Trends in specialized palliative care for non-cancer patients in Germany - Data from the National Hospice and Palliative Care Evaluation (HOPE)

Introduction: The proportion of non-cancer patients (NCs) admitted to palliative care (PC) services increases steadily. Nevertheless, little is known not only about their specific problems, needs that have to be met, but also about improvements that have taken place already. This analysis focuses on developments seen in NC management concerning end-of-life care. Methods: The German Hospice and Palliative Care Evaluation (HOPE) is a national long-term quality assurance project providing information on PC patients. Data from yearly evaluation periods between 2007 and 2011 are used to investigate differences between NC patients documented from 2002 to 2005 in symptoms, treatment and general condition. Results: The proportion of NC patients increased from 3.5% (147 / 4182) to 8.1% (558 / 6854). NC patients, which are now referred to PC services, are younger, show less need for nursing support, die less often during inpatient stay. Overall a greater variety of diagnoses were found and patients suffer from less complex symptoms and problems at admission. Conclusions: Despite the continuously growing number of patients with non-malignant diseases, their number in PC services is still low. As small steps in the right direction have been taken, integrating PC ideas earlier into treatment of chronic diseases to improve quality of life of NCs during the final stages of their diseases will continue to challenge the health care systemin terms of workload, need of more staff and further training of medical professionals dealing with NCs in the future. (C) 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.