Kamal Arif H, Gradison Margaret, Maguire Jennifer M, Taylor Donald, Abernethy Amy P
Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC
Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC.
J Oncol Pract. 2014 Jul;10(4):281-7. doi: 10.1200/JOP.2013.001212. Epub 2014 Jun 10.
Quality assessment is a critical component of determining the value of medical services, including palliative care. Characterization of the current portfolio of measures that assess the quality of palliative care delivered in oncology is necessary to identify gaps and inform future measure development.
We performed a systematic review of MEDLINE/PubMed and the gray literature for quality measures relevant to palliative care. Measures were categorized into National Quality Forum domains and reviewed for methodology of development and content. Measures were additionally analyzed to draw summative conclusions on scope and span.
Two hundred eighty-four quality measures within 13 measure sets were identified. The most common domains for measure content were Physical Aspects of Care (35%) and Structure and Processes of Care (22%). Of symptom-related measures, pain (36%) and dyspnea (26%) were the most commonly addressed. Spiritual (4%) and Cultural (1%) Aspects of Care were least represented domains. Generally, measures addressed processes of care, did not delineate benchmarks for success, and often did not specify intended interventions to address unmet needs. This was most evident regarding issues of psychosocial and spiritual assessment and management.
Within a large cohort of quality measures for palliative, care is often a focus on physical manifestations of disease and adverse effects of therapy; relatively little attention is given to the other aspects of suffering commonly observed among patients with advanced cancer, including psychological, social, and spiritual distress.
质量评估是确定医疗服务价值的关键组成部分，包括姑息治疗。有必要对当前评估肿瘤学中姑息治疗质量的一系列措施进行特征描述，以识别差距并为未来措施的制定提供信息。
我们对MEDLINE/PubMed和灰色文献进行了系统回顾，以查找与姑息治疗相关的质量措施。将这些措施归类到国家质量论坛领域，并对其制定方法和内容进行审查。此外，还对这些措施进行了分析，以得出关于范围和跨度的总结性结论。
在13个措施集中识别出了284项质量措施。措施内容最常见的领域是护理的身体方面（35%）和护理的结构与过程（22%）。在与症状相关的措施中，疼痛（36%）和呼吸困难（26%）是最常涉及的。护理的精神方面（4%）和文化方面（1%）是代表性最少的领域。一般来说，这些措施关注护理过程，没有划定成功的基准，并且通常没有指定针对未满足需求的预期干预措施。这在心理社会和精神评估及管理问题上最为明显。
在大量姑息治疗质量措施中，护理通常侧重于疾病的身体表现和治疗的不良反应；对于晚期癌症患者中常见的其他痛苦方面，包括心理、社会和精神困扰，关注相对较少。
