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Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 1/2008

01-01-2008 | Original Article

Quality of life diagnosis and therapy as complex intervention for improvement of health in breast cancer patients: delineating the conceptual, methodological, and logistic requirements (modeling)

Authors: Monika Klinkhammer-Schalke, Michael Koller, Jeremy C. Wyatt, Brunhilde Steinger, Christoph Ehret, Brigitte Ernst, Ferdinand Hofstädter, Wilfried Lorenz

Published in: Langenbeck's Archives of Surgery | Issue 1/2008

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Abstract

Background and aims

A system for quality of life (QoL) diagnosis and therapy in breast cancer patients was developed according to the Medical Research Council (MRC) framework of complex interventions. Along MRC’s five phases in the continuum of evidence, the present paper deals with phase I: modeling (i.e., delineating the conceptual, methodological, and logistic requirements).

Basic elements

Theoretical background is a new conceptualization of QoL that provides a rational basis to diagnose “diseased” QoL. A care pathway as the central part of modeling is composed of the following interrelated structural elements: patients (n = 170), clinicians (n = 10), experts in a quality of life unit (n = 5), coordinating practitioners (n = 38), local opinion leaders (n = 12), and professional therapists for QoL enhancing therapies (n = 75). Networking of these structural elements was achieved by clinical algorithm. In the clinical center, the patient and doctor delivered a questionnaire (EORTC) and health status report. The QoL unit transformed it into a profile and experts’ report. The coordinating practitioner transformed the latter into a decision on QoL therapy and the care pathway ended with the professional therapists. Implementation of this system used a multifaceted strategy including educational outreach visits, local opinion leaders, and quality circles.

Conclusion

The suffering cancer patient is the main focus of this QoL diagnosis and therapy system. It will have to pass the rigorous test of a definitive randomized trial.
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Metadata
Title
Quality of life diagnosis and therapy as complex intervention for improvement of health in breast cancer patients: delineating the conceptual, methodological, and logistic requirements (modeling)
Authors
Monika Klinkhammer-Schalke
Michael Koller
Jeremy C. Wyatt
Brunhilde Steinger
Christoph Ehret
Brigitte Ernst
Ferdinand Hofstädter
Wilfried Lorenz
Publication date
01-01-2008
Publisher
Springer-Verlag
Published in
Langenbeck's Archives of Surgery / Issue 1/2008
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-007-0210-5

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