Development of quality indicators for palliative care in Belgium.

Leemans, K., Cohen, J., Block, L. van den, Stichele, R. Vander, Francke, A.L., Deliens, L. Development of quality indicators for palliative care in Belgium. European Journal of Palliative Care: 2011 172. Abstract. 12th EAPC Congress 'Palliative Care Reaching Out', 18-21 mei 2011, Lisbon, Portugal.
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Aims: Evaluation of quality of palliative care is an important condition to optimize and improve care. This study aims to develop a comprehensive set of quality indicators to monitor the quality of palliative care in Flanders, Belgium. Methods: An extensive literature review led to the identification of 337 national and international quality indicators, divided into 9 domains and 154 themes. In accordance with the systematic RANDmethod (combining scientific evidence with consensus among stakeholders), we organized 2 consecutive multidisciplinary palliative care expert panels, a first one to identify and select the themes most important to palliative care, and a second one to assess a list of quality indicators within those selected themes in terms of importance and necessity. Results: The first panel of experts selected 57 important themes within 9 domains: 1) physical treatment and care, 2) psychological, social and spiritual treatment and care, 3) information, communication, planning and decision making with patients, 4) with family and 5) with other caregivers, 6) type of care at the end of life, 7) coordination and continuity of care, 8) support for family, and 9) structure of care. The assessment of all indicators on importance and necessity occurred via an assignment at home followed by a joint panel discussion where indicators could be modified or added. The second panel of experts withheld 57 indicators within these themes. For a number of domains within palliative care such as spiritual and social care and coordination of care, the existence of good quality indicators in the literature appears scarce. Conclusion: Literature review and expert panels lead to the selection of 57 indicators to measure quality of palliative care in Flanders across 9 domains of palliative care. This set of quality indicators now will be tested and evaluated in practice, in order to eventually implement the set safeguarding an adequate monitoring of the quality of end-of-life care. (aut. ref.)