Quality of the End of Life Care
Condition: Cancer
MeSH terms: Death
Study type: Observational

Summary: 
      End-of life care is one of the principle components of cancer care. Measurement of the
      quality of care provided for end-of-life cancer patients is an important issue. Recently
      there has been an increased emphasis on measuring and monitoring the quality of cancer care
      for the purpose of improving clinical practice. Despite increasing attention paid to
      end-of-life care in recent years, many studies have described difficulties in the final phase
      of life, including problems with access to hospice, inadequate symptom management, care
      giving burdens, care mismatched with patient preferences, and inappropriate resource use.
      Measuring quality of life is an important issue for monitoring clinical practice and
      improving outcome. Although patient assessment is the best quality measure, it is impractical
      to measure the quality of end-of-life care because of the difficulties of accurate
      prognostication for end-of-life and many patients are too ill to provide assessments. In
      contrast, several recent studies developed quality indicators (QIs) of palliative and
      end-of-life care, which assess the quality from existing sources such as administrative data
      or medical chart data.
    

Detailed description: 
      Quality of care has been defined as the 'degree to which health services for individuals and
      populations increase the likelihood of desired health outcomes and are consistent with
      current professional knowledge'.The challenge remains, however, to define key indicators of
      quality of care, to link those indicators with health outcomes, and to establish reliable,
      valid, and timely measurements of the indicators.

      The development of QIs is based on the assumption that there is available evidence or a
      consensus position that can be used to assess the quality of care provided. As many areas of
      health care interventions operate with a limited evidence base, it is often necessary to
      combine the existing evidence with consensus techniques; such techniques explore consensus
      among a group of experts to reach a final aggregate opinion, expert-based knowledge

      A systematic review published in 2006 that reviewed literature and relevant websites from
      USA, Europe, Canada, and Australia concluded that there were limited tools to evaluate
      whether cancer patients receive effective supportive treatment. In response, the
      cancer-quality Assessing Symptoms Side Effects and Indicators of Supportive Treatment
      (ASSIST) measures were developed .These ninety two quality indicators (QIs) were developed
      for medical record abstraction using the RAND-UCLA QI development method; they cover
      assessment and treatment of pain and other symptoms as well as information and care planning.
      However there are a number of other indicators that can be studied these include intensive
      care unit (ICU) visit, Emergency (ER) visits and chemotherapy use close to death.
    

Intervention name(s): survey
Intervention type(s): Other
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Adult patients with advanced cancer defined as patients who are 18 years or older with
        stage IV or metastatic disease at the last month of their life.