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Aim: The aim of the present survey was to describe and evaluate experiences of German psychosocial cancer counselling centers with user surveys as a quality management measure., Methods: Representatives of various psychosocial cancer counselling centers were asked to prepare an experience report on user surveys. Nine field reports were presented and discussed in summary by the working group "Cancer Counselling Centers" of the Working Group Psychooncology of the German Cancer Society (PSO). Special attention was paid to the short questionnaire KBS-N (Cancer Counselling Centre Questionnaire) recommended by the working group., Results: All psychosocial cancer counselling centers reported positive experiences with user surveys, which, however, represent an effort in terms of personnel and logistics. In addition to the KBS-N, more detailed questionnaires were also used. The surveys were conducted either continuously or on a random basis over a limited period of time. Those seeking advice were usually asked at a defined time directly after the initial interviews or after the end of the counselling sequence. The response rate was higher (85-95%) when the questionnaire was handed out personally after the initial consultation than for postal delivery and return (47-89%). All counselling centers reported positive feedback on the counselling services provided. Isolated points of criticism were related in particular to organizational framework conditions., Conclusion: After weighing up the costs and benefits, an active follow-up survey of those seeking advice using the short questionnaire KBS-N appears to be a practicable quality assurance measure, at least over a limited period of time. More detailed user surveys require more effort and are therefore more suitable for use in research that go beyond quality assurance., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Breastfeeding is one of the foundations of child health, development, and survival. Despite extensive evidence that lack of breastfeeding is associated with higher mortality rates and other long-term negative health outcomes, less than half of all babies under the age of 6 months are breastfed worldwide. Breastfeeding counselling is one of the key interventions, to improve breastfeeding rates., Aim: The objective of this guideline is to give recommendations on how to implement breastfeeding counselling to improve breastfeeding practices., Methods: This guideline was developed by the World Health Organization (WHO) according to the methods outlined in the WHO handbook for guideline development. This publication is a summary of the most important aspects of this guideline translated into German by members of the WHO Collaborating Centre at the Danube University Krems (Austria)., Results/conclusions: This guideline is based on current evidence and gives recommendations and makes comments on the implementation of breastfeeding counselling, such as frequency, timing, or mode and provider of breastfeeding counselling to improve breastfeeding practices. The scope of the guideline is limited to this intervention., Competing Interests: Gerald Gartlehner und Barbara Nußbaumer-Streit haben in den letzten drei Jahren von der Weltgesundheitsorganisation (WHO) Honorare für das Abhalten von GRADE-Workshops erhalten., (© Georg Thieme Verlag KG Stuttgart · New York.)

At present, the question of what quality of counselling means is very open. This is particularly reflected in the lack of a widely accepted catalogue of criteria. For evaluations and further developments of corresponding advisory services, this represents an essential issue. In this article a causal-theoretical model for quality in care counselling is developed and tested based on empirical data collected by compass private pflegeberatung (care consultants). The results lead to implications for the legally formulated evaluation order according to § 7a of the Social Security Code XI (SGB XI).

Objectives: Quality assurance has become increasingly relevant in the field of outpatient psychosocial cancer counseling. At the same time, no studies are currently available that analyze outpatient psychosocial cancer counseling centers in Germany with respect to standards of service quality. Therefore, this study aimed to determine whether these centers meet selected quality criteria of outpatient psychosocial cancer counseling., Methods: Based on quality standards of outpatient psychosocial cancer counseling previously developed by us in a Delphi study, we surveyed 106 out of 151 German psychosocial outpatient cancer counseling centers registered in a publicly accessible data base of Germany's cancer information service in Heidelberg with respect to the selected quality characteristics. Data analysis used descriptive statistical techniques., Results: The centers of the sample differ in how many of them fulfill the quality standards selected for analysis here. More than 90% provide the services described by the standards as required. In contrast, in the personnel domain, there appears to be room for improvement with respect to the amount of service hours available for psychologists and the number of counselors with advanced training in psycho-oncology. Also, external supervision and case conferences turn out to be quality characteristics with room for improvement in the domain of quality assurance as do distress screening in the domain of diagnostics and using systematic documentation., Conclusion: Referring to recent standards of quality of outpatient psychosocial cancer counseling allowed us to delineate strength and weaknesses that may serve as starting points for quality improvement in the centers providing psychosocial cancer counseling. However, further research is necessary to arrive at a more comprehensive picture of the degree to which outpatient psychosocial cancer counseling centers in Germany comply with current standards of service quality., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: So far, advance directives (AD) are often used ineffectively in Germany. Counseling for advance directives is neither legally required nor are quality standards available. Little is known about the structure and content of the counseling offered by the many different providers. The goal of this study was to assess the current practice and possible improvements of AD consultations by different professional groups in the Munich region in Germany compared to international Advance Care Planning (ACP) programs as best practice models., Methods: An explorative online survey (using the Likert scale) of general practitioners, notaries, nurses and hospice workers in the Munich area was conducted. The data were analyzed using SPSS and Excel., Results: Content and structure of counseling services differ not only between but also within counseling groups, sometimes considerably. Consultations mostly last up to 60 minutes and included 1-2 sessions. Despite the fact that most counselors (46-79 % in the respective groups) favor routinely offered consultations, most counseling sessions are initiated by the consulted individuals themselves. Among other things, counseling sessions cover the topics of hydration (often / always [o / a] 69-97 %), permanent unconsciousness (o / a 48-94 %) and terminal illnesses (o / a 77-97 %). Especially the participation of future legal representatives in the counseling sessions (o / a 18-85 %), the drafting of emergency plans (0-45 %) and the completion of advance directives within the counseling session (29-51 %) was heterogeneous., Conclusions: The current counseling practice for advance directives varies considerably and does not yet reliably meet the best practice standards of ACP programs. This study thus underscores the need for comprehensive ACP programs., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: First, to assess the quality of counselling for acute diarrhoea; second, to evaluate the patient's approach and different user groups as a determinant of counselling., Methods: The simulated patient methodology was used in all 21 community pharmacies in a north-eastern German city with a population of about 63,000. Four scenarios related to self-medication for acute diarrhoea were developed and used in all pharmacies (total: 84 visits). Two scenarios were direct product-based requests for loperamide (scenario 1: a 74-year old woman with diabetes and hypertension; scenario 3: a 30-year old man with no primary disease). Scenario 2 and 4 were symptom-based requests asking for medicine for acute diarrhoea (scenario 2: a 74-year old woman with diabetes and hypertension; scenario 4: a 30-year old man with no primary disease). The assessment sheet included 9 objective items relating to the pharmacological advice to avoid a subjective evaluation by the mystery shoppers (e. g., the friendliness of the customer contact). Simulated patient visits were conducted covertly by five untrained female master students. After evaluation of the data every pharmacy received an individual performance feedback to encourage behavioural change and improve counselling quality., Results: Overall, the quality of counselling was quite poor (277 out of 756 possible points). The most commonly provided information was dosage (86.9 %); information on adverse effects was least commonly provided (3.6 %). Furthermore, there was a huge difference in the counselling quality between the pharmacies (minimum 4 points, maximum 20 points out of 36 possible points). The symptom-based requests scored significantly better (95 and 85 out of 189 possible points) than the direct product-based requests (42 and 55 out of 189 possible points). The symptom-based requests had a significantly better counselling quality for an older woman with primary disease than for a younger man without any primary disease. This difference was not observed with the direct product-based requests., (Copyright © 2016. Published by Elsevier GmbH.)

Background: Patient centred and individually-tailored counselling of older people with a chronic condition who live at home is a useful intervention to support their independence., Aim: The paper presents the development and psychometric testing of the APN-BQ Instrument, to measure patient-centeredness., Method: To measure the quality of an in-home counselling intervention, a 23-item questionnaire was developed and tested with 206 people 80 years and older. Principal component analysis with Varimax Rotation was conducted (n = 206)., Results: Analysis revealed a four factor (fs = 0.91) model scoring in 19 items. All factors loaded > 0.45. Cronbach's alpha was 0.86. The utility and acceptance of the instrument was confirmed by the high response rate (100 %) and the fact that participants answered 98.8 % of all questions., Conclusions: The APN-BQ has shown to be a reliable Instrument with good content and construct validity. It is a tool for APNs to measure structure, process, and outcome quality of a patient-centred and individually-tailored counselling program, including the degree of patient participation, and patient empowerment.

The DNRfK (German Network for Tobacco-Free Hospitals & Health-Care Services) is based on the Code of the ENSH-Global Network for Tobacco-Free Health-Care Services. To evaluate the project, a total survey of network members using an online questionnaire (78 items) was carried out (n=181; 67.4% response rate). At the time of the recording period, 17% achieved the silver level of certification, 43% the bronze level and 40% had not been certified. Various smoking cessation methods are offered (motivational interviewing, 47%; brief interventions, 45%; individual counselling, 45%). Smokers received pharmacological support in 63% of the hospitals. Smoking cessation services are mainly carried out by physicians (63%), nursing staff (51%) and psychologists (51%). Guideline-oriented smoking cessation is offered by 36% of participants (69% silver level, 33% bronze level, and 32% in clinics without certification). The Code has been widely accepted and, consequently, well implemented by members. The quality of the tobacco control measures and evidence-based smoking cessation treatments increases with duration of membership and certification level or is validated through this. Some deficiencies were found with respect to training-the-trainer qualifications and follow-up measurements., (© Georg Thieme Verlag KG Stuttgart · New York.)

Group and individual counseling sessions play a key role in adolescent obesity treatment. The requirements of these training sessions are defined in national guidelines, e.g., the German "Adipositas-Konsensuspapier" (Obesity Consensus Paper). Literature research between 2005 and 2010 showed that the long-term effects of these sessions were low, based on five reviews considering obesity treatment and six reviews dealing with motivational interviewing (MI). The reviews underline high attrition and dropout rates associated with decreasing compliance. Individual requirements for resilient motivation and relapse prevention are described with the help of the transtheoretical model of behavioral change and the self-control model. By integrating MI into group and individual counseling sessions, behavioral change can be encouraged over the long term. The stages of change can be ascertained and coping strategies of three different risk situations can be established. MI seems to be helpful especially at the beginning and end of treatment, during the state of maintenance.

Objective: The importance of online counselling for many areas of health care has been increasing over the last years. Nevertheless, there is a lack of systematic research on the quality and specifics of the therapeutic intervention., Methods: n = 1056 responses written by online counsellors between 12 / 2007 and 11 / 2008 were qualitatively analyzed regarding content and frequencies., Results: Within a generalized counselling structure that contains greeting, mirroring, intervention and closure, further structural aspects could be determined and linked to the counselling goals., Conclusions: The study's results serve the purpose of creating a better theoretical foundation for online counselling in health care., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background and Objective: Patients with chronic disease have to rely on safe and efficacious drug treatment. They therefore need individual information on their medicaton, in which counselling within the setting of general practice plays a pivotal role. However, information that seems to be relevant from the doctor's point of view is not necessarily consistent with the information patients consider to be necessary. The question was addressed in this study on to what extent patients are satisfied with the information they have received on their medication in general practice?, Methods: A standardized questionnaire consisting of the SIMS-D (German version of the Satisfaction with Information about Medicines Scale) and MARS-D (German version of the Medication Adherence Report Scale) was sent to 834 chronically ill patients between March 2007 and April 2008., Results: Patients felt quite satisfied with the information they received on "action and usage" of medication (mean 6.95; range 0 - 9). They were not quite so satisfied with the information they received on "potential problems of medication". Self-reported adherence showed a high mean of 23.6 (range 5 - 25). Less than half of the doctors (43.6 %) inquired "always" or "often" whether patients were taking any other drugs than those prescribed., Conclusion: Patients wish to have more information on potential drug-related problems. More attention needs to be given to a structured review of drugs prescribed in general practice., (Georg Thieme Verlag KG Stuttgart * New York.)

Purpose: Since completion of the AREDS study, evidence has accumulated to suggest that some form of dietary supplementation may be of value in special individuals who are at risk of progressive age-related macular degeneration (ARMD). We wanted to find out which of the many supplements available are recommended in practice and which instructions, promises, and purchasing arguments are used by German pharmacies., Methods: A blinded consultation following a standardized protocol was carried out in 60 pharmacies., Results: In 36 pharmacies specific products for dietary supplementation were recommended, but the dosage never complied with the AREDS study, and in 24 pharmacies, the necessity for a medical examination or consultation with an ophthalmologist was not mentioned. Possible interactions with other drugs or side effects were generally excluded., Conclusions: Potential risks of supplement intake were underestimated. Medical knowledge of the most frequent cause of blindness in the Western world was insufficient. A clear policy of recommendations according to evidence-based criteria is needed.

Counsellors of Independent Health Information Centres according to 65b Social Security Code V provide the public with comprehensive information on health and disease-related themes, as well as on their financial, service, and legal aspects; they also provide extensive counselling and psychosocial support. The counsellors mostly have a university background in educational, social, medical, or legal disciplines; they usually have long-term experience in counselling as well as additional professional qualifications. In addition to the provision of information, independent health information centres must also be active in assuring and promoting their own quality control. Different measures are applied for this purpose, however at this time there are no standardised, high-quality activities of the independent health information centres to ensure quality.

Women with familial predisposition for breast and ovarian cancer represent a small group of patients with very high risk for developing breast and/ or ovarian cancer before the age of 50 years. The individual breast cancer risk can be assessed by genetic counselling and can be specified by genetic diagnostics. As part of the gynaecological consultation, adequate preventive measures are offered. Psycho-oncological counselling may help in decision making. For hereditary carcinomas, counselling is still not considered as a routine medical care, even though basic and routine preventive measures are insufficient for this group of high risk patients. Within the last years, 12 specialized centres in Germany have developed a patient care concept for women with a familial risk for breast and ovarian cancer. Establishment of these centres for familial breast and ovarian cancer and use of evidence-based medical care was initiated in a nationwide interdisciplinary joint research project and supported by the German Cancer AiD. These measures were integrated in a quality assurance concept for structure, process and result optimization. Thus, all requirements for introducing these services into routine patient management have been fulfilled.

Background: This project aims to develop an evidence based clinical guideline for the rehabilitation of cardiac patients considering recent scientific literature (stage 1), procedures received by cardiac patients undergoing rehabilitation carried by the German Federal Insurance Institute for Salaried Employees (BfA) based on the Classification of Therapeutic Procedures (KTL) (stage 2), and expert agreement of the professionals involved (stage 3). This study presents the results of stage 2. The analysis of the KTL-statistics was carried out to determine whether it is essentially necessary to implement a guideline and to define "critical" aspects, i. e. aspects that require high priority implementation. The project is part of a research programme funded by the BfA., Methods: 317 out of the 840 possible KTL-codes were attributed to one of twelve therapeutic modules that--according to the results of stage 1--are characteristics of cardiac rehabilitation. For these modules the number of people having received therapeutic procedures belonging to the respective module the duration per patient and per week were calculated. The influence of concomitant factors such as age, gender and indication were analysed multivariately. Furthermore, the hospitals involved were compared. The analyses are based on approximately 87,400 KTL-entries from 5,494 patients (indication: "myocardial infarction" or "coronary artery bypass surgery") treated in 2000., Results: On average the patients receive therapeutic procedures "stemming" from 5.5 modules. More than 90 % receive procedures assigned to the modules "endurance training" or "motivation", respectively, and almost 70 % from "nutrition training". The other modules are rendered not consistently and occasionally to a relatively small degree. Younger patients following a myocardial infarction receive therapeutic procedures more frequently and longer while older patients after bypass surgery are treated less frequently and for a shorter duration. There is substantial variability between individual clinics., Discussion: It appears to be necessary to implement clinical practice guidelines in all evaluated therapeutic modules but "endurance training" and "motivation". An evidence based clinical practice guideline for the rehabilitation of cardiac patients should detail the kind and extent of procedure(s) required. It should also inform about the lack of evidence for variations in treatment with respect to age, gender, or indication. To facilitate monitoring of the degree of implementation of the guideline precise instructions for the documentation using the KTL should be developed and implemented. As a next step towards an evidence based, empirically proven and acceptable guideline this project's results will be discussed with experts from science and clinical practice.

The German Medical Association and the Federal Centre for Health Education have developed counselling material to support physicians in their efforts at counselling and treating persons with alcohol problems. The material consists of a counselling manual for diagnosis and therapy in the framework of ambulatory primary health care and of a brochure for patients on the basis of evidence-based medicine. The counselling manual for general practitioners and the brochure for the patients are both designed around the same core ideas and make a distinction between low risk alcohol consumption and risky alcohol consumption, between alcohol abuse and alcohol addiction and contain supplementary information on the specific offers of the addiction-aid-system.

Has not the term "rehabilitation" been very frequently used lately to describe exclusively vocational rehabilitation? If, however, "rehabilitation" does not cover all aspects of rehabilitation including the efforts made to provide the severely handicapped with the opportunity of developing their potential to the fullest then the severely handicapped are automatically considered segregated. What we do for them can only be described in a negative way. We are unable to integrate them vocationally but we do not want to leave them their fate, either. Without a positive exression for the efforts made for these fellow-citizens alone from the way we think and talk this part of rehabilitation implies inhuman tendencies.

18 months after a mass examination for coronary heart disease risk factors in employees of a large industrial firm, 75% of the subjects examined at that time were re-interviewed and measurements of blood pressure and weight repeated. Despite an altogether inadequate longterm control of the risk factors detected, a part of the subjects examined had drawn consequences regarding their way of life by reducing weight, changing smoking habits and increasing physical activity, thus proving the effectiveness of information and advice received in a screening investigation. In about 40% of the overweight subjects a reduction in weight and in half of the hypertensives a lowering of blood pressure to values below 160/95 mmHg was noted.