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The ZESOR-Study - A Goal-orientated Approach to Evaluate Oncological Inpatient Rehabilitation Programs

Background and objectives:
The majority of oncological rehabilitation prrograms in Germany take place in inpatient settings (Koch & Weis, 1997). Intermediate and longterm effects and process characteristics of these programs are rarely examined. Also there exists only few studies evaluating rehabilitation under goal-orientated aspects.

Thus, the objective of the following study, which is granted by the Rehabilitationswissenschaftlicher Forschungsverbund Freiburg/Bad Säckingen, is to evaluate process characteristics as well as outcomes with a goal-orientated methodology. The design has three measurement points: T1 at baseline/admission, T2 after the rehabilitation program/discharge and T3, a one-year-follow-up. Additionally, a group of cancer patients who do not participate in any inpatient program will be assessed as a control condition.
The study should answer the following questions:

What are the outcomes of oncological inpatient rehabilitation programs with respect to the domains
- physical and psychological state,
- quality of life,
- coping,
- psychosocial integration
compared with a group of patients who do not participate in rehabilitation programs?

What is the relation between goal setting, goal modification and goal attainment on the one hand and individual and program characteristics on the other hand?

How stable are the effects of inpatient rehabilitation interventions after 1 year?

What are the predictors for the intermediate and longternm effects of rehabilitation?

Methods:
The treatment group of our study consists of 250 women with breast cancer participating in rehabilitation programs immediately after the acute treatment. The patients of the treatment group were investigated with self-reporting questionnaires at the beginning and the end of their hospital stay as well as 1 year later. This multicenter study is carried out in cooperation with three further centers for oncological rehabilitation.
The 250 patients of the control group are recruited in cooperating hospitals in Southern Germany specialised on acute breast cancer treatment. Women under the control condition follow the same data collection schedule as women of the treatment group.

In order to evaluate outcome parameters and process characteristics, the following areas will be targeted:

- Generic and cancer-specific measures of quality of life
- Psychological state/coping
- Needs for rehabilitation/status of rehabilitation
- Satisfaction with the treatment
- Social support

The main areas as mentionned above will be assessed with the following standardized instruments:

- The EORTC-QL-C30/quality of life
- The TSK (Trier Coping Scales)/coping
- The HADS (Hospital Anxiety and Depression
Scale) / psychological state

To assess individual goal attainment in the intervention group we employed a procedure following the traditional approach of Goal Attainment Scaling (Kiresuk et al., 1968,
1994). In a pilot study, medical specialists, psycho-oncologists and women with breast cancer were asked in focus groups about their experiences and goals concerning oncological inpatient intervention programs. This dicussion provided us a large pool of so called rehabilitation goals, that are partly specific for women with breast cancer. A catalogue was developed, which delivers a systematic structure of rehabilitation goals that allows each patient to set her own goals and priorities. This goal catalogue is also used in an adapted version to ask for doctor's and psychologists view of individual rehabilitation priorities.

Results:
The study started at the Tumor Biology Center - Freiburg in december 1998.
The data collection in the cooperating centers has begun in april 1999. The recruitment of patients for the control condition will start in june 1999. First results show good feasibility of our methodological approach and a good practicability in daily clinical routine.

Discussion:
The study as outlined above makes an important contribution to assess the effects of inpatient rehabilitation programs. The aims of this study are
1. to evaluate systematically needs for rehabilitation,
2. to identify predictors and process characteristics for positive outcomes and
3. to assess effects of rehabilitation programs over time.
The use of a control group design will help us to identify these differential outcomes. Thus, the study design is innovative within the present endeavours to evaluate the efficacy of inpatient rehabilitation programs.