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Smrke U, Abalde-Cela S, Loly C, Calbimonte JP, Pires LR, Lin S, Sánchez A, Tement S, Mlakar I. Quality of Life of Colorectal Cancer Survivors: Mapping the Key Indicators by Expert Consensus and Measures for Their Assessment. Healthcare (Basel) 2024; 12:1235. [PMID: 38921349 PMCID: PMC11203183 DOI: 10.3390/healthcare12121235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/15/2024] [Accepted: 06/18/2024] [Indexed: 06/27/2024] Open
Abstract
Quality of life (QoL) assessments are integral to cancer care, yet their effectiveness in providing essential information for supporting survivors varies. This study aimed to elucidate key indicators of QoL among colorectal cancer survivors from the perspective of healthcare professionals, and to evaluate existing QoL questionnaires in relation to these indicators. Two studies were conducted: a Delphi study to identify key QoL indicators and a scoping review of questionnaires suitable for colorectal cancer survivors. Fifty-four healthcare professionals participated in the Delphi study's first round, with 25 in the second. The study identified two primary QoL domains (physical and psychological) and 17 subdomains deemed most critical. Additionally, a review of 12 questionnaires revealed two instruments assessing the most important general domains. The findings underscored a misalignment between existing assessment tools and healthcare professionals' clinical priorities in working with colorectal cancer survivors. To enhance support for survivors' QoL, efforts are needed to develop instruments that better align with the demands of routine QoL assessment in clinical practice.
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Affiliation(s)
- Urška Smrke
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia
| | - Sara Abalde-Cela
- RUBYnanomed LDA, Praça Conde de Agrolongo, 4700-314 Braga, Portugal
| | - Catherine Loly
- Gastroenterology Department, University Hospital of Liège, 4000 Liège, Belgium
| | - Jean-Paul Calbimonte
- Institute of Informatics, University of Applied Sciences and Arts Western Switzerland HES-SO, 3960 Sierre, Switzerland
- The Sense Innovation & Research Center, 1007 Lausanne, Switzerland
| | - Liliana R. Pires
- RUBYnanomed LDA, Praça Conde de Agrolongo, 4700-314 Braga, Portugal
| | - Simon Lin
- Science Department, Symptoma GmbH, 5020 Vienna, Austria
- Department of Internal Medicine, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Alberto Sánchez
- Department of eHealth, Galician Research & Development Center in Advanced Telecommunications (GRADIANT), 26334 Vigo, Spain
| | - Sara Tement
- Department of Psychology, Faculty of Arts, University of Maribor, 2000 Maribor, Slovenia
| | - Izidor Mlakar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia
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Donnelly C, Or M, Toh J, Thevaraja M, Janssen A, Shaw T, Pathma-Nathan N, Harnett P, Chiew KL, Vinod S, Sundaresan P. Measurement that matters: A systematic review and modified Delphi of multidisciplinary colorectal cancer quality indicators. Asia Pac J Clin Oncol 2024; 20:259-274. [PMID: 36726222 DOI: 10.1111/ajco.13917] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 02/03/2023]
Abstract
AIM To develop a priority set of quality indicators (QIs) for use by colorectal cancer (CRC) multidisciplinary teams (MDTs). METHODS The review search strategy was executed in four databases from 2009-August 2019. Two reviewers screened abstracts/manuscripts. Candidate QIs and characteristics were extracted using a tailored abstraction tool and assessed for scientific soundness. To prioritize candidate indicators, a modified Delphi consensus process was conducted. Consensus was sought over two rounds; (1) multidisciplinary expert workshops to identify relevance to Australian CRC MDTs, and (2) an online survey to prioritize QIs by clinical importance. RESULTS A total of 93 unique QIs were extracted from 118 studies and categorized into domains of care within the CRC patient pathway. Approximately half the QIs involved more than one discipline (52.7%). One-third of QIs related to surgery of primary CRC (31.2%). QIs on supportive care (6%) and neoadjuvant therapy (6%) were limited. In the Delphi Round 1, workshop participants (n = 12) assessed 93 QIs and produced consensus on retaining 49 QIs including six new QIs. In Round 2, survey participants (n = 44) rated QIs and prioritized a final 26 QIs across all domains of care and disciplines with a concordance level > 80%. Participants represented all MDT disciplines, predominantly surgical (32%), radiation (23%) and medical (20%) oncology, and nursing (18%), across six Australian states, with an even spread of experience level. CONCLUSION This study identified a large number of existing CRC QIs and prioritized the most clinically relevant QIs for use by Australian MDTs to measure and monitor their performance.
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Affiliation(s)
- Candice Donnelly
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Michelle Or
- Radiation Oncology Network, Western Sydney Local Health District, Westmead, Australia
| | - James Toh
- Department of Surgery, Westmead Hospital, Westmead, Australia
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | | | - Anna Janssen
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | | | - Paul Harnett
- Westmead Clinical School, University of Sydney, Sydney, Australia
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Westmead, Australia
| | - Kim-Lin Chiew
- Ingham Institute for Applied Medical Research, Liverpool, Australia
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, Australia
- South Western Clinical School, University of New South Wales, Randwick, Australia
- Princess Alexandra Hospital, Division of Cancer Services, Brisbane, Australia
| | - Shalini Vinod
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, Australia
- South Western Clinical School, University of New South Wales, Randwick, Australia
| | - Puma Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, Westmead, Australia
- Westmead Clinical School, University of Sydney, Sydney, Australia
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Mohan HM, Sijmons JML, Maida JV, Walker K, Kuryba A, Syk I, Iversen LH, Hariot A, Ko CY, Tanis PJ, Tollenaar RAEM, Avellaneda N, Smart P. Identifying a common data dictionary across colorectal cancer outcome registries: A mapping exercise to identify opportunities for data dictionary harmonisation. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107937. [PMID: 38232520 DOI: 10.1016/j.ejso.2023.107937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/23/2023] [Accepted: 12/23/2023] [Indexed: 01/19/2024]
Abstract
IMPORTANCE The development of colorectal cancer outcome registries internationally has been organic, with differing datasets, data definitions and infrastructure across registries which has limited data pooling and international comparison. Currently there is no comprehensive data dictionary identified as a standard. This study is part of an international collaboration that aims to identify areas of data capture and usage which may be optimised to improve understanding of colorectal cancer outcomes. OBJECTIVE This study aimed to compare and identify commonalities and areas of difference across major colorectal cancer registries. We sought to establish datasets comprising of mutually collected common fields, and a combined comprehensive dataset of all collected fields across major registries to aid in establishing a future colorectal cancer registry database standard. DESIGN AND METHODS This mixed qualitative and quantitative study compared data dictionaries from three major colorectal cancer outcome registries: Bowel Cancer Outcomes Registry (BCOR) (Australia and New Zealand), National Bowel Cancer Audit (NBOCA) (United Kingdom) and Dutch ColoRectal Audit (DCRA) (Netherlands). Registries were compared and analysed thematically, and a common dataset and combined comprehensive dataset were developed. These generated datasets were compared to data dictionaries from Sweden (SCRCR), Denmark (DCCG), Argentina (BNCCR-A) and the USA (NAACCR and ACS NSQIP). Fields were assessed against prominent quality indicator metrics from the literature and current case-use. RESULTS We developed a combined comprehensive dataset of 225 fields under seven domains: demographic, pre-operative, operative, post-operative, pathology, neoadjuvant therapy, adjuvant therapy, and follow up/recurrence. A common dataset was developed comprising 38 overlapping fields, showing a low degree of mutually collected data, especially in preoperative, post operative and adjuvant therapy domains. The BNCCR-A, SCRCR and DCCG databases all contained a high percentage of common dataset fields. Fields were poorly comparable when viewed form current quality indicator metrics. CONCLUSION This study mapped data dictionaries of prominent colorectal cancer registries and highlighted areas of commonality and difference The developed common field dataset provides a foundation for registries to benchmark themselves and work towards harmonisation of data dictionaries. This has the potential to enable meaningful large-scale international outcomes research.
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Affiliation(s)
- Helen M Mohan
- Bowel Cancer Outcomes Registry (BCOR), Australia; Bowel Cancer Outcomes Registry (BCOR), New Zealand; Austin Health, Heidelberg, Victoria, Australia; Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.
| | - Julie M L Sijmons
- Dutch ColoRectal Audit (DCRA), Dutch Institute for Clinical Auditing (DICA), the Netherlands; Amsterdam University Medical Centre (UMC), Location AMC, Amsterdam, the Netherlands
| | - Jack V Maida
- Bowel Cancer Outcomes Registry (BCOR), Australia; Bowel Cancer Outcomes Registry (BCOR), New Zealand; Austin Health, Heidelberg, Victoria, Australia
| | - Kate Walker
- National Bowel Cancer Audit (NBOCA), England, UK; National Bowel Cancer Audit (NBOCA), Wales, UK; London School of Hygiene and Tropical Medicine, London, England, UK
| | - Angela Kuryba
- National Bowel Cancer Audit (NBOCA), England, UK; National Bowel Cancer Audit (NBOCA), Wales, UK; Royal College of Surgeons of England, London, England, UK
| | - Ingvar Syk
- Swedish Colorectal Cancer Registry (SCRCR), Sweden; Skåne University Hospital Lund, Lund, Sweden
| | - Lene H Iversen
- Danish Colorectal Cancer Group (DCCG) Database, Denmark; Aarhus University Hospital (AUH), Aarhus, Denmark
| | - Alexander Hariot
- Bowel Cancer Outcomes Registry (BCOR), Australia; Bowel Cancer Outcomes Registry (BCOR), New Zealand; Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | | | - Pieter J Tanis
- Dutch ColoRectal Audit (DCRA), Dutch Institute for Clinical Auditing (DICA), the Netherlands; Amsterdam University Medical Centre (UMC), Location AMC, Amsterdam, the Netherlands
| | - Rob A E M Tollenaar
- Dutch ColoRectal Audit (DCRA), Dutch Institute for Clinical Auditing (DICA), the Netherlands; Leiden University Medical Centre, Leiden, the Netherlands
| | - Nicholas Avellaneda
- Base Nacional de Cáncer Colorrectal en Argentina (BNCCR-A), Argentinian Colorectal Cancer Consortium (ACCC), Argentina; Norberto Quirno Center for Medical Education and Clinical Research, Buenos Aires, Argentina
| | - Philip Smart
- Bowel Cancer Outcomes Registry (BCOR), Australia; Bowel Cancer Outcomes Registry (BCOR), New Zealand; Austin Health, Heidelberg, Victoria, Australia
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Akhtar OS, Andrabi SAR, Bhat PS, Akhtar SS. Quality of Care for Prostate Cancer in Kashmir, India: A Real-World Study. Cureus 2023; 15:e43507. [PMID: 37719520 PMCID: PMC10500619 DOI: 10.7759/cureus.43507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Purpose Despite the importance of quality care for patients with prostate cancer, significant gaps exist in healthcare delivery, including diagnosis and treatment. Our objective was to assess the quality of care (QoC) using retrospective data from prostate care patients in our center. Methods We performed a retrospective study of prostate cancer patients registered at a dedicated cancer care center in the Kashmir region from 2012 to 2020. A set of 15 quality indicators representing crucial facets of diagnosis, pathology, and treatment was identified from a comprehensive list developed and validated by other researchers. Results The final analysis of all indicators was conducted on 46 patients with a median age of 70 years (52-92 years). In the majority of patients, the diagnosis (89.1%) was made through a prostatic biopsy, while only five patients were diagnosed solely based on the prostate-specific antigen. Transrectal ultrasound (TRUS) or transurethral resection (TURP)-guided biopsy was documented in 84.8% of patients, with Gleason grading documented in 87.5% of patients. However, the number of positive cores was mentioned for only 25.7% of patients. Radical prostatectomy was the primary treatment for most patients with localized prostate cancer (58.3%). The majority of patients with metastatic prostate cancer were treated with orchidectomy (55%), owing to easy access and the lower cost of surgical castration. Conclusion The study demonstrated a lack of compliance with many QoC indicators at the diagnostic and therapeutic levels. However, large-scale, population-based studies are needed to establish the compliance of prostate cancer QoC in Kashmir. The quality indicator assessment can guide the necessary actions required to improve QoC for prostate cancer patients.
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Affiliation(s)
- Omar S Akhtar
- Centre of Urology, Hakim Sanaullah Specialist Hospital and Cancer Centre, Sopore, IND
| | - Sayed Abdur R Andrabi
- Medical Oncology and Palliative Care, Dr. Shad Salim's Oncology Centre, Srinagar, IND
| | - Pakeezah S Bhat
- Medical Oncology, Dr. Shad Salim's Oncology Centre, Srinagar, IND
| | - Shad S Akhtar
- Medical Oncology, Dr. Shad Salim's Oncology Centre, Srinagar, IND
- Medical Oncology, Hakim Sanaullah Specialist Hospital and Cancer Centre, Sopore, IND
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Rajaguru V, Jang J, Kwon JA, Kim JH, Shin J, Chun M. A scoping review on population-centered indicators for cancer care continuum. Front Public Health 2022; 10:912946. [PMID: 36311597 PMCID: PMC9614426 DOI: 10.3389/fpubh.2022.912946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/22/2022] [Indexed: 01/22/2023] Open
Abstract
Purpose The purpose of this study was to develop prioritized cancer indicators and measure the population-based monitoring of the entire life cycle of cancer care, guiding the improvement of care delivery systems. Methods Scoping review was performed based on the Joanna Briggs Institute's methodology. Electronic databases were searched in PubMed, Cochrane Library, EMBASE, Ovid Medline, RISS, KISS, and KoreaMed. The searches were limited to articles published in English between 2010 and 2020. No restrictions were applied regarding the publication status or country of origin, and all study designs were included. Gray literature was used to broaden the search's scope, identify new recommendations, need to be in connect with subject experts, and explore pertinent websites. The process and selected indicators were analyzed based on their frequency distribution and percentage. Results The literature search yielded 6,202 works. In addition, national and international cancer guidelines were obtained from official database reports. A total of 35 articles and 20 reports regarding cancer indicators were finally selected for data synthesis. Based on them, 254 core sets of cancer indicators were identified. The selected indicators were classified into six domains based on the continuum of cancer care and survivor's life cycle, namely, primary prevention (61, 24.0%), secondary prevention (46, 18.1%), treatment (85, 33.5%), quality of care (33, 13.0%), survivor management (33, 13.0%), and end-of-life care (14, 5.5%). Conclusion There is a growing interest in developing specific areas of cancer care. Cancer indicators can help organizations, care providers, and patients strive for optimal care outcomes. The identified indicators could guide future innovations by identifying weaknesses in cancer prevention and management.
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Affiliation(s)
- Vasuki Rajaguru
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Jieun Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, United States
| | - Jeoung A. Kwon
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
| | - Jae Hyun Kim
- Department of Health Administration, Dankook University, Cheonan, South Korea
| | - Jaeyong Shin
- Institute of Health Services Research, Yonsei University, Seoul, South Korea,Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, South Korea,*Correspondence: Jaeyong Shin
| | - Mison Chun
- Department of Radiation Oncology, School of Medicine, Ajou University, Suwon, South Korea,Mison Chun
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6
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Heenan MA, Randall GE, Evans JM. Selecting Performance Indicators and Targets in Health Care: An International Scoping Review and Standardized Process Framework. Healthc Policy 2022; 15:747-764. [PMID: 35478929 PMCID: PMC9038160 DOI: 10.2147/rmhp.s357561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Health care organizations monitor hundreds of performance indicators. It is unclear what processes and criteria organizations use to identify the indicators they use, who is involved in these processes, how performance targets are set, and what the impacts of these processes are. The purpose of this study is to synthesize international approaches to indicator selection and develop a standardized process framework. Methods Using the PubMed and Web of Science search engines, a scoping review of peer reviewed and grey literature following PRISMA-ScR guidelines was conducted to identify documents describing indicator selection processes used by health systems. English-language papers from 11 countries published from 2010 to 2020 were included. Papers were thematically analyzed to develop a standardized process framework. Results The review included 33 peer-reviewed papers and 11 grey-literature documents. While there are common practices used in health care to select indicators, no single standardized process framework for indicator selection exists. Arbitrary or incomplete indicator selection processes risk over-measurement, lack of alignment with strategic and operational goals, lack of support by end-users, and paralyzed decision-making ability. By consolidating international practices, we developed the 5-P indicator selection process framework to mitigate process risks and support high-quality indicator selection processes. Conclusion The 5-P indicator selection process framework consists of five domains and 17 elements, and offers health care agencies a practical structure they can use to design indicator selection processes. The framework also provides researchers with a basis by which the implementation of these processes may be evaluated.
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Affiliation(s)
- Michael A Heenan
- DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
- Correspondence: Michael A Heenan, Email
| | - Glen E Randall
- DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Jenna M Evans
- DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
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Quintana JM, Anton-Ladislao A, Lázaro S, Gonzalez N, Bare M, de Larrea NF, Redondo M, Escobar A, Sarasqueta C, Garcia-Gutierrez S, Aguirre U, Briones E, Group FTRCCR. Quality Indicators and Outcomes in a Prospective Cohort of Colorectal Cancer Patients. J Gastrointest Cancer 2021; 54:20-26. [PMID: 34893952 DOI: 10.1007/s12029-021-00779-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Some quality indicators of proper health care in patients with colorectal cancer have been established. AIMS Our goal was to evaluate the relationship between performing of certain procedures or treatments, included as quality indicators, and some outcomes of indicators in the follow-up of colorectal cancer patients. METHODS This was a prospective cohort study of patients diagnosed with colorectal cancer that underwent surgery and were followed at 1, 2, 3, and 5 years. CT scanning, colonoscopy, chemotherapy, and radiotherapy were evaluated in relation to various clinical outcomes and PROM changes over 5 years. Multivariable generalized linear mixed models were used to evaluate their effect on mortality, complications, recurrence, and PROM changes (HAD, EQ-5D, EORTC-Q30) at the next follow-up. RESULTS CT scanning or colonoscopy was related to a decrease in the risk of dying, while chemotherapy at a specified moment was related to an increased risk. In the case of recurrence, CT scanning and chemotherapy showed statistically increased the risk, while all the procedures and treatments influenced complications. Regarding PROM scales, CT scanning, colonoscopy, and radiotherapy showed statistically significant results with respect to an increase in anxiety and decrease in quality of life measured by the EORTC. However, undergoing radiotherapy at a specified moment increased depression levels, and overall, receiving radiotherapy decreased the quality of life of the patients, as measured by the EuroQol-5d. CONCLUSIONS After adjustment for sociodemographic factors, comorbidities, and severity of the disease, performing certain quality indicators of proper health care in patients with colorectal cancer was related to less mortality but higher adverse outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02488161.
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Affiliation(s)
- José M Quintana
- Unidad de Investigación, Hospital Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Bizkaia, Spain. .,Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain.
| | - Ane Anton-Ladislao
- Unidad de Investigación, Hospital Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Bizkaia, Spain.,Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
| | - Santiago Lázaro
- Servicio de Cirugía General, Hospital Basurto, Bilbao, Bizkaia, Spain.,Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
| | - Nerea Gonzalez
- Unidad de Investigación, Hospital Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Bizkaia, Spain.,Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
| | - Marisa Bare
- Unidad de Epidemiología Clínica, Corporacio Parc Tauli, Barcelona, Spain.,Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
| | - Nerea Fernandez de Larrea
- Centro Nacional de Epidemiología, ISCIII, Madrid, Spain.,CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Maximino Redondo
- Unidad de Investigación, Hospital Costa del Sol, Malaga, Spain.,Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
| | - Antonio Escobar
- Unidad de Investigación, Hospital Basurto, Bilbao, Bizkaia, Spain.,Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
| | - Cristina Sarasqueta
- Unidad de Investigación, Hospital Donostia/BioDonostia, Donostia, Guipuzkoa, Spain.,Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
| | - Susana Garcia-Gutierrez
- Unidad de Investigación, Hospital Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Bizkaia, Spain.,Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
| | - Urko Aguirre
- Unidad de Investigación, Hospital Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Bizkaia, Spain.,Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain
| | - Eduardo Briones
- UDG Salud Publica, Distrito AP Sevilla, Sevilla, Spain.,CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
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Pooni A, Schmocker S, Brown C, MacLean A, Hochman D, Williams L, Baxter N, Simunovic M, Liberman S, Drolet S, Neumann K, Jhaveri K, Kirsch R, Kennedy ED. Quality indicator selection for the Canadian Partnership against Cancer rectal cancer project: A modified Delphi study. Colorectal Dis 2021; 23:1393-1403. [PMID: 33626193 DOI: 10.1111/codi.15599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022]
Abstract
AIM It is well established that (i) magnetic resonance imaging, (ii) multidisciplinary cancer conference (MCCs), (iii) preoperative radiotherapy, (iv) total mesorectal excision surgery and (v) pathological assessment as described by Quirke are key processes necessary for high quality, rectal cancer care. The objective was to select a set of multidisciplinary quality indicators to measure the uptake of these clinical processes in clinical practice. METHOD A multidisciplinary panel was convened and a modified two-phase Delphi method was used to select a set of quality indicators. Phase 1 included a literature review with written feedback from the panel. Phase 2 included an in-person workshop with anonymous voting. The selection criteria for the indicators were strength of evidence, ease of capture and usability. Indicators for which ≥90% of the panel members voted 'to keep' were selected as the final set of indicators. RESULTS During phase 1, 68 potential indicators were generated from the literature and an additional four indicators were recommended by the panel. During phase 2, these 72 indicators were discussed; 48 indicators met the 90% inclusion threshold and included eight pathology, five radiology, 11 surgical, six radiation oncology and 18 MCC indicators. CONCLUSION A modified Delphi method was used to select 48 multidisciplinary quality indicators to specifically measure the uptake of key processes necessary for high quality care of patients with rectal cancer. These quality indicators will be used in future work to identify and address gaps in care in the uptake of these clinical processes.
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Affiliation(s)
- Amandeep Pooni
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Selina Schmocker
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Carl Brown
- Department of Colorectal Surgery, St Paul's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anthony MacLean
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Hochman
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Lara Williams
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Nancy Baxter
- University of Toronto, Toronto, ON, Canada.,Department of Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Marko Simunovic
- Department of Surgery, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Sender Liberman
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Sébastien Drolet
- Department of Surgery, Université Laval, Quebec City, QC, Canada
| | - Katerina Neumann
- Department of Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Kartik Jhaveri
- University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, Mount Sinai Hospital and Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Richard Kirsch
- University of Toronto, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Erin D Kennedy
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
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Craven BC, Alavinia SM, Wiest MJ, Farahani F, Hitzig SL, Flett H, Jeyathevan G, Omidvar M, Bayley MT. Methods for development of structure, process and outcome indicators for prioritized spinal cord injury rehabilitation Domains: SCI-High Project. J Spinal Cord Med 2019; 42:51-67. [PMID: 31573444 PMCID: PMC6781197 DOI: 10.1080/10790268.2019.1647386] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: High-quality rehabilitation care following spinal cord injury or disease (SCI/D) is critical for optimizing neurorecovery and long-term health outcomes. This manuscript describes the methods used for developing, refining, and implementing a framework of structure, process, and outcome indicators that reflect high-quality rehabilitation among adults with SCI/D in Canada. Methods: This quality improvement initiative was comprised of the following processes: (1) prioritization of care Domains by key stakeholders (scientists, clinicians, therapists, patients and stakeholder organizations); (2) assembly of 11 Domain-specific Working Groups including 69 content experts; (3) conduct of literature searches, guideline and best practice reviews, and outcome synthesis by the Project Team; (4) refinement of Domain aim and construct definitions; (5) conduct of cause and effect analysis using Driver diagrams; (6) selection and development of structure, process and outcome indicators; (7) piloting and feasibility analysis of indicators and associated evaluation tools; and, (8) dissemination of the proposed indicators. Result: The Project Team established aims, constructs and related structure, process, and outcome indicators to facilitate uniform measurement and benchmarking across 11 Domains of rehabilitation, at admission and for 18 months thereafter, among adult Canadians by 2020. Conclusion: These processes led to the selection of a feasible set of indicators that once implemented should ensure that adults with SCI/D receive timely, safe, and effective rehabilitation services. These indicators can be used to assess health system performance, monitor the quality of care within and across rehabilitation settings, and evaluate the rehabilitation outcomes of the population to ultimately enhance healthcare quality and equity.
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Affiliation(s)
- B. Catharine Craven
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada, B. Catharine Craven, KITE – Toronto Rehab – University Health Network, 206-H 520 Sutherland Drive, Toronto, Ontario, Canada M4G3V9; Ph: 416-597-3422 x6122.
| | - S. Mohammad Alavinia
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matheus J. Wiest
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Farnoosh Farahani
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Sander L. Hitzig
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Heather Flett
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Departmenet of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Gaya Jeyathevan
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Maryam Omidvar
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Mark T. Bayley
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
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Abstract
OBJECTIVE All healthcare systems require valid ways to evaluate service delivery. The objective of this study was to identify existing content validated quality indicators (QIs) for responsible use of medicines (RUM) and classify them using multiple frameworks to identify gaps in current quality measurements. DESIGN Systematic review without meta-analysis. SETTING All care settings. SEARCH STRATEGY CINAHL, Embase, Global Health, International Pharmaceutical Abstract, MEDLINE, PubMed and Web of Science databases were searched up to April 2018. An internet search was also conducted. Articles were included if they described medication-related QIs developed using consensus methods. Government agency websites listing QIs for RUM were also included. ANALYSIS Several multidimensional frameworks were selected to assess the scope of QI coverage. These included Donabedian's framework (structure, process and outcome), the Anatomical Therapeutic Chemical (ATC) classification system and a validated classification for causes of drug-related problems (c-DRPs; drug selection, drug form, dose selection, treatment duration, drug use process, logistics, monitoring, adverse drug reactions and others). RESULTS 2431 content validated QIs were identified from 131 articles and 5 websites. Using Donabedian's framework, the majority of QIs were process indicators. Based on the ATC code, the largest number of QIs pertained to medicines for nervous system (ATC code: N), followed by anti-infectives for systemic use (J) and cardiovascular system (C). The most common c-DRPs pertained to 'drug selection', followed by 'monitoring' and 'drug use process'. CONCLUSIONS This study was the first systematic review classifying QIs for RUM using multiple frameworks. The list of the identified QIs can be used as a database for evaluating the achievement of RUM. Although many QIs were identified, this approach allowed for the identification of gaps in quality measurement of RUM. In order to more effectively evaluate the extent to which RUM has been achieved, further development of QIs may be required.
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Affiliation(s)
- Kenji Fujita
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebekah J Moles
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Timothy F Chen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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11
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Ortelli L, Spitale A, Mazzucchelli L, Bordoni A. Quality indicators of clinical cancer care for prostate cancer: a population-based study in southern Switzerland. BMC Cancer 2018; 18:733. [PMID: 29996904 PMCID: PMC6042390 DOI: 10.1186/s12885-018-4604-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/18/2018] [Indexed: 12/31/2022] Open
Abstract
Background Quality of cancer care (QoCC) has become an important item for providers, regulators and purchasers of care worldwide. Aim of this study is to present the results of some evidence-based quality indicators (QI) for prostate cancer (PC) at the population-based level and to compare the outcomes with data available in the literature. Methods The study included all PC diagnosed on a three years period analysis (01.01.2011–31.12.2013) in the population of Canton Ticino (Southern Switzerland) extracted from the Ticino Cancer Registry database. 13 QI, approved through the validated Delphi methodology, were calculated using the “available case” approach: 2 for diagnosis, 4 for pathology, 6 for treatment and 1 for outcome. The selection of the computed QI was based on the availability of medical documentation. QI are presented as proportion (%) with the corresponding 95% confidence interval. Results 700 PC were detected during the three-year period 2011–2013: 78.3% of them were diagnosed through a prostatic biopsy and for 72.5% 8 or more biopsy cores were taken. 46.5% of the low risk PC patients underwent active surveillance, while 69.2% of high risk PC underwent a radical treatment (radical prostatectomy, radiotherapy or brachytherapy) and 73.5% of patients with metastatic PC were treated with hormonal therapy. The overall 30-day postoperative mortality was 0.5%. Conclusions Results emerging from this study on the QoCC for PC in Canton Ticino are encouraging: the choice of treatment modalities seems to respect the international guidelines and our results are comparable to the scarce number of available international studies. Additional national and international standardisation of the QI and further QI population-based studies are needed in order to get a real picture of the PC diagnostic-therapeutic process progress through the definition of thresholds of minimal standard of care. Electronic supplementary material The online version of this article (10.1186/s12885-018-4604-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Ortelli
- Ticino Cancer Registry, Cantonal Institute of Pathology, Via in Selva 24, 6600, Locarno, Switzerland.
| | - Alessandra Spitale
- Ticino Cancer Registry, Cantonal Institute of Pathology, Via in Selva 24, 6600, Locarno, Switzerland
| | - Luca Mazzucchelli
- Clinical Pathology, Cantonal Institute of Pathology, 6600, Locarno, Switzerland
| | - Andrea Bordoni
- Ticino Cancer Registry, Cantonal Institute of Pathology, Via in Selva 24, 6600, Locarno, Switzerland
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12
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Keikes L, Koopman M, Tanis PJ, Lemmens VE, Punt CJ, van Oijen MG. Evaluating the scientific basis of quality indicators in colorectal cancer care: A systematic review. Eur J Cancer 2017; 86:166-177. [DOI: 10.1016/j.ejca.2017.08.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/22/2017] [Accepted: 08/30/2017] [Indexed: 12/31/2022]
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13
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Beets G, Sebag-Montefiore D, Andritsch E, Arnold D, Beishon M, Crul M, Dekker JW, Delgado-Bolton R, Fléjou JF, Grisold W, Henning G, Laghi A, Lovey J, Negrouk A, Pereira P, Roca P, Saarto T, Seufferlein T, Taylor C, Ugolini G, Velde CVD, Herck BV, Yared W, Costa A, Naredi P. ECCO Essential Requirements for Quality Cancer Care: Colorectal Cancer. A critical review. Crit Rev Oncol Hematol 2017; 110:81-93. [DOI: 10.1016/j.critrevonc.2016.12.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/05/2016] [Indexed: 01/08/2023] Open
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McNair AGK, Heywood N, Tiernan J, Verjee A, Bach SP, Fearnhead NS. A national patient and public colorectal research agenda: integration of consumer perspectives in bowel disease through early consultation. Colorectal Dis 2017; 19:O75-O85. [PMID: 27870254 DOI: 10.1111/codi.13564] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/15/2016] [Indexed: 02/08/2023]
Abstract
AIM There is a recognized need to include the views of patients and the public in prioritizing health research. This study aimed: (i) to explore patients' views on colorectal research; and (ii) to prioritize research topics with patients and the public. METHOD In phase 1, 12 charitable organizations and patient groups with an interest in bowel disease were invited to attend a consultation exercise. Participants were briefed on 25 colorectal research topics prioritized by members of the Association of Coloproctology of Great Britain and Ireland. Focus groups were conducted and discussions were recorded with field notes. Analysis was conducted using principles of thematic analysis. In phase 2, a free public consultation was undertaken. Participants were recruited from newspaper advertisements, were briefed on the same research topics and were asked to rate the importance of each on a five-point Likert scale. Descriptive statistics were used to rank the topics. Univariable linear regression compared recorded demographic details with mean topic scores. RESULTS Focus groups were attended by 12 patients who highlighted the importance of patient-centred information for trial recruitment and when selecting outcome measures. Some 360 people attended the public consultation, of whom 277 (77%) were recruited. Participants rated 'What is the best way to treat early cancer in the back passage?' highest, with 227 (85%) scoring it 4 or 5. There was no correlation between participant demographics and mean topic scores. CONCLUSION The present study prioritized a colorectal research agenda with the input of patients and the public. Further research is required to translate this agenda into real improvements in patient care.
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Affiliation(s)
- A G K McNair
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- National Cancer Research Institute, London, UK
| | - N Heywood
- University Hospital of South Manchester, Wythenshaw, UK
| | - J Tiernan
- John Goligher Colorectal Unit, St James's University Hospital, Leeds, UK
| | - A Verjee
- Bowel Disease Research Foundation, London, UK
- Crohn's and Colitis UK, St Albans, UK
| | - S P Bach
- Colorectal Surgery, University of Birmingham, Birmingham, UK
- Royal College of Surgeons of England, Lincoln's Inn Fields, London, UK
| | - N S Fearnhead
- Addenbrooke's Hospital, Cambridge, UK
- Research and Audit Committee, Association of Coloproctology of Great Britain and Ireland, London, UK
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15
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Tiernan J, Cook A, Geh I, George B, Magill L, Northover J, Verjee A, Wheeler J, Fearnhead N. Use of a modified Delphi approach to develop research priorities for the association of coloproctology of Great Britain and Ireland. Colorectal Dis 2014; 16:965-70. [PMID: 25284641 PMCID: PMC4262073 DOI: 10.1111/codi.12790] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/18/2014] [Indexed: 12/13/2022]
Abstract
AIM The modified Delphi approach is an established method for reaching a consensus opinion among a group of experts in a particular field. We have used this technique to survey the entire membership of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to reach a consensus on prioritizing clinical research questions in colorectal disease. METHOD Three rounds of surveys were conducted using a web-based tool. In the first, the ACPGBI membership was invited to submit research questions. In Rounds 2 and 3 they were asked to score questions on priority. A steering group analysed the results of each round to identify those questions ranked as being of highest priority. RESULTS Five hundred and two questions were submitted in Round 1. Following two rounds of voting and analysis, a list of 25 priority questions was produced, including 15 cancer-related and 10 noncancer-related questions. CONCLUSION It is anticipated that these results will: (i) set the research agenda over the next few years for the study of colorectal disease in the United Kingdom, (ii) promote development and (iii) define funding of new research and prioritize areas of unmet clinical need where the potential clinical impact is greatest.
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Affiliation(s)
- J Tiernan
- Huddersfield Royal InfirmaryHuddersfield, UK
| | - A Cook
- NIHR Evaluations Trials and Studies Coordinating Centre, Wessex Institute, University of Southampton, University Hospitals NHS TrustSouthampton, UK
| | - I Geh
- University Hospital Birmingham NHS Trust and University of BirminghamBirmingham, UK
| | - B George
- John Radcliffe HospitalOxford, UK
| | - L Magill
- Birmingham Clinical Trials Unit, University of BirminghamBirmingham, UK
| | - J Northover
- Imperial CollegeLondon, UK,St Mark's HospitalHarrow, UK
| | - A Verjee
- Bowel Disease Research FoundationLondon, UK,Crohn's and Colitis UKSt Alban's, UK
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