title: Recording patient preferences for end-of-life care as an incentivized quality indicator: what do general practice staff think?
abstract: BACKGROUND
  Since April 2009, indicators for the UK Quality and Outcomes Framework pilot have been developed and piloted across a nationally representative sample of practices. In October 2009 a single palliative care indicator was piloted for 6 months that looked at, 'the percentage of patients on the palliative care register who have a preferred place to receive end-of-life care documented in the records'.
  
  
  OBJECTIVE
  The aim of this study was to gain the views and experiences of general practice staff on whether the inclusion of a single incentivized indicator to record the preferred place to receive end-of-life care would improve the quality of palliative care. Any issues arising from its implementation in a pay-for-performance scheme were also explored.
  
  
  METHODS
  Interviews took place with 57 members of staff in 24 practices: 21 GPs, 16 practice managers, 12 nurses and eight others (mostly information technology experts).
  
  
  RESULTS
  The indicator was not deemed appropriate for incentivization due to concerns about incentivizing an isolated, single issue within a multi-faceted, multi-disciplinary and complex topic. Palliative care was seen to be too sensitive and patient specific to be amenable to population-level quality measurement. In implementation, the indicator would pose potential harm to patients who may be asked about their end-of-life care at an inappropriate time and by a member of staff who may not be best placed to address this sensitive topic.
  
  
  CONCLUSIONS
  The most appropriate time to ask a patient about end-of-life care is subjective and patient specific and therefore does not lend itself to an inflexible single indicator. Focusing on one isolated question simplifies and distracts from a multi-faceted and complex issue and may lead to patient harm.
authors.affiliation: School of Community Based Medicine, University of Manchester, Manchester, UK. kerin.hannon@manchester.ac.uk
authors.forename: Kerin L
authors.initials: KL
authors.lastname: Hannon
authors.forename: Helen E
authors.initials: HE
authors.lastname: Lester
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Campbell
mesh_terms: D001291:Attitude of Health Personnel; D005194:Family Practice; D006801:Humans; D008503:Medical Staff / Q000523:psychology; D057240:Patient Preference; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D013727:Terminal Care / Q000523:psychology / Q000592:standards*