title: How to measure the international development of palliative care? A critique and discussion of current approaches.
abstract: BACKGROUND
  A number of research projects have been conducted that aim to gather data on the international development of palliative care. These data are important for policy makers and palliative care advocates.
  
  
  OBJECTIVE
  The aim of this article was to provide a critical comparative analysis of methodological approaches used to assess the development and status of palliative care services and infrastructure at an international level.
  
  
  METHODS
  A selective literature review that focused on the methodological features of eight identified reports was undertaken.
  
  
  RESULTS
  Reviewed reports were found to differ in adopted methodologies and provided uneven amounts of methodological information. Five major methodological limitations were identified (lack of theory, use of experts as source of information, grey literature, difficulties in ranking, and the problematic nature of data on service provision). A set of recommendations on how to deal with these issues in future research is provided.
  
  
  CONCLUSIONS
  Measuring the international development of palliative care is a difficult and challenging task. The results of this study could be used to improve the validity of future research in this field.
authors.affiliation: The International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom. Electronic address: m.loucka@lancaster.ac.uk.
authors.forename: Martin
authors.initials: M
authors.lastname: Loucka
authors.affiliation: The International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom.
authors.forename: Sheila
authors.initials: S
authors.lastname: Payne
authors.affiliation: The International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Brearley
mesh_terms: D006302:Health Services Research / Q000379:methods*; D006801:Humans; D038622:Internationality; D008962:Models, Theoretical; D010166:Palliative Care; D011642:Publications
keywords: International comparison; hospice care; methodology; provision; quality of care; reporting