The PEF-Adjuvant project is receiving €1 million in funding from the Gemeinsamer Bundesausschuss (Joint Federal Committee, G-BA) through its innovation fund. The project at the National Center for Tumour Diseases (NCT) Heidelberg and Heidelberg University Hospital (UKHD) aims to involve patients with malignant melanoma more closely in treatment decisions. Participative Decision Making (Partizipative Entscheidungsfindung, PEF) is intended to improve treatment outcomes and increase patient satisfaction. Skin tumor centers at all six NCT locations are involved in PEF-Adjuvant.

The National Center for Tumor Diseases (NCT) Heidelberg is a joint institution of the German Cancer Research Center (DKFZ), Heidelberg University Hospital (UKHD), Heidelberg University Medical Faculty, and Heidelberg Thorax Clinic.

The number of cases of malignant melanoma is steadily increasing and is responsible for more than 90 percent of skin cancer deaths in Germany. After surgery, patients with malignant melanoma and a high risk of recurrence are faced with the decision for or against adjuvant, i.e., supportive systemic therapy. 

The decision is not easy: the treatment can reduce the risk of recurrence, but it can also lead to significant side effects. Jessica Hassel, head of the Skin Tumor Center at NCT Heidelberg and UKHD, says: “Many patients have felt uncertain and inadequately supported when weighing up this decision. Our PEF-Adjuvant project aims to change that.” PEF stands for participatory decision-making – patients should be actively and systematically involved in the decision-making process.

The intervention consists of three components: structured PEF training for physicians, an information flyer for patients, and a digital decision aid. In addition to text, the decision aid contains explanatory videos, graphics, and interactive content tailored to the stage and mutation status of the disease.

A multicenter study is investigating the effect of the package of measures. In addition to the NCT Heidelberg, leading skin tumor centers at all five other NCT locations are involved in PEF-Adjuvant. Christiane Bieber, Clinic for General Internal Medicine and Psychosomatics, UKHD, says: "In addition to decision-making conflicts, medical courses, and quality of life, we also record psychological aspects such as the desire for co-determination as well as stress and fears caused by the disease. In addition, interviews are conducted with both patients and physicians in order to identify and understand personal experiences and the resulting attitudes."

The G-BA's Innovation Fund is providing PEF-Adjuvant with nearly one million euros in funding over three years. The project closes a gap in care, as there is currently no decision-making aid for this patient group in German-speaking countries. “We plan to include 294 patients in the study. The collaboration within the NCT with six excellent locations will help us to recruit the required number of patients and obtain meaningful results,” says Jessica Hassel.

In the future, patients will be involved in therapy decisions according to their wishes and will be able to make informed decisions. In the long term, this can help patients feel better supported, be more satisfied with therapy decisions and medical consultations, and use resources more efficiently. The decision aid developed within PEF-Adjuvant will be freely available online after the project is completed.

Facts and figures

PEF-Adjuvant:
Participatory decision-making (PEF) for adjuvant systemic therapy in melanoma – multicenter, prospective, cluster-randomized implementation study in a stepped-wedge design

Funding period: January 1, 2026 – December 31, 2028

Funding amount: up to €999,493.25

Project management:
Prof. Dr. Christiane Bieber, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital (UKHD)
Prof. Dr. Jessica C. Hassel, University Dermatology Clinic, UKHD, and National Center for Tumour Diseases (NCT) Heidelberg

Project coordination:
M.Sc. Milena Borchers
PD Dr. Susanne Dugas-Breit

Consortium partners:
Dr. Marietta Kirchner, Medical Biometry, UKHD
Prof. Dr. Martin Dugas, Medical Informatics, UKHD

Patient participation:
Dr. Cindy Körner, Patient Research Council NCT Heidelberg
Angelika Ballweber, Patient Research Council NCT Heidelberg

Skin tumor centers at the other five NCT locations:
Prof. Dr. Friedegund Meier, University Hospital Dresden, NCT Dresden
Prof. Dr. Max Schlaak, Skin Tumor Center, Charité-Universitätsmedizin Berlin, NCT Berlin
Prof. Dr. Carola Berking, Dermatology Clinic, University Hospital Erlangen, NCT WERA
Prof. Dr. Lisa Zimmer, Skin Tumor Center, University Hospital Essen, NCT West
Prof. Dr. Andrea Forschner, University Dermatology Clinic Tübingen, NCT Southwest

Press contact:
Dr. Martin Staiger
National Center for Tumor Diseases (NCT) Heidelberg
Communications and Events
Im Neuenheimer Feld 460
69120 Heidelberg, Germany
Tel.: +49 6221 56-311272
Email: martin.staiger@nct-heidelberg.de
www.nct-heidelberg.de

The National Center for Tumor Diseases (NCT) Heidelberg
The National Center for Tumor Diseases (NCT) Heidelberg is a joint institution of the German Cancer Research Center (DKFZ), the University Hospital Heidelberg (UKHD), the Heidelberg Medical Faculty of the Heidelberg University and the Thoraxklinik Heidelberg. The aim of the NCT Heidelberg is to transfer promising approaches from cancer research into clinical practice as quickly as possible, and thus to benefit patients. This applies to both diagnosis and treatment, in aftercare or prevention. Participation in clinical studies opens up access to innovative therapies. The NCT Heidelberg is thus a leader in transferring new research results from the laboratory to the clinic The NCT Heidelberg, founded in 2004, is part of the NCT with further locations in Berlin, Dresden, SouthWest (Tübingen-Stuttgart/Ulm), WERA (Würzburg, Erlangen, Regensburg, Augsburg) and West (Essen/Cologne).
 

German Cancer Research Center (DKFZ)
With more than 3,000 employees, the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) is Germany’s largest biomedical research institute. DKFZ scientists identify cancer risk factors, investigate how cancer progresses and develop new cancer prevention strategies. They are also developing new methods to diagnose tumors more precisely and treat cancer patients more successfully. The DKFZ's Cancer Information Service (KID) provides patients, interested citizens and experts with individual answers to questions relating to cancer.

To transfer promising approaches from cancer research to the clinic and thus improve the prognosis of cancer patients, the DKFZ cooperates with excellent research institutions and university hospitals throughout Germany:

• National Center for Tumor Diseases (NCT, 6 sites)  
• German Cancer Consortium (DKTK, 8 sites)
• Hopp Children's Cancer Center (KiTZ) Heidelberg
• Helmholtz Institute for Translational Oncology (HI-TRON Mainz) - A Helmholtz Institute of the DKFZ
• DKFZ-Hector Cancer Institute at the University Medical Center Mannheim
• National Cancer Prevention Center (jointly with German Cancer Aid) 

The DKFZ is 90 percent financed by the Federal Ministry of Research, Technology and Space and 10 percent by the state of Baden-Württemberg. The DKFZ is a member of the Helmholtz Association of German Research Centers.

Heidelberg University Hospital and Faculty of Medicine: Internationally Renowned Patient Care, Research and Teaching

Heidelberg University Hospital (Universitätsklinikum Heidelberg, UKHD) is one of the largest and most prestigious medical centers in Germany. The Medical Faculty of Heidelberg University (Medizinische Fakultät Heidelberg, MFHD) belongs to the internationally renowned biomedical research institutions in Europe. Both institutions have the common goal of developing new therapies and implementing them rapidly for patients. Heidelberg University Hospital and the Medical Faculty of Heidelberg University employs around 14.500 employees and is committed to providing trainings and qualifications. Every year, around 86,000 patients and more than 1.100.000 outpatient cases are treated in more than 50 clinical departments with almost 2.500 beds.

Together with the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) and the German Cancer Aid, the UKHD established the first National Center for Tumor Diseases (NCT) in Heidelberg. The goal is to provide care at the highest level as an oncology center of excellence and to rapidly transfer promising approaches from cancer research to the hospital. In addition, the UKHD operates in partnership with the DKFZ and the University of Heidelberg the Hopp Children’s Cancer center Heidelberg (KiTZ), a unique and nationally known therapy and research center for oncological and hematological diseases in children and adolescents.

The Heidelberg Curriculum Medicinale (HeiCuMed) is one of the top medical training programs in Germany. Currently, there are about 4.000 future physicians studying in Heidelberg.

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