title: Quality indicators for palliative and end of life care: a review of Swedish policy documents.
abstract: BACKGROUND
  All patients with palliative and end of life care needs should be guaranteed equal and safe treatment and care, regardless of their disease or site of care. The inclusion of quality indicators in national guidelines and other guiding documents supports quality assurance and improvement in provision of care. The aim of this paper was to review existing quality indicators in national Swedish policy documents relevant to palliative and end of life care.
  
  
  METHODS
  We reviewed existing guidelines for diseases expected to require palliative care issued by the National Board of Health and Welfare, existing regional clinical practice guidelines and the annual report of the Swedish Register of Palliative Care (SRPC) up until 2010.
  
  
  RESULTS
  We found 11 quality indicators pertinent to palliative and end of life care in the guidelines for cancer diseases and 'The care and nursing of the elderly'. The indicators included assessment and treatment of pain, communication with the patient and the family, documentation in the patient record and registration in the SRPC. In the national guidelines for cardiology, pulmonary diseases, stroke, diabetes and dementia, there were no indicators relevant for palliative or end of life care.
  
  
  CONCLUSIONS
  In the existing Swedish national guidelines for many different diseases, there is still a great need to define clinically relevant and feasible outcome measures of quality of palliative and end of life care.
authors.affiliation: Palliative Research Centre, Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden.
authors.forename: Susanne
authors.initials: S
authors.lastname: Lind
authors.affiliation: Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Adolfsson
authors.affiliation: Department of Radiation Sciences, University of Umeå, Umeå, Sweden FoU unit, Östersunds Hospital, Östersund, Sweden.
authors.forename: Bertil
authors.initials: B
authors.lastname: Axelsson
authors.affiliation: Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden Department of Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Carl Johan
authors.initials: CJ
authors.lastname: Fürst
keywords: Cancer; Chronic conditions; End-of-life; Quality indicators; Symptoms and symptom management