Implementierung und Evaluation einer integrierten Versorgungsstrategie für Patientinnen mit Brustkrebs auf der Basis von Lebensqualitätsdiagnostik und -therapie

This thesis aims at the implementation of a novel system of quality
of life (QoL) diagnostics and therapy for patients with breast
cancer in a defined region. The relevance of this QoL system for
the treatment was analyzed as well as the influence of specific
cut-off points on the rate of patients classified as diseased. A
further point of interest consisted in the effect of the
implementation program on attitude and behavior of the physicians
involved. Based on social-psychological methods for influencing
behavior, this system was introduced into clinical routine by means
of outreach visits, opinion leaders, and interactive quality
circles. Quality of life data were self-reported by patients
(EORTC-QLQ-C30 plus BR23), whereas physicians filled in a health
status questionnaire for every patient. Based on theoretical
reasoning and empirical results, a cut-off point was defined to
record individual deficits in quality of life that required
treatment. Empirical results about group decision processes were
systematically considered for the development of a judgment system
that integrates relevant information and recommends specific
therapies. Thirty-eight coordinating physicians, who were
identified on the basis of their documentation for the Tumor Center
Regensburg, recorded the data of 170 patients with regard to
quality of life and health status. Both samples were representative
for the underlying population. Quality of life diagnostics resulted
in relevant additional information that could not be predicted by
either socio-demographic or medical data. The cut-off point
classified 9 to 37% of patients as sick and in need of treatment.
These rates corresponded to epidemiologic findings in the
literature. The use of established evaluation models revealed the
structural prerequisites of the project as well as each step of
implementation. Furthermore, it showed a positive attitude of the
physicians towards the QoL system, an acceptable execution of the
recommended QoL therapies, and an extensive commitment at the
subsequent randomized trial. Further research should analyze the
actual benefit of the QoL system for the treatment of patients, a
validation of the cut-off point, and a further exploration of
methods to overcome barriers for implementation. In a nutshell,
this paper demonstrates that QoL should be systematically
integrated, based on social-psychological concepts and methods,
into the treatment of patients with breast cancer.