Quality of Life Research

, Volume 18, Issue 1, pp 125–136 | Cite as

Logistics of collecting patient-reported outcomes (PROs) in clinical practice: an overview and practical examples




Interest in collecting patient-reported outcomes (PROs), such as health-related quality of life (HRQOL), health status reports, and patient satisfaction is on the rise and practical aspects of collecting PROs in clinical practice are becoming more important. The purpose of this paper is to draw the attention to a number of issues relevant for a successful integration of PRO measures into the daily work flow of busy clinical settings.


The paper summarizes the results from a breakout session held at an ISOQOL special topic conference for PRO measures in clinical practice in 2007.


Different methodologies of collecting PROs are discussed, and the support needed for each methodology is highlighted. The discussion is illustrated by practical real-life examples from early adaptors who administered paper–pencil, or electronic PRO assessments (ePRO) for more than a decade. The paper also reports about new experiences with more recent technological developments, such as SmartPens and Computer Adaptive Tests (CATs) in daily practice.


Methodological and logistical issues determine the resources needed for a successful integration of PRO measures into daily work flow procedures and influence significantly the usefulness of PRO data for clinical practice.


Patient-reported outcomes Clinical practice ePRO assessments Health-related quality of life 


  1. 1.
    Greenhalgh, J., Long, A. F., & Flynn, R. (2005). The use of patient reported outcome measures in routine clinical practice: Lack of impact or lack of theory? Social Science and Medicine, 60, 833–843. doi: 10.1016/j.socscimed.2004.06.022.PubMedCrossRefGoogle Scholar
  2. 2.
    Li, C., Friedman, B., Conwell, Y., & Fiscella, K. (2007). Validity of the patient health questionnaire 2 (PHQ-2) in identifying major depression in older people. Journal of the American Geriatrics Society, 55, 596–602. doi: 10.1111/j.1532-5415.2007.01103.x.PubMedCrossRefGoogle Scholar
  3. 3.
    Ouimette, P., Wade, M., Prins, A., & Schohn, M. (2008). Identifying PTSD in primary care: Comparison of the primary care-PTSD screen (PC-PTSD) and the general health questionnaire-12 (GHQ). Journal of Anxiety Disorders, 22, 337–343.PubMedCrossRefGoogle Scholar
  4. 4.
    Williams, J. W., Jr, Noel, P. H., Cordes, J. A., Ramirez, G., & Pignone, M. (2002). Is this patient clinically depressed? Journal of the American Medical Association, 287, 1160–1170. doi: 10.1001/jama.287.9.1160.PubMedCrossRefGoogle Scholar
  5. 5.
    Juniper, E. F., Bousquet, J., Abetz, L., & Bateman, E. D. (2006). Identifying ‘well-controlled’ and ‘not well-controlled’ asthma using the asthma control questionnaire. Respiratory Medicine, 100, 616–621. doi: 10.1016/j.rmed.2005.08.012.PubMedCrossRefGoogle Scholar
  6. 6.
    Atherton, P. J., & Sloan, J. A. (2006). Rising importance of patient-reported outcomes. The Lancet Oncology, 7, 883–884. doi: 10.1016/S1470-2045(06)70914-7.PubMedCrossRefGoogle Scholar
  7. 7.
    Bren, L. (2006). The importance of patient-reported outcomes…it’s all about the patients. FDA Consumer, 40, 26–32.PubMedGoogle Scholar
  8. 8.
    van Andel, G., Bottomley, A., Fossa, S. D., Efficace, F., Coens, C., Guerif, S., et al. (2008). An international field study of the EORTC QLQ-PR25: A questionnaire for assessing the health-related quality of life of patients with prostate cancer. European Journal of Cancer, 44, 2418–2424. doi: 10.1016/j.ejca.2008.07.030.PubMedCrossRefGoogle Scholar
  9. 9.
    Chisholm, M. A., Williamson, G. M., Lance, C. E., & Mulloy, L. L. (2007). Predicting adherence to immunosuppressant therapy: A prospective analysis of the theory of planned behaviour. Nephrology, Dialysis, Transplantation, 22, 2339–2348. doi: 10.1093/ndt/gfm149.PubMedCrossRefGoogle Scholar
  10. 10.
    Luszczynska, A., Sarkar, Y., & Knoll, N. (2007). Received social support, self-efficacy, and finding benefits in disease as predictors of physical functioning and adherence to antiretroviral therapy. Patient Education and Counseling, 66, 37–42. doi: 10.1016/j.pec.2006.10.002.PubMedCrossRefGoogle Scholar
  11. 11.
    Efficace, F., Innominato, P. F., Bjarnason, G., Coens, C., Humblet, Y., Tumolo, S., et al. (2008). Validation of patient’s self-reported social functioning as an independent prognostic factor for survival in metastatic colorectal cancer patients: Results of an international study by the Chronotherapy Group of the European Organisation for Research and Treatment of Cancer. Journal of Clinical Oncology, 26, 2020–2026. doi: 10.1200/JCO.2007.12.3117.PubMedCrossRefGoogle Scholar
  12. 12.
    Gotay, C. C., Kawamoto, C. T., Bottomley, A., & Efficace, F. (2008). The prognostic significance of patient-reported outcomes in cancer clinical trials. Journal of Clinical Oncology, 26, 1355–1363. doi: 10.1200/JCO.2007.13.3439.PubMedCrossRefGoogle Scholar
  13. 13.
    Rumsfeld, J. S., MaWhinney, S., McCarthy, M., Jr., Shroyer, A. L., VillaNueva, C. B., O’Brien, M., et al. (1999). Health-related quality of life as a predictor of mortality following coronary artery bypass graft surgery. Participants of the Department of veterans affairs cooperative study group on processes, structures, and outcomes of care in cardiac surgery. Journal of the American Medical Association, 281, 1298–1303. doi: 10.1001/jama.281.14.1298.PubMedCrossRefGoogle Scholar
  14. 14.
    Gwaltney, C. J., Shields, A. L., & Shiffman, S. (2008). Equivalence of electronic and paper-and-pencil administration of patient-reported outcome measures: A meta-analytic review. Value in Health, 11, 322–333. doi: 10.1111/j.1524-4733.2007.00231.x.PubMedCrossRefGoogle Scholar
  15. 15.
    Bettinville, A., Rabenberg, H., & Hansgen, K. D. (2005). An enquiry into the WILDE-Intelligence-Test (WIT): Comparability of application of the paper-pencil-version vs. the computer based application—an analysis based on data of the Leipzig Vocational Retraining Center. Die Rehabilitation, 44, 237–243. doi: 10.1055/s-2005-866926.PubMedCrossRefGoogle Scholar
  16. 16.
    Folk, L. C., March, J. Z., & Hurst, R. D. (2006). A comparison of linear, fixed-form computer-based testing versus traditional paper-and-pencil-format testing in veterinary medical education. Journal of Veterinary Medical Education, 33, 455–464. doi: 10.3138/jvme.33.3.455.PubMedCrossRefGoogle Scholar
  17. 17.
    Norman, G. J., Sallis, J. F., & Gaskins, R. (2005). Comparability and reliability of paper- and computer-based measures of psychosocial constructs for adolescent physical activity and sedentary behaviors. Research Quarterly for Exercise and Sport, 76, 315–323.PubMedGoogle Scholar
  18. 18.
    Webb, P. M., Zimet, G. D., Fortenberry, J. D., & Blythe, M. J. (1999). Comparability of a computer-assisted versus written method for collecting health behavior information from adolescent patients. The Journal of Adolescent Health, 24, 383–388. doi: 10.1016/S1054-139X(99)00005-1.PubMedCrossRefGoogle Scholar
  19. 19.
    Heuser, J., & Geissner, E. (1998). Computerized version of the pain experience scale: A study of equivalence. Schmerz (Berlin, Germany), 12, 205–208. doi: 10.1007/s004820050143.Google Scholar
  20. 20.
    Velikova, G., Wright, E. P., Smith, A. B., Cull, A., Gould, A., Forman, D., et al. (1999). Automated collection of quality-of-life data: A comparison of paper and computer touch-screen questionnaires. Journal of Clinical Oncology, 17, 998–1007.PubMedGoogle Scholar
  21. 21.
    Cook, A. J., Roberts, D. A., Henderson, M. D., Van Winkle, L. C., Chastain, D. C., & Hamill-Ruth, R. J. (2004). Electronic pain questionnaires: A randomized, crossover comparison with paper questionnaires for chronic pain assessment. Pain, 110, 310–317. doi: 10.1016/j.pain.2004.04.012.PubMedCrossRefGoogle Scholar
  22. 22.
    Schaeren, S., Bischoff-Ferrari, H. A., Knupp, M., Dick, W., Huber, J. F., & Theiler, R. (2005). A computer touch-screen version of the North American Spine Society outcome assessment instrument for the lumbar spine. The Journal of Bone and Joint Surgery. British Volume, 87, 201–204. doi: 10.1302/0301-620X.87B2.15548.PubMedCrossRefGoogle Scholar
  23. 23.
    Bliven, B. D., Kaufman, S. E., & Spertus, J. A. (2001). Electronic collection of health-related quality of life data: Validity, time benefits, and patient preference. Quality of Life Research, 10, 15–22. doi: 10.1023/A:1016740312904.PubMedCrossRefGoogle Scholar
  24. 24.
    Burke, J. D., Burke, K. C., Baker, J. H., & Hillis, A. (1995). Test-retest reliability in psychiatric patients of the SF-36 Health Survey. International Journal of Methods in Psychiatric Research, 5, 189–194.Google Scholar
  25. 25.
    Kleinman, L., Leidy, N. K., Crawley, J., Bonomi, A., & Schoenfeld, P. (2001). A comparative trial of paper-and-pencil versus computer administration of the Quality of Life in Reflux and Dyspepsia (QOLRAD) Questionnaire. Medical Care, 39, 181–189. doi: 10.1097/00005650-200102000-00008.PubMedCrossRefGoogle Scholar
  26. 26.
    Ryan, J. M., Corry, J. R., Attewell, R., & Smithson, M. J. (2002). A comparison of an electronic version of the SF-36 General Health Questionnaire to the standard paper version. Quality of Life Research, 11, 19–26. doi: 10.1023/A:1014415709997.PubMedCrossRefGoogle Scholar
  27. 27.
    Saleh, K. J., Radosevich, D. M., Kassim, R. A., Moussa, M., Dykes, D., Bottolfson, H., et al. (2002). Comparison of commonly used orthopaedic outcome measures using palm-top computers and paper surveys. Journal of Orthopaedic Research, 20, 1146–1151. doi: 10.1016/S0736-0266(02)00059-1.PubMedCrossRefGoogle Scholar
  28. 28.
    Wilson, A. S., Kitas, G. D., Carruthers, D. M., Reay, C., Skan, J., Harris, S., et al. (2002). Computerized information-gathering in specialist rheumatology clinics: An initial evaluation of an electronic version of the Short Form 36. Rheumatology (Oxford England), 41, 268–273. doi: 10.1093/rheumatology/41.3.268.CrossRefGoogle Scholar
  29. 29.
    Beebe, T. J., Harrison, P. A., McRae, J. A., & Evans, J. A. (2006). The effects of data collection mode and disclosure on adolescent reporting of health behavior. Social Science Computer Review, 24, 476–488. doi: 10.1177/0894439306288690.CrossRefGoogle Scholar
  30. 30.
    DeAngelis, S. (2000). Equivalency of computer-based and paper-and-pencil testing. Journal of Allied Health, 29, 161–164.PubMedGoogle Scholar
  31. 31.
    Duncan, P., Reker, D., Kwon, S., Lai, S. M., Studenski, S., Perera, S., et al. (2005). Measuring stroke impact with the Stroke Impact Scale: Telephone versus mail administration in veterans with stroke. Medical Care, 43, 507–515. doi: 10.1097/01.mlr.0000160421.42858.de.PubMedCrossRefGoogle Scholar
  32. 32.
    Hepner, K. A., Brown, J. A., & Hays, R. D. (2005). Comparison of mail and telephone in assessing patient experiences in receiving care from medical group practices. Evaluation & the Health Professions, 28, 377–389. doi: 10.1177/0163278705281074.CrossRefGoogle Scholar
  33. 33.
    de Vries, H., Elliott, M. N., Hepner, K. A., Keller, S. D., & Hays, R. D. (2005). Equivalence of mail and telephone responses to the CAHPS Hospital Survey. Health Services Research, 40, 2120–2139. doi: 10.1111/j.1475-6773.2005.00479.x.PubMedCrossRefGoogle Scholar
  34. 34.
    Powers, J. R., Mishra, G., & Young, A. F. (2005). Differences in mail and telephone responses to self-rated health: Use of multiple imputation in correcting for response bias. Australian and New Zealand Journal of Public Health, 29, 149–154. doi: 10.1111/j.1467-842X.2005.tb00065.x.PubMedCrossRefGoogle Scholar
  35. 35.
    Beebe, T. J., Mcrae, J. A., Harrison, P. A., Davern, M. E., & Quinlan, K. B. (2005). Mail surveys resulted in more reports of substance use than telephone surveys. Journal of Clinical Epidemiology, 58, 421–424. doi: 10.1016/j.jclinepi.2004.10.007.PubMedCrossRefGoogle Scholar
  36. 36.
    Kraus, L., & Augustin, R. (2001). Measuring alcohol consumption and alcohol-related problems: Comparison of responses from self-administered questionnaires and telephone interviews. Addiction (Abingdon, England), 96, 459–471. doi: 10.1046/j.1360-0443.2001.9634599.x.Google Scholar
  37. 37.
    Ravens-Sieberer, U., Erhart, M., Wetzel, R., Krugel, A., & Brambosch, A. (2008). Phone respondents reported less mental health problems whereas mail interviewee gave higher physical health ratings. Journal of Clinical Epidemiology, 61, 1056–1060. doi: 10.1016/j.jclinepi.2007.12.003.PubMedCrossRefGoogle Scholar
  38. 38.
    Rodriguez, H. P., von Glahn, T., Rogers, W. H., Chang, H., Fanjiang, G., & Safran, D. G. (2006). Evaluating patients’ experiences with individual physicians: A randomized trial of mail, Internet, and interactive voice response telephone administration of surveys. Medical Care, 44, 167–174. doi: 10.1097/01.mlr.0000196961.00933.8e.PubMedCrossRefGoogle Scholar
  39. 39.
    Krueger, A. B., & Stone, A. A. (2008). Assessment of pain: A community-based diary survey in the USA. Lancet, 371, 1519–1525. doi: 10.1016/S0140-6736(08)60656-X.PubMedCrossRefGoogle Scholar
  40. 40.
    Meara, A. (2008). Director of medical management at the CMO of the Montefiori Medical Center. Ref Type: Personal Communication.Google Scholar
  41. 41.
    Bischoff-Ferrari, H. A., Vondechend, M., Bellamy, N., & Theiler, R. (2005). Validation and patient acceptance of a computer touch screen version of the WOMAC 3.1 osteoarthritis index. Annals of the Rheumatic Diseases, 64, 80–84. doi: 10.1136/ard.2003.019307.PubMedCrossRefGoogle Scholar
  42. 42.
    Cook, I. A., Balasubramani, G. K., Eng, H., Friedman, E., Young, E. A., Martin, J., et al. (2007). Electronic source materials in clinical research: Acceptability and validity of symptom self-rating in major depressive disorder. Journal of Psychiatric Research, 41, 737–743. doi: 10.1016/j.jpsychires.2006.07.015.PubMedCrossRefGoogle Scholar
  43. 43.
    Kable, S., Henry, R., Sanson-Fisher, R., Ireland, M., & Cockburn, J. (2006). Is a computer questionnaire of childhood asthma acceptable in general practice? Family Practice, 23, 88–90. doi: 10.1093/fampra/cmi079.PubMedCrossRefGoogle Scholar
  44. 44.
    Thumboo, J., Wee, H. L., Cheung, Y. B., Machin, D., Luo, N., & Fong, K. Y. (2006). Development of a smiling touchscreen multimedia program for HRQoL assessment in subjects with varying levels of literacy. Value in Health, 9, 312–319. doi: 10.1111/j.1524-4733.2006.00120.x.PubMedCrossRefGoogle Scholar
  45. 45.
    Williams, C. A., Templin, T., & Mosley-Williams, A. D. (2004). Usability of a computer-assisted interview system for the unaided self-entry of patient data in an urban rheumatology clinic. Journal of the American Medical Informatics Association, 11, 249–259. doi: 10.1197/jamia.M1527.PubMedCrossRefGoogle Scholar
  46. 46.
    Carr, A. J., Thompson, P. W., & Kirwan, J. R. (1996). Quality of life measures. British Journal of Rheumatology, 35, 275–281. doi: 10.1093/rheumatology/35.3.275.PubMedCrossRefGoogle Scholar
  47. 47.
    Bezjak, A., Ng, P., Skeel, R., DePetrillo, A. D., Comis, R., & Taylor, K. M. (2001). Oncologists’ use of quality of life information: Results of a survey of eastern cooperative oncology group physicians. Quality of Life Research, 10, 1–13. doi: 10.1023/A:1016692804023.PubMedCrossRefGoogle Scholar
  48. 48.
    Till, J. E. (1994). Measuring quality of life: Apparent benefits, potential concerns. The Canadian Journal of Oncology, 4, 243–248.PubMedGoogle Scholar
  49. 49.
    Taylor, K. M., Macdonald, K. G., Bezjak, A., Ng, P., & DePetrillo, A. D. (1996). Physicians’ perspective on quality of life: An exploratory study of oncologists. Quality of Life Research, 5, 5–14. doi: 10.1007/BF00435963.PubMedCrossRefGoogle Scholar
  50. 50.
    Katon, W., Von Korff, M., Lin, E., Walker, E., Simon, G. E., Bush, T., et al. (1995). Collaborative management to achieve treatment guidelines. Impact on depression in primary care. Journal of the American Medical Association, 273, 1026–1031. doi: 10.1001/jama.273.13.1026.PubMedCrossRefGoogle Scholar
  51. 51.
    Katz, S. J., Kessler, R. C., Lin, E., & Wells, K. B. (1998). Medication management of depression in the United States and Ontario. Journal of General Internal Medicine, 13, 77–86. doi: 10.1046/j.1525-1497.1998.00022.x.PubMedCrossRefGoogle Scholar
  52. 52.
    Regier, D. A., Narrow, W. E., Rae, D. S., Manderscheid, R. W., Locke, B. Z., & Goodwin, F. K. (1993). The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry, 50, 85–94.PubMedGoogle Scholar
  53. 53.
    Rose, M., Hess, V., Horhold, M., Brahler, E., & Klapp, B. F. (1999). Mobile computer-assisted psychometric diagnosis. Economic advantages and results on test stability. Psychotherapie, Psychosomatik, Medizinische Psychologie, 49, 202–207.PubMedGoogle Scholar
  54. 54.
    Greenhalgh, J., & Meadows, K. (1999). The effectiveness of the use of patient-based measures of health in routine practice in improving the process and outcomes of patient care: A literature review. Journal of Evaluation in Clinical Practice, 5, 401–416. doi: 10.1046/j.1365-2753.1999.00209.x.PubMedCrossRefGoogle Scholar
  55. 55.
    Espallargues, M., Valderas, J. M., & Alonso, J. (2000). Provision of feedback on perceived health status to health care professionals: A systematic review of its impact. Medical Care, 38, 175–186. doi: 10.1097/00005650-200002000-00007.PubMedCrossRefGoogle Scholar
  56. 56.
    Donaldson, M. S. (2004). Taking stock of health-related quality-of-life measurement in oncology practice in the United States. Journal of the National Cancer Institute. Monographs, 33, 155–167. doi: 10.1093/jncimonographs/lgh017.PubMedCrossRefGoogle Scholar
  57. 57.
    Detmar, S. B., Muller, M. J., Schornagel, J. H., Wever, L. D., & Aaronson, N. K. (2002). Health-related quality-of-life assessments and patient-physician communication: A randomized controlled trial. JAMA: The Journal of the American Medical Association, 288(23), 3027–3034. doi: 10.1001/jama.288.23.3027.CrossRefGoogle Scholar
  58. 58.
    Rubenstein, L. V., McCoy, J. M., Cope, D. W., Barrett, P. A., Hirsch, S. H., Messer, K. S., et al. (1995). Improving patient quality of life with feedback to physicians about functional status. Journal of General Internal Medicine, 10, 607–614. doi: 10.1007/BF02602744.PubMedCrossRefGoogle Scholar
  59. 59.
    Velikova, G., Booth, L., Smith, A. B., Brown, P. M., Lynch, P., Brown, J. M., et al. (2004). Measuring quality of life in routine oncology practice improves communication and patient well-being: A randomized controlled trial. Journal of Clinical Oncology, 22, 714–724. doi: 10.1200/JCO.2004.06.078.PubMedCrossRefGoogle Scholar
  60. 60.
    Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36® Health Survey Manual and Interpretation Guide. Boston, MA: New England Medical Center, The Health Institute.Google Scholar
  61. 61.
    Kroenke, K., Spitzer, R. L., & Williams, J. B. (2002). The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine, 64, 258–266.PubMedGoogle Scholar
  62. 62.
    Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B., Berry, J. T., & Mokdad, A. H. (2008). The PHQ-8 as a measure of current depression in the general population. Journal of Affective Disorders (in press).Google Scholar
  63. 63.
    Kroenke, K., Spitzer, R. L., & Williams, J. B. (2003). The patient health questionnaire-2: Validity of a two-item depression screener. Medical Care, 41(11), 1284–1292. doi: 10.1097/01.MLR.0000093487.78664.3C.PubMedCrossRefGoogle Scholar
  64. 64.
    McHorney, C. A., & Tarlov, A. R. (1995). Individual-patient monitoring in clinical practice: Are available health status surveys adequate? Quality of Life Research, 4, 293–307. doi: 10.1007/BF01593882.PubMedCrossRefGoogle Scholar
  65. 65.
    Embretson, S., & Reise, S. P. (2000). Item response theory for psychologists. Mahwah, NJ: Laurence Erlbaum Associates Inc.Google Scholar
  66. 66.
    Hambleton, R. K., Swaminathan, H., & Rogers, H. J. (1991). Fundamentals of item response theory. London: Sage Publications.Google Scholar
  67. 67.
    Embretson, S. E. (1996). The new rules of measurement. Psychological Assessment, 8, 341–349. doi: 10.1037/1040-3590.8.4.341.CrossRefGoogle Scholar
  68. 68.
    Wainer, H., Dorans, N., & Flaugher, R. (2000). Computerized adaptive testing: A primer. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  69. 69.
    Wainer, H., & Mislevy, R. J. (2000). Item response theory, item calibration, and proficiency estimation. In H. Wainer, N. J. Dorans, R. Flaugher, B. F. Green, R. J. Mislevy, L. Steinberg, & D. Thissen (Eds.), Computerized adaptive testing: A primer (2nd ed., pp. 61–101). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  70. 70.
    Rose, M., Bjorner, J., Becker, J., Fries, J. F., & Ware, J. (2008). Development of a preliminary physical function item bank supported the expected advantages of the Patient-Reported Outcome Measurement System (PROMIS). Journal of Clinical Epidemiology, 61, 17–33. doi: 10.1016/j.jclinepi.2006.06.025.PubMedCrossRefGoogle Scholar
  71. 71.
    Bjorner, J. B., Chang, C. H., Thissen, D., & Reeve, B. B. (2007). Developing tailored instruments: Item banking and computerized adaptive assessment. Quality of Life Research, 16(Suppl 1), 95–108. doi: 10.1007/s11136-007-9168-6.PubMedCrossRefGoogle Scholar
  72. 72.
    Cella, D., Yount, S., Rothrock, N., Gershon, R., Cook, K., Reeve, B., et al. (2007). The Patient-Reported Outcomes Measurement Information System (PROMIS): Progress of an NIH Roadmap cooperative group during its first two years. Medical Care, 45, S3–S11. doi: 10.1097/01.mlr.0000258615.42478.55.PubMedCrossRefGoogle Scholar
  73. 73.
    Reeve, B. B., Hays, R. D., Bjorner, J. B., Cook, K. F., Crane, P. K., Teresi, J. A., et al. (2007). Psychometric evaluation and calibration of health-related quality of life item banks: Plans for the Patient-Reported Outcomes Measurement Information System (PROMIS). Medical Care, 45, S22–S31. doi: 10.1097/01.mlr.0000250483.85507.04.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  1. 1.Dept of Psychosomatic MedicineUniversity Clinic EppendorfHamburgGermany
  2. 2.QualityMetricLincolnUSA
  3. 3.Dept of Radiation Oncology, Princess Margaret Hospital, University Health NetworkUniversity of TorontoTorontoCanada

Personalised recommendations