Quality measures for symptoms and advance care planning in cancer: a systematic review.
OBJECTIVE
Measuring quality of care for symptom management and ascertaining patient goals offers an important step toward improving palliative cancer management. This study was designed to identify systematically the quality measures and the evidence to support their use in pain, dyspnea, depression, and advance care planning (ACP), and to identify research gaps.


METHODS
English-language documents were selected from MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO (1995 to 2005); Internet-based searches; and contact with measure developers. We used terms for each domain to select studies throughout the cancer care continuum. We included measures that expressed a normative relationship to quality, specified the target population, and specified the indicated care. Dual data review and abstraction was performed by palliative care researchers describing populations, testing, and attributes for each measure.


RESULTS
A total of 4,599 of 5,182 titles were excluded at abstract review. Of 537 remaining articles, 19 contained measures for ACP, six contained measures for depression, five contained measures for dyspnea, and 20 contained measures for pain. We identified 10 relevant measure sets that included 36 fully specified or fielded measures and 14 additional measures (16 for pain, five for dyspnea, four for depression, and 25 for ACP). Most measures were unpublished, and few had been tested in a cancer population. We were unable to describe the specifications of all measures fully and did not search for measures for pain and depression that were not cancer specific.


CONCLUSIONS
Measures are available for assessing quality and guiding improvement in palliative cancer care. Existing measures are weighted toward ACP, and more nonpain symptom measures are needed. Additional testing is needed before the measures are used for accountability, and basic research is required to address measurement when self-report is impaired.
Lorenz
Karl A
KA
Veterans Affairs Greater Los Angeles Healthcare System, Division of General Internal Medicine, Los Angeles, CA 90073, USA. karl.lorenz@med.va.gov
Lynn
Joanne
J
Dy
Sydney
S
Wilkinson
Anne
A
Mularski
Richard A
RA
Shugarman
Lisa R
LR
Hughes
Rhonda
R
Asch
Steven M
SM
Rolon
Cony
C
Rastegar
Afshin
A
Shekelle
Paul G
PG
D032722:Advance Care Planning / Q000592:standards*; D003863:Depression / Q000209:etiology / Q000628:therapy; D004417:Dyspnea / Q000209:etiology / Q000628:therapy; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010166:Palliative Care / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D011788:Quality of Life