Quality of the End of Life Care

Overview

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.

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.