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Quality Indicators in Surgical Palliative Care: A Systematic Review
Katherine C Lee1, Claire M Sokas2, Jocelyn Streid3
1Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Surgery, University of California, San Diego, California, USA.
Journal of Pain and Symptom Management
|February 1, 2021
Summary
Developing quality indicators for palliative care in seriously ill surgical patients is crucial. This review identified existing indicators, highlighting a need for better development and application, especially for non-physical aspects of care.
Area of Science:
- Palliative care research
- Surgical quality improvement
- Health services research
Background:
- High-quality palliative care is essential for patient-centered surgical care in seriously ill patients.
- Developing specific quality indicators is necessary for integrating palliative care into surgical quality improvement programs.
Purpose of the Study:
- To identify and characterize existing quality indicators for palliative care in seriously ill surgical patients.
- To assess the methodological quality of these identified indicators.
Main Methods:
- A PRISMA-guided systematic review was conducted.
- Studies reporting on the development and characteristics of palliative care quality indicators and guidelines in adult surgical patients were included.
- Measures were categorized using the National Consensus Project domains and the Donabedian quality framework, and assessed for methodological quality.
Main Results:
- 263 unique measures from 26 studies were identified, with 70% being process measures.
- Indicators focused on End-of-Life Care (31.5%) and Physical Aspects of Care (20.8%), while Spiritual (2.6%) and Cultural Aspects (1.2%) were underrepresented.
- Methodological quality varied; most studies defined a purpose and used evidence, but lacked target population input and practical application discussion.
Conclusions:
- This review informed the development of quality indicators for seriously ill surgical patients.
- Few indicators addressed non-physical suffering or palliative surgery.
- Future efforts should focus on developing and practically applying palliative care quality indicators in surgical settings.
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