title: [Preventive crisis management in general outpatient palliative care - prospectively cross-sectional study of General Practitioners in Eastern Bavaria].
abstract: BACKGROUND
  General out-patient palliative care (GOPC) must be integrated into the care of patients with life-limiting diseases. Aim of the study was to evaluate experiences of general practitioners concerning advance directives and palliative emergency sheets.
  
  
  METHODS
  A self-provided survey was mailed to all general practitioners in Regensburg (cross-sectional study). Main outcome measures included responses regarding a palliative emergency sheet (PES) and a palliative emergency plan (PEP). The investigation period was four months. The analysis was performed using defined criteria (e. g. professional experience concerning palliative care patients, patients treated in nursing homes, patients with dementia).
  
  
  RESULTS
  Sixty-nine questionnaires from 259 were analysed (response rate 27 %). 86 % of respondents named practical experience in the care of palliative patients, 46 % named theoretical knowledge in this field. 41 % and 40 % consider creating an advance directive for their practical work as important/very important (p = 0.004 concerning the treatment of more than five palliative care patients per three months). 52 % and 49 % regard a PES or a PEP to be relevant (PES median: 6.5, SD ± 2.7; PEP median: 6.5 SD ± 2.9; inter-group analysis p < 0.05). 94 % of respondents name the general practitioner to be suitable for creating an advance directive.
  
  
  CONCLUSIONS
  In Germany, GOPC in end-of-life care is very important. This study shows that advance directives were declared as an important instrument for patients? autonomy. The sense of PES and PEP to ensure patients? autonomy, especially for acute emergency medical palliative care, must be better recognized. However, the increase in acceptance in the GOPC for such instruments must be disclosed. Further studies to investigate this problem are necessary.
authors: Klinik für Anästhesiologie, Klinikum der Universität Regensburg. christoph.wiese@klinik.uni-regensburg.de
authors: C H R
authors: CH
authors: Wiese
authors: G
authors: G
authors: Duttge
authors: M
authors: M
authors: Taghavi
authors: C L
authors: CL
authors: Lassen
authors: N
authors: N
authors: Meyer
authors: R
authors: R
authors: Andreesen
authors: B M
authors: BM
authors: Graf
authors: J
authors: J
authors: Pfirstinger
mesh_terms: D000328:Adult; D016223:Advance Directives; D000553:Ambulatory Care / Q000379:methods*; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D058006:General Practice; D005858:Germany; D006302:Health Services Research; D006707:Homes for the Aged; D006801:Humans; D016224:Living Wills; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D010166:Palliative Care / Q000379:methods*; D026684:Personal Autonomy; D011795:Surveys and Questionnaires