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From conceptual domains to operational indicators in palliative end-of-LIFE care: a narrative review
Catalina Paredes-Coronel1,2, Maria Herrera-Abian3,4,5, Javier Rocafort-Gil3
1Unidades de Cuidados Paliativos, Unidad de Innovación Clínica y Organizativa, Madrid, Spain.
Background:
Quality indicators (QIs) are important tools for evaluating and improving care delivery at the end of life. However, despite increasing interest in palliative end-of-life care (PEoLC), there remains limited agreement regarding how quality should be measured, and many proposed indicators remain conceptually rather than operationally defined.
Objectives:
To synthesize how quality in PEoLC has been conceptualized in the literature and explore how commonly reported domains may be translated into measurable constructs.
Methods:
A narrative (state-of-the-art) review of peer-reviewed literature published between 2015 and 2025 was conducted using MEDLINE (via PubMed), the Cochrane Library, and complementary searches of Google Scholar. Studies addressing quality indicators in PEoLC were identified through a structured search and screened for conceptual relevance. An interpretive synthesis was undertaken to identify recurring domains of quality and explore potential approaches to their operationalization.
Results:
Nineteen studies were included. Recurring domains of quality included communication and shared decision-making, symptom management, psychosocial and spiritual support, respect for patient preferences, specialist palliative care involvement, and avoidance of non-beneficial interventions. Although these domains were consistently represented across the literature, they were often described conceptually, with limited attention to how they might be measured in practice. Based on an interpretive synthesis of the evidence, a preliminary framework was developed linking recurrent domains to illustrative examples of potential operational indicators.
Conclusion:
While considerable consensus exists regarding the domains that characterize high-quality PEoLC, greater methodological work is needed to translate these concepts into robust and standardized measurement approaches. The framework proposed in this review should be considered exploratory and hypothesis-generating, providing a foundation for future consensus-building and validation studies.