Toward population-based indicators of quality end-of-life care: testing stakeholder agreement.
BACKGROUND
Quality indicators (QIs) are tools designed to measure and improve quality of care. The objective of this study was to assess stakeholder acceptability of QIs of end-of-life (EOL) care that potentially were measurable from population-based administrative health databases.


METHODS
After a literature review, the authors identified 19 candidate QIs that potentially were measurable through administrative databases. A modified Delphi methodology, consisting of multidisciplinary panels of cancer care health professionals in Nova Scotia and Ontario, was used to assess agreement on acceptable QIs of EOL care (n = 21 professionals; 2 panels per province). Focus group methodology was used to assess acceptability among patients with metastatic breast cancer (n = 16 patients; 2 groups per province) and bereaved family caregivers of women who had died of metastatic breast cancer (n = 8 caregivers; 1 group per province). All sessions were audiotaped, transcribed verbatim, and audited, and thematic analyses were conducted.


RESULTS
Through the Delphi panels, 10 QIs and 2 QI subsections were identified as acceptable indicators of quality EOL care, including those related to pain and symptom management, access to care, palliative care, and emergency room visits. When Delphi panelists did not agree, the principal reasons were patient preferences, variation in local resources, and benchmarking. In the focus groups, patients and family caregivers also highlighted the need to consider preferences and local resources when examining quality EOL care.


CONCLUSIONS
The findings of this study should be considered when developing quality monitoring systems. QIs will be most useful when stakeholders perceive them as measuring quality care.
Grunfeld
Eva
E
Cancer Outcomes Research Program, Cancer Care Nova Scotia, Halifax, Nova Scotia. eva.grunfeld@ccns.nshealth.ca
Urquhart
Robin
R
Mykhalovskiy
Eric
E
Folkes
Amy
A
Johnston
Grace
G
Burge
Frederick I
FI
Earle
Craig C
CC
Dent
Susan
S
D001293:Attitude to Death; D001943:Breast Neoplasms / Q000556:secondary / Q000628:therapy*; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008499:Medical Records; D009674:Nova Scotia / Q000453:epidemiology; D010166:Palliative Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards*; D011788:Quality of Life; D013727:Terminal Care / Q000592:standards*