Swiss medical weekly最新文献

{"title":"2026 Swiss Society for Infectious Diseases recommendations for <i>Clostridioides difficile</i> infection.","authors":"Benoit Guery, Werner C Albrich, Silvio D Brugger, Romain Martischang, Virginie Prendki, Giacomo Stroffolini, Sarah Tschudin-Sutter","doi":"10.57187/5395","DOIUrl":"10.57187/5395","url":null,"abstract":"<p><p>The most recent Swiss Society for Infectious Diseases recommendations for Clostridioides difficile infection (CDI) in Switzerland were based on the 2018 American guidelines. Since then, a large number of new studies have been published, and updated international guidelines - both European and American - have introduced substantial innovations in CDI diagnosis and treatment. This document represents a consensus statement developed by a group of experts appointed by the Swiss Society for Infectious Diseases. The objective of these national guidelines is to provide a comprehensive, evidence-based and context-specific framework for the diagnosis, treatment, prevention and follow-up of CDI across all stages of disease. By synthesising the latest clinical evidence, recent international guideline updates, and national organisational and regulatory considerations, these guidelines aim to harmonise clinical practice, promote high-quality and equitable patient care and support clinicians in making informed, patient-centred decisions within the Swiss healthcare system. These guidelines are endorsed by the Swiss Society for Infectious Diseases.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5395"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shortages of paediatric primary care and contributing factors in Switzerland: a nationwide paediatrician survey and cross-sectional workforce analysis.","authors":"Lorenz M Leuenberger, Fabiën N Belle, Julian Jakob, Rotraud Katharina Saurenmann, Oliver Sutter, Philipp Jenny, Claudia Elisabeth Kuehni","doi":"10.57187/5362","DOIUrl":"https://doi.org/10.57187/5362","url":null,"abstract":"<p><strong>Background and aim of the study: </strong>Shortages of primary care paediatricians in Switzerland have been reported by the media, parents, and physicians. We sought to gain a comprehensive understanding of the paediatric primary care workforce by quantifying supply density and assessing paediatricians' views on the shortage and its contributing factors.</p><p><strong>Methods: </strong>We conducted an online survey from September 2024 to February 2025 among all board-certified members of the Swiss Society of Paediatrics, excluding retired members. The questionnaire included questions on perceived shortage, working conditions, and contributing factors. We estimated the paediatric primary care workforce in full-time equivalents (FTEs) and calculated the supply density across Swiss cantons by combining data from our survey with physician statistics from the Swiss Medical Association and population statistics from the Federal Statistical Office.</p><p><strong>Results: </strong>We contacted 1940 paediatricians, 1155 (60%) of whom answered our survey. Among respondents, 61% were based in practices, 29% in hospitals, and 10% in both settings. We estimated that 1017 full-time equivalent (FTE) primary care paediatricians worked in Switzerland in 2024, resulting in 0.63 FTEs per 1000 children (<18 years). Among primary care paediatricians, two-thirds (70% [95% CI 68-73]) perceived a shortage. Most reported working part-time (87% [86-89]), and respondents saw a median of 22 [IQR 17, 26] patients per full day. Respondents agreed that there is an insufficient number of physicians in Switzerland (69% [66-71]) and a high prevalence of part-time work (65% [62-67]), resulting in insufficient FTEs in paediatric primary care (79% [77-81]). Marked regional differences in supply density emerged, and this variability could be partly attributed to associations with financial disincentives (R2: 0.39) and rural characteristics (R2: 0.33).</p><p><strong>Conclusion: </strong>The regional paediatric primary care shortages in Switzerland, which are linked to a limited workforce, prevalent part-time work, financial disincentives, and the rural nature of affected regions, highlight the need for regionally targeted policy solutions.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5362"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescents and young adults with cancer in Switzerland: a large retrospective single-centre cohort analysis of key care pathways and outcomes by sex and age.","authors":"Eva S L Pedersen, Hanna Fischer, Daniëlle Verschoor, Ogo E Oromalu, Christoph Ryser, Marie-Noëlle Kronig, Thomas Pabst, Martin D Berger, Eva Segelov, Berna C. Özdemir","doi":"10.57187/5301","DOIUrl":"10.57187/5301","url":null,"abstract":"<p><strong>Study aims: </strong>Adolescents and young adults with cancer represent a distinct population facing unique challenges. While large registry-based studies exist, they often overlook aspects of local care. This study aimed to describe the demographic and clinical characteristics of adolescent and young adult patients with cancer treated at a Swiss tertiary centre, with particular focus on cancer type, sex, age variations, fertility preservation, palliative care, clinical trial participation and survival outcomes.</p><p><strong>Patients and methods: </strong>A retrospective single-centre study was conducted using electronic medical records of patients aged 15-39 years treated for an initial cancer diagnosis at University Hospital Bern (Inselspital) between 2015 and 2021. Descriptive statistics were used to summarise patient and cancer characteristics, and group differences were assessed using K-sample equality of medians and chi-squared tests. Kaplan-Meier plots evaluated 5-year survival, and logistic regression identified survival predictors.</p><p><strong>Results: </strong>The cohort included 395 patients (67% male), with a median age of 27 years. The most frequent diagnoses were Hodgkin lymphoma (25%) and testicular cancer (24%), followed by non-Hodgkin lymphoma, leukaemia and central nervous system tumours (each 11%). Median time from diagnosis to first treatment was 13 days. Fertility consultations were held in 58% of cases (higher among males: 61% vs 50%). Clinical trial participation was 29%. Five-year survival was 84% overall, but significantly lower in older patients and those with metastatic disease.</p><p><strong>Conclusions: </strong>This is the first study to report on adolescent and young adult cancer patients at a Swiss tertiary centre. While overall survival was favourable, disparities were observed based on age, diagnosis and disease stage. These findings underscore the need for targeted improvements in palliative care services, fertility counselling and trial inclusion for adolescent and young adult cancer patients.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5301"},"PeriodicalIF":1.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toxoplasmosis in focus - how a small parasite conquers the world.","authors":"Sabine Majer","doi":"10.57187/4379","DOIUrl":"https://doi.org/10.57187/4379","url":null,"abstract":"<p><p>Toxoplasma gondii is one of the most important parasites globally in both veterinary and human medicine, with significant impacts on livestock. Approximately one-third of the global population is latently infected. In humans, infection is typically asymptomatic or causes mononucleosis-like symptoms, but primary infection during pregnancy and reactivation in immunocompromised individuals are of particular concern. Latent infection may be associated with personality and neuropsychiatric disorders or neurodegenerative diseases. Despite a sound rationale, many congenital toxoplasmosis surveillance programmes have been discontinued due to limited effectiveness. Current One Health research focuses on developing new therapies and vaccines to prevent transmission in humans and animals.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"4379"},"PeriodicalIF":1.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and therapeutic gaps in Chronic Obstructive Pulmonary Disease management and their associations with 1-year survival after hospitalisation for acute exacerbations.","authors":"Julian S Flury, David Srivastava, Recep A Hacialioglu, Sabrina Jegerlehner","doi":"10.57187/4634","DOIUrl":"https://doi.org/10.57187/4634","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Chronic Obstructive Pulmonary Disease (COPD) remains a leading cause of morbidity and mortality globally. Acute exacerbations of COPD (AE-COPD) significantly worsen patient outcomes; however, COPD is frequently underdiagnosed and undertreated despite established guidelines.This study aimed to assess (1) the characteristics of patients hospitalised for a first episode of AE-COPD, (2) the differences between patients who had received guideline-recommended inhalation therapy prior to their first AE-COPD hospitalisation and those who had not, and (3) the associations between patient characteristics, pre-hospital inhalation treatment status and 1-year all-cause mortality following the index hospitalisation.</p><p><strong>Methods: </strong>In this retrospective cohort study, 1855 consecutive patients admitted with clinically and spirometrically diagnosed AE-COPD to a secondary-level Swiss hospital between September 2016 and September 2024 were analysed. The primary outcome was 1-year all-cause mortality following the index hospitalisation. Survival was analysed using Kaplan-Meier estimates and Cox proportional hazards regression, with results reported as hazard ratios with 95% confidence intervals.</p><p><strong>Results: </strong>Overall, 50.6% (n = 938) of patients lacked documented spirometric GOLD staging and 82.6% (n = 1533) had no recorded risk classification. Patients were stratified based on pre-admission use of long-acting inhalation therapy: Group 1 (no therapy, n = 834 [45.0%]) and Group 2 (therapy, n = 1021 [55.0%]). Baseline characteristics were largely comparable between groups; however, patients receiving long-acting inhalation therapy (Group 2) had significantly more patients with spirometrically confirmed COPD. During 1-year follow-up, 236 deaths (12.7%) occurred, in 133 of the 834 (15.9%) Group 1 patients and 103 of the 1021 (10.1%) Group 2 patients  (log-rank p <0.001). In multivariable Cox regression analysis, no long-acting inhalation therapy (Group 1) as a variable was independently associated with higher 1-year all-cause mortality (adjusted HR: 1.95, CI: 1.48-2.56, p <0.001).</p><p><strong>Conclusion: </strong> Significant diagnostic and therapeutic gaps were observed in patients hospitalised for the first episode of AE-COPD. Guideline-recommended inhalation therapy prior to hospitalisation was independently associated with decreased 1-year all-cause mortality. Our findings suggest that guideline-recommended inhalation therapy reflects structured COPD care, earlier diagnosis and closer medical follow-up rather than a pharmacological effect alone. Hospitalisation for AE-COPD represents a critical opportunity to reassess the diagnosis and optimise long-term management, even within a well-resourced healthcare system.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"4634"},"PeriodicalIF":1.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extensive cervical myelitis following pembrolizumab treatment after prior radiotherapy: a case report.","authors":"Bettina Simon, Manon Noirat, Sandra Martinez-Ballart, Marie-Delphine Le Coultre, Caroline Mona, Denise Becker, Jens Lustenberger, Christian Monnerat","doi":"10.57187/5378","DOIUrl":"https://doi.org/10.57187/5378","url":null,"abstract":"<p><strong>Introduction: </strong>Immune checkpoint inhibitors represent a significant therapeutic advancement in the management of multiple malignancies. However, they are associated with rare but potentially severe neurological immune-related adverse events.</p><p><strong>Case presentation: </strong>We report the case of a patient in his 70s with metastatic lung adenocarcinoma who developed extensive cervical myelitis following pembrolizumab immunotherapy in the context of prior cervical radiotherapy. Spinal magnetic resonance imaging (MRI) revealed extensive inflammatory lesions involving the cervical spinal cord with extension to the thoracic region.</p><p><strong>Management and outcomes: </strong>Despite the discontinuation of pembrolizumab and the early initiation of aggressive immunosuppressive therapy including high-dose corticosteroids, plasmapheresis, intravenous immunoglobulin and tocilizumab, the clinical course was rapidly and progressively unfavourable.</p><p><strong>Conclusion: </strong>This case highlights the potential severity of immune-mediated myelitis, raises the question of whether there is a deleterious interaction between immune checkpoint inhibitor and prior radiotherapy, and illustrates the limitations of current therapeutic strategies in cases of refractory forms.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5378"},"PeriodicalIF":1.6,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of chronic non-cancer pain in Swiss nursing homes: an observational mixed-methods study.","authors":"Florent Macé, Marion Yerli, Damien Cateau, Tosca Bizzozzero, Isabelle Levasseur, Anne Niquille","doi":"10.57187/4743","DOIUrl":"10.57187/4743","url":null,"abstract":"<p><strong>Study aims: </strong>The management of chronic non-cancer pain in nursing home residents represents a major challenge, given the complexity and fragility of this population. The aim of this study was to evaluate professional practice in this management in nursing homes of the French-speaking part of Switzerland.</p><p><strong>Methods: </strong>Our observational study was based on a panel of 124 nursing homes in the Vaud canton. Two convergent parallel approaches were carried out to collect data: an online questionnaire for nurses and referring physicians about the chronic pain management practices of their nursing home, as well as a retrospective observational study analysing analgesic consumption in nursing homes of the Vaud canton between 2017 and 2021.</p><p><strong>Results: </strong>Our study highlights that mixed pain evaluation (self- and hetero-assessment) and non-pharmacological measures (i.e. physiotherapy, psychological and adapted physical activities) are used in the management of chronic non-cancer pain within the studied nursing homes. Opioid analgesics are mainly considered when non-pharmacological measures and step 1 analgesics are insufficient to manage the pain. When an opioid analgesic is considered, tramadol and morphine are the most frequently prescribed drugs among step 2 and 3 analgesics. Collaboration between nurses and physicians in pain management is evaluated as good or excellent by most interviewees, with mutual recognition of each other's professional role. The pharmacist's role seems more limited, mainly to providing reminders of best prescribing practices for analgesics during quality circle sessions, and routinely verifying the adequacy of analgesic treatments prescribed. The lack of time at the resident's bedside, the nurses' specific skills in pain management, and the reluctance of patients to report their pain were the main obstacles mentioned by the interviewed professionals. A disparity between nursing homes was observed in terms of quantitative and qualitative consumption of analgesics.</p><p><strong>Conclusion: </strong>This study shows that healthcare professionals in nursing homes considered are aware and adhere to recommendations for chronic non-cancer pain management, whether in terms of pain assessment, or non-pharmacological and pharmacological measures. This management is supported by interprofessional practice within these nursing homes, in terms of defining the roles of each and sharing tasks between physicians and nurses. However, a strengthening of the interprofessional collaboration, a more extensive training of nurses as well as audit and feedback on analgesic use would be levers to foster better management of chronic non-cancer pain among nursing home residents.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"4743"},"PeriodicalIF":1.6,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating clinical severity, functional impairment, and contextual factors in psychiatric work capacity evaluations.","authors":"Cristian Damsa, Jules Mathys, Annie Forclaz, Elodie Vilcot, Alicia Grillet, Vanessa Schaerer, Braulio Mora, Alin-Constantin Toanchina, Cristina Patru, Aurica Stroescu, Lino Aranda Assuncao, Annie Lufungula, Philippe Rossignon, Ahamada Badini, Jean-Luc Bendeck, Sara Medjmadj, Veronica Rato, Olida Bezafy Nirina, Nader Perroud","doi":"10.57187/5372","DOIUrl":"10.57187/5372","url":null,"abstract":"<p><p>Internationally, psychiatric work capacity assessments increasingly emphasise functioning, participation, contextual factors, and return-to-work processes rather than diagnosis alone. Nevertheless, substantial inter-rater variability persists in routine clinical practice, particularly in short-term sickness benefit evaluations, in which clinicians must balance therapeutic protection, proportionality, prevention of chronicity, and occupational reintegration. Since 2015, Swiss Federal Supreme Court case law has progressively established a structured medico-legal framework for evaluating psychiatric disorders, initially for persistent somatoform pain disorders and subsequently for depressive and substance-related disorders. These principles were mainly developed for disability insurance and long-term invalidity assessments. However, their direct application to sickness benefit insurance may be clinically problematic because such evaluations involve shorter time horizons, different objectives, and a preventive dimension. Drawing on fifteen years of structured intervision among independent psychiatrists engaged in ongoing clinical practice, this Viewpoint presents a pragmatic clinical synthesis of dimensions that have already been described separately in the international peer-reviewed literature on psychiatric work capacity assessment. The framework integrates symptom severity, functional impairment, contextual stressors, and longitudinal coherence into a simplified four-level model intended to facilitate communication among general practitioners, psychiatrists, employers, insurers, and medical advisors. Severity level 0 corresponds to situations with no clinically relevant psychiatric disorder or objective functional impairment. Severity level 1 includes mild but clinically meaningful conditions in which temporary preventive sick leave may support stabilisation and recovery. Severity level 2 encompasses moderate disorders associated with clear functional repercussions that may require time-limited incapacity and regular reassessment. Severity level 3 refers to severe psychiatric disorders associated with marked and pervasive impairment that may require prolonged support and multidisciplinary coordination. The originality of this framework lies not in the creation of new validated constructs, but in the synthesis and simplified visual operationalisation of function-oriented and biopsychosocial dimensions already recognised internationally, including functioning-based and return-to-work approaches. Therefore, this framework should not be interpreted as a psychometric scale or a validated medico-legal instrument but rather as a clinically pragmatic tool intended to support proportionate reasoning and reduce variability in routine psychiatric work capacity evaluations across healthcare systems.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5372"},"PeriodicalIF":1.6,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of basic vs private health insurance status on treatments and outcomes of ST-elevation myocardial infarction patients in Switzerland: insights from the AMIS Plus registry.","authors":"Jan Loosli, Fabienne Foster-Witassek, Marco Roffi, Viktor Von Wyl, Hans Rickli, Giovanni Pedrazzini, Dragana Radovanovic","doi":"10.57187/5113","DOIUrl":"https://doi.org/10.57187/5113","url":null,"abstract":"<p><p>  BACKGROUND: Large disparities in treatments and outcomes of ST-elevation myocardial infarction (STEMI) patients driven by insurance status have been reported. However, it is unknown whether this applies to Switzerland, a country characterised by an overall high income, mandatory basic health insurance covering virtually all treatments and the option of a supplementary private health insurance allowing for full institution and doctor choice as well as a higher service standard. This study aimed to assess the impact of insurance status on treatments and outcomes in STEMI patients in Switzerland.</p><p><strong>Methods: </strong>STEMI patients enrolled in the nationwide Acute Myocardial Infarction in Switzerland (AMIS) Plus registry between 2005 and 2023 were analysed. We compared patients with basic health insurance only to those with supplementary private health insurance with respect to optimal medical therapy, percutaneous coronary intervention (PCI) and outcomes. Primary outcome measures were rates of optimal medical therapy and full guideline-recommended treatment (FGRT) (defined as optimal medical therapy plus PCI). Secondary outcome measures were in-hospital all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), length of stay and 1-year all-cause mortality after discharge. Multivariate logistic mixed-effects models examined whether insurance type influenced treatments and outcomes.</p><p><strong>Results: </strong>Among 16,463 patients, 13,023 (79.1%) had only basic health insurance. Patients with basic health insurance only were younger, more often males and had higher rates of obesity, diabetes and active smoking, but lower rates of cancer than supplementary private health insurance patients. In addition, they more often received optimal medical therapy and FGRT. Patients with basic health insurance only had higher rates of in-hospital mortality and MACCE. However, after adjusting for covariates, no statistically significant associations were identified between insurance type and access to optimal medical therapy or FGRT, in-hospital mortality, MACCE, length of stay or 1-year mortality after discharge.</p><p><strong>Conclusion: </strong>In this study, we observed no significant association between insurance status and treatments or outcomes of STEMI patients, suggesting a high level of equity in acute cardiac care in Switzerland.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5113"},"PeriodicalIF":1.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"iDecide: the Advance Directive app to facilitate engagement in Advance Care Planning.","authors":"Alexander Von Segesser, Rahel Rüegg, Patrick Schneier, Sibylle Felber, Maud Maessen, Steffen Eychmüller","doi":"10.57187/4775","DOIUrl":"https://doi.org/10.57187/4775","url":null,"abstract":"<p><strong>Study aims: </strong>Advance Directives (AD) are central to Advance Care Planning (ACP), allowing patients to document medical preferences in legally binding documents. Despite broad public awareness and support, only one-fifth of the Swiss population has completed an AD. Consequently, the roadmap for ACP implementation by the ACP National Task Force calls for the development of digital applications to promote ACP in Switzerland. This study details the development process for the mobile application \"iDecide\" for AD creation based on the Swiss Medical Association (FMH) AD template. The primary aim is to ensure optimal usability and user satisfaction with the app.</p><p><strong>Methods: </strong>Using a Participatory Action Research (PAR) approach, four research cycles were conducted to create an evidence-based AD creation tool. The iDecide app, published in October 2024 (www.idecide.ch), was reviewed by users through an online survey. The survey evaluated the app's user-friendliness, educational information quality and concordance with ACP goals, measuring 14 items on a 5-point Likert scale.</p><p><strong>Results: </strong>The PAR approach led to the successful development of the iDecide app for AD creation. The app guides users through the process of drafting their personalised AD. It provides multimedia patient information on the content and value of AD, encourages reflection on personal preferences and promotes communication with surrogate decision-makers and healthcare professionals. The drafted AD is available in both print and in a digital format via an offline QR code. This QR code allows AD information to be stored, shared and accessed when needed. Survey responses from 94 app users indicated high usability, information quality and user satisfaction. On a 5-star rating system, the mean overall rating was 4.69 (SD: 0.57, 95% CI: 4.56-4.81), consistent across age groups. Users rated the app as easy to use and making AD creation more attractive.</p><p><strong>Discussion: </strong>While various online forms for AD creation exist in Switzerland, no mobile app has previously enabled the public to complete an AD. iDecide is a ready-to-use AD application, operating without the need for additional infrastructure and freely available to the general public. The tool aligns with the national roadmap for ACP implementation and adheres to key recommendations for digital ACP tool design. It effectively tackles barriers to widespread AD implementation in Switzerland, addressing engagement and accessibility issues. iDecide thus has the potential to empower people to actively engage in their ACP.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"4775"},"PeriodicalIF":1.6,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}