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Ehret, Christoph (2007): Implementierung und Evaluation einer integrierten Versorgungsstrategie für Patientinnen mit Brustkrebs auf der Basis von Lebensqualitätsdiagnostik und -therapie. Dissertation, LMU München: Faculty of Psychology and Educational Sciences
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Abstract

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.