Retrospektive Erhebung zur Behandlungszufriedenheit der Angehörigen von Patienten mit inkurablen Kopf-Halstumoren in fortgeschrittener Palliativsituation

Patients with advanced head and neck cancer are commonly situated in a palliative stadium. Without any curative options left, the appropriate treating concept at this stage is the best supportive care therapy. This therapy tries to offer the best care for the terminally ill patient based on the palliative care theory. The palliative care is a holistic point of view and contains not only the best supportive care for patients in an advanced stadium of disease, but also sets out to improve the quality of life for the patients faced with a fatal illness as well as for their families. Thus, in order to comfort the patient, it provides spiritual and psychosocial support in addition to pain and symptom relief from the point of the diagnosis until the final stage of the illness. In addition it offers consultation for the bereaved during and after the decease of the patient. A particular difficult feature of the treatment of head and neck cancer patients is, that they are often faced with disfigurement in the orofacial region because of extensive tissue involvement which causes devastating side effects such as changes in appearance, speech, swallowing, severe pain, dyspnea and xerostomia. These alterations are often hard to handle for the patients and their relatives and threaten the quality of life for both. In addition, most of the patients wish to spend their final stage at home with their loved ones. However, the majority of people with a terminal illness are currently placed in a hospital or another institution like a nursing home. Thus, a central question for the palliative care of head and neck cancer patients is how to provide them with special and extensive nursing combined with medical care while offering them the greatest comfort in their accommodation. The purpose of this doctoral thesis is to examine the quality of different institutions where terminal ill head and neck cancer patients were supported during their final period of life. In order to do this, a questionnaire was administered with 56 relatives of deceased head and neck cancer patients who were treated in the Department of Otolaryngology, Head & Neck Surgery, University of Marburg, Germany, between 2000 and 2010. The thesis presents and compares the collected statements about the quality of palliative care in either the Department of Otolaryngology, Head & Neck Surgery of the University Hospital, in different local hospices, or at home with outpatient palliative care and a general practitioner. In numbers, 24 (42,9 %) of the patients were accommodated at the university hospital, 16 (26,8 %) patients stayed at a hospice and 16 (26,8 %) patients were at home during the last stage of their illness. The average patients age at the point of death was 62,5. Of the patients, 78,6 % were male and 21,4 % were female. Most of the interviewed relatives were female (73,2 %), the smaller part were male (26,8 %). Overall, the satisfaction of the respondents with the terminal care of head and neck cancer patients was equally high at the University Hospital and the hospice. However, the gathered data showed a decreasing satisfaction with terminal care at home. Therefore, the present study reveals a positive trend for specialized palliative care in a hospice or in a palliative care unit of a hospital, a result which supports the conclusion of the current literature. Nevertheless, it must be stressed, that the limited amount of participants and institutions in the present inquiry is not sufficient to clearly identify a significant difference between the satisfaction with different hospitalization forms for head and neck cancer patients in an advanced palliative situation.