title: Quality measures for palliative care in patients with cancer: a systematic review.
abstract: OBJECTIVE
  Quality assessment is a critical component of determining the value of medical services, including palliative care. Characterization of the current portfolio of measures that assess the quality of palliative care delivered in oncology is necessary to identify gaps and inform future measure development.
  
  
  METHODS
  We performed a systematic review of MEDLINE/PubMed and the gray literature for quality measures relevant to palliative care. Measures were categorized into National Quality Forum domains and reviewed for methodology of development and content. Measures were additionally analyzed to draw summative conclusions on scope and span.
  
  
  RESULTS
  Two hundred eighty-four quality measures within 13 measure sets were identified. The most common domains for measure content were Physical Aspects of Care (35%) and Structure and Processes of Care (22%). Of symptom-related measures, pain (36%) and dyspnea (26%) were the most commonly addressed. Spiritual (4%) and Cultural (1%) Aspects of Care were least represented domains. Generally, measures addressed processes of care, did not delineate benchmarks for success, and often did not specify intended interventions to address unmet needs. This was most evident regarding issues of psychosocial and spiritual assessment and management.
  
  
  CONCLUSIONS
  Within a large cohort of quality measures for palliative, care is often a focus on physical manifestations of disease and adverse effects of therapy; relatively little attention is given to the other aspects of suffering commonly observed among patients with advanced cancer, including psychological, social, and spiritual distress.
authors.affiliation: Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC arif.kamal@duke.edu.
authors.forename: Arif H
authors.initials: AH
authors.lastname: Kamal
authors.affiliation: Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC.
authors.forename: Margaret
authors.initials: M
authors.lastname: Gradison
authors.affiliation: Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Maguire
authors.affiliation: Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC.
authors.forename: Donald
authors.initials: D
authors.lastname: Taylor
authors.affiliation: Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC.
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
mesh_terms: D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000592:standards*