Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz最新文献

Introduction: According to the ruling of the Federal Constitutional Court of 26 February 2020, assisted suicide is legal if it is based on a freely made decision ("Freiverantwortlichkeit") by the person concerned. To date, there have been few empirical studies on the current practice of dealing with requests for assisted suicide in Germany.

Methods: Since 1 November 2024, case reports on (requests for) assisted suicide and on the practice of assisted suicide can be entered anonymously on an electronic platform. Descriptive analysis of quantitative data and content analysis of qualitative data.

Results: Of the 206 entries, 133 case reports on (requests for) assisted suicide could be included for further analysis. Concerns about loss of self-determination (n = 33) and independence (n = 20) were the most frequently cited reasons for requesting assisted suicide. In 22 case reports, information was provided on assisted suicide, and in a further 18 case reports, on planned assisted suicide. Doctors and employees of euthanasia organizations were most frequently involved in assessing decisional capacity and further criteria for legal assisted suicide. In seven case reports, it was stated that two independent persons were involved in the assessment. With regard to existing needs, clear legal regulations (n = 33) and professional guidelines (n = 20) were most frequently mentioned.

Discussion: Based on the data collected, substantive and procedural aspects of possible guideline recommendations for assessing "Freiverantwortlichkeit" and providing counseling in cases of requests for assisted suicide are discussed.

Background: The ruling of the German Federal Constitutional Court of February 2020 might reinforce patients to be more straightforward about suicidal ideation. This study aims 1) to evaluate experiences of healthcare professionals with suicidal ideation within the therapeutic context and their awareness of suicide prevention services and 2) to assess their resources and need for institutional support.

Methods: Online survey of all healthcare professionals of an academic tertiary hospital between February and March 2024. The analysis was conducted quantitatively; free-text responses were analysed for content.

Results: Of the 741 healthcare professionals who participated, 83% experienced a situation of suicidal ideation within the therapeutic context 1 to > 5 times; 42% were asked for suicide assistance. Only 33% knew specific suicide prevention services. As resources to cope with suicidal ideation, they named "knowledge of human nature" (78%) and "interprofessional consultation" (74%). The need for "training" (68%), "communication guidelines" (55%) and "supervision" (36%) was outlined.

Discussion: Most participating healthcare professionals experienced suicidal ideation within the therapeutic context, and a relevant portion was asked for suicide assistance. However, suicide prevention services were less well known. As suicide wishes may increase in hospitals, strategies to provide prevention information and hospital staff support are essential.

Patient safety (PaSi) is no longer understood as merely the prevention of adverse events, but rather as all activities aimed at ensuring a safe care environment and a culture of patient safety. PaSi is considered one of the most pressing goals in healthcare. Consequently, a large number of stakeholders in joint self-administration in Germany are now working to improve PaSi. The methods used to determine PaSi range from patient surveys and voluntary reports by healthcare providers using critical incident reporting systems (CIRS) to analyses of medical records and routine data, while the search for the prerequisites for safe care makes use of classic quality management methods. Evaluation results from Germany indicate that most PaSi incidents (PSI) remain undetected and that there is still a great need for research to investigate PSI incidences, determinants of PSI, and interventions to prevent PSI as well as to create a PaSi culture.

Patient autonomy is regarded as a central ethical and health policy principle of modern healthcare delivery. Its practical implementation is gaining increasing importance in light of the rapidly advancing digital transformation of the healthcare system. Digital technologies are changing the conditions under which autonomy can be exercised and safeguarded. They alter access to information and orientation within healthcare settings, thereby influencing individual decision-making processes. Against this backdrop, a purely individualistic concept of autonomy proves insufficient. For the digitalization of healthcare to meaningfully strengthen patient autonomy, it must go beyond technical and organisational implementation and include a conceptual and structural engagement with autonomy. This gives rise to a political and socio-structural design mandate that goes far beyond the introduction of individual applications. A consistent commitment to an expanded understanding of autonomy places substantial demands on the development and integration of digital infrastructures. Digital solutions must function reliably, reflect societal diversity, enable participation and support orientation. Safeguarding informational and participatory self-determination additionally requires an interplay of targeted political governance, coherent regulation, technically robust interoperability and socially responsive structural conditions. The aim of this article is to examine these requirements in detail and to profile them, with regard to a patient-oriented design of digital infrastructures, as an emancipatory mandate for a patient-centered health care system.

Patient-reported outcome measures (PROMs) are becoming increasingly important for patient-centered assessment of treatment success in healthcare. In recent decades, a large number of instruments have been developed that allow for differentiated recording of symptoms, everyday functions, and various aspects of quality of life. PROMs are now used in nearly 50% of all clinical studies to compare treatments in terms of their benefits for patients. In addition, PROMs are used in quality assurance to compare the treatment success of various healthcare providers. In individual treatment, PROMs can be used to screen for psychological burden or mental health condition.The use of PROMs as an intervention in themselves is relatively new. Systematic symptom assessment in oncology allows side effects to be better controlled and regularly shows positive effects on patients' quality of life.Nevertheless, PROMs have been little used in routine clinical practice to date. For clinicians, the benefits for their daily work rarely outweigh the additional effort involved. The prerequisites for successful implementation in clinical processes currently appear to be, on the one hand, intersectoral harmonization of measurements and, on the other hand, better integration into electronic health records. In Germany and Europe, various initiatives have emerged in recent years, including as part of the Medical Informatics Initiative, which address both issues. It seems inconceivable that empirically oriented medicine will in the long term dispense recording one of the central therapeutic goals-how the patient is doing.

In recent years, oncological research has made significant progress improving treatment outcomes. Nevertheless, there is a growing recognition that greater focus must be placed on the patient's perspective, particularly with regard to quality of life and psychological coping. This article examines the integration of patient experience and knowledge into cancer research from a multi-stakeholder perspective, with a focus on self-help-oriented research.The article examines the integration of patient experience and knowledge into cancer research from a multi-stakeholder perspective, with a focus on self-help-oriented research. Cancer self-help plays a prominent role in patient participation and representation. The involvement of self-help groups (SHGs) and self-help organisations (SHOs) can significantly improve the feasibility, quality and, in particular, patient relevance of oncological studies. However, the degree of participation of members from SHGs and SHOs in research projects can vary greatly, from research without, to research with, or even research by self-help. The participatory and thus cooperative, joint and equal research represents the most democratic approach and is considered optimal. This results in various advantages for the directly and indirectly involved interest groups, such as researchers, patients and their relatives, healthcare professionals and care facilities, health and pension insurance funds, and society. However, self-help-oriented research is not without its prerequisites. The last part of the article discusses the conditions that promote success and the existing barriers to successful cooperation between research and self-help.

Introduction: Individuals with complex healthcare needs, such as those with chronic and multiple conditions, require continuous, cross-sectoral care. However, an increasingly complex healthcare system, characterized by a strict separation between outpatient and inpatient care, hampers continuity of care and contributes to overuse, underuse, and misuse of services. Healthcare navigators ("Gesundheitslotsen") aim to address these challenges by supporting affected individuals in navigating the healthcare system.

Methods: This scoping review provides an overview of the target populations, roles, and qualifications of navigators as well as the legal framework and effectiveness of navigators studied in projects funded by the German Innovation Fund (New Forms of Care) since 2016. All projects concerning navigators listed in the Innovation Fund database with a project report available as of 1 April 2025 were included in the analysis.

Results: A total of 31 navigator projects were identified, addressing a wide range of target groups. The most frequently targeted populations included individuals in challenging life situations (n = 10) and with cardiovascular diseases (n = 5), mental or neurological disorders (n = 5), and metabolic conditions (n = 3). Across all projects, 153 distinct endpoints were evaluated. In most cases, no effect was observed. Statistically significant positive effects were most frequently reported for patient-reported outcome measures (PROMs) (n = 21), process indicators (n = 19), and patient-reported experience measures (PREMs) (n = 10). Negative effects were primarily observed in health economic outcomes, particularly in terms of increased costs (n = 5).

Discussion: Standardizing reporting on pilot projects, concisely describing activities of patient navigators, and making greater use of impact models could help to improve understanding of the effectiveness of patient navigators in the future.