Multidisciplinary Clinical Quality Indicators for Head and Neck Cancer: A Modified Delphi Study in Australia

Monitoring delivery of cancer care is critical to improve outcomes in increasingly resource-constrained settings. The aim of this study was to develop a priority set of multidisciplinary quality indicators (QIs) for benchmarking and monitoring the quality of care for head and neck cancer (HNC) in Australia.

Following a systematic literature review, a modified Delphi consensus process was undertaken with Australian health professionals and people with lived experience of HNC. Consensus was sought over three rounds. In Rounds 2 and 3, participants rated the importance of QIs on a scale of 1 (not at all important) to 7 (highly important). QIs reached consensus if they had a mean importance score ≥ 6 (out of 7) and ≥ 75% of participants rated them 6 or 7.

The systematic review identified 317 unique QIs, and 81 were chosen for presentation in Rounds 2 of the Delphi. In Round 2, 66 health professionals and 12 people with lived experience of HNC reached consensus on 48 QIs, with three reworded and one new QI added. Fifty-two QIs were presented in Round 3; 42 health professionals and 10 people with lived experience participated, reaching consensus on 24 QIs. Most of the QIs fell under the treatment domain, with commencement of curative treatment and documentation of surgical margins attaining the highest consensus.

We developed a priority set of 24 clinically relevant QIs for HNC, which will be tested in a clinical quality registry to benchmark optimal management of HNC and outcomes.