title: Quality indicators in the management of bladder cancer: A modified Delphi study.
abstract: Survival in patients with bladder cancer has only moderately improved over the past 2 decades. A potential reason for this is nonadherence to clinical guidelines and best practice, leading to wide variations in care. Common quality indicators (QIs) are needed to quantify adherence to best practice and provide data for benchmarking and quality improvement.
  
  
  
  To produce an evidence- and consensus-based list of QIs for the management of bladder cancer.
  
  
  
  A modified Delphi method was used to develop the indicator list. Candidate indicators were extracted from the literature and rated by a 27-member Canadian expert panel in several rounds until consensus was reached on the final list of indicators. In rounds with numeric ratings, a frequency analysis was performed.
  
  
  
  A total of 86 indicators were rated, 52 extracted from the literature and 34 suggested by the panel. After iterative rounds of ratings and discussion, a final list of 60 QIs spanning several disciplines and phases of the cancer care continuum was developed.
  
  
  
  This is the first study to comprehensively produce common QIs representing structure, process, and outcome measures in bladder cancer management. Though developed in Canada, these indicators can be used in other countries with slight modifications to track performance and improve care.
authors.affiliation: Department of Family Medicine, McGill University, Montreal, QC, Canada.
authors.forename: Satya R
authors.initials: SR
authors.lastname: Khare
authors.affiliation: Department of Urology, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Armen
authors.initials: A
authors.lastname: Aprikian
authors.affiliation: Department of Urology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Black
authors.affiliation: Division of Medical Oncology, University of Montreal, Montreal, QC, Canada.
authors.forename: Normand
authors.initials: N
authors.lastname: Blais
authors.affiliation: Department of Oncology, Queen's University, Kingston, ON, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Booth
authors.affiliation: Department of Pathology, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Fadi
authors.initials: F
authors.lastname: Brimo
authors.affiliation: Division of Urology, Western University, London, ON, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Chin
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Chung
authors.affiliation: Division of Urology, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Darrel
authors.initials: D
authors.lastname: Drachenberg
authors.affiliation: Division of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Libni
authors.initials: L
authors.lastname: Eapen
authors.affiliation: Division of Urology, University of Alberta, Edmonton, AB, Canada.
authors.forename: Adrian
authors.initials: A
authors.lastname: Fairey
authors.affiliation: Departments of Surgery (Urology), Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: Fleshner
authors.affiliation: Division of Urology, Laval University, Quebec City, QC, Canada.
authors.forename: Yves
authors.initials: Y
authors.lastname: Fradet
authors.affiliation: Division of Urology, University of Calgary, Calgary, AB, Canada.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Gotto
authors.affiliation: Division of Urology, Western University, London, ON, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Izawa
authors.affiliation: Departments of Surgery (Urology), Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Jewett
authors.affiliation: Departments of Surgery (Urology), Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Girish
authors.initials: G
authors.lastname: Kulkarni
authors.affiliation: Division of Urology, Laval University, Quebec City, QC, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Lacombe
authors.affiliation: Division of Urology, University of Alberta, Edmonton, AB, Canada.
authors.forename: Ron
authors.initials: R
authors.lastname: Moore
authors.affiliation: Division of Urology, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Morash
authors.affiliation: Division of Medical Oncology, University of Alberta, Edmonton, AB, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: North
authors.affiliation: Division of Urology, Dalhousie University, Halifax, NS, Canada.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Rendon
authors.affiliation: Division of Urology, University of Montreal, QC, Canada.
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.affiliation: Division of Urology, McMaster University, Hamilton, ON, Canada.
authors.forename: Bobby
authors.initials: B
authors.lastname: Shayegan
authors.affiliation: Department of Oncology, Queen's University, Kingston, ON, Canada; Department of Urology, Queen's University, Kingston, ON, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Siemens
authors.affiliation: Department of Urology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: So
authors.affiliation: Department of Medical Oncology, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Srikala S
authors.initials: SS
authors.lastname: Sridhar
authors.affiliation: Department of Urology, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Samer L
authors.initials: SL
authors.lastname: Traboulsi
authors.affiliation: Department of Urology, McGill University Health Centre, Montreal, QC, Canada. Electronic address: wassim.kassouf@muhc.mcgill.ca.
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
mesh_terms: D003697:Delphi Technique; D005260:Female; D006801:Humans; D008297:Male; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
keywords: Bladder cancer; Outcome; Quality improvement; Quality indicators