Population-Based Quality Indicators for End-of-Life Cancer Care

Abstract

Improving the quality of cancer care is an international priority. Population-based quality indicators (QIs) are key to this process yet remain almost exclusively used for evaluating care during the early, often curative, stages of disease.OBJECTIVES To identify all existing QIs for the care of patients with cancer who have advanced disease and/or are at the end of life and to evaluate each indicator's measurement properties and appropriateness for use.EVIDENCE REVIEW For this systematic review, 5 electronic databases (MEDLINE, Embase, CINAHL, PsycINFO, and the Cochrane Library) were searched from inception through February 4, 2019, for studies describing the development, review, and/or testing of QIs for the care of patients with cancer who have advanced disease and/or are at the end of life. For each QI identified, descriptive information was extracted and 6 measurement properties (acceptability, evidence base, definition, feasibility, reliability, and validity) were assessed using previously established criteria, with 4 possible ratings: positive, intermediate, negative, and unknown. Ratings were collated and each QI classified as appropriate for use, inappropriate for use, or of limited testing. Among the QIs determined as appropriate for use, a recommended shortlist was generated by excluding those that were specific to patient subgroups and/or care settings; related QIs were identified, and the indicator with the highest rating was retained.FINDINGS The search yielded 7231 references, 35 of which (from 28 individual studies) met the eligibility criteria. Of 288 QIs extracted (260 unique), 103 (35.8%) evaluated physical aspects of care and 109 (37.8%) evaluated processes of care. Quality indicators relevant to psychosocial (18 [6.3%]) or spiritual and cultural (3 [1.0%]) care domains were limited. Eighty QIs (27.8%) were determined to be appropriate for use, 116 (40.3%) inappropriate for use, and 92 (31.9%) of limited testing. The measurement properties with the fewest positive assessments were acceptability (38 [13.2%]) and validity (63 [21.9%]). Benchmarking data were reported for only 16 QIs (5.6%). The final 15 recommended QIs came from 6 studies. CONCLUSIONS AND RELEVANCEThe findings suggest that only a small proportion of QIs developed for the care of patients with cancer who have advanced disease and/or are at the end of life have received adequate testing and/or are appropriate for use. Further testing may be needed, as is research to establish benchmarking data and to expand QIs relevant to psychosocial, cultural, and spiritual care domains.

Cancer care near the end‐of‐life in Austria: A retrospective data analysis

“…Hence they can support the improvement of health care along the continuum of interventions by early detection coordination of multimodal regimes or providing symptomatic (palliative) care (De Roo et al 2013 ; Earle et al 2003 ). Quality indicators in the area of cancer care encompass ‘amount of inpatient deaths’ ‘extensive use of systemic chemotherapy at the EOL’ ‘admission to intensive care units (ICUs) and hospitalisations at the EOL’ or ‘lack of referral to palliative care units’ (De Schreye et al 2017 ; Earle et al 2003 2008 ; Henson et al 2020 ; Wild & Patera 2013 ).…”

Quality of End-of-Life Cancer Care in Canada: A 12-Year Retrospective Analysis of Three Provinces’ Administrative Health Care Data Evaluating Changes over Time

“…Administrative health care data has been employed to understand quality indicators of EOL care in numerous countries, such as the United States, Japan, Sweden, Belgium, and the United Kingdom [ 4 , 5 , 6 , 7 ]. However, the specific quality indicators used vary, which limits the ability to compare quality across services or settings [ 8 ]. In light of this, a systematic review published by Henson et al evaluated 260 unique quality indicators of cancer care and found that of these, only 80 quality indicators received adequate testing to be appropriate for performance metrics.…”

Quality of End-of-Life Care for People with Advanced Non-Small Cell Lung Cancer in Ontario: A Population-Based Study

“…Measures of quality EOL cancer care are explicitly defined as measurable items of practice performance used to evaluate the quality of care provided by a healthcare organization [ 9 ]. Commonly used and previously identified aggressive EOL outcomes from administrative data include hospital-centric measures such as visits to the emergency department (ED) or admission to the hospital or intensive care unit (ICU) in last 30 days of life, receiving systemic therapy within the last 14 days of life, or death in hospital [ 10 , 11 ].…”