Department of Health Policy and Management, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA.
Cancer. 2010 Jul 1;116(13):3267-75. doi: 10.1002/cncr.25109.
Although measuring the quality of symptom management and end-of-life care could help provide a basis for improving supportive care for advanced cancer, few quality indicators in this area have been rigorously developed or evaluated.
The authors conducted a pilot evaluation of a comprehensive set of 92 supportive oncology quality indicators, Cancer Quality-ASSIST, including outpatient and hospital indicators for symptoms commonly related to cancer and its treatment and information and care planning. They operationalized the indicators and developed an electronic abstraction tool and extensive guidelines and training materials. Quality assurance nurses abstracted the medical records for 356 advanced cancer patients in 2 settings: a Veterans Administration hospital and an academic hospital and cancer center. The authors evaluated the indicators' feasibility, inter-rater reliability, and validity.
The authors successfully evaluated 78 indicators across the domains; results were similar in the 2 settings. They could not feasibly evaluate 3 indicators because of low prevalence; 22 indicators had significant inter-rater reliability issues, 9 had significant validity issues, and 3 had both reliability and validity issues, leaving a set of 41 indicators most promising for further testing and use in this population, with an overall kappa score of 0.85 for specified care.
Of 92 Cancer Quality-ASSIST quality indicators for symptoms, treatment toxicity, and information and care planning, 41 were sufficiently feasible, reliable, and valid to be used for patients with advanced cancer in these settings. This set of indicators shows promise for describing key supportive care processes in advanced cancer.
虽然衡量症状管理和临终关怀的质量有助于为改善晚期癌症的支持性护理提供依据，但该领域的质量指标很少经过严格的制定和评估。
作者对一套全面的 92 项支持肿瘤学质量指标（癌症质量评估系统，Cancer Quality-ASSIST）进行了试点评估，其中包括与癌症及其治疗相关的常见症状、信息和护理计划的门诊和住院指标。他们将这些指标进行了操作化处理，并开发了电子数据采集工具以及广泛的指南和培训材料。质量保证护士对 2 个环境中的 356 例晚期癌症患者的病历进行了摘录：一个退伍军人管理局医院和一个学术医院及癌症中心。作者评估了这些指标的可行性、组内信度和有效性。
作者成功评估了 78 个领域的指标；在这 2 个环境中的结果相似。由于低患病率，他们无法对 3 个指标进行可行性评估；22 个指标的组内信度存在显著问题，9 个指标的有效性存在显著问题，3 个指标的信度和有效性均存在问题，因此留下了 41 个指标，这些指标最有希望在该人群中进一步测试和使用，特定护理的总体 Kappa 评分为 0.85。
在 92 项癌症质量评估系统用于症状、治疗毒性和信息及护理计划的质量指标中，有 41 项对于这些环境中的晚期癌症患者来说具有足够的可行性、可靠性和有效性，可以用于描述晚期癌症的关键支持性护理过程。
