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In 2004 the German Institute for Quality and Efficiency in Health Care (IQWiG) was given a statutory mandate to prepare and publish evidence-based information for consumers and patients. The current study investigated the extent to which the IQWiG's "Change of Life" information pack was found to be both comprehensible and useful by users. A total of 41 qualitative, semi-structured interviews were conducted with menopausal women. The partial analysis presented here is based solely on the "Decision Aid" part of the information pack. For many women the information contained in the Decision Aid was new and the manner of presentation unusual. In the sample investigated here the Decision Aid was used rather as a confirmation of decisions that had already been made than as an aid in the decision-making process. Where it was not possible to harmonise the scientific evidence presented with the individual's own opinion, the decision-making conflict was intensified. Balancing of individual preferences against study results proved to be difficult for two reasons: first, the unusual manner of presentation and second, the two contrasting poles of "science-based information" and "own preferences", which were not regarded as being of equal significance. This conflict represents a fundamental problem in evidence-based decision aids.

Comparative Effectiveness Research (CER) seeks to establish treatment objectives and concepts striving to achieve patient relevant progress in therapy on the basis of published evidence. Using the example of palliative medicine and palliative care, respectively, it will be demonstrated that these two are under-researched areas of care. In addition, it will become clear that the success of this interdisciplinary treatment concept for the seriously ill must be weighed in the light of traditional clinical research - far beyond the cancer diagnosis. The current distinction between curative and palliative research and care urgently needs to be reconsidered.

The significance of palliative care as an interdisciplinary and multi-professional approach to treating patients with extremely severe medical conditions should be investigated using the same methodological standards as for clinical medicine in general. Clinical studies in palliative medicine show that certain standards, e.g. in pain therapy, have still not been sufficiently implemented. There is also a lack of methodologically appropriate studies to investigate palliative medicine as a complex intervention. This research deficit is all the more regrettable as - specifically in the field of oncology - it can be demonstrated that the benefit provided by the services of palliative care teams is very large, especially for patients with a particularly unfavorable course of the disease.

Mit dem Begriff Versorgungsforschung verbindet sich die Vorstellung, dass Wissenschaft helfen kann, durch ein besseres Verstandnis der patientennahen Prozesse innerhalb des hoch komplexen Systems der medizinischen Versorgung innovative Entwicklungen unter der Leitidee von Qualitat und Kosteneffektivitat moglichst zeitnah und breitenwirksam zu implementieren. Nachdem sich 2003 funfundzwanzig Fachgesellschaften zu dieser Neuorientierung der Forschung positiv geausert haben, stellt sich zugleich mit der Frage nach den erforderlichen Ressourcen die Frage nach den methodologischen Voraussetzungen Erfolg versprechender Studien. Es wird dafur pladiert, die Entwicklung von Health Technology Assessment und Versorgungsforschung als Parallelprozesse zu begreifen, die darauf angewiesen sind, ihre Relevanz und Akzeptanz von Beginn an auch unter dem Aspekt der Erfassung des Forschungs-Impacts zu diskutieren. Die reklamierte Gleichbehandlung mit der biomedizinischen Grundlagenforschung wird davon abhangen, ob es gelingt, die theoretischen Grundlagen von Versorgungsforschung so wirksam zu begrunden, dass diese nicht als beilaufige Anwendungsforschung, sondern mit der Orientierung auf zeitnahe und nachhaltige Implementation von Innovationen notwendigerweise auch als Grundlagenforschung verstanden wird. The scientific approach to health services research is thought to provide a better understanding of patient-centered processes within the hyper-complex system of medicine. The basic idea is to create new forms of routine within a framework of high quality and efficiency. In Germany in 2003 more than twenty-five medical societies demanded a consequent promotion of health services research. Besides the crucial question of sufficient resources, this leads to the value of methodological standards within health services research. Health Services Research and Health Technology Assessment should be looked upon as parallel processes which both depend on demonstrating relevance and gaining public acceptance. Evaluations of the impact of health services research should be integrated into a broader theoretical concept. Solid foundations for health services research as a basic theory for understanding the “last mile” of medicine are necessary in order to achieve the same esteem as the biomedical research now holds.

Departing from the latest academic research into Nazi medicine in Germany, the author looks at theoretical and ideological concepts in German history that left their mark on the formation of race hygiene. He argues that the overdramatization of the economic burden caused by the special requirements of the chronically ill and handicapped runs through all epochs of modern medical history and that this culturally pessimistic way of looking at a serious social problem in Germany reveals a frightening tradition which reached its crudest climax in the so-called T4 operation of the Nazis. The author makes a plea for this dark chapter of German medical history to be carefully analyzed and for the results of this research to be used in the current discussion on the further development of the health system, particularly in regard to patients who require special care.