Pilot Study for Developing Guidelines of Integrated Rehabilitation for Breast Cancer Patients in Slovenia

Key Contextual Factors

• Participating institutions: Institute of Oncology Ljubljana, University Medical Center Ljubljana, University rehabilitation institute Ljubljana, Slovenian cancer Registry.
• For the development of the pilot study we involved/included health professionals from different fields of activity, being part of multidisciplinary group, consisting of the professionals: oncologists, psychologist, psychiatrist, psychiatrist, specialist of occupational medicine, physicist – all from above mentioned institutions, general practitioner, representative of Ministry of health, Health Insurance institute, Slovenian cancer Registry and Non-government organization of cancer patients.
• Strategic plan covers all cancer patients, pilot study is executed on breast cancer patients.

Key Components/Steps

• 2017/2018: survey among cancer patients, needs and wishes in the field of integral rehabilitation and cross-sectional analysis of the situation of integrated rehabilitation in Slovenia.
• Set up a Multidisciplinary Group for Integrated Rehabilitation (MGIR) and defined criteria for “Integrated Rehabilitation”.
• We edited a “Strategic action plan for integrated rehabilitation of cancer patients”.
• 2018/2019: MGIR prepared clinical guidelines and a roadmap with a new concept of rehabilitation based on the patient's needs assessment for patients with breast cancer. Integrated Rehabilitation Nurse Coordinator defined as the central person in the concept of Integrated rehabilitation.
• Individualized and coordinated integrated rehabilitation of breast cancer patients was tested on a representative sample of the so-called intervention group of 300 patients 25 and 65 years of age. The control group of 300 breast cancer patients did not go through the intervention. MGIR supervised and controlled the course of the pilot project.
• Nurse coordinator and other professionals were included as part of the staff team of a pilot: oncologists, nurses, clinical psychologist, psychiatrist, specialist of occupational medicine, physiatrist.
• We got financial support for the implementation of the pilot through targeted research program, financed by Slovenian Research Agency and Ministry of health. Nurse coordinator is paid by Institute of Oncology.

Main Impacts / Added Value

• The pilot study should help implementing in practice conditions that will enable better quality of life of cancer patients because their problems will be identified and treated earlier.
• We will take advantage of resources at the primary level of Health system which is in accordance with patients’ wishes which was to get help near their homes if possible.
• With decentralized integrated rehabilitation all cancer patients will have the same level of care.
• Integrated rehabilitation will have positive impact on reduction of absenteeism from work and disability retirement.

Lessons Learned

For the development of the study and future key conditions we established:

• good cooperation with the Ministry of health and got;
• financial support from the Slovenian Research Agency and Ministry of Health.

We foresee main problems:

• specialists of occupational medicine are not a part of public health system. We have to change this practice through changing the law on health care activity to be able to carry out professional rehabilitation;
• we have too few clinical psychologists to be able to carry out psychological support according to our clinical guidelines and patient’s needs;
• financial support is not sufficient.

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