title: The quality of supportive care among inpatients dying with advanced cancer.
abstract: OBJECTIVE
  Managing symptoms and communicating effectively are essential aspects of providing high-quality cancer care, especially among patients with advanced cancer. The purpose of this study is to apply novel quality indicators to measure the quality of supportive care provided to patients with advanced cancer who died in a large university medical center.
  
  
  METHODS
  Cancer quality ASSIST is a comprehensive quality indicator (QI) set that includes 92 symptom and care planning indicators, of which we piloted 15 applicable to persons with advanced cancer who died in the hospital setting. We evaluated medical records of all adult terminal hospitalizations with lengths of stay ≥3 days at one university medical center between April 2005 and April 2006.
  
  
  RESULTS
  Of 496 decedents, 118 had advanced cancer (mean age 60, 54% male). Forty-five percent received chemotherapy or radiation in the month prior to or during admission. During the hospitalization, 56% of the patients spent time in the ICU (median length of stay 8 days), one in five received first-time hemodialysis, and 23% had a ventilator withdrawn anticipating death. The 118 patients triggered 596 quality indicators of which 476 passed (QI level pass rate 80%, range 50-100%). Pain assessment and management were consistently performed; however, other cancer supportive care needed improvement: 26% of patients not receiving cancer therapy who had nausea and vomiting received inadequate follow-up, more than one quarter of patients with dyspnea had this symptom inadequately addressed, and 29% of patients taking long-acting opioids were not prescribed a bowel regimen. Timely discussion of patient preferences upon admission to the ICU or initiation of mechanical ventilation occurred in 64 and 69% of cases, respectively.
  
  
  CONCLUSIONS
  This set of quality indicators can evaluate the quality of supportive and end-of-life care provided to inpatients dying with advanced cancer and identify aspects of care that need improvement.
authors.affiliation: Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90024, USA. awalling@mednet.ucla.edu
authors.forename: Anne M
authors.initials: AM
authors.lastname: Walling
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Karl A
authors.initials: KA
authors.lastname: Lorenz
authors.forename: Jennifer
authors.initials: J
authors.lastname: Malin
authors.forename: Carol P
authors.initials: CP
authors.lastname: Roth
authors.forename: Tod
authors.initials: T
authors.lastname: Barry
authors.forename: Neil S
authors.initials: NS
authors.lastname: Wenger
mesh_terms: D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D019984:Quality Indicators, Health Care; D013727:Terminal Care / Q000592:standards*