[Validation of Personal Factors in Breast Cancer Rehabilitation - A National Delphi Survey]

Objective: In the International Classification of Functioning, Disability and Health (ICF), data on environmental and personal factors, the so-called facilitators or barriers, can be gathered. The World Health Organization (WHO) has not classified personal factors. This is justified with the cultural differences among countries. The German society for social medicine and prevention (DGSMP) has performed pioneering work and has provided a classification draft. The aim of this study is to validate this draft in the context of oncological rehabilitation of breast cancer patients in Germany. Design: 21 experts from 8 rehabilitation centers and 2 breast cancer support groups in Germany were interviewed about personal factors in a 2-round survey using the Delphi technique. The expert group included doctors, nurses, therapists, psychologists with experience in rehabilitation of breast cancer patients and breast cancer patients. The responses of the first round were linked to the DGSMP draft. The degree of fit was calculated by means of the kappa statistic. In the second round, the focus was on the agreement of the personal factors determined in the first round. Results: The experts identified 244 factors out of which 203 (83.2%) were linked to the DGSMP draft. There are 77 categories in the DGSMP draft; 43 of them were included by the experts in the first round and 34 were not mentioned (kappa coefficient 0.776; 95% bootstrapped confidence interval 0.712-0.817). In the second round, 34 of the 43 named DGSMP categories achieved an agreement of at least 75% among the experts. Conclusions: The draft of the DGSMP working group is a comprehensive collection of facilitators and barriers in breast cancer rehabilitation and should be integrated reasonably in rehabilitation. More research on personal facilitators and barriers has to be carried out to show their concrete influence on functioning ability of breast cancer patients.