Measuring What Matters: Top-Ranked Quality Indicators for Hospice and Palliative Care From the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association

Dy, Sydney M.; Kiley, Kasey B.; Ast, Katherine; Lupu, Dale; Norton, Sally A.; McMillan, Susan C.; Herr, Keela; Rotella, Joseph; Casarett, David

doi:10.1016/j.jpainsymman.2015.01.012

Cited by 198 publications

(201 citation statements)

References 20 publications

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“…Improving care for seriously ill surgical patients requires that quality measures, such as those tracked by the National Surgical Quality Improvement Project and Medicare, hold surgeons accountable for documenting treatment preferences, and delivering care consistent with those preferences. 19 Surgeons in this study were widely inconsistent in their prognostic estimates. Surgeons, like other physicians, are generally poor at formulating and communicating prognosis.…”

Section: Discussionmentioning

confidence: 74%

Surgeons' Perspectives on Avoiding Nonbeneficial Treatments in Seriously Ill Older Patients with Surgical Emergencies: A Qualitative Study

Cauley

Block

Koritsanszky

et al. 2016

Journal of Palliative Medicine

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Background: Clinical decisions for seriously ill older patients with surgical emergencies are highly complex. Measuring the benefits of burdensome treatments in this context is fraught with uncertainty. Little is known about how surgeons formulate treatment decisions to avoid nonbeneficial surgery, or engage in preoperative conversations about end-of-life (EOL) care. Objective: We sought to describe how surgeons approach such discussions, and to identify modifiable factors to reduce nonbeneficial surgery near the EOL. Design: Purposive and snowball sampling were used to recruit a national sample of emergency general surgeons. Semistructured interviews were conducted between February and May 2014. Measurements: Three independent coders performed qualitative coding using NVivo software (NVivo version 10.0, QSR International). Content analysis was used to identify factors important to surgical decision making and EOL communication.Results: Twenty-four surgeons were interviewed. Participants felt responsible for conducting EOL conversations with seriously ill older patients and their families before surgery to prevent nonbeneficial treatments. However, wide differences in prognostic estimates among surgeons, inadequate data about postoperative quality of life (QOL), patients and surrogates who were unprepared for EOL conversations, variation in perceptions about the role of palliative care, and time constraints are contributors to surgeons providing nonbeneficial operations. Surgeons reported performing operations they knew would not benefit the patient to give the family time to come to terms with the patient's demise. Conclusions: Emergency general surgeons feel responsible for having preoperative discussions about EOL care with seriously ill older patients to avoid nonbenefical surgery. However, surgeons identified multiple factors that undermine adequate communication and lead to nonbeneficial surgery.

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Section: Discussionmentioning

confidence: 74%

Surgeons' Perspectives on Avoiding Nonbeneficial Treatments in Seriously Ill Older Patients with Surgical Emergencies: A Qualitative Study

Cauley

Block

Koritsanszky

et al. 2016

Journal of Palliative Medicine

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“…8 Recently, some quality indicators were developed in the broad field of palliative/end-of-life care. 17,19,20 Some of these include aspects of communication and decision-making, but these domains are not the focus of these measures. Accordingly, we developed 9 and have now validated a novel set of quality indicators that are specifically related to end-of-life communication and decision-making.…”

Section: Discussionmentioning

confidence: 99%

Validation of quality indicators for end-of-life communication: results of a multicentre survey

Heyland

Dodek

You

et al. 2017

CMAJ

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Despite numerous calls to improve end-of-life care, and communication and decision-making in particular, [1][2][3][4] over 2 decades there has been little progress in this arena. 5,6 One of the major reasons for this limited progress may be the lack of quality indicators that are meaningful at a health system level to guide decision-makers as they introduce policies and practices to improve end-of-life care. 7,8 We recently published a study that used a modified Delphi consensus process to develop a set of quality indicators related to advance care planning, goals-of-care discussions and documentation of these plans and goals (Table 1).9 Quality indicators should be evaluated based on their reliability, validity, responsiveness to change and ease of implementation.10 Because of the robust methodology used in developing these quality indicators, 9 we believe they are clinically sensible and have face and content validity. Here we describe implementation of these quality indicators in a multicentre study to evaluate their feasibility and construct validity. A secondary objective was to establish a method for ranking institutions with respect to their performance in end-of-liferelated communication and decision-making. MethodsThis work was guided by a conceptual model of communication and decision-making in seriously ill and older patients who had been admitted to hospital, and the impact of these processes on patient-centred outcomes (Figure 1). 9 To validate the aforementioned quality indicators, we conducted a multicentre, prospective audit of communication and decision-making related to the use or nonuse of life-sustaining treatments during serious illness, from the perspectives of patients and their family members; this was called the Audit of Communication, Care Planning, and The lack of validated quality indicators is a major barrier to improving end-of-life communication and decision-making. We sought to show the feasibility of and provide initial validation for a set of quality indicators related to end-of-life communication and decision-making.

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“…There is a persistence of pain over consecutive, regular assessments, and over the last weeks of life, pain increases significantly. 27,28,33,34 Although these findings are troubling given that alleviation of pain and suffering are hallmarks of high quality end-of-life care for any individual who is dying 44 and that healthcare providers have an ethical responsibility to alleviate pain, 45 they are not surprising given that previous research suggests that high quality end-of-life care is often lacking in NHs. 46e48 Furthermore, often determining when residents are entering the final stage of life has been challenging.…”

Section: Discussionmentioning

confidence: 99%

Pain Trajectories of Nursing Home Residents Nearing Death

Thompson

Doupe

Reid

et al. 2017

Journal of the American Medical Directors Association

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Measuring What Matters: Top-Ranked Quality Indicators for Hospice and Palliative Care From the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association

Abstract: Further development will assemble implementation tools for quality measurement and benchmarking.

Cited by 198 publications

References 20 publications

Surgeons' Perspectives on Avoiding Nonbeneficial Treatments in Seriously Ill Older Patients with Surgical Emergencies: A Qualitative Study

Surgeons' Perspectives on Avoiding Nonbeneficial Treatments in Seriously Ill Older Patients with Surgical Emergencies: A Qualitative Study

Validation of quality indicators for end-of-life communication: results of a multicentre survey

Pain Trajectories of Nursing Home Residents Nearing Death

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