Quality Indicators in Surgical Palliative Care: A Systematic Review

Katherine C Lee; Claire M Sokas; Jocelyn Streid; Steven S Senglaub; Kathleen Coogan; Anne M Walling; Zara Cooper

doi:10.1016/j.jpainsymman.2021.01.122

Quality Indicators in Surgical Palliative Care: A Systematic Review

J Pain Symptom Manage. 2021 Sep;62(3):545-558. doi: 10.1016/j.jpainsymman.2021.01.122. Epub 2021 Jan 30.

Authors

Katherine C Lee¹, Claire M Sokas², Jocelyn Streid³, Steven S Senglaub², Kathleen Coogan², Anne M Walling⁴, Zara Cooper⁵

Affiliations

¹ Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Surgery, University of California, San Diego, California, USA.
² Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
³ Department of Anesthesiology and Perioperative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁴ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA; Greater Los Angeles Veterans Affairs Healthcare System, David Geffen School of Medicine at University of California, Los Angeles, California, USA.
⁵ Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA. Electronic address: zcooper@partners.org.

PMID: 33524478
DOI: 10.1016/j.jpainsymman.2021.01.122

Abstract

Context: Defining high quality palliative care in seriously ill surgical patients is essential to provide patient-centered surgical care. Quality indicators specifically for seriously ill surgical patients are necessary in order to integrate palliative care into existing surgical quality improvement programs.

Objectives: To identify existing quality indicators that measure palliative care delivery in seriously ill surgical patients, characterize their development, and assess their methodological quality.

Methods: A PRISMA-guided systematic review included studies that reported on the development process and characteristics of palliative care quality indicators and guidelines in adult surgical patients. Relevant measures were categorized into the previously defined National Consensus Project domains of palliative care and the Donabedian quality framework, and assessed for methodological quality.

Results: There were 263 unique measures identified from 26 studies, of which 70% were process measures. Indicators addressing Care of the Patient Near the End of Life (31.5%) and Physical Aspects of Care (20.8%) were the most common. Indicators addressing Spiritual (2.6%) and Cultural Aspects of Care (1.2%) were the least common. Methodological quality varied widely across studies. Although most studies defined a purpose for the indicators and used scientific evidence, many studies lacked input from target populations and few had discussed the practical application of indicators.

Conclusion: This review was a key step that informed efforts to develop quality indicators for seriously ill surgical patients. Few indicators addressed non-physical aspects of suffering and no indicators were identified addressing palliative surgery. Future attention is needed toward the development and practical application of palliative care quality indicators in surgical patients.

Keywords: Surgical palliative care; palliative care research; quality improvement; serious illness care; surgical quality.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Adult
Delivery of Health Care
Hospice and Palliative Care Nursing*
Humans
Palliative Care*
Quality Indicators, Health Care
Quality of Health Care

Grants and funding

K76 AG054859/AG/NIA NIH HHS/United States