title: Outcome indicators in palliative care--how to assess quality and success. Focus group and nominal group technique in Germany.
abstract: OBJECTIVE
  The call for clinically relevant outcome criteria has been raised, as assessment of adequate quality of service providers is essential with increasing momentum in the development of palliative care in most European countries. The aim of this study is to investigate important dimensions and indicators for assessment and evaluation of palliative care from the perspective of multi-disciplinary German experts working over years in the field of palliative care.
  
  
  METHODS
  A focus group, using the structured consensus method of the improved nominal group technique (INGT), with nine experts from different disciplines was conducted in Germany.
  
  
  RESULTS
  An abundance of topics (16) were identified, pointing at the complexity of the issue. Main topics were: quality of life, needs assessments of patients and relatives, resource assessment, surveillance of decision-making processes, as well as spiritual well-being. The following properties were claimed as essential for outcome criteria sensitivity, without additional burden on patients, easy applicability, scientific validity, and helpful for communication within the team, ethical discussions as well as for quality management.
  
  
  CONCLUSIONS
  The study identified topics considered important by experts in clinical practise. The discussions exposed the diversity of demands on outcome assessment put up by different stakeholder groups. This and the high number of relevant items show the complexity for the agreement on a unique set of outcome criteria. Further research considering other perspectives is needed.
authors.affiliation: Department of Palliative Medicine, RWTH Aachen University, Aachen, Germany. tpastrana@ukaachen.de
authors.forename: Tania
authors.initials: T
authors.lastname: Pastrana
authors.forename: Lukas
authors.initials: L
authors.lastname: Radbruch
authors.forename: Friedemann
authors.initials: F
authors.lastname: Nauck
authors.forename: Gerhard
authors.initials: G
authors.lastname: Höver
authors.forename: Martin
authors.initials: M
authors.lastname: Fegg
authors.forename: Martina
authors.initials: M
authors.lastname: Pestinger
authors.forename: Josef
authors.initials: J
authors.lastname: Ross
authors.forename: Norbert
authors.initials: N
authors.lastname: Krumm
authors.forename: Christoph
authors.initials: C
authors.lastname: Ostgathe
mesh_terms: D032921:Consensus; D017144:Focus Groups; D005858:Germany; D006801:Humans; D020380:Needs Assessment / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010166:Palliative Care / Q000458:organization & administration* / Q000523:psychology; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D011788:Quality of Life; D029181:Spirituality
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