Bernd Alt-Epping

Breaking bad news – an interdisciplinary curricular teaching-concept

Background: The concerns of patients suffering from life-threatening disease and end-of-life care aspects have gained increasing attention in public perception. The increasing focus on palliative medicine questions can be considered to be paradigmatic for this development. Palliative medicine became a compulsory subject of the undergraduate curriculum in Germany to be implemented until 2013. The preexisting conditions and qualifications at the medical faculties vary, though. We describe the conceptual process, didactic background, and first experiences with the new interdisciplinary course “Delivering bad news” as a compulsory part of the palliative medicine curriculum. Methods: Since autumn 2009, this course has been taught at the University Medical Center Göttingen, consisting of two double lessons in the final year of medical education. Considering the curriculum-based learning goals in Göttingen, the focus of this course is to impart knowledge, attitudes and communication skills relating to “bad news”. Results: Although the seminar requires adequate staff and is time-consuming, students have accepted it and gave high marks in evaluations. In particular, the teachers’ performance and commitment was evaluated positively. Discussion and Conclusions: We describe the first experiences with a new course. Didactic structure, theoretical contents, role-plays and usage of media (film, novel) are well- suited to communicate topics such as “bad news”. Additional experiences and evaluations are necessary. According to the progressive nature of learning, it might be worthwhile to repeat communication- centered questions several times during medical studies.

Implementing the cross-disciplinary subject of palliative medicine (Q13) against the backdrop of recent changes of the legal framework using University Medical School Gottingen as an example.

Palliative care for patients with advanced and progressive diseases has recently become an integrated and compulsory part of undergraduate training in Germany. Up until now, undergraduate teaching in this cross-disciplinary medical field varied and therefore problems during the implementation process with regard to formal aspects and teaching content are to be expected. This contribution summarizes the new legislative framework for palliative care as an independent specialty in undergraduate medical training and describes format, content and problems of the current implementation process at the University Medical School Göttingen, in order to provide advice and support for other faculties.

Implementierung eines Klinischen Ethikkomitees

An der Universitatsmedizin Gottingen (UMG) wurde im Herbst 2010 ein Klinisches Ethikkomitee gegrundet. Damit reiht Gottingen sich in die vor allem im vergangenen Jahrzehnt stetig gewachsene Anzahl universitarer Kliniken ein, die ein solches Gremium an ihrem Hause einrichten (vgl. Frewer et al. 2008; Dorries 2010).

Selbstbestimmung braucht Vertrauen – Entscheidungsfindung am Lebensende

Bereits Norbert Elias macht in seinem Aufsatz ‚Uber die Einsamkeit der Sterbenden in unseren Tagen‘ (1983) darauf aufmerksam, dass die allmahliche Verdrangung des Todes ein Phanomen moderner hochzivilisierter Gesellschaften sei. Durch den stetig voranschreitenden medizinischen Fortschritt, die steigende Lebenserwartung und die Moglichkeiten durch Praventivmasnahmen Krankheiten vorzubeugen, habe der Tod mit der Zeit an Bedrohlichkeit verloren. Die Vorstellung vom Tod sei haufig an ein Bild ‚friedlichen‘ Sterbens gebunden (ebd. 75).

Palliative Care for Patients with Haematological Malignancies

Tremendous therapeutic advance has been made in treating patients with haematological disease during the past decades. Despite this, very many patients will eventually die from their disease, and another number of patients will die from complications and side effects of the therapeutic regimen itself. Given the burdensome and disease-specific course of most haematological malignancies, very little is known about the specific clinical, nursing and psychosocial needs of patients suffering from incurable and advanced haematological disease. Therefore, this chapter will on the one hand seek to provide haematologists with knowledge on the assessment and multi-professional care of this particularly vulnerable group of patients and to demonstrate how palliative care structures may help in supporting the care for patients with incurable haematological disease. On the other hand, this chapter will provide palliative care physicians and teams with a basis of knowledge on the biology, the therapy and the prognostic trajectories of different haematological entities, enabling those of us who work in specialised palliative care to specifically support these patients and understand the complex clinical situations that differ markedly from those encountered in patients with solid tumour entities.

Emergencies in Oncology and Crises in Palliative Care

It belongs to the distinguishing features of cancer that its disease trajectory and its causative treatment implicate numerous critical situations and emergencies that lead to life-threatening situations, and in a significant proportion of patients, these emergencies (instead of the tumour manifestations themselves) will be life-limiting. Therefore, the care of patients suffering from cancer as well as the respective anticancer treatment requires profound expertise in oncology and in emergency care.