. "3 Quality of Care and Quality Indicators for End-of-Life Cancer Care: Hope for the Best, Yet Prepare for the Worst." Improving Palliative Care for Cancer. Washington, DC: The National Academies Press, 2001.
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Improving Palliative Care for Cancer
directions for taking pain medications does provide an important target for improving and enhancing the quality of care. Moreover, patient-centered reports and preference-based questions have strong face validity with health care providers. In the future, surveys have to rely on all three methodologies to capture the consumer perspective on quality of care at the end of life. (See Figure 3-5 for examples of questions from a bereaved family member survey to examine the quality of care for dying persons and their families.)
TABLE 3-4 Status of Quality Indicator Development for End-of-Life Care
Domain
Proposed Indicators
Readiness
Pain
Frequency and severity of pain from Minimum Data Set
Proposed indicators require validation, but can be measured for all hospitalized cancer patients
Major limitation: captures only health care provider perspective
Patient and family perspective on pain management
Instruments available (e.g., from American Pain Society or Toolkit of Instruments to Measure End-of-Life Care)
Satisfaction
Measures of patient satisfaction, based on patient or surrogate responses
New instruments have undergone reliability and validity testing. Additional questions are specific for cancer (e.g., whether patients are informed of recommended treatments, access to high-quality clinical trials) and incorporation into ongoing data collection efforts
New instruments include some questions relevant to people dying from cancer
Shared Decisionmaking
Questions from Toolkit of Instruments to Measure End-of-Life Care
