Cancer care quality measures should be disseminated widely and communicated to purchasers, providers, consumer organizations, individuals with cancer, policy makers, and health services researchers, in a form that is relevant and useful for health care decision-making.

Quality measures enable consumers and purchasers to judge the quality of a system of care by its performance relative to evidence-based standards.

RECOMMENDATION 4: Ensure the following elements of quality care for each individual with cancer:

  • that recommendations about initial cancer management, which are critical in determining long-term outcome, are made by experienced professionals;
  • an agreed-upon care plan that outlines goals of care;
  • access to the full complement of resources necessary to implement the care plan;
  • access to high-quality clinical trials;
  • policies to ensure full disclosure of information about appropriate treatment options;
  • a mechanism to coordinate services; and
  • psychosocial support services and compassionate care.

Some elements of care simply make sense—that is, they have strong face validity and can reasonably be assumed to improve care unless and until evidence accumulates to the contrary. This recommendation amounts to a statement of the ideal, based on principles of cancer care articulated by cancer survivors. Details of how to interpret and apply the principles will vary according to health plan, cancer type, stage of disease, and preferences of the individual needing care.

RECOMMENDATION 5: Ensure quality of care at the end of life, in particular, the management of cancer-related pain and timely referral to palliative and hospice care.

Cancer is the second leading cause of death in the United States. A strong body of evidence suggests that the experience of dying for many with cancer can be greatly improved with better palliative care (IOM, 1997).* Many individuals with cancer suffer pain needlessly and have their treatment preferences ignored. Practice guidelines are available to assist health care providers in this area, but they have not been adopted widely. Financial barriers limit effective care for people at the end of life. Additional studies are needed to identify nonfinancial barriers to appropriate end-of-life care.

*  

The NCPB paper "Issues in End-of-Life Care for People with Cancer: Interviews with Selected Providers and Researchers" supplements the 1997 IOM report, Approaching Death: Improving Care at the End of Life.



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