Palliative Care Quality Measures
Focus is often on physical, and not psychosocial, concerns.
A wide variety of quality measures have been developed for various aspects of care. In order to identify quality measures specific to palliative care, researchers conducted a systematic review of MEDLINE/PubMed. Measures were categorized into the eight National Quality Forum domains (Physical Aspects of Care, Structure and Processes of Care, Care of the Imminently Dying, Ethical and Legal Aspects of Care, Psychiatric and Psychological Aspects of Care, Social Aspects of Care, Spiritual/Existential Aspects of Care, and Cultural Aspects of Care) and reviewed for methodology of development and content.
The most common domains of quality measures in the literature were physical aspects of care (35%) and structure and processes of care (22%). Pain (36%) and dyspnea (26%) were the most commonly addressed symptom measures. Spiritual (4%) and cultural aspects of care (1%) were the least represented domains. Measures that typically addressed processes of care did not state or measure outcomes, and often did not describe interventions to address the patient’s needs and concerns. The researchers concluded that in the palliative care literature, there is often a focus on physical symptoms while other aspects of palliative care, such as psychological, social, and spiritual distress, receive less attention. Based on my experience, I can confirm that this occurs in clinical practice as well.
Kamal AH. Quality Measures for Palliative Care in Patients with Cancer: A Systematic Review. Journal of Oncology Practice. 2014; 10(4):281-287.