Quality care means providing patients with appropriate services in a technically competent manner, with good communication, shared decision making, and cultural sensitivity.
The first step in assessing quality of care is establishing which attributes of care are linked to optimal outcomes (e.g., survival, enhanced quality of life). Large, carefully designed clinical trials are usually necessary to establish which specific processes of care or treatments are effective. Early detection of breast cancer through screening mammography, for example, has been shown to reduce mortality significantly for women age 50 and older. Other types of research, notably health services research, also have a role to play in defining high-quality care. Next, observations of current medical practice—for example, through reviews of a sample of medical records—reveal the extent to which effective care is being applied. Measures of quality may assess structural aspects of the health care delivery system (e.g., hospital case volume), processes of care (e.g., use of screening), or outcomes of care (e.g., survival, quality of life). Each of these dimensions of quality could be assessed to provide complementary information.
More is known about the quality of care for breast cancer than for any other kind of cancer. Treatment of early breast cancer saves lives, and early detection through screening contributes to early diagnosis, when treatment is most effective. When established quality measures have been used to assess the care women receive, the following quality problems have been identified:
The consequences of these lapses in care are, in some cases, reduced survival and, in others, compromised quality of life.
Based on the best available evidence, some individuals with cancer do not receive care known to be effective for their condition. The magnitude of the problem is not known, but the National Cancer Policy Board believes it is substantial. The reasons for failure to deliver high-quality care have not been studied adequately, nor has there been much investigation of how appropriate standards vary from patient to patient.
The means for improving the quality of cancer care, which involve changes in the health care system, are the first five of a total of ten recommendations of the National Cancer Policy Board. Implementation of these recommendations may vary by locality and by system of care with, for example, different mechanisms needed in rural versus urban areas, or for particularly high-risk or underserved populations.