Implementierungsleitfaden Therapieziele Onkologie
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Empfehlungs- und Behandlungsplan

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The therapy intent arises at the recommendation (tumor board). It follows that what is recommended and what is actually delivered are distinct objects.

Two CarePlan roles

  • Recommendation care plan — the tumor board's synthesised list of recommendations (proposed TumorboardServiceRequest/TumorboardMedicationRequest, intent = proposal); carries the overarching goal.
  • Treatment care plan — the episode-specific plan of actually delivered care; carries the respective episode goal.
Empfehlungs- und Behandlungsplan: zwei Rollen des CarePlan Links die grobkoernige Empfehlung des Tumorboards (EmpfehlungsCarePlan, intent proposal) mit uebergeordnetem Ziel; rechts feinkoernige Behandlungsplaene autonomer Leistungserbringer (intent order) mit Episodenzielen. Verbunden ueber basedOn auf Plan- und Request-Ebene; bewusst kein partOf. Empfehlung — Tumorboard Behandlung — autonome Leistungserbringer Tumorboard CareTeam EmpfehlungsCarePlan intent: proposal — grobkörnig verfolgt: übergeordnetes Ziel (kurativ) Empfehlung: platinbasierte Chemo + Checkpoint-Inhibitor — proposal Empfehlung: Operation — proposal BehandlungsCarePlan ① neoadjuvante Systemtherapie — custodian: Klinik A verfolgt: Ziel Tumorverkleinerung (→ OP) MedicationRequest — order: Carboplatin AUC5 + Pembrolizumab q3w Anbindung: Apotheke · Terminbuchung BehandlungsCarePlan ② Operation — custodian: andere Einrichtung (Klinik B) verfolgt: Ziel R0-Resektion · ypCR ServiceRequest: Operation — order basedOn basedOn Request.basedOn kein partOf — keine zentrale Steuerung der Behandlungsplan erfüllt die Empfehlung; zeitlich und organisatorisch entkoppelt (eigener custodian je Plan) Modellierungs-Hinweis: activity.detail vs. eigenständige Requests Die Empfehlungen könnten theoretisch inline im Plan liegen (CarePlan.activity.detail) — intersektoral ist die Profilierung als Empfehlungs-ServiceRequest / Empfehlungs-MedicationRequest sinnvoller: referenzierbar, einzeln erfüllbar (Request.basedOn) und über Einrichtungsgrenzen austauschbar. Plan Ziel-Referenz Maßnahme / Request Akteur / Hinweis Eine Empfehlung — mehrere Behandlungspläne: Umsetzung an verschiedenen Einrichtungen, verbunden über basedOn.

Different level of detail, decoupled in time and organisation

The recommendation is coarse-grained ("which strategy, which modalities, which goal"); the treatment plan is fine-grained ("which substance/dose/schedule, which procedure, at which site"). For example, the recommendation may specify a drug class ("platinum-based chemotherapy + checkpoint inhibitor"), while the treatment plan sets the concrete substances and may link to pharmacy/ordering and appointment-booking systems. Recommendation and delivery are decoupled in time and across organisations (each treatment plan has its own custodian).

basedOn, not partOf

The treatment plan fulfils the recommendation via CarePlan.basedOn (not partOf, which would imply central steering that does not exist in German intersectoral care).

Reference to established protocols

A treatment plan often references an established protocol (guideline, study protocol, SOP) via instantiatesCanonical (computable PlanDefinition) or instantiatesUri. Two template levels work together: CPG guidelines as recommendation templates and a protocol catalogue as treatment templates. A normative catalogue for systemic protocols does not yet exist; one is expected from the PHOENIX initiative from Q4 2026 (European Common Cancer Model). It will initially cover systemic chemo-/targeted protocols; non-chemo systemic therapies, surgery, pre-/aftercare and radiotherapy are not yet covered.