Tanja Krones

• Prof.
• Medical Doctor at University of Zurich

Background Due to its high incidence, prostate cancer (PC) imposes a burden on Western societies. Individualized treatment decision for nonmetastatic PC (eg, surgery, radiation, focal therapy, active surveillance, watchful waiting) is challenging. The range of options might make affected persons seek peer-to-peer counseling. Besides traditional fac...

Introduction The integration of shared decision making (SDM) in Swiss clinical practice has considerably progressed.¹ It is formally integrated and endorsed by the Swiss Medical Society and the smarter medicine/choosing wisely Switzerland campaign. This symposium will present innovative approaches to promote a wider implementation of SDM across cli...

Introduction Shared decision making (SDM) and advance care planning (ACP) are important evidence and ethics based concepts and communication tools to aid the treatment decision-making process. Although recommended in the care of patients with risks of complications, SDM and ACP have not yet been described as components of one single process. We the...

Objective To evaluate the nationwide online decision aid ‘Entscheidungshilfe Prostatakrebs’ (established in 2016, >11.000 users and 60 new users/week) for patients with non‐metastatic prostate cancer (PCa), from the perspective of patients and urologists. Patients and Methods To provide personalised information, the tool collects most of the Inter...

BACKGROUND Due to its high incidence, prostate cancer (PC) imposes a burden on Western societies. Individualized treatment decision for nonmetastatic PC (eg, surgery, radiation, focal therapy, active surveillance, watchful waiting) is challenging. The range of options might make affected persons seek peer-to-peer counseling. Besides traditional fac...

Self-determination is pivotal for a patient’s autonomy. Decisions at the end of life should reflect the human right to decide on the last days of life according to personal beliefs, philosophy, preferences, and values. Advance Care Planning (ACP) aims to ensure that patients receive medical care consistent with their values, goals, and priorities d...

Background and Aims Shared decision making (SDM) and advance care planning (ACP) are important evidence and ethics based concepts that can be translated in communication tools to aid the treatment decision-making process. Although both have been recommended in the care of patients with risks of complications, they have not yet been described as two...

We describe the development of ACP in Switzerland during the last decade in the German- and French-speaking cantons and on the national level. In 2013, a revision of the Swiss civil law came into force, declaring advance directives (ADs) as binding. Since then, ACP has been researched and implemented primarily by universities and university hospita...

Background Conversations about treatment goals, care planning and shared decision making are key to patient-centered care and rely heavily on specific communication skills. In Switzerland, Advance Care Planning (ACP) and shared decision making have been integrated into the curricula of many medical, nursing, and other health care professions and is...

Background As discussed worldwide, Advance Care Planning (ACP) needs successful and feasible processes. Useful documentation needs to be viewed in relation to the specific healthcare context, as there are significant differences in clinical practice. Methods In Switzerland, ACP is used as a standardized advance health care planning tool adapted to...

Background Shared decision making (SDM) and advance care planning (ACP) are two patient-centered concepts that support patients, their relatives and clinicians to engage in a decision-making process in which patient autonomy is better respected. Integrating the two complex interventions into one may support patients with moderate and high treatment...

Background Shared decision making (SDM) and advance care planning (ACP) are two patient-centered concepts that support patients, their relatives and healthcare professionals engage in a decision-making process in which patient autonomy is best put into practice. Combining the two complex interventions into one process may support patients with mode...

Background Shared decision making (SDM) and advance care planning (ACP) are two patient-centered concepts that support patients, their relatives and healthcare professionals engage in a decision-making process in which patient autonomy is best put into practice. Combining these complex interventions into one may support patients with moderate and h...

Shared Decision-Making as a Genuine Interprofessional Endeavor Abstract. In parallel with the growing complexity of decision-making processes, also the complexity of communication increases. This phenomenon requires adapted communication skills from all professions involved in the treatment of the patient. Consequently, the process of shared decisi...

Simulationen mit Simulationspersonen (Schauspieler*innen) gehören in der medizinischen Lehre zum Ausbildungs-Standard. In der medizinethischen Lehre ist dies bisher nicht in gleichem Umfang der Fall. Für ihren Einsatz, insbesondere in der klinischen Ethik, können gute Gründe angeführt werden, wie beispielsweise die Möglichkeit konkreter Erfahrungen...

Zusammenfassung Simulationen mit Simulationspersonen (Schauspieler*innen) gehören in der medizinischen Lehre zum Ausbildungs-Standard. In der medizinethischen Lehre ist dies bisher nicht in gleichem Umfang der Fall. Für ihren Einsatz, insbesondere in der klinischen Ethik, können gute Gründe angeführt werden, wie beispielsweise die Möglichkeit konkr...

Departing from the Swiss healthcare context and from the experience of the clinical ethics unit at a larger university hospital, this chapter discusses what “witnessing” structural vulnerability of patients actually entails for clinical ethics services from a normative point of view. It discusses the foundations and duties of clinical ethics servic...

The Swiss healthcare system is highly decentralized, making implementation of shared decision making (SDM) and patient and public involvement (PPI) quite slow; nonetheless, change is happening. SDM is now a core communication competency for medical school graduates, as reflected by a dedicated station on the federal exam, and is endorsed by several...

Inequitable access to deceased donor organs for transplantation has received considerable scrutiny in recent years. Emerging evidence suggests patients with impaired decision-making capacity (IDC) face inequitable access to transplantation. The “Ethical and Legal Issues” working group of the European Society of Transplantation undertook an expert c...

Objective: This study explores the supportive needs of informal caregivers of people with amyotrophic lateral sclerosis (ALS) in Switzerland. Method: We conducted semi-structured interviews with nine informal caregivers currently providing care to a person with ALS, 14 bereaved informal caregivers, and 13 healthcare professionals. Interviews were r...

Zusammenfassung. Mit steigender Komplexität der Entscheidungsprozesse steigt auch die Komplexität der Kommunikationsprozesse, welche von allen an der Behandlung beteiligten Fachpersonen angepasste kommunikative Fertigkeiten erfordern. Shared Decision-Making (SDM) erfordert deswegen als Prozess der gemeinsamen Entscheidungsfindung auch einen konsequ...

Background Extracorporeal life support (ECLS) provides support to patients with cardiopulmonary failure refractory to conventional therapy. While ECLS is potentially life-saving, it is associated with severe complications; decision making to initiate ECLS must, therefore, carefully consider which patients ECLS potentially benefits despite its conse...

Various indicators have been used to evaluate advance care planning, including completion rates, type of care received, and satisfaction. Recent consensus suggests, though, that receiving care consistent with one’s goals is the primary outcome of advance care planning and assessment should capture this metric. Goal concordant care is challenging to...

The National Cancer Plan emphasises the importance of medical communication and calls for its integration into medical education and training. In this context, the Milestone Communication Approach meets the communicative challenges in dealing with lung cancer patients. Interprofessional tandems, consisting of doctors and nurses, conduct structured...

Der Umgang mit Gesundheit und Krankheit, noch mehr aber die Übergänge zwischen dem einen und dem anderen Zustand, weisen mit der Entwicklung des therapeutischen Wissens und Könnens und der Strukturen in der Gesundheitsversorgung eine Vielfalt an ethischen Bezügen auf.

Bei der Behandlung von an Krebs erkrankten Patienten in der letzten Lebensphase ist der Patientenwille auch in Situationen, in denen der Patient selbst nicht mehr seinen Willen äußern kann, maßgebliche Grundlage für ärztliches Handeln. In der klinischen Praxis ist die Feststellung des Patientenwillens selbst bei Vorliegen einer Patientenverfügung h...

Artificial intelligence (AI) systems are increasingly being used in healthcare, thanks to the high level of performance that these systems have proven to deliver. So far, clinical applications have focused on diagnosis and on prediction of outcomes. It is less clear in what way AI can or should support complex clinical decisions that crucially depe...

Zusammenfassung Wir berichten über einen multimorbiden 56-jährigen Patienten, welcher mit unbehandelter Tumorerkrankung nach Multiorganversagen auf die Palliativstation verlegt wurde. Aufgrund einer Eisenmangelanämie wurde eine Magen-Darm-Diagnostik zum Ausschluss einer gastrointestinalen Blutung durchgeführt. Diese Untersuchung zeigte ein Adenokar...

Die Corona-Pandemie berührt weite Bereiche des gesellschaftlichen, wirtschaftlichen und politischen Lebens. Mit hoher Dringlichkeit stellt sich angesichts der Ressourcenknappheit die Forderung nach einer konkret gelebten Solidarität und verantwortungsvollen ­Koordination zwischen Behörden, Organisationen, Institutionen, Generationen und Individuen....

Die Corona-Pandemie berührt weite Bereiche des gesellschaftlichen, wirtschaftlichen und politischen Lebens. Mit hoher Dringlichkeit stellt sich angesichts der Ressourcenknappheit die Forderung nach einer konkret gelebten Solidarität und verantwortungsvollen ­Koordination zwischen Behörden, Organisationen, Institutionen, Generationen und Individuen....

Dieser Band präsentiert einen Überblick über die Medizinethik. Er stellt konzeptuelle und methodische Zugänge zum Fach dar und bietet Einblicke in zentrale Themenfelder. Kurze Einführungen und Lektürefragen zu ausgewählten Texten erleichtern die systematische Einordnung der verschiedenen theoretischen und praktischen Fragestellungen der Medizinethi...

Die ethische Bewertung von Schwangerschaftsabbrüchen zählt nicht nur zu den historisch am längsten diskutierten Themen der Medizinethik (s. Kap. 53: »Abtreibung – medizingeschichtlich«): In der jüngeren Geschichte ist die Diskussion über die Zulässigkeit von Schwangerschaftsabbrüchen in der Medizinethik einerseits auf das Engste mit einer breiten g...

Redaktionskomitee Federführende Fachgesellschaft

Das Institut für Biomedizinische Ethik und Medizingeschichte der Universität Zürich organisierte im Dezember 2019 zusammen mit den Universitätsspitälern Zürich und Basel ein Symposium zum Thema Shared Decision-Making. Etwa 50 Ex- perten aus dem schweizerischen Gesundheitswesen waren zum Austausch von Erfahrungen und Ansichten eingeladen worden. Das...

Zusammenfassung Wir berichten über einen multimorbiden 56-jährigen Patienten, welcher mit unbehandelter Tumorerkrankung nach Multiorganversagen auf die Palliativstation verlegt wurde. Aufgrund einer Eisenmangelanämie wurde eine Magen-Darm-Diagnostik zum Ausschluss einer gastrointestinalen Blutung durchgeführt. Diese Untersuchung zeigte ein Adenokar...

Artificial intelligence (AI) systems are increasingly being used in healthcare, thanks to the high level of performance that these systems have proven to deliver. So far, clinical applications have focused on diagnosis and on prediction of outcomes. It is less clear in what way AI can or should support complex clinical decisions that crucially depe...

Introduction: he effectiveness of extracorporeal life support (ECLS) in critically ill patients remains unclear despite a substantial increase in its use. This study critically assesses existing ECLS guidelines, consensus statements, and position papers to systematically review them for agreements and differences regarding indications and contrain...

Easier access to prenatal diagnostic procedures led to its widespread use as a screening measure. Hence, today it is more common for life-limiting illnesses to be diagnosed during fetal life. The concept of Advance Care Planning (ACP) provides a framework for caregivers, families and their multidisciplinary teams to anticipate and plan ahead for po...

Herkunft, Alter oder kognitive Beeinträchtigung sollten kein Hindernis für eine hochwer­ tige Spitalbehandlung sein. Die Realität sieht jedoch oft anders aus. Aufgrund besonderer Bedürfnisse können manche Patientengruppen im Akutspital besonders verletzlich sein. Was bedeutet gesundheitliche Chancengleichheit für diese Patient(inn)en? Und wie könne...

Countries deciding on deconfinement measures after initial lock-downs in response to the COVID-19 pandemic often include the continued confinement of those most vulnerable to the disease in these plans as a matter of course. Such continued confinement, however, is neither innocuous nor obviously justified. In this paper, we examine more systematica...

Background Only very few studies have been published on Shared Decision-Making (SDM) and Advance Care Planning (ACP) including high risk patients with aortic valve stenosis addressing transcatheter aortic valve replacement (TAVR), surgical valve replacement (SAVR) and palliative care as treatment options. Therefore, the aim of this study is to stre...

Background Anticipatory planning including advance care planning has become one of the megatrends in health care. As in many countries, terminology and understanding of anticipatory planning varies significantly. Aim For a common understanding of anticipation and guidance in clinical practice, we aimed to develop a national framework for anticipat...

Background Until now, there has not been any official ACP program in Swiss nursing homes. We implemented an already developed and successfully tested Swiss ACP program for acute care hospitals in two Swiss nursing homes. The aim of this study was to better understand the process, chances and difficulties of the implementation steps. Methods After...

Background Relatives of patients in need of care and of those who are seriously ill assume a variety of tasks. The aim of this study is a systematic review on needs, chances, risks and barriers of care giving relatives regarding advance care planning (ACP). Methods Qualitative and quantitative studies were identified through Pubmed, EMBASE, PsycIN...

Background The application was developed 2016 in Switzerland. The tool combines the different concepts of ACP, shared decision making (SDM) and medical emergency planning. In step one all documents and decision aids to create a living will are provided. Depending on the specifications the patient made in the living will (especially concerning treat...

Background When there is no advance care planning (ACP), relatives feel uncomfortable and ambivalent when deciding on behalf of someone who has lost decision-making capacity. The aim of this study was to understand proxies’ needs and gather experts’ views on how to improve ACP in Switzerland. Methods We conducted 20 interviews with proxies and fou...

Neugeborene bilden mit fast 40 Prozent die größte Gruppe der Todesfälle im Kindes- und Jugendalter in Deutschland. Die interprofessionelle Projektgruppe PaluTiN (Palliativversorgung und Trauerbegleitung in der Peri- und Neonatologie) hat unter dem Dach des Bundesverbandes Das frühgeborene Kind e. V. Leitsätze für eine zeitgemäße und alle relevanten...

General practitioners (GPs) play a key role in the timely diagnosis of dementia and also in advance care planning (ACP). They often have known patients and their families for decades and are familiar with their values and treatment preferences; they are, therefore, in a position to initiate the ACP process even before the appearance of the first sy...

Early results of hand and face transplants and other grafts such as those of uterus, penis, trachea, larynx or abdominal wall have confirmed the potential for vascularized composite allotransplantation (VCA) to restore appearance, anatomy, function, independence, and social integration in patients suffering from devastating tissues deficits untreat...

Aim of the Study: A substantial proportion of deaths of patients in the Intensive Care Unit (ICU) follow a decision to limit life-sustaining therapies. Patients with moderate to severe Traumatic Brain Injury (TBI) differ from the general ICU population: They are usually younger, previously healthy, and often with no advance directives. The objectiv...

Objectives To investigate the impact of advance care planning (ACP) including decision aids for severely ill medical inpatients. Methods Single-centre randomised controlled trial at a Swiss university hospital. Patients were randomly assigned (1:1) to receive an extra consultation with the hospital social service or a consultation with in-house fa...

Advance Care Planning in Swiss Nursing Homes: Results of a Focus Group Study Abstract. Advance Care Planning (ACP) is a standardized consultation process in which patients define their therapy goals for future medical treatments with the help of a qualified health care facilitator. This way, ACP increases the probability that patients' wishes are f...

Hintergrund: Notfallmediziner sind in ihrer Praxis häufig mit Patienten konfrontiert, die sich durch Suizid das Leben nehmen oder lebensverlängernde Maßnahmen nicht beginnen oder abbrechen wollen. Ziel der Arbeit: Um eine adäquate Bearbeitung dieser Fallkonstellationen zu gewährleisten, ist auch in solchen Notfallsituationen eine systematische ethi...

Background Emergency physicians are often confronted with patients after a suicidal attempt or who want to forgo or not initiate life-sustaining treatments. Objectives In order to adequately deal with these cases, a systematic approach is also crucial in emergency situations, which is developed in the article. Materials and methods Based on a sys...

Background: No standards exist regarding decision making for comatose patients, especially concerning life-saving treatments. The aim of this retrospective, single-center study was to analyze outcomes and the decision-making process at the end of life (EOL) in patients with traumatic brain injury (TBI) in a Swiss academic tertiary care hospital....

Neugeborene bilden mit fast 40 % die größte Gruppe der Todesfälle im Kindes- und Jugendalter in Deutschland. Die interprofessionelle Projektgruppe PaluTiN (Palliativversorgung und Trauerbegleitung in der Peri- und Neonatologie) hat unter dem Dach des Bundesverbandes Das frühgeborene Kind e. V. Leitsätze für eine zeitgemäße und alle relevanten Aspek...

Advance Care Planning is a structured and facilitated process that enables patients and their caregivers to think about their attitudes towards life and death and their wishes concerning future health care in the case of decisional incapacity. The concept combines individual counselling of the patient with a regional, systemic approach to make sure...

Liver transplantation has emerged to a highly efficient treatment for a variaty of acute and chronic liver diseases. Organ shortage, however, is becoming an increasing problem worldwide, limiting the applicability of liver transplantation. In addition, potential recipients are becoming sicker, thereby increasing the risk of loosing the graft during...

Half a century ago, the progress in medicine has become best visible in the intensive care units with the new possibilities of prolonging life. These possibilities have also challenged the relationship between medicine and death. The traditional view of death as an enemy had to be reviewed in the context of breathtaking advances in prolonging biolo...

Objectives: Recent investigations of ethnicity related disparities in health care have focused on the contribution of providers' implicit biases. A significant effect on health care outcomes is suggested, but the results are mixed. The purpose of this integrative literature review is to provide an overview and synthesize the current empirical rese...

BACKGROUND The decision aid "Entscheidungshilfe Prostatakrebs" is available online free of charge since June 2016. It is designed to support patients with their treatment decision-making and to lighten the burden on their treating urologists. This study evaluates usage data from the first 3 months. MATERIALS AND METHODS The ICHOM standard set was...

Refers to: Karen Lutfey Spencer, What is the future of research on medical decision making? (And is it bright?): A response to Drewniak and colleagues, Social Science & Medicine, Volume 168, November 2016, Pages 175-177. http://dx.doi.org/10.1016/j.socscimed.2016.09.017