Enhancing the Status of Quality of Life Diagnostics in Caring for Breast Cancer Patients: Results From a Multilevel Implementation Study in a Regional Tumor Centre
Improving cancer patients' quality of life (QL) requires that QL-diagnostics, the
availability of QL-enhancing treatment options and treatment decisions are being integrated
into a clinical path. This description presents the development and implementation of such a
clinical path in the Tumorcenter Regensburg.
The acting persons and institutions in this clinical path are the breast cancer patients,
the hospitals, the family doctors or gynaecologists, and a QL-study team. Starting point is
the QL-assessment either in the hospital or in doctors' practice (EORTC QLQ-C30 plus BR-23).
The caring physician documents the patients' health status. Based on these two pieces of
information, the QL-study team writes up a medical/QL-opinion plus therapy recommendation.
This report is sent to the caring physician. The effectiveness of the therapy recommendation
is assessed in the following QL-assessment. This clinical path is implemented via three
interrelated methods of implementation: local opinion leaders, outreach visits, and quality
A total of 38 physicians were made familiar with QL-diagnostics through outreach visits, and
12 opinion leaders were identified and convinced to support this project. The quality circle
provided regular CME meetings on QL-enhancing therapy options (pain control, psychotherapy,
physiotherapy, nutrition, social rehabilitation). A total of 170 QL-reports were sent to
physicians. All 38 doctors found the QL-profiles comprehensible and the therapy
recommendations clinically relevant. The most common QL-problems were emotional functioning,
fatigue, and arm/shoulder problems.
QL-diagnostics is a new way to individualise and to rationalise patient care. It transforms
the QL-concept into a decision-relevant, integral part of a clinical path that aims to
provide high quality patient care.
Additional Descriptors: Psychosocial, Observational Model: Defined Population, Time Perspective: Longitudinal, Time Perspective: Prospective
Monika KS Klinkhammer-Schalke, MD
Tumorzentrum Regensburg e.V.
Germany: Ethics Commission