title: Quality indicators for palliative care services: mixed-method study testing for face validity, feasibility, discriminative power and usefulness.
abstract: BACKGROUND
  In the absence of a standardized, comprehensive and valid set of quality indicators for palliative care, we developed one for palliative care services in Belgium.
  
  
  OBJECTIVE
  This study evaluates its face validity, feasibility, discriminative power and usefulness.
  
  
  METHODS
  We combined a quantitative analysis evaluating the answers with qualitative interviews with the contact persons of all participating services.
  
  
  METHODS
  The quality indicator set was implemented in nine palliative care services in Belgium involving a measurement procedure with questionnaires to the patients of the services, their professional caregivers, family carers and physicians.
  
  
  RESULTS
  The response rate was 56% for patients, 97% for caregivers, 56% for family carers and 65% for physicians, indicating good feasibility of the measurement procedure. During the interviews, caregivers found the indicator scores valid and none was extremely skewed, confirming their discriminative power. Still, 20 of the 80 indicators showed problems of feasibility and 5 of usefulness. One was discarded and the others were improved by changing either the formulation of the indicator or the questions used. Most participants expressed a desire for a smaller but still comprehensive set.
  
  
  CONCLUSIONS
  Based on the results, minor adjustments were made to individual indicators, to the measurement tools and to the procedure used; the quality indicators are now ready for further evaluation and use across palliative care services in Belgium. As soon as these indicators are being used systematically, it will be possible to demonstrate and compare quality at the national and international levels and to evaluate improvement initiatives.
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium kleemans@vub.ac.be.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Leemans
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
authors.forename: Anneke L
authors.initials: AL
authors.lastname: Francke
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Vander Stichele
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium Department of Family Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
mesh_terms: D001530:Belgium; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D006801:Humans; D007407:Interviews as Topic; D010166:Palliative Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires; D063189:Symptom Assessment
keywords: Quality indicators; feasibility studies; palliative care; palliative medicine; quality assessment; quality improvement; terminal care