Fred Hutchinson Cancer Research Center, Seattle, WA
Kristine Stickney, Karma Kreizenbeck, Catherine R. Fedorenko, Bernardo Goulart, Veena Shankaran, J. Randall Curtis, Gary H. Lyman, Csaba Mera, Bruce Smith, Scott David Ramsey
Background: Palliative care in oncology encompasses a wide array of care, and optimal performance metrics remain uncertain. To address this issue we held a regional meeting that included patient advocates, clinicians, private and public payers and researchers to identify quality indicators for palliative care, discuss palliative care (PC) quality measurement in the region, review preliminary results and metrics for PC, and identify opportunities to improve care. Methods: Regional experts facilitated discussions. Data was presented from a regional insurance claims-cancer registry linked database. Participants were asked to: discuss and prioritize interventions to improve palliative care in oncology and create metric dashboards for healthcare providers. Results: Oncology-specific recommendations for interventions: early and continuous palliative care discussions from diagnosis through EOL; training existing care team on palliative care conversations, through standard certification programs; pair patients with an experienced patient/patient advocate; educate caregivers, patients and providers respectively on how to communicate about PC and care choices; and patient navigation to manage symptoms of advanced cancer. Feedback on prioritization of palliative care/EOL metrics: see Table. Conclusions: A multi-stakeholder approach can be effective for developing metrics and interventions to improve palliative care by providing an understanding of the information needs of the community.
Stakeholder | Metric/data needs | Concerns/considerations for metric development |
---|---|---|
Patients/advocates | Tools/information to manage patient family relationships and insure patient preferences are honored | Metrics should lead to solutions that are flexible, secure and available |
Payers | Patient Reported Outcomes (PRO) | Reliable measures of patient comfort and QOL |
Administrators | Advanced Directives (ADs) and PROs | Need outcome measures: was pain managed, AD followed |
Clinicians | PROs, ADs, rates of readmissions and ED visits, and costs of care | Both qualitative and quantitative data important |
IT professionals | ADs | Difficulty collecting metrics beyond existing quality reporting requirements |
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