Langenbeck's Archives of Surgery

, Volume 393, Issue 1, pp 1–12 | Cite as

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)

  • Monika Klinkhammer-Schalke
  • Michael Koller
  • Jeremy C. Wyatt
  • Brunhilde Steinger
  • Christoph Ehret
  • Brigitte Ernst
  • Ferdinand Hofstädter
  • Wilfried Lorenz
Original Article


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.


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.


Complex intervention Modeling Quality of life Breast cancer Implementation 



The authors would like to thank Sabine Fleischmann for her careful management of the QoL profile data bank. Furthermore, we are indebted to Laura Wilkie and Monika Schöll for their editorial support. Supported by the program “Bayern aktiv” of the Bavarian Ministry of Health, grant no. 710 302.


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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Monika Klinkhammer-Schalke
    • 1
  • Michael Koller
    • 2
  • Jeremy C. Wyatt
    • 3
  • Brunhilde Steinger
    • 1
  • Christoph Ehret
    • 1
  • Brigitte Ernst
    • 1
  • Ferdinand Hofstädter
    • 1
  • Wilfried Lorenz
    • 1
  1. 1.Tumor Center RegensburgRegensburgGermany
  2. 2.Center for Clinical TrialsUniversity Hospital RegensburgRegensburgGermany
  3. 3.Health Informatics CentreUniversity of DundeeDundeeUnited Kingdom

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