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)

Klinkhammer‐Schalke, Monika; Koller, Michael; Wyatt, Jeremy; Steinger, B.; Ehret, Christoph; Ernst, B.; Hofstädter, Ferdinand; Lorenz, W.

doi:10.1007/s00423-007-0210-5

Cited by 24 publications

(35 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The situation was routine clinical care (Klinkhammer-Schalke et al, 2008), not a scientific setting with its well-known reductionism. Patients and doctors used the same Likert-scale-type question to judge patient global QoL.…”

Section: Discussionmentioning

confidence: 99%

“…Doctors gave their judgement at the very end of the health status form that included all relevant information on patients' current status of health and treatment and also psychosocial co-fatalities (Troidl et al, 1998). The doctors were trained in QoL assessment during the implementation procedure, especially by outreach visits (Klinkhammer-Schalke et al, 2008). Hence they knew about the subject and what to do.…”

Section: Discussionmentioning

confidence: 99%

“…The interaction and the relative responsibilities of these individuals were determined in a care pathway (Klinkhammer-Schalke et al, 2008) (Table 1). Main patient inclusion criteria were diagnosis of primary breast cancer and informed consent to participate in the study.…”

Section: Study Participantsmentioning

confidence: 99%

“…Their professional background required specific training in the area of expertise. Professional therapists participated in quality circles of the Tumor Center Regensburg, that provided regular trainings using PDCA cycles (PDCA ¼ plan, do, check and act) (Klinkhammer-Schalke et al, 2008).…”

Section: Study Participantsmentioning

confidence: 99%

“…The first paper summarised the conceptual basis underlying the project (preclinical phase) and modelling (phase 1 of the MRC scheme, Table 1 (Klinkhammer-Schalke et al, 2008)). …”

mentioning

confidence: 99%

See 4 more Smart Citations

Implementing a system of quality-of-life diagnosis and therapy for breast cancer patients: results of an exploratory trial as a prerequisite for a subsequent RCT

Klinkhammer‐Schalke¹,

Koller

Ehret³

et al. 2008

Br J Cancer

View full text Add to dashboard Cite

A system for quality-of-life diagnosis and therapy (QoL system) was implemented for breast cancer patients. The system fulfilled the criteria for complex interventions (Medical Research Council). Following theory and modeling, this study contains the exploratory trial as a next step before the randomised clinical trial (RCT) answering three questions: (1) Are there differences between implementation sample and general population? (2) Which amount and type of disagreement exist between patient and coordinating practitioners (CPs) in assessed global QoL? (3) Are there empirical reasons for a cutoff of 50 points discriminating between healthy and diseased QoL? Implementation was successful: 74% of CPs worked along the care pathway. However, CPs showed preferences for selecting patients with lower age and UICC prognostic staging. Patients and CPs disagreed considerably in values of global QoL, despite education in QoL assessment by outreach visits, opinion leaders and CME: Zero values of QoL were only expressed by patients. Finally, the cutoff of 50 points was supported by the relationship between QoL in single items and global QoL: no patients with values above 50 dropped global QoL below 50, but values below 50 and especially at 0 points in single items, induced a dramatic fall of global QoL down to below 50. The exploratory trial was important for defining the complex intervention in the definitive RCT: control for age and prognostic stage grading, support for a QoL unit combining patient's and CP's assessment of QoL and support for the 50-point cutoff criterion between healthy and diseased QoL.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Participantsmentioning

confidence: 99%

Section: Study Participantsmentioning

confidence: 99%

“…The first paper summarised the conceptual basis underlying the project (preclinical phase) and modelling (phase 1 of the MRC scheme, Table 1 (Klinkhammer-Schalke et al, 2008)). …”

mentioning

confidence: 99%

See 3 more Smart Citations