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Palliative care quality indicators in Italy. What do we evaluate?

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Abstract

Purpose

In recent years, the number of palliative service providers has increased significantly. This expansion necessitates an evaluation in order to provide the basis for quality improvement of the care. Policymakers, managers of palliative care programs, and others committed to the improvement of end-of-life care need methods and criteria to measure and evaluate the care delivered. As quality measurement is expensive and difficult to undertake, it is fundamental that quality measures evaluate the right things. Quality evaluation in Italy is supported by health authorities who have developed some indicators of palliative care. The aims of this study were to give an overview of these indicators.

Methods

We analyzed all palliative care indicators developed by Italian national authorities from 2000 to the present. These indicators have been divided into three different levels of analysis (structure, process, and outcome). Subsequently, two reviewers have independently compared their degree of concordance with domains, and guidelines developed by the NCP for palliative care and after careful discussion an expert panel has elaborated a final consensus document.

Results

Most of the quality indicators analyzed deal with the structure and process of palliative care, however they miss outcomes and do not cover domains mainly concerned with spiritual, ethical, cultural, or existential aspects of care.

Conclusions

More attention should be paid to the development of outcome indicators of palliative care. The attempt to identify a group of indicators which cover every domain of palliative care represents a challenge for the future in terms of finding new cognitive models more oriented toward subjectivity.

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References

  1. NIH (2004) NIH state-of-the-science conference statement on improving end-of-life care. Consens State Sci Statements 21(3):1–26

    Google Scholar 

  2. WHO (2010) Definition of palliative care http://www.who.int/cancer/palliative/definition/en/. Accessed 13 Aug 2010

  3. Zucco F (2010) Hospice in Italia, seconda rilevazione ufficiale. Medica editoria e Diffusione scientifica, Milano

    Google Scholar 

  4. Sepulveda C, Marlin A, Yoshida T, Ullrich A (2002) Palliative care: the World Health Organization's global perspective. J Pain Symptom Manage 24:91–96

    Article  PubMed  Google Scholar 

  5. Granda-Cameron C, Viola SR, Lynch MP, Polomano RC (2008) Measuring patient oriented outcomes in palliative care: functionality and quality of life. Clin J Oncol Nurs 12:65–77

    Article  PubMed  Google Scholar 

  6. Ahmed N, Bestall JC, Ahmedzai SH et al (2004) Systematic review of the problems and issues of accessing specialist palliative care by patients, carers and health and social care professionals. Palliat Med 18(6):525–542

    Article  PubMed  CAS  Google Scholar 

  7. Peruselli C, Marinari M, Brivio B et al (1997) Evaluating a home palliative care service: development of indicators for a continuous quality improvement program. J Palliat Care 13:34–42

    PubMed  CAS  Google Scholar 

  8. Donabedian A (1988) The quality of care. How can it be assessed? JAMA 260:1743–1748

    Article  PubMed  CAS  Google Scholar 

  9. Seow H, Snyder CF, Mularski RA et al (2009) A framework for assessing quality indicators for cancer care at the end of life. J Pain Symptom Manage 38:903–912

    Article  PubMed  Google Scholar 

  10. Aspinal F, Addington-Hall J, Hughes R, Higginson IJ (2003) Using satisfaction to measure the quality of palliative care: a review of the literature. J Adv Nurs 42:324–339

    Article  PubMed  Google Scholar 

  11. Jocham HR, Dassen T, Widdershoven G, Halfens R (2006) Quality of life in palliative care cancer patients: a literature review. J Clin Nurs 15:1188–1195

    Article  PubMed  Google Scholar 

  12. Teno JM, Byock I, Field MJ (1999) Research agenda for developing measures to examine quality of care and quality of life of patients diagnosed with life-limiting illness. J Pain Symptom Manage 17:75–82

    Article  PubMed  CAS  Google Scholar 

  13. National Consensus Project for Quality Palliative Care (2009) Clinical practice guidelines for quality palliative care, second edition http://www.nationalconsensusproject.org. Accessed 11 Sept 2010

  14. Presidenza del Consiglio dei Ministri—Conferenza Stato Regioni (2003). Indicatori per la verifica dei risultati ottenuti dalla rete di assistenza ai pazienti terminali e per la valutazione delle prestazioni erogate. Repertorio Atti N. 1665

  15. Ministero della Salute (2007) DM N. 43. Definizione degli standard relativi all'assistenza ai malati terminali in trattamento palliative

  16. Legge N. 18 (2010) Disposizioni per garantire l'accesso alle cure palliative e alla terapia del dolore

  17. Ferrell B, Connor SR, Cordes A et al (2007) The national agenda for quality palliative care: the National Consensus Project and the National Quality Forum. J Pain Symptom Manage 33:737–744

    Article  PubMed  Google Scholar 

  18. Rodella S (2010) La qualità dell'assistenza sanitaria secondo Avedis Donabedian. Il pensiero scientifico editore, Roma

    Google Scholar 

  19. Sistema nazionale per le linee guida (2009) Come organizzare una conferenza di consenso http://www.snlg-iss.it Accessed 17 March 2011

  20. Seow H, Snyder CF, Shugarman LR et al (2009) Developing quality indicators for cancer end-of-life care: proceedings from a national symposium. Cancer 115:3820–3829

    Article  PubMed  Google Scholar 

  21. Pastrana T, Radbruch L, Nauck F et al (2010) Outcome indicators in palliative care—how to assess quality and success. Focus group and nominal group technique in Germany. Support Care Cancer 18:859–868

    Article  PubMed  Google Scholar 

  22. Lorenz K (2008) Progress in measuring and improving palliative and end-of-life quality. J Palliat Med 11:682–684

    Article  PubMed  Google Scholar 

  23. Peruselli C, Paci E, Franceschi P, Legori T, Mannucci F (1997) Outcome evaluation in a home palliative care service. J Pain Symptom Manage 13:158–165

    Article  PubMed  CAS  Google Scholar 

  24. Sato K, Miyashita M, Morita T et al (2008) Reliability assessment and findings of a newly developed quality measurement instrument: quality indicators of end-of-life cancer care from medical chart review at a Japanese regional cancer center. J Palliat Med 11(5):729–737

    Article  PubMed  Google Scholar 

  25. Bakitas M, Bishop MF, Caron P, Stephen L (2007) Developing successful model of cancer palliative care services. Semin Oncol Nurs 26(4):266–285

    Article  Google Scholar 

  26. Ostgathe C, Voltz R (2010) Quality indicators in end-of-life care. Curr Opin Support Palliat Care 4:170–173

    Article  PubMed  Google Scholar 

  27. Pasman HR, Brandt HE, Deliens L, Francke AL (2009) Quality indicators for palliative care: a systematic review. J Pain Symptom Manage 38:145–156

    Article  PubMed  Google Scholar 

  28. Mularski RA, Dy SM, Shugarman LR et al (2007) A systematic review of measures of end-of-life care and its outcomes. Health Serv Res 42:1848–1870

    Article  PubMed  Google Scholar 

  29. Marzano M (2004) Scene Finali. Mulino editore, Milano

    Google Scholar 

  30. Holland J, Weiss T (2008) The new standard of quality cancer care: integrating the psychosocial aspects in routine cancer from diagnosis through survivorship. Cancer J 14:425–428

    Article  PubMed  Google Scholar 

  31. Institute of Medicine (US) Committee on Psychosocial Services to Cancer Patients/Families in a Community Setting (2008) Cancer care for the whole patient: meeting psychosocial health needs. National Academies Press, Washington

    Google Scholar 

  32. Battaglia L, Carpanelli I, Tuveri G (2010) Etica nella cura oncologica. Carocci Faber, Roma

  33. Donabedian A (1981) Using decision analysis to formulate process criteria for quality assessment. Inq Summer 18:102–119

    CAS  Google Scholar 

  34. Lohr KN, Yordy KD, Thier SO (1988) Current issues in quality of care. Health Aff 7:5–18

    Article  CAS  Google Scholar 

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Conflict of interest statement

None disclosed.

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Authors and Affiliations

  1. School of Nursing, University “Tor Vergata”, Via Montpellier, 1, 00133, Rome, Italy

    Daniela D’Angelo, Ercole Vellone & Rosaria Alvaro

  2. Palliative Care network, “ANTEA Center”, Rome, Italy

    Chiara Mastroianni & Giuseppe Casale

  3. School of Public Health, University “La Sapienza”, Rome, Italy

    Roberto Latina

  4. School of Nursing, University “Campus Bio-Medico”, Rome, Italy

    Maria Grazia De Marinis

Authors
  1. Daniela D’Angelo
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  2. Chiara Mastroianni
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  3. Ercole Vellone
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  4. Rosaria Alvaro
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  5. Giuseppe Casale
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  6. Roberto Latina
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  7. Maria Grazia De Marinis
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Corresponding author

Correspondence to Daniela D’Angelo.

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D’Angelo, D., Mastroianni, C., Vellone, E. et al. Palliative care quality indicators in Italy. What do we evaluate?. Support Care Cancer 20, 1983–1989 (2012). https://doi.org/10.1007/s00520-011-1301-y

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  • DOI: https://doi.org/10.1007/s00520-011-1301-y

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