnostic techniques in palliative care (PC) requires a thorough balance between a physical, psychosocial (and financial) burden and its therapeutic relevance in far advanced diseases. The extent of diagnostic employment in PC, preferred techniques, application problems, its informative value and therapeutic significance still have to be described. Methods: The Hospice and Palliative Care Evaluation (HOPE) 2007 collected data from the application of microbiological and imaging techniques in German PC institutions. Furthermore, 70 consecutive ultrasound scans in our PC unit have been retrospectively analyzed. In 691 PC patients (from a total of 3184 in HOPE), diagnostic techniques (DIA) were applied and documented. Results: In-patients with DIA (86,1%) and the HOPE collective showed a comparable age and duration of hospital stay. Microbiological techniques contributed to 26,1% of all documented in-patient investigations, imaging techniques 69,1%. Ultrasound was the preferred imaging technique on PC units (67,1%), whilst radiography, CT or MRI scans were rather employed on oncology wards. Nuclear imaging was rarely documented. In 80,8%, imaging diagnostics were considered relevant for further treatment decisions (inpatients only); transportation problems and pain during imaging were relevant obstacles. In our own patient cohort, ultrasound was applied rather for general prognostic purposes, less often resulting in immediate therapeutic actions. Transportation problems could be almost entirely avoided by using a mobile ultrasound device. Conclusion: DIA in PC are applied independently of age or duration of hospital stay; its therapeutic significance is considered to be high; procedural problems may be resolvable. Therefore, this survey might challenge the tradition of low technology in PC.