Annelotte van Bommel

172 diseaseortreatmentonperceivedqualityoflife.Somehospitalshavestartedusingthese PROMs and questionnaires which patients periodically fill out to give them tools when they have to make decisions regarding their treatment. As such, adding results from PROMs have the potency to enhance the inner circle of auditing, i.e. the PDCA cycle in whichpatients anddoctors reflect on the results of and experiencewith the care that is provided in the institutionwhere thepatient is treated ( Figure 3 ). By strengthening this inner Audit circle, wewill truly live up to the legacy of Ernest A. Codman. Figure 3. Inner circle; the Plan Do Check Act cycle on a regional and individual hospital level using clinical audit data for improvement of breast cancer care. With the constitution of a multidisciplinary nationwide audit such as the NBCA, real-world data is disclosed, not only for clinicians, but also for other stakeholders and most importantly for patients. The audit data reveal a good quality of current breast cancer care and areas for improvement with the potential to learn from best practices. With the implementation of PROMs, steps are being made to use these data for personalized medicine, where the data could be used for treatment decisions and self-monitoring of recovery; steps that are essential in achieving an ever-higher level of quality of received care.