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[Practice guideline for breast cancer rehabilitation from the perspective of the rehabilitation centres: findings of a user survey on acceptance and practicability of the pilot version].

BACKGROUND
The pilot phase of the rehabilitation guideline for patients with breast cancer of the German Pension Fund was accompanied by a user survey. This survey allowed oncological rehabilitation centres to comment on the guideline and to suggest changes.


METHODS
In the autumn of 2007 a total of 57 oncological rehabilitation centres treating a minimum of 50 patients with breast cancer (ICD-10: C50) annually were contacted with a written survey. The questionnaire was accompanied by an overview of performance data according to the KTL (Classification of Therapeutic Procedures) from 2006 allowing to determine the degree of adherence to the guideline's requirements.


RESULTS
Between 75% and 95% of the respondents agree that the rehabilitation guideline for breast cancer fulfils the quality attributes "scientific foundation (evidence)", "relevance for day-to-day work", "up-to-dateness", and "inter- and multidisciplinary development". 65% consider the guideline's comprehensiveness as "adequate" and structure and clarity as "rather to very structured". The individual chapters and treatment modules are "rather to very comprehensible" for 68% to 100%. Further information is needed especially with regard to "methodological overview", "information on the guideline's integration into the Pension Insurance's quality assurance programme", "scope" and "minimum percentage of patients requiring such treatment". Between 70% and 85% consider the KTL codes suggested to sufficiently represent the therapeutic contents of the treatment modules. 20% to 68% agree with the guideline's requirements regarding the "minimum percentage of patients requiring such treatment". In 7 of a total of 15 treatment modules the requirements are considered "adequate". The main reasons for insufficient adherence to the guideline's requirements are coding problems, as well as a high treatment volume and shortage of staff. The implementation of the guideline for the rehabilitation of patients with breast cancer raises positive and negative expectations.


DISCUSSION
The discussion centers around the normative standards regarding the minimum percentage of patients requiring such treatment that is considered too high in many modules. However, suggestions to alter the treatment requirements are at times quite heterogeneous. Coding problems should not be overrated as the performance data so far available date back to a period prior to introduction of the new KTL 2007.


CONCLUSION
At the end of the pilot phase the guideline will be revised where necessary, taking the rehabilitation centres' feedback into account. The Pension Insurance considers the guideline for the rehabilitation of patients with breast cancer an important addition to the quality assurance programme. According to the survey's results the guideline is generally accepted and realisable.