'Better see a doctor?' Status quo of symptom checker apps in Germany: A cross-sectional survey with a mixed-methods design (CHECK.APP).

Background: Symptom checker apps (SCAs) offer symptom classification and low-threshold self-triage for laypeople. They are already in use despite their poor accuracy and concerns that they may negatively affect primary care. This study assesses the extent to which SCAs are used by medical laypeople in Germany and which software is most popular. We examined associations between satisfaction with the general practitioner (GP) and SCA use as well as the number of GP visits and SCA use. Furthermore, we assessed the reasons for intentional non-use. Methods: We conducted a survey comprising standardised and open-ended questions. Quantitative data were weighted, and open-ended responses were examined using thematic analysis. Results: This study included 850 participants. The SCA usage rate was 8%, and approximately 50% of SCA non-users were uninterested in trying SCAs. The most commonly used SCAs were NetDoktor and Ada. Surprisingly, SCAs were most frequently used in the age group of 51-55 years. No significant associations were found between SCA usage and satisfaction with the GP or the number of GP visits and SCA usage. Thematic analysis revealed skepticism regarding the results and recommendations of SCAs and discrepancies between users' requirements and the features of apps. Conclusion: SCAs are still widely unknown in the German population and have been sparsely used so far. Many participants were not interested in trying SCAs, and we found no positive or negative associations of SCAs and primary care.

"That's just Future Medicine" - a qualitative study on users' experiences of symptom checker apps.

BACKGROUND: Symptom checker apps (SCAs) are mobile or online applications for lay people that usually have two main functions: symptom analysis and recommendations. SCAs ask users questions about their symptoms via a chatbot, give a list with possible causes, and provide a recommendation, such as seeing a physician. However, it is unclear whether the actual performance of a SCA corresponds to the users' experiences. This qualitative study investigates the subjective perspectives of SCA users to close the empirical gap identified in the literature and answers the following main research question: How do individuals (healthy users and patients) experience the usage of SCA, including their attitudes, expectations, motivations, and concerns regarding their SCA use? METHODS: A qualitative interview study was chosen to clarify the relatively unknown experience of SCA use. Semi-structured qualitative interviews with SCA users were carried out by two researchers in tandem via video call. Qualitative content analysis was selected as methodology for the data analysis. RESULTS: Fifteen interviews with SCA users were conducted and seven main categories identified: (1) Attitudes towards findings and recommendations, (2) Communication, (3) Contact with physicians, (4) Expectations (prior to use), (5) Motivations, (6) Risks, and (7) SCA-use for others. CONCLUSIONS: The aspects identified in the analysis emphasise the specific perspective of SCA users and, at the same time, the immense scope of different experiences. Moreover, the study reveals ethical issues, such as relational aspects, that are often overlooked in debates on mHealth. Both empirical and ethical research is more needed, as the awareness of the subjective experience of those affected is an essential component in the responsible development and implementation of health apps such as SCA. TRIAL REGISTRATION: German Clinical Trials Register (DRKS): DRKS00022465. 07/08/2020.

Only the anxious ones? Identifying characteristics of symptom checker app users: a cross-sectional survey.

BACKGROUND: Symptom checker applications (SCAs) may help laypeople classify their symptoms and receive recommendations on medically appropriate actions. Further research is necessary to estimate the influence of user characteristics, attitudes and (e)health-related competencies. OBJECTIVE: The objective of this study is to identify meaningful predictors for SCA use considering user characteristics. METHODS: An explorative cross-sectional survey was conducted to investigate German citizens' demographics, eHealth literacy, hypochondria, self-efficacy, and affinity for technology using German language-validated questionnaires. A total of 869 participants were eligible for inclusion in the study. As n = 67 SCA users were assessed and matched 1:1 with non-users, a sample of n = 134 participants were assessed in the main analysis. A four-step analysis was conducted involving explorative predictor selection, model comparisons, and parameter estimates for selected predictors, including sensitivity and post hoc analyses. RESULTS: Hypochondria and self-efficacy were identified as meaningful predictors of SCA use. Hypochondria showed a consistent and significant effect across all analyses OR: 1.24-1.26 (95% CI: 1.1-1.4). Self-efficacy OR: 0.64-0.93 (95% CI: 0.3-1.4) showed inconsistent and nonsignificant results, leaving its role in SCA use unclear. Over half of the SCA users in our sample met the classification for hypochondria (cut-off on the WI of 5). CONCLUSIONS: Hypochondria has emerged as a significant predictor of SCA use with a consistently stable effect, yet according to the literature, individuals with this trait may be less likely to benefit from SCA despite their greater likelihood of using it. These users could be further unsettled by risk-averse triage and unlikely but serious diagnosis suggestions. TRIAL REGISTRATION: The study was registered in the German Clinical Trials Register (DRKS) DRKS00022465, DERR1- https://doi.org/10.2196/34026 .

[Familiarity with and Dissemination of Advance Directives in Germany: Results of a Representative Survey of the General Population]. / Bekanntheit und Verbreitung von Patientenverfügungen in Deutschland ­ Ergebnisse einer repräsentativen Umfrage in der Allgemeinbevölkerung.

With an advance directive, people can make provisions for the case of incapacity to give consent with regard to future medical and nursing treatment decisions. Currently, there are no data available on how well known and widespread advance directives are in the population in Germany. The aim of the study was, in addition to record awareness and dissemination, to find out more about the reasons for (not) writing an advance directive and about information and support used by people. An online survey of a representative sample of the general population (n=1000) was conducted. The data were analysed descriptively and by means of regression analysis. The survey showed that 92% of the sample knew about advance directives, and 37% had already created one. The probability of having already written an advance directive increases with increasing age. The reported reasons for (not) writing were heterogeneous. Almost 2/3 of all respondents had already accessed information on this topic, mainly via the Internet. The majority of those surveyed was not aware of any support available in drafting the advance directive. These findings provide suggestions for tailoring information and support services.

[Factors of endangering and violation of autonomy in residential nursing homes: results of a scoping review]. / Faktoren der Autonomiegefährdung und -verletzung in stationären Altenpflegeeinrichtungen: Ergebnisse eines Scoping Review.

Background: Respecting autonomy is one of the guiding principles of medical and nursing ethics. Nursing home residents represent a particularly relevant target group whose autonomy can be endangered or violated. Aim: The study aimed to identify factors that endanger or violate the nursing home residents' autonomy and to determine specific life situations and contexts in which these factors are located. Methods: A scoping review was carried out according to the Joanna Briggs Institute-method. Empirical results from journal articles from the publication period 2000-2021 were included. The articles were analyzed using qualitative content analysis. Results: A total of 75 articles were finally included in the review. Identified factors of the endangerment and violation of autonomy are assigned to topic areas located at the level of actors, (care) relationships and structures. Factors that can violate or endanger the residents' autonomy were found in the entire everyday life of the residents. Conclusion: The localization of the identified endangerments/violations on various actor and structural levels indicates the need for comprehensive preservation and promotion of residents' autonomy in nursing homes.

Ethical, legal, and social aspects of symptom checker applications: a scoping review.

Symptom Checker Applications (SCA) are mobile applications often designed for the end-user to assist with symptom assessment and self-triage. SCA are meant to provide the user with easily accessible information about their own health conditions. However, SCA raise questions regarding ethical, legal, and social aspects (ELSA), for example, regarding fair access to this new technology. The aim of this scoping review is to identify the ELSA of SCA in the scientific literature. A scoping review was conducted to identify the ELSA of SCA. Ten databases (e.g., Web of Science and PubMed) were used. Studies on SCA that address ELSA, written in English or German, were included in the review. The ELSA of SCA were extracted and synthesized using qualitative content analysis. A total of 25,061 references were identified, of which 39 were included in the analysis. The identified aspects were allotted to three main categories: (1) Technology; (2) Individual Level; and (3) Healthcare system. The results show that there are controversial debates in the literature on the ethical and social challenges of SCA usage. Furthermore, the debates are characterised by a lack of a specific legal perspective and empirical data. The review provides an overview on the spectrum of ELSA regarding SCA. It offers guidance to stakeholders in the healthcare system, for example, patients, healthcare professionals, and insurance providers and could be used in future empirical research to investigate the perspectives of those affected, such as users.

Wishes and Needs of Nursing Home Residents: A Scoping Review.

Falling birth rates and rising life expectancy are leading to global aging. The proportional increase in older people can be observed in almost all countries and regions worldwide. As a result, more people spend their later years in nursing homes. In homes where person-centered care is implemented, residents report greater satisfaction and quality of life. This approach is based on the wishes and needs of the residents. Therefore, the purpose of this scoping review is to explore the wishes and needs of nursing home residents. A scoping review of the literature was conducted in which 12 databases were systematically searched for relevant articles according to PRISMA-ScR guidelines. Both quantitative and qualitative study designs were considered. A total of 51 articles met the inclusion criteria. Included articles were subjected to thematic analysis and synthesis to categorize findings into themes. The analysis identified 12 themes to which the wishes and needs were assigned: (1) Activities, leisure, and daily routine; (2) Autonomy, independence, choice, and control; (3) Death, dying, and end-of-life; (4) Economics; (5) Environment, structural conditions, meals, and food; (6) Health condition; (7) Medication, care, treatment, and hygiene; (8) Peer relationship, company, and social contact; (9) Privacy; (10) Psychological and emotional aspects, security, and safety; (11) Religion, spirituality; and (12) Sexuality. Nursing home residents are not a homogeneous group. Accordingly, a wide range of needs and wishes are reported in the literature, assigned to various topics. This underscores the need for tailored and person-centered approaches to ensure long-term well-being and quality of life in the nursing home care setting.

Ethical, Legal, and Social Implications of Symptom Checker Apps in Primary Health Care (CHECK.APP): Protocol for an Interdisciplinary Mixed Methods Study.

BACKGROUND: Symptom checker apps (SCAs) are accessible tools that provide early symptom assessment for users. The ethical, legal, and social implications of SCAs and their impact on the patient-physician relationship, the health care providers, and the health care system have sparsely been examined. This study protocol describes an approach to investigate the possible impacts and implications of SCAs on different levels of health care provision. It considers the perspectives of the users, nonusers, general practitioners (GPs), and health care experts. OBJECTIVE: We aim to assess a comprehensive overview of the use of SCAs and address problematic issues, if any. The primary outcomes of this study are empirically informed multi-perspective recommendations for different stakeholders on the ethical, legal, and social implications of SCAs. METHODS: Quantitative and qualitative methods will be used in several overlapping and interconnected study phases. In study phase 1, a comprehensive literature review will be conducted to assess the ethical, legal, social, and systemic impacts of SCAs. Study phase 2 comprises a survey that will be analyzed with a logistic regression. It aims to assess the user degree of SCAs in Germany as well as the predictors for SCA usage. Study phase 3 will investigate self-observational diaries and user interviews, which will be analyzed as integrated cases to assess user perspectives, usage pattern, and arising problems. Study phase 4 will comprise GP interviews to assess their experiences, perspectives, self-image, and concepts and will be analyzed with the basic procedure by Kruse. Moreover, interviews with health care experts will be conducted in study phase 3 and will be analyzed by using the reflexive thematical analysis approach of Braun and Clark. RESULTS: Study phase 1 will be completed in November 2021. We expect the results of study phase 2 in December 2021 and February 2022. In study phase 3, interviews are currently being conducted. The final study endpoint will be in February 2023. CONCLUSIONS: The possible ethical, legal, social, and systemic impacts of a widespread use of SCAs that affect stakeholders and stakeholder groups on different levels of health care will be identified. The proposed methodological approach provides a multifaceted and diverse empirical basis for a broad discussion on these implications. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00022465; https://tinyurl.com/yx53er67. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34026.

Needs and Needs Communication of Nursing Home Residents with Depressive Symptoms: A Qualitative Study.

Nursing home residents are affected by depressive symptoms more often than elders living at home. There is a correlation between unmet needs and depression in nursing home residents, while met needs positively correlate with greater satisfaction and well-being. The study aims to examine the needs of nursing home residents with depressive symptoms and the communication of those needs, as no previous study has explicitly addressed the needs of this group of people and the way they are communicated. We conducted semi-structured interviews with 11 residents of three nursing homes and analyzed them using content-structuring content analysis. The residents reported diverse needs, assigned to 12 categories. In addition, barriers such as health impairments prevented the fulfillment of needs. As to the communication of needs, various interlocutors, facilitators, and barriers were identified. The findings reveal that residents can express their needs and are more likely to do so if the interlocutors are patient and take them seriously. However, lack of confidants, missing or non-functioning communication tools, impatience and perceived lack of understanding on the part of caregivers, and residents' insecurities limit communication of needs.

[The Autonomy of Patients in Inpatient Medical Rehabilitation - Aspects of Endangerment and Preservation]. / Die Autonomie von Rehabilitanden in der stationären medizinischen Rehabilitation ­ Aspekte der Gefährdung und Wahrung.

PURPOSE: The aim of the study is to identify aspects within inpatient medical rehabilitation that may endanger or preserve the autonomy of patients. METHODS: A scoping review was carried out on the basis of the current state of scientific knowledge. The methodological approach was based on the specifications of the Joanna Briggs Institute. The research and generation of findings were logged according to the PRISMA-ScR checklist. RESULTS: The final study inclusion comprises 39 empirical and normative-theoretical contributions. Autonomy-threatening aspects were assigned to the following domains: Rehabilitation system, rehabilitation clinics, staff, patients and third parties. Aspects potentially preserving the autonomy of patients included the following domains: Rehabilitation clinics, staff, concepts and forms of expression as well as instruments. CONCLUSION: A large number of heterogeneous aspects can endanger, but can also preserve or promote the autonomy of patients during their stay in inpatient medical rehabilitation. These are located throughout in the entire rehabilitation process and concern the structural, organizational and personal level. The autonomy of patients should not only be treated as an outcome of rehabilitation, but also as a requirement for structures and actors during the rehabilitation stay.

[Living wills of residents in nursing homes - which treatment situations and treatment measures are decreed?] / Patientenverfügungen von Bewohnenden in Pflegeeinrichtungen ­ welche Behandlungssituationen und Behandlungsmaßnahmen werden vorausverfügt?

BACKGROUND: The possibility of using a living will to influence later treatment in the event of incapacity to consent is nowadays an important element in safeguarding patients' autonomy at the end of life. Refusing or consenting treatment measures in advance of treatment is of particular importance for nursing home residents, not only against the background of the COVID-19 pandemic. METHODS: We conducted a survey of all resident-documents in 13 nursing homes of different sizes and service providers in the city and district of Wuerzburg. The documents were analysed according to a deductive-inductive procedure using categorical summaries and descriptive frequency counts. RESULTS: In 265 recorded living wills, 2072 treatment situations and 1673 treatment measures could be identified. Residents largely agree to symptom-relieving and nursing measures and often reject life-prolonging or life-substaining treatment measures, the latter mostly being limited to specific, defined situations. The reference to certain treatment situations regarding resuscitation attempts, both in the form of refusal and consent, was identified in 88.6 % of the living wills. 62 % of the living wills could be assigned to a template. DISCUSSION: The study provides information about the content of living wills of nursing home residents. It thus provides information on medical treatment preferences in the case of incapacity to consent and shows that treatment measures (including resuscitation) are mostly related to specific treatment situations.

[Experiences and perspectives of nursing home residents with depressive symptoms during the COVID-19 pandemic: a qualitative study]. / Erfahrungen und Sichtweisen von Pflegeheimbewohnenden mit depressiver Symptomatik während der COVID-19-Pandemie: eine qualitative Studie.

BACKGROUND: The COVID-19 pandemic requires extensive health protection interventions in order to prevent infections in the long-term care setting. These interventions impact residents' lives, including an increase in depressive symptoms and other negative concomitants. OBJECTIVE: The study aimed to explore the experiences and perspectives of nursing home residents with depressive symptoms during the pandemic. METHODS: In this study nine guideline-based interviews were conducted with residents. These were analyzed using the content-structured content analysis according to Kuckartz. RESULTS: Three main themes were identified: perceptions and emotions related to the pandemic, changes and limitations due to the interventions and wishes in terms of the pandemic. The residents reported both emotional distress and not being afraid of infection and its consequences. In addition, some respondents reported unpleasant restrictions, such as wearing masks. In some cases their usefulness was critically questioned. Furthermore, various wishes of the residents in relation to the pandemic, such as leaving the nursing home, were identified. CONCLUSION: The study showed complex perceptions, changes, and wishes due to the pandemic and its interventions. Therefore, an individual approach to residents with depressive symptoms is necessary to avoid an increase in mental health problems. Against this background, there is a need for participatory implementation of health protection measures for the particularly vulnerable group of nursing home residents.

Wishes and needs of nursing home residents and their relatives regarding end-of-life decision-making and care planning-A qualitative study.

AIMS AND OBJECTIVES: To explore wishes and needs, such as existing and preferred communication processes, of residents and relatives regarding medical and nursing planning at the end of life. BACKGROUND: Nursing home residents are a relevant target group for advance care planning (ACP) due to their high age and multimorbidity. Their relatives seem to be important partners in terms of communication and their documentation of wishes and needs. DESIGN: A qualitative descriptive design was used. METHODS: Thirty-two guideline-based interviews with nursing home residents (n = 24) and relatives (n = 8) were conducted in nursing homes in Germany (n = 7). All interviews were analysed by content-structured content analysis. The COREQ checklist was used to document reporting of the study. RESULTS: Residents particularly express wishes and needs regarding their health, like the desire to maintain or improve one's current state of health and to be active and mobile and also regarding their social situation, for example the well-being of relatives and beloved ones. A limited group of people was identified with whom residents spoke about issues such as preparedness and self-determination. These were mainly their relatives. Relatives themselves have a need for more communication. Various communication barriers could be identified. CONCLUSION: Residents express diverse and partly explicit wishes and needs. Although many of the respondents had already drafted advanced directives, the demand for offers of communication to plan ahead for the end of life remains clear. The results indicate the unconditional participation of relatives and people close to the residents, if they are available. RELEVANCE TO CLINICAL PRACTICE: Derivations for a target group-related ACP concept in the study region are identified. Besides the involvement of relatives, nurses could also be involved in the communication and decision-making process of residents in nursing homes under certain conditions.

[Medical Rehabilitation Group Programmes Concerning Nutrition Training: Results of a National Survey]. / Ernährungsbezogene Gruppenangebote in der medizinischen Rehabilitation: Ergebnisse einer bundesweiten Befragung.

PURPOSE: To describe the current practice of nutritional group programmes, the need for further development and training needs of the nutritional teams in medical rehabilitation in Germany. METHODS: 546 psychosomatic and somatic inpatient rehabilitation clinics were contacted. 192 clinics and 202 teams of nutritionists took part in the questionnaire survey. RESULTS: In 89% of the clinics one nutritional team is responsible for all rehabilitation patients. Teams are responsible for an average of 3,4 indication groups (SD=2,4). They report group programms of M=4,9 performance units (SD=1,6). 56% of the group programmes (n=998; nutritional training group, seminar, lecture, unit of an educational programme) are applied across indications. 73% comprise only one unit, the duration is usually up to 60 minutes (93%). 76% of the groups have ≤ 15 participants, and 93% are at least partially manual-based. On average 5,8 topics (SD=1,5), 1,9 didactic methods (SD=0,8) and 1,9 materials (SD=0,9) are reported. In part, there are differences between programme units. The number of participants and the number of sessions showed significant correlations to didactic methods and materials. Programmes conducted in larger groups (>15 participants) or single sessions used more lectures, whereas programmes comprising less participants or several sessions used more interactive methods and materials. For further development, flexible combinable modules are seen as more helpful than completely manualised group concepts. Main concepts should focus on motivation and behaviour change in everyday life as well as healthy eating in different life situations. There is a high interest in advanced training (M=8,5; SD=2,2; maximum=10) with a preference for attendance-based seminars. Prefered contents are motivation, behaviour change in everyday life, and management of difficult group situations. CONCLUSION: Current practice comprises a variety of nutritional group programmes with substantial heterogeneity between the nutritional teams. Therefore, separate modules which can be used for different programmes as well as trainings adressing particularly issues such as motivation and behaviour change in everyday life may be useful for further development and improvement.

[Health-Promoting Offers at Schools in the City and District of Würzburg]. / Gesundheitsfördernde Angebote an Schulen in Stadt und Landkreis Würzburg.

The aim of the project was to gather information on existing and assess needs for health-promoting offers for pupils at general and vocational schools in the city and district of Wuerzburg (n=156) in order to derive recommendations for action. First, a qualitative document analysis of the homepages of all schools was performed, using a content-structuring content analysis. Based on the generated findings, a written questionnaire survey was conducted. The results show that in particular the topics of nutrition and exercise are extensively dealt with in most school types. Special offers for stress management and relaxation or time and self-management are still expandable across schools. Offers for dealing with (new and social) media do exist - curriculum-dependent - at many schools of different forms. The need for support from the school management is rated very highly. Further support is needed, especially with regard to the financing of external experts.