van Riet Paap Jasper, Vernooij-Dassen Myrra, Dröes Rose-Marie, Radbruch Lukas, Vissers Kris, Engels Yvonne
Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, P,O, Box 9101, 6500, HB, Nijmegen, The Netherlands.
BMC Health Serv Res. 2014 Sep 17;14:396. doi: 10.1186/1472-6963-14-396.
Large numbers of vulnerable patients are in need of palliative cancer and dementia care. However, a wide gap exists between the knowledge of best practices in palliative care and their use in everyday clinical practice. As part of a European policy improvement program, quality indicators (QIs) have been developed to monitor and improve the organisation of palliative care for patients with cancer and those with dementia in various settings in different European countries.
A multidisciplinary, international panel of professionals participated in a modified RAND Delphi procedure to compose a set of palliative care QIs based on existing sets of QIs on the organisation of palliative care. Panellists participated in three written rounds, one feedback round and one meeting. The panel's median votes were used to identify the final set of QIs.
The Delphi procedure resulted in 23 useful QIs. These QIs represent key elements of the organisation of good clinical practice, such as the availability of palliative care teams, the availability of special facilities to provide palliative care for patients and their relatives, and the presence of educational interventions for professionals. The final set also includes QIs that are related to the process of palliative care, such as documentation of pain and other symptoms, communication with patients in need of palliative care and their relatives, and end-of-life decisions.
International experts selected a set of 23 QIs for the organisation of palliative care. Although we particularly focused on the organisation of cancer and dementia palliative care, most QIs are generic and are applicable for other types of diseases as well.
大量脆弱患者需要癌症和痴呆症的姑息治疗。然而，姑息治疗最佳实践的知识与日常临床实践中的应用之间存在很大差距。作为欧洲政策改进计划的一部分，已制定质量指标（QIs），以监测和改善欧洲不同国家各种环境下癌症患者和痴呆症患者的姑息治疗组织情况。
一个多学科的国际专业小组参与了改良的兰德德尔菲程序，根据现有的姑息治疗组织质量指标集，编制了一套姑息治疗质量指标。小组成员参与了三轮书面调查、一轮反馈调查和一次会议。小组的中位数投票用于确定最终的质量指标集。
德尔菲程序产生了23个有用的质量指标。这些质量指标代表了良好临床实践组织的关键要素，如姑息治疗团队的可用性、为患者及其亲属提供姑息治疗的特殊设施的可用性，以及针对专业人员的教育干预措施的存在。最终指标集还包括与姑息治疗过程相关的质量指标，如疼痛和其他症状的记录、与需要姑息治疗的患者及其亲属的沟通，以及临终决策。
国际专家为姑息治疗组织选定了一套23个质量指标。尽管我们特别关注癌症和痴呆症姑息治疗的组织，但大多数质量指标是通用的，也适用于其他类型的疾病。
