title: Reliability assessment and findings of a newly developed quality measurement instrument: quality indicators of end-of-life cancer care from medical chart review at a Japanese regional cancer center.
abstract: OBJECTIVE
  To assess the reliability of quality indicators of end-of-life cancer care (QI-EOL) and evaluate the quality of end-of-life cancer care in general wards by using QI-EOL.
  
  
  METHODS
  A retrospective chart review study was conducted on patients with cancer who died in general wards (n = 104) and the palliative care unit (PCU; n = 200) between September 2004 and February 2006 at a regional cancer center in Japan. Herein, we measured QI-EOL, which was developed to evaluate the quality of end-of-life cancer care based on medical charts. We preliminarily assessed the interrater reliability of QI-EOL and subsequently compared the percentages of QI-EOL documented between settings.
  
  
  RESULTS
  The reliability of QI-EOL was assured in 27 of 29 indicators (kappa > 0.40 or agreement > 90%). For the reliable indicators, we found wide variation in the percentages of QI-EOL documented, ranging from 0% to 98% in general wards. Thirteen of 27 indicators were significantly less documented in general wards than in PCU. Presence of delirium or agitation was less documented (15% in general wards, 55% in PCU, p < 0.001), although presence of pain (92%, 93%, p = 1.000) and dyspnea (78%, 78%, p = 1.000) were similarly documented. Observation and oral care (22%, 62%, p < 0.001) differed significantly. Patient's (29%, 45%, p = 0.009) and family's (30%, 45%, p = 0.014) preferred place of care were infrequently documented. For psychosocial and spiritual concerns, no significant differences were found.
  
  
  CONCLUSIONS
  QI-EOL is generally a reliable quality measure instrument. We found the need for improvements of end-of-life cancer care in general wards using the QI-EOL.
authors.affiliation: Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. kazukisato-tky@umin.ac.jp
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sato
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyashita
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.forename: Makiko
authors.initials: M
authors.lastname: Sanjo
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Shima
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Uchitomi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009369:Neoplasms; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013727:Terminal Care / Q000592:standards*