gms | German Medical Science

27. Deutscher Krebskongress

Deutsche Krebsgesellschaft e. V.

22. - 26.03.2006, Berlin

Evaluation of a multifaceted strategy to implement quality of life in a regional tumor center

Meeting Abstract

  • corresponding author presenting/speaker Christoph Ehret - Tumorzentrum Regensburg e.V., Deutschland
  • Monika Klinkhammer-Schalke - Tumorzentrum Regensburg e.V.
  • Michael Koller - Zentrum für Klinische Studien, Regensburg
  • Brunhilde Steinger - Tumorzentrum Regensburg e.V.
  • Brigitte Ernst - Tumorzentrum Regensburg e.V.
  • Ferdinand Hofstädter - Tumorzentrum Regensburg e.V.
  • Wilfried Lorenz - Tumorzentrum Regensburg e.V.

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocPO555

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Veröffentlicht: 20. März 2006

© 2006 Ehret et al.
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Introduction: Quality of life (Qol) is frequently measured in cancer trials without ensuring that attending physicians utilize this information properly. Before a clinical trial about Qol-diagnostics and –therapy can be started, an implementation strategy has to be successfully conducted and evaluated; otherwise the results are confounded with the effectiveness of implementation.

Methods: A four facetted approach combined clinical path, outreach visits, opinion leaders and CME within a quality circle, to implement Qol-diagnostics and –therapy of patients with breast cancer in a regional tumor center. A clinical path embedded the system into clinical routine. Outreach visits trained general practitioners (GP) and clinicians in Qol-diagnostics and -therapy. Local opinion leaders ensured their support within the quality circle. It was also founded to solve acute problems involving all relevant parties.

The expert unit with 5 specialists in oncology, psychology and trial methodology/Qol analyzed the Qol profiles and indicated therapy (physiotherapy/lymph drainage, psycho therapy, nutrition/physical fitness, social rehabilitation, pain therapy), if the patient showed deficits < 50 on the respective score of a EORTC QL-profile (0=bad to 100=good).

Implementation was evaluated also by a multifaceted approach: Several contacts to every doctor studying knowledge, attitudes and behavior concering Qol by semi-structured interviews.

Results: The clinical path is shown in Fig.1 [Fig. 1]. 38/39 GPs asserted their attendance, also all 11 opinion leaders. 5 hospitals and 25 GPs enrolled 170 patients between 12/2002 and 6/2004. The expert unit compiled reports with therapeutic recommendations for every patient and discussed them with 20 GPs in their practice. 16 GPs (80%) rated the report as comprehensible and the recommendation as plausible, 14 (70%) intended to follow the recommendation. Four months later the 16 GPs were called by telephone: 5/16 reported to have administered at least one option.

The quality circle conducted 11 meetings. This resulted in improved programs for ambulant rehabilitation, short time psychotherapy (5-10 treatments) and a better quality management in physiotherapy.

Global Qol in the 170 patients showed no relationship to prognostic factor UICC (Spearman-r=.036;p=.663), weak relationship to doctors’ rating of Qol (ICC1=.54). Qol appeared as an largely independent, additional information.

Conclusion: Evaluation showed a great commitment of the participating doctors as well as improvement of medical care. Combination of objective health status (determined by physician) and subjective suffering (expressed by patients) is necessary to achieve a complete healing for the patient.