Most Quality Indicators for Terminal Cancer Care Unacceptable: Study

By Anne Harding

November 07, 2019

NEW YORK (Reuters Health) - Only a fraction of the hundreds of population-based quality indicators (QIs) developed to assess end-of-life cancer care are appropriate and adequately tested, according to new findings in JAMA Oncology.

"There are lots of quality indicators available but we need to be really careful when we're choosing a quality indicator. Hopefully what this review has done is given some advice on what are the best ones out there," Dr. Lesley Anne Henson of the Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation at King's College London, the study's first author, told Reuters Health by phone.

"What's happened is we've tried very quickly to develop our science around quality measurement," she added. "Some of that rush to do that means some of these indicators haven't been evaluated or fully tested."

Currently, all nationally reported cancer quality measures in the U.K. deal with the early stages of the disease, Dr. Henson and her team note in JAMA Oncology, online October 24. They searched the literature for QIs focused on patients with advanced disease and/or who were at the end of life, extracting 260 unique QIs from 35 references to 28 studies.

There were 103 QIs on physical aspects of care (35.8%), 109 (37.8%) on processes of care, 18 (6.3%) on psychosocial care domains and three (1.0%) on spiritual and cultural domains.

Overall, 80 QIs (27.8%) were appropriate for use, according to the authors; 116 (40.3%) were inappropriate for use and 92 (31.9%) had only limited testing.

Just 38 (13.2%) had positive assessments for acceptability and 63 (21.9%) for validity. Sixteen (5.6%) reported benchmarking data.

Dr. Henson and her colleagues list 15 QIs drawn from six studies that are "scientifically sound and applicable across all care settings and that collectively evaluate quality across multiple domains of care."

Six of the recommended QIs cover structure and processes of care, eight address physical aspects of care, and one concerns communication, advanced care planning, ethical and legal aspects of care.

She and her colleagues conclude: "Future research to establish benchmarking data and to expand the number of QIs relevant to psychosocial, cultural, and spiritual care domains also appears to be needed."


JAMA Oncol 2019.