title: Quality of care for cancer patients on home parenteral nutrition: development of key interventions and outcome indicators using a two-round Delphi approach.
abstract: OBJECTIVE
  Clear recommendations on how to guide patients with cancer on home parenteral nutrition (HPN) are lacking as the use of HPN in this population remains a controversial issue. Therefore, the aims of this study were to rank treatment recommendations and main outcome indicators to ensure high-quality care and to indicate differences in care concerning benign versus malignant patients.
  
  
  METHODS
  Treatment recommendations, identified from published guidelines, were used as a starting point for a two-round Delphi approach. Comments and additional interventions proposed in the first round were reevaluated in the second round. Ordinal logistic regression with SPSS 2.0 was used to identify differences in care concerning benign versus malignant patients.
  
  
  RESULTS
  Twenty-seven experts from five European countries completed two Delphi rounds. After the second Delphi round, the top three most important outcome indicators were (1) quality of life (QoL), (2) incidence of hospital readmission and (3) incidence of catheter-related infections. Forty-two interventions were considered as important for quality of care (28/42 based on published guidelines; 14/42 newly suggested by Delphi panel). The topics 'Liver disease' and 'Metabolic bone disease' were considered less important for cancer patients, together with use of infusion pumps (p = 0.004) and monitoring of vitamins and trace elements (p = 0.000). Monitoring of QoL is considered more important for cancer patients (p = 0.03).
  
  
  CONCLUSIONS
  Using a two-round Delphi approach, we developed a minimal set of 42 interventions that may be used to determine quality of care in HPN patients with malignancies. This set of interventions differs from a similar set developed for benign patients.
authors.affiliation: Pharmacy Department, University Hospitals Leuven, & Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium. mira.dreesen@uzleuven.be
authors.forename: Mira
authors.initials: M
authors.lastname: Dreesen
authors.forename: Veerle
authors.initials: V
authors.lastname: Foulon
authors.forename: Martin
authors.initials: M
authors.lastname: Hiele
authors.forename: Kris
authors.initials: K
authors.lastname: Vanhaecht
authors.forename: Lutgart
authors.initials: L
authors.lastname: De Pourcq
authors.forename: Loris
authors.initials: L
authors.lastname: Pironi
authors.forename: André
authors.initials: A
authors.lastname: Van Gossum
authors.forename: Jann
authors.initials: J
authors.lastname: Arends
authors.forename: Cristina
authors.initials: C
authors.lastname: Cuerda
authors.forename: Paul
authors.initials: P
authors.lastname: Thul
authors.forename: Frederico
authors.initials: F
authors.lastname: Bozzetti
authors.forename: Ludo
authors.initials: L
authors.lastname: Willems
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology; D003697:Delphi Technique; D005060:Europe; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D009369:Neoplasms / Q000473:pathology / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods; D016331:Parenteral Nutrition, Home / Q000379:methods / Q000592:standards*; D010359:Patient Readmission / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D011788:Quality of Life