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Gallastegui-Brana A, Rodríguez-Nunez A, Palacios J, Soto-Soto F, Castellano J, Soto-Guerrero S, Pérez-Cruz PE. Development and Validation of a Tool to Assess the Structural Quality of Palliative Care Services. J Pain Symptom Manage 2023; 65:490-499.e50. [PMID: 36702392 DOI: 10.1016/j.jpainsymman.2023.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/01/2023] [Accepted: 01/08/2023] [Indexed: 01/25/2023]
Abstract
CONTEXT The current gap in access to palliative care requires the expansion of palliative care services worldwide. There is little information about the structural components required by palliative care services to provide adequate end-of-life care. No specific tools have been developed to assess the structural quality of these services. OBJECTIVE To develop and validate a tool to assess the structural quality of palliative care services. METHODS A scoping review of literature was performed to identify structural quality indicators of palliative care services. National experts participated in a two-round Delphi method to reach consensus regarding the importance and measurement feasibility of each proposed indicator. Consensus was reached for each indicator if 60% or more considered them both important and feasible. The selected indicators were tested among Chilean palliative care services to assess instrument psychometric characteristics. RESULTS Thirty-one indicators were identified. Thirty-five experts participated in a two-round Delphi survey. Twenty-one indicators reached consensus and were included in the structural quality of palliative care services tool (SQPCS-21). This instrument was applied to 201 out of 250 palliative care services in Chile. Achievement for each indicator varied between 8% and 96% (mean 52%). The total SQPCS-21 score varied between 3 and 21 points (mean 11 points). CONCLUSION The SQPCS-21 tool to assess structural quality of palliative care services, has good content and construct validity and its application provides information about institutions at the individual and aggregated level. This tool can provide guidance to monitor the structural quality of palliative care worldwide.
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Affiliation(s)
- Aintzane Gallastegui-Brana
- Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina (A.G.B., A.R.N., J.P., S.S.G., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile; Escuela de Enfermería (A.G.B.), Pontificia Universidad Católica de Chile, Centro Colaborador OPS/OMS, Santiago, Chile
| | - Alfredo Rodríguez-Nunez
- Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina (A.G.B., A.R.N., J.P., S.S.G., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile; Sección Medicina Paliativa, Escuela de Medicina (A.R.N., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile; Instituto Nacional del Cáncer (A.R.N., F.S.S.), Santiago, Chile
| | - Josefa Palacios
- Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina (A.G.B., A.R.N., J.P., S.S.G., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Joel Castellano
- Programa Farmacología y Toxicología (J.C.), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Soto-Guerrero
- Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina (A.G.B., A.R.N., J.P., S.S.G., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pedro E Pérez-Cruz
- Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina (A.G.B., A.R.N., J.P., S.S.G., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile; Sección Medicina Paliativa, Escuela de Medicina (A.R.N., P.E.P.C.), Pontificia Universidad Católica de Chile, Santiago, Chile.
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Consensus-based recommendations for psychosocial support measures for parents and adult children at the end of life: results of a Delphi study in Germany. Support Care Cancer 2022; 30:669-676. [PMID: 34363494 PMCID: PMC8636430 DOI: 10.1007/s00520-021-06452-x] [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: 02/18/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE The availability of psychosocial support measures has a significant impact on the quality of life of terminally ill and dying patients and the burden experienced by their relatives. To date, no intervention has specifically focused on promoting interaction within the dyads of the following: (1) terminally ill adult children and their parents and (2) terminally ill parents and their adult children. A national Delphi study was conducted to provide appropriate recommendations for dyadic psychosocial support measures. METHODS Recommendations were formulated from qualitative interview data on the experiences and wishes of patients and family caregivers within these two dyads. Experts from palliative and hospice care providers rated the relevance and feasibility of 21 recommendations on two 4-point Likert-type scales, respectively. Additional suggestions for improvement were captured via free text fields. Individual items were considered consented when ≥ 80% of participants scored 1 (strongly agree) or 2 (somewhat agree) regarding both relevance and feasibility. RESULTS A total of 27 experts (35% response rate) completed two Delphi rounds. Following the first round, 13 recommendations were adjusted according to participants' comments. After the second round, consensus was achieved for all 21 of the initially presented recommendations. CONCLUSION The Delphi-consented recommendations for parents and adult children at the end of life provide the first guidance for hands-on dyadic psychosocial support measures for parent-adult child relationships, specifically. The next step could involve the structured implementation of the recommendations, accompanied by scientific research. This study was registered on October 27, 2017, with the German Clinical Trials Register (DRKS00013206).
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Dudgeon D. The Impact of Measuring Patient-Reported Outcome Measures on Quality of and Access to Palliative Care. J Palliat Med 2020; 21:S76-S80. [PMID: 29283866 DOI: 10.1089/jpm.2017.0447] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Measuring performance for palliative care is complex as care is delivered in many sites, over time and jointly to the patient and family. Measures of structural processes do not necessarily capture aspects that are important to patients and families nor reflect holistic multidisciplinary outcomes of care. This article focuses on the question as to whether measurement of patient-reported outcome measures improves the outcomes of quality and access to palliative care. OBJECTIVES To review the international evidence that measurement of indicators of desired outcomes improves the quality of and access to palliative care, in order to apply them to the Canadian context. DESIGN Rapid review. SETTING Canadian context. FINDINGS This review identified six systematic reviews and forty-seven studies that describe largely national efforts to arrive at a consensus as to what needs to be measured to assess quality of palliative care. Patient-reported outcome measures (PROMs) are becoming more prevalent, with emerging evidence to suggest that their measurement improves outcomes that are important to patients. Several Canadian initiatives are in place, including the Canadian Partnership Against Cancer's efforts, in conjunction with other partners, to develop common quality measures. Results from Australia's Palliative Care Outcomes Collaborative demonstrate that patient-centered improvements in palliative care can be measured by using patient-reported outcomes derived at the point of care and delivered nationally. CONCLUSIONS Measurement of quality palliative and end-of-life care is very complex. It requires that both administrative data and PROMs be assessed to reflect outcomes that are important to patients and families. Australia's national initiative is a promising exemplar for continued work in this area.
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Affiliation(s)
- Deborah Dudgeon
- School of Medicine, Queen's University , Kingston, Ontario, Canada
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Hamatani Y, Takada Y, Miyamoto Y, Kawano Y, Anchi Y, Shibata T, Suzuki A, Nishikawa M, Ito H, Kato M, Shiga T, Fukumoto Y, Izumi C, Yasuda S, Ogawa H, Sugano Y, Anzai T. Development and Practical Test of Quality Indicators for Palliative Care in Patients With Chronic Heart Failure. Circ J 2020; 84:584-591. [PMID: 31983725 DOI: 10.1253/circj.cj-19-0225] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Palliative care is highly relevant for patients with heart failure (HF), and there is a need for quantitative information on quality of care. Accordingly, this study aimed to develop a set of quality indicators (QIs) for palliative care of HF patients, and to conduct a practical pilot measurement of the proposed QIs in clinical practice.Methods and Results:We used a modified Delphi technique, a consensus method that involves a comprehensive literature review, face-to-face multidisciplinary panel meeting, and anonymous rating in 2 rounds. A 15-member multidisciplinary expert panel individually rated each potential indicator on a scale of 1 (lowest) to 9 (highest) for appropriateness. All indicators receiving a median score ≥7 without significant disagreement were included in the final set of QIs. Through the consensus-building process, 35 QIs were proposed for palliative care in HF patients. Practical measurement in HF patients (n=131) from 3 teaching hospitals revealed that all of the proposed QIs could be obtained retrospectively from medical records, and the following QIs had low performance (<10%): "Intervention by multidisciplinary team", "Opioid therapy for patients with refractory dyspnea", and "Screening for psychological symptoms". CONCLUSIONS The first set of QIs for palliative care of HF patients was developed and could clarify quantitative information and might improve the quality of care.
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Affiliation(s)
- Yasuhiro Hamatani
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuko Takada
- Department of Nursing, National Cerebral and Cardiovascular Center
| | - Yoshihiro Miyamoto
- Division of Data Management, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | - Yukie Kawano
- Department of Nursing, National Cerebral and Cardiovascular Center
| | - Yuta Anchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | - Mitsunori Nishikawa
- Department of Palliative Care, National Center for Geriatrics and Gerontology
| | - Hiroto Ito
- National Center of Neurology and Psychiatry.,Japan Organization of Occupational Health and Safety
| | - Masashi Kato
- Department of Psycho-Oncology, National Cancer Center
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuo Sugano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center.,Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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Lo TJ, Neo PS, Peh TY, Akhileswaran R, Chen WT, Lee A, Wee NT, Jin OY, Poon E, Seah A, Weng SC, Hwang MKY, Cheng GS, Jen LT, An BTS, Ping WY, Ying OW, Mayganathan K, Jin OY, Ying PT, Pin TY, Yee CW, Yin TTP, Ying TY. Improving Quality of Palliative Care Through Implementation of National Guidelines for Palliative Care. J Palliat Med 2019; 22:1439-1444. [DOI: 10.1089/jpm.2018.0345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tong Jen Lo
- Division of Supportive and Palliative Care, National Cancer Center Singapore, Singapore
| | - Patricia S.H. Neo
- Division of Supportive and Palliative Care, National Cancer Center Singapore, Singapore
| | - Tan Ying Peh
- Division of Supportive and Palliative Care, National Cancer Center Singapore, Singapore
| | | | - Wei Ting Chen
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore
- Nursing Service, Tan Tock Seng Hospital, Singapore
| | - Angel Lee
- Saint Andrew's Community Hospital, Singapore
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Arias-Casais N, Garralda E, López-Fidalgo J, Rhee JY, Pons JJ, de Lima L, Centeno C. Consensus Building on Health Indicators to Assess PC Global Development With an International Group of Experts. J Pain Symptom Manage 2019; 58:445-453.e1. [PMID: 31163260 DOI: 10.1016/j.jpainsymman.2019.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022]
Abstract
CONTEXT International consensus on indicators is necessary to standardize the global assessment of palliative care (PC) development. OBJECTIVES To identify the best indicators to assess current national-level PC development. METHODS Experts in PC development were invited to rate 45 indicators organized by domains of the World Health Organization Public Health Strategy in a two-round RAND/UCLA-modified Delphi process. In the first round, experts rated indicators by relevance, measurability, and feasibility (1-9). Ratings were used to calculate a global score (1-9). Indicators scoring >7 proceeded to the second round for fine-tuning of global scores. Median, confidence interval, Content Validity Index, and Disagreement Index were calculated. Indicators scoring a lower limit 95% confidence interval of ≥7 and a Content Validity Index of ≥0.30 were selected. RESULTS 24 experts representing five continents and several organizations completed the study. 25 indicators showed a high content validity and level of agreement. Policy indicators (n = 8) included the existence of designated staff in the National Ministry of Health and the inclusion of PC services in the basic health package and in the primary care level list of services. Education indicators (n = 4) focused on processes of official specialization for physicians, inclusion of teaching at the undergraduate level, and PC professorship. Use of medicines indicators (n = 4) consisted of opioid consumption, availability, and prescription requirements. Services indicators (n = 6) included number and type of services for adults and children. Additional indicators for professional activity (n = 3) were identified. CONCLUSION The first list including 25 of the best indicators to evaluate PC development at a national level has been identified.
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Affiliation(s)
- Natalia Arias-Casais
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain.
| | - Eduardo Garralda
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain; IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra), Pamplona, Spain
| | - Jesús López-Fidalgo
- Universidad de Navarra, ICS, Statistics Unit, Campus universitario, Pamplona, Spain
| | - John Y Rhee
- Department of Medicine, Mount Sinai Hospital, New York, USA
| | - Juan José Pons
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Department of History, History of Art and Geography, University of Navarra, Pamplona, Spain
| | - Liliana de Lima
- International Association for Hospice and Palliative Care, Houston, USA
| | - Carlos Centeno
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain; IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra), Pamplona, Spain
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7
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McCorry NK, O'Connor S, Leemans K, Coast J, Donnelly M, Finucane A, Jones L, Kernohan WG, Perkins P, Dempster M. Quality indicators for Palliative Day Services: A modified Delphi study. Palliat Med 2019; 33:197-205. [PMID: 30451082 PMCID: PMC6350181 DOI: 10.1177/0269216318810601] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The goal of Palliative Day Services is to provide holistic care that contributes to the quality of life of people with life-threatening illness and their families. Quality indicators provide a means by which to describe, monitor and evaluate the quality of Palliative Day Services provision and act as a starting point for quality improvement. However, currently, there are no published quality indicators for Palliative Day Services. AIM: To develop and provide the first set of quality indicators that describe and evaluate the quality of Palliative Day Services. DESIGN AND SETTING: A modified Delphi technique was used to combine best available research evidence derived from a systematic scoping review with multidisciplinary expert appraisal of the appropriateness and feasibility of candidate indicators. The resulting indicators were compiled into ‘toolkit’ and tested in five UK Palliative Day Service settings. RESULTS: A panel of experts independently reviewed evidence summaries for 182 candidate indicators and provided ratings on appropriateness, followed by a panel discussion and further independent ratings of appropriateness, feasibility and necessity. This exercise resulted in the identification of 30 indicators which were used in practice testing. The final indicator set comprised 7 structural indicators, 21 process indicators and 2 outcome indicators. CONCLUSION: The indicators fulfil a previously unmet need among Palliative Day Service providers by delivering an appropriate and feasible means to assess, review, and communicate the quality of care, and to identify areas for quality improvement.
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Affiliation(s)
- Noleen K McCorry
- 1 Centre of Excellence for Public Health, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Sean O'Connor
- 2 School of Nursing, Ulster University, Newtownabbey, UK
| | - Kathleen Leemans
- 3 End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,4 Department of Radiotherapy and Supportive Care, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Joanna Coast
- 5 Health Economics at Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Donnelly
- 1 Centre of Excellence for Public Health, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Anne Finucane
- 6 Marie Curie Hospice, Edinburgh, UK.,7 Usher Institute of Population Health Sciences and Informatics, University of Edinburgh
| | | | | | - Paul Perkins
- 9 Sue Ryder Leckhampton Court Hospice, Cheltenham, UK.,10 Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Martin Dempster
- 11 School of Psychology, Queen's University Belfast, Belfast, UK
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Harrison TG, Tam-Tham H, Hemmelgarn BR, James MT, Sinnarajah A, Thomas CM. Identification and Prioritization of Quality Indicators for Conservative Kidney Management. Am J Kidney Dis 2018; 73:174-183. [PMID: 30482578 DOI: 10.1053/j.ajkd.2018.08.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/29/2018] [Indexed: 01/28/2023]
Abstract
RATIONALE & OBJECTIVE Conservative kidney management is holistic patient-centered care for patients with kidney failure that focuses on delaying the progression of kidney disease and symptom management, without the provision of renal replacement therapy. Currently there is no consensus as to what constitutes high-quality conservative kidney management. We aimed to develop a set of quality indicators for the conservative management of kidney failure. STUDY DESIGN Nominal group technique and Delphi survey process. SETTING & PARTICIPANTS 16 patients and caregivers from Calgary, Canada, participated in 2 nominal group meetings. 91 multidisciplinary health care professionals from 10 countries took part in a Delphi process. ANALYTICAL APPROACH Nominal group technique study of patients and caregivers was used to identify and prioritize a list of quality indicators. A 4-round Delphi process with health care professionals was used to rate the quality indicators until consensus was reached (defined as a mean rating on the Likert scale ≥7.0 and percent agreement >75%). Quality indicators that met criteria for consensus inclusion in the Delphi survey were ranked, and comparisons were made with nominal group priorities. RESULTS 99 quality indicators met consensus criteria for inclusion. The most highly rated quality indicator in the Delphi process was the "percentage of patients that die in the place they desire." There was significant discordance between priorities of the nominal groups with that of the Delphi survey, with only 1 quality indicator being shared on each groups' top 10 list of quality indicators. LIMITATIONS Participants were largely from high-income English-speaking countries, and most already had structured conservative kidney management programs in place, all potentially limiting generalizability. CONCLUSIONS Quality of conservative kidney management care is important to patients, caregivers, and health care professionals. However, discordant quality indicator priorities between groups suggested that care providers delivering conservative kidney management may not prioritize what is most important to those receiving this care. Conservative kidney management programs and health care providers can improve the applicability of this consensus-based quality indicator list to their program by further developing and evaluating it for use in their program.
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Affiliation(s)
- Tyrone G Harrison
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Helen Tam-Tham
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T James
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Aynharan Sinnarajah
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Chandra M Thomas
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
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9
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Rhee JY, Garralda E, Namisango E, Luyirika E, de Lima L, Powell RA, Centeno C. Developing Macroindicators of Palliative Care Development in Africa: A Process with In-Country and International Experts. J Palliat Med 2017; 21:342-353. [PMID: 29027836 DOI: 10.1089/jpm.2017.0207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Indicators specific to the African context are important to measure palliative care (PC) development accurately. OBJECTIVE To describe the process used to develop a set of PC macroindicators for Africa. DESIGN Open-ended interviews on national PC development were conducted with five African Country Experts. Indicators were rated (1-4) by 14 Country Experts for validity and feasibility. An additional 11 interviews were conducted to ensure indicator saturation. Indicators scoring ≥3 proceeded to a modified two-round RAND/UCLA Delphi with global experts on PC development (International Committee). Finally, indicators were ranked by the project team. SETTING/SUBJECTS Sixteen country experts from 7 African countries and 14 International Committee members. RESULTS One hundred three indicators were rated by Country Experts, and 58 proceeded to the Delphi. Thirty-eight indicators were rated as important by the International Committee, and the project team ranked 19 of these as most important. Service indicators (n = 6) included the number of types of services most important in Africa (e.g., hospices, home based) and coverage. Policy indicators (n = 4) included the existence of PC in national policies, guidelines, and budget and a responsible person. Education indicators (n = 3) consisted of inclusion of PC in medical and nursing curricula and recognition as a specialty. Medicine indicators (n = 4) focused on morphine availability, consumption, and prescribing barriers. Vitality indicators (n = 2) reflected the existence of a national association and its activity. CONCLUSION The process to develop African-specific PC indicators resulted in 19 indicators that were used to measure PC development as a comparative baseline for development in African countries.
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Affiliation(s)
- John Y Rhee
- 1 Icahn School of Medicine at Mount Sinai , New York, New York.,2 ATLANTES Research Program, Institute for Culture and Society, University of Navarra , Pamplona, Spain
| | - Eduardo Garralda
- 2 ATLANTES Research Program, Institute for Culture and Society, University of Navarra , Pamplona, Spain .,3 IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra) , Pamplona, Spain
| | - Eve Namisango
- 4 African Palliative Care Association , Kampala, Uganda
| | | | - Liliana de Lima
- 5 International Association for Hospice and Palliative Care , Houston, Texas
| | | | - Carlos Centeno
- 2 ATLANTES Research Program, Institute for Culture and Society, University of Navarra , Pamplona, Spain .,3 IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra) , Pamplona, Spain .,7 Department of Palliative Medicine and Symptom Control, Clínica Universidad de Navarra, University of Navarra , Pamplona, Spain
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10
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Potential palliative care quality indicators in heart disease patients: A review of the literature. J Cardiol 2017; 70:335-341. [DOI: 10.1016/j.jjcc.2017.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/21/2017] [Accepted: 02/28/2017] [Indexed: 11/17/2022]
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11
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Sobota AE, Shah N, Mack JW. Development of quality indicators for transition from pediatric to adult care in sickle cell disease: A modified Delphi survey of adult providers. Pediatr Blood Cancer 2017; 64. [PMID: 27905689 DOI: 10.1002/pbc.26374] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/25/2016] [Accepted: 10/30/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Transition from pediatric to adult care is a vulnerable time for young adults with sickle cell disease (SCD); however, improvements in transition are limited by a lack of quality indicators. The purpose of this study was to establish quality indicators for transition in SCD and to determine the optimal timing between the final pediatric visit and the first adult provider visit. PROCEDURE We conducted a modified Delphi survey to reach a consensus on which quality indicators are most important for a successful transition. Our expert panel consisted of members of the Sickle Cell Adult Provider Network. In the first round, the participants ranked a list of quality indicators by importance. In the second round, the participants chose their "top 5" quality indicators in terms of importance and also ranked them on feasibility. RESULTS The response rates for the two rounds were 68 and 96%, respectively. Nine quality indicators were chosen as "top 5" by a majority of respondents, including communication between pediatric and adult providers, timing of first adult visit, patient self-efficacy, quality of life, and trust with their adult provider. Based on the comments from round 1, respondents were also asked for the optimal timing between leaving pediatric care and entering adult care. Most recommended a first adult visit within 2 months of the final pediatric visit. CONCLUSIONS By using these quality indicators chosen by the majority of respondents, we can better develop and evaluate transition programs for young adults with SCD and improve health outcomes for these vulnerable patients.
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Affiliation(s)
- Amy E Sobota
- Boston University School of Medicine, Boston, Massachusetts.,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Nishita Shah
- Boston University School of Public Health, Boston, Massachusetts
| | - Jennifer W Mack
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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12
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Kaye EC, Abramson ZR, Snaman JM, Friebert SE, Baker JN. Productivity in Pediatric Palliative Care: Measuring and Monitoring an Elusive Metric. J Pain Symptom Manage 2017; 53:952-961. [PMID: 28062335 DOI: 10.1016/j.jpainsymman.2016.12.326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/16/2016] [Accepted: 12/15/2016] [Indexed: 11/17/2022]
Abstract
CONTEXT Workforce productivity is poorly defined in health care. Particularly in the field of pediatric palliative care (PPC), the absence of consensus metrics impedes aggregation and analysis of data to track workforce efficiency and effectiveness. Lack of uniformly measured data also compromises the development of innovative strategies to improve productivity and hinders investigation of the link between productivity and quality of care, which are interrelated but not interchangeable. OBJECTIVES To review the literature regarding the definition and measurement of productivity in PPC; to identify barriers to productivity within traditional PPC models; and to recommend novel metrics to study productivity as a component of quality care in PPC. METHODS PubMed® and Cochrane Database of Systematic Reviews searches for scholarly literature were performed using key words (pediatric palliative care, palliative care, team, workforce, workflow, productivity, algorithm, quality care, quality improvement, quality metric, inpatient, hospital, consultation, model) for articles published between 2000 and 2016. Organizational searches of Center to Advance Palliative Care, National Hospice and Palliative Care Organization, National Association for Home Care & Hospice, American Academy of Hospice and Palliative Medicine, Hospice and Palliative Nurses Association, National Quality Forum, and National Consensus Project for Quality Palliative Care were also performed. Additional semistructured interviews were conducted with directors from seven prominent PPC programs across the U.S. to review standard operating procedures for PPC team workflow and productivity. RESULTS Little consensus exists in the PPC field regarding optimal ways to define, measure, and analyze provider and program productivity. Barriers to accurate monitoring of productivity include difficulties with identification, measurement, and interpretation of metrics applicable to an interdisciplinary care paradigm. In the context of inefficiencies inherent to traditional consultation models, novel productivity metrics are proposed. CONCLUSIONS Further research is needed to determine optimal metrics for monitoring productivity within PPC teams. Innovative approaches should be studied with the goal of improving efficiency of care without compromising value.
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Affiliation(s)
- Erica C Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
| | | | - Jennifer M Snaman
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Sarah E Friebert
- Division of Pediatric Palliative Care, Akron Children's Hospital, Akron, Ohio, USA
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Defining Ocular Surface Disease Activity and Damage Indices by an International Delphi Consultation. Ocul Surf 2017; 15:97-111. [DOI: 10.1016/j.jtos.2016.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/11/2016] [Accepted: 08/31/2016] [Indexed: 01/28/2023]
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Iliffe S, Davies N, Manthorpe J, Crome P, Ahmedzai SH, Vernooij-Dassen M, Engels Y. Improving palliative care in selected settings in England using quality indicators: a realist evaluation. BMC Palliat Care 2016; 15:69. [PMID: 27484414 PMCID: PMC4970274 DOI: 10.1186/s12904-016-0144-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 07/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England. METHODS 1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service change in selected settings (general practice, community palliative care teams, care homes, hospital wards, in-patient hospices) with a before-and-after evaluation, and 3) realist evaluation of processes and outcomes across settings. Participants in each setting were supported to identify no more than three Quality Indicators to work on over an eight-month period in 2013/2014. RESULTS General practices could not be recruited to the study. Care homes were recruited but not retained. Hospital wards were recruited and retained, and using the Quality Indicator (QI) set achieved some of their desired changes. Hospices and community palliative care teams were able to use the QI set to achieve almost all their desired changes, and develop plans for quality improvements. Improvements included: increasing the utility of electronic medical records, writing a manual for end of life care, establishing working relationships with a hospice; standardising information transfer between settings, holding regular multi-disciplinary team meetings, exploration of family carers' views and experiences; developing referral criteria, and improvement of information transfer at patient discharge to home or to hospital. Realist evaluation suggested that: 1) uptake and use of QIs are determined by organisational orientation towards continuous improvement; 2) the perceived value of a QI package was not powerful enough for GPs and care homes to commit to or sustain involvement; 3) the QI set may have been to narrow in focus, or more specialist than generalist; and 4) the greater the settings' 'top-down' engagement with this change project, the more problematic was its implementation. CONCLUSIONS Whilst use of QIs may facilitate improvements in specialist palliative care services, different QI sets may be needed for generalist care settings.
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Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - Nathan Davies
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, Strand, London, WC2B 6NR, UK
| | - Peter Crome
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Sam H Ahmedzai
- Department of Oncology and Metabolism, School of Medicine and Biomedical Science, The University of Sheffield, Sheffield, S10 2RX, UK
| | - Myrra Vernooij-Dassen
- Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, 6500 HB, Nijmegen, The Netherlands
| | - Yvonne Engels
- Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, 6500 HB, Nijmegen, The Netherlands
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Berendt J, Stiel S, Simon ST, Schmitz A, van Oorschot B, Stachura P, Ostgathe C. Integrating Palliative Care Into Comprehensive Cancer Centers: Consensus-Based Development of Best Practice Recommendations. Oncologist 2016; 21:1241-1249. [PMID: 27440065 DOI: 10.1634/theoncologist.2016-0063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/17/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND International associations admit that specialized palliative care (SPC) is an obvious component of excellent cancer care. Nevertheless, gaps in integration at the international level have been identified. Recommendations for integrating SPC in clinical care, research, and education are needed, which are subject of the present study. MATERIALS AND METHODS A Delphi study, with three written Delphi rounds, including a face-to-face-meeting with a multiprofessional expert panel (n = 52) working in SPC in 15 German Comprehensive Cancer Centers (CCCs) funded by the German Cancer Aid was initiated. Initial recommendations are built on evidence-based literature. Consensus was defined in advance with ≥80% agreement based on the question of whether each recommendation was unambiguously formulated, relevant, and realizable for a CCC. RESULTS A total of 38 experts (73.1%) from 15 CCCs performed all three Delphi rounds. Consensus was achieved for 29 of 30 recommendations. High agreement related to having an organizationally and spatially independent palliative care unit (≥6 beds), a mobile multiprofessional SPC team, and cooperation with community-based SPC. Until round 3, an ongoing discussion was registered on hospice volunteers, a chair of palliative care, education in SPC among staff in emergency departments, and integration of SPC in decision-making processes such as tumor boards or consultation hours. Integration of SPC in decision-making processes was not consented by a low-rated feasibility (76.3%) due to staff shortage. CONCLUSION Recommendations should be considered when developing standards for cancer center of excellence in Germany. Definition and implementation of indicators of integration of SPC in CCCs and evaluation of its effectiveness are current and future challenges. IMPLICATIONS FOR PRACTICE General and specialized palliative care (SPC) is an integral part of comprehensive cancer care. However, significant diversity concerning the design of SPC in the German Comprehensive Cancer Center (CCC) Network led to the establishment of consensual best practice recommendations for integration of SPC into the clinical structures, processes, research, and education throughout the CCC network. The recommendations contribute to a greater awareness relating to the strategic direction and development of SPC in CCCs. The access to information about SPC and access to offers regarding SPC shall be facilitated by implementing the recommendations in the course of treatment of patients with cancer.
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Affiliation(s)
- Julia Berendt
- Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany
| | - Stephanie Stiel
- Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany
| | - Steffen T Simon
- Department of Palliative Medicine, University Hospital of Cologne and Centre for Integrated Oncology Cologne/Bonn, Bonn, Germany
| | - Andrea Schmitz
- Interdisciplinary Center for Palliative Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Birgitt van Oorschot
- Interdisciplinary Center for Palliative Medicine, Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Würzburg, Germany
| | - Peter Stachura
- Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany
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Davis MP, Strasser F, Cherny N. How well is palliative care integrated into cancer care? A MASCC, ESMO, and EAPC Project. Support Care Cancer 2015; 23:2677-85. [PMID: 25676486 DOI: 10.1007/s00520-015-2630-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/22/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The benefits of integration of palliative care into oncology have become evidence-based. How palliative care is perceived and structured in various settings and countries would be of interest. METHOD We used a previously published questionnaire to survey multiple institutions with members in MASCC and ESMO. The survey was made available on the MASCC website for approximately 6 months and repeated requests were made to complete the survey. Comparisons were made between NCI/ESMO designated cancer centers, nondesignated cancer centers, and urban hospitals. RESULTS One hundred eighty-three different institutions completed this survey, 28 % of ESMO designated centers. Most institutions had palliative care programs and most programs consisted of an inpatient consult service and outpatient clinics. A minority had inpatient palliative care beds and institution supported hospice services. Barriers to palliative care were largely financial. Integration of palliative care into oncology was highly desirable but only a minority of respondents felt that their institution would financially support expanded services and additional palliative care personnel. Designated centers were more likely to have expanded palliative care services. DISCUSSION Our findings are very similar to those previously published. Multiple studies have demonstrated that though palliative care integration into oncology is highly beneficial as measured by patient related outcomes, there is a great concern about reimbursement for services and budget constraints which prevent expansion of services. CONCLUSION Palliative care integration into cancer care is largely through consulting services for inpatients and outpatient clinics. Financial concerns limit integration and expansion of palliative care services. Designated cancer centers have more extensive palliative care services relative to nondesignated cancer centers and urban hospitals.
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Affiliation(s)
- Mellar P Davis
- Palliative Medicine and Supportive Oncology Services, Division of Solid Tumor, Taussig Cancer Institute, The Cleveland Clinic, Cleveland Clinic Lerner School of Medicine Case Western Reserve University, Cleveland, OH, USA,
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Woitha K, Hasselaar J, van Beek K, Ahmed N, Jaspers B, Hendriks JCM, Radbruch L, Vissers K, Engels Y. Testing feasibility and reliability of a set of quality indicators to evaluate the organization of palliative care across Europe: a pilot study in 25 countries. Palliat Med 2015; 29:157-63. [PMID: 25634899 DOI: 10.1177/0269216314562100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A well-organized palliative care service is a prerequisite for offering good palliative care. Reliable and feasible quality indicators are needed to monitor the quality of their organization. AIM To test feasibility and reliability of a previously developed set of quality indicators in settings and services that provide palliative care across Europe. METHODS A total of 38 quality indicators, applicable in all types of settings, rated in a RAND Delphi process, and operationalized into 38 yes/no questions, were used. Descriptives statistics, factor and reliability analyses, analysis of variance, and chi-square analyses were used. DESIGN Cross-sectional online survey. SETTING/PARTICIPANTS Questionnaires were sent to representatives of 217 palliative care settings in 25 countries. Included settings were hospices, inpatient dedicated palliative care beds, palliative care outpatient clinics, palliative care units, day care centers for palliative care, palliative care home support teams, inpatient palliative care support teams, care homes, and nursing homes. RESULTS All invited 25 European Association of Palliative Care countries took part. In total, 107 out of 217 participants responded (57%). The quality indicators were reduced to four coherent sub-scales, being "equipment and continuity of care," "structured documentation of essential palliative care elements in the medical record," "training and appraisal of personnel," and "availability of controlled drugs." No significant differences in quality criteria between the different types of settings and services were identified. CONCLUSION The set of quality indicators appeared to measure four reliable domains that assess the organization of different palliative care settings. It can be used as a starting point for quality improvement activities.
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Affiliation(s)
- Kathrin Woitha
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karen van Beek
- Department of Radiotherapy-Oncology and Palliative Medicine, University Hospital Leuven, Leuven, Belgium
| | - Nisar Ahmed
- Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK
| | - Birgit Jaspers
- Palliative Care Centre, Department of Palliative Medicine, Malteser Hospital Bonn/Rhein-Sieg, University of Bonn, Bonn, Germany Department of Palliative Medicine, Georg-August-University of Göttingen, Göttingen, Germany
| | - Jan C M Hendriks
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lukas Radbruch
- Palliative Care Centre, Department of Palliative Medicine, Malteser Hospital Bonn/Rhein-Sieg, University of Bonn, Bonn, Germany
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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van Riet Paap J, Vernooij-Dassen M, Dröes RM, Radbruch L, Vissers K, Engels Y. Consensus on quality indicators to assess the organisation of palliative cancer and dementia care applicable across national healthcare systems and selected by international experts. BMC Health Serv Res 2014; 14:396. [PMID: 25228087 PMCID: PMC4177156 DOI: 10.1186/1472-6963-14-396] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 09/09/2014] [Indexed: 11/20/2022] Open
Abstract
Background Large numbers of vulnerable patients are in need of palliative cancer and dementia care. However, a wide gap exists between the knowledge of best practices in palliative care and their use in everyday clinical practice. As part of a European policy improvement program, quality indicators (QIs) have been developed to monitor and improve the organisation of palliative care for patients with cancer and those with dementia in various settings in different European countries. Method A multidisciplinary, international panel of professionals participated in a modified RAND Delphi procedure to compose a set of palliative care QIs based on existing sets of QIs on the organisation of palliative care. Panellists participated in three written rounds, one feedback round and one meeting. The panel’s median votes were used to identify the final set of QIs. Results The Delphi procedure resulted in 23 useful QIs. These QIs represent key elements of the organisation of good clinical practice, such as the availability of palliative care teams, the availability of special facilities to provide palliative care for patients and their relatives, and the presence of educational interventions for professionals. The final set also includes QIs that are related to the process of palliative care, such as documentation of pain and other symptoms, communication with patients in need of palliative care and their relatives, and end-of-life decisions. Conclusion International experts selected a set of 23 QIs for the organisation of palliative care. Although we particularly focused on the organisation of cancer and dementia palliative care, most QIs are generic and are applicable for other types of diseases as well.
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Affiliation(s)
- Jasper van Riet Paap
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, P,O, Box 9101, 6500, HB, Nijmegen, The Netherlands.
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Face-validation of quality indicators for the organization of palliative care in hospitals in Indonesia: a contribution to quality improvement. Support Care Cancer 2014; 22:3301-10. [DOI: 10.1007/s00520-014-2343-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/29/2014] [Indexed: 10/24/2022]
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Centeno C. International research: comparison and collaboration to understand and promote palliative care. Palliat Med 2014; 28:99-100. [PMID: 24436493 DOI: 10.1177/0269216313518146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Carlos Centeno
- ATLANTES Research Program, Institute for Culture and Society (ICS), University of Navarra, Pamplona, Spain
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