[Healthcare structures in palliative care medicine : Flowchart for patients with incurable cancer]

Background: In Germany the structures of generalized and specialized palliative care services have considerably increased over the last decade with respect to the number, quality and differentiation. The goal is to improve or to maintain the quality of life for patients with life-threatening illnesses.

Aim: The current structures of generalized and specialized palliative care services in Germany are presented.

Material and methods: The structures of healthcare services are presented primarily based on the S3 guidelines on palliative care for patients with incurable cancer. An extrapolation to all patients with incurable illnesses and limited life-expectancy has been carried out.

Results: Palliative care in Germany can be differentiated into two sectors. Generalized palliative care provides care for patients with a low or moderately complex situation on general hospital and oncology wards, in long-term care facilities and in the domestic environment. Specialized palliative care services manage patients with a highly complex situation in palliative care units, by a palliative care support team in hospitals or in palliative medical day care centers and as outpatients in specialized outpatient palliative home care, in specialized palliative outpatient clinics or day care hospices. Inpatient hospices and the outpatient hospice services are overlapping sectors and can be assigned to both generalized and specialized palliative care.

Conclusion: Despite a good development in recent years, a nationwide and sufficient provision of palliative care services has still not been achieved and some services have hardly been developed, e. g. palliative outpatient clinics. Hospital palliative care support teams should soon be available in all hospitals caring for patients with life-threatening illnesses, due to the requirements of the Hospice and Palliative Care Act from 2015.