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Modern medicine has increased the number of treatment options in almost every case of illness. Therefore, patients, medical and nursing staff are more challenged as before to actively decide which measures to take. Scientists from Munich and Heidelberg developed guidelines to support cancer patients, relatives and the treatment team to talk openly and repeatedly early on.  As a result, patients are able to determine their situation at the end of life more realistic and are able to communicate their desires more effectively to the physician. The joint project of the National Center for Tumor Diseases (NCT) Heidelberg and the University Hospital Munich was honored with the Lohfert-Award 2016.

The NCT Heidelberg is a joint institution of the German Cancer Research Center (DKFZ), the University Hospital Heidelberg and the German Cancer Aid.

The Lohfert Foundation annually awards field-tested and sustainable concepts in medicine, which put the patient and his needs and interests at the center. The goal of the foundation, which was founded in 2010, is to enhance the inpatient - path at the hospital, the clinical communication and the security of patients. The Lohfert- award recipients are Prof. Dr. Dr. Eva Winkler from the NCT Heidelberg and Dr. Pia Heußner of the University Hospital Munich with their project “Therapy-restriction: Enhancing the joint decision making with oncological patients”.  The price endows 20.000 Euros. The award ceremony took place on September 16^th 2016 during the12th congress of health economy in Hamburg.

Many patients decide to have more life quality instead of further life-extending measures at the end of life. However, there are also patients who want a maximal therapy, even though hope is very small and benefits are not very likely. Others do not even want to know their prognosis. Unfortunately, it also happens that patients are not asked what they want or their desires are not documented. Therefore, conflicts can arise between the affected person and the medical stuff while planning further treatment.

According to a survey of the Thorax Clinic of the University Hospital Heidelberg and the NCT Heidelberg, 93 percent of cancer patients indicated their desire to participate in decisions at the end of life.  However, only 61 percent felt like they were sufficiently involved.

In April 2012, an interventional study started with the goal to enhance decision-making at the end of life. Scientists Eva Winkler and Pia Heußner were in charge of the project, which was supported by the German Cancer Aid. Based on the study results, the scientists developed guidelines for daily hospital routines with different occupational groups of the Medical Clinic and the Polyclinic II in Munich. The guidelines support medical stuff to get to know patients’ desires faster and to consider them accordingly.  Furthermore the guidelines provide tips of how to handle difficult conversations.

„A big challenge is to create the guidelines in a way so they are well applicable to daily hospital routines and generate actual additional value” reports Winkler. The conversations are meant to avoid over-therapy. At the end of life, patients should experience treatment rather as benefit instead of a burden.

„Joint decision - making ensures the patients will. Care can be adjusted to patients’ needs”, explains Winkler. “Today we know that the anticipatory planning of treatment, preparing patients early on for decisions at the end of life, reduces fear and depression, which enhances the life quality of the patient. “

How the guidelines prove itself at the University Hospital Großhadern in Munich is currently evaluated. With the prize money the scientists want to continuously enhance the guidelines and introduce them in other hospitals.  The guidelines are meant to be adjusted and established at the NCT Heidelberg as well. 

Pia Heußner is senior physician at the Medical Clinic and Ployclinic II of the Ludwig-Maximilian LMU University Hospital Munich, where she is in charge of the psycho-oncology. Eva Winkler is senior physician for endocrine tumors at the NCT Heidelberg and is in charge of the “ethics and patient orientation in oncology.”

More information about the award-winners is available in the video of the Lohfert Foundation:
https://www.youtube.com/watch?v=lewfPnnzV-8

The guidelines are available for download:
http://www.ethikkomitee.de/downloads/leitlinie-zur-therapiebegrenzung.pdf