Quality of the End of Life Care

Quality of care has been defined as the 'degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge'.The challenge remains, however, to define key indicators of quality of care, to link those indicators with health outcomes, and to establish reliable, valid, and timely measurements of the indicators.

The development of QIs is based on the assumption that there is available evidence or a consensus position that can be used to assess the quality of care provided. As many areas of health care interventions operate with a limited evidence base, it is often necessary to combine the existing evidence with consensus techniques; such techniques explore consensus among a group of experts to reach a final aggregate opinion, expert-based knowledge

A systematic review published in 2006 that reviewed literature and relevant websites from USA, Europe, Canada, and Australia concluded that there were limited tools to evaluate whether cancer patients receive effective supportive treatment. In response, the cancer-quality Assessing Symptoms Side Effects and Indicators of Supportive Treatment (ASSIST) measures were developed .These ninety two quality indicators (QIs) were developed for medical record abstraction using the RAND-UCLA QI development method; they cover assessment and treatment of pain and other symptoms as well as information and care planning. However there are a number of other indicators that can be studied these include intensive care unit (ICU) visit, Emergency (ER) visits and chemotherapy use close to death.

Inclusion criteria

• Documented confirmed cancer diagnosis.
• 18 year or older.
• Patients with advanced cancer (stage IV or with metastasis).
• Any hospital admission within the last 30 days.

Exclusion criteria

• Cancer patients admitted under care of other specialties other than oncology.
• Patients who had a major surgery within one month of death, which required admission for more than 1 day under general anesthesia.
• Patients who were following with other hospitals transferred and died within 3 days of admission.
• Cancer diagnosis was made only on death certificate with no prior cancer diagnosis.
• Patient died outside hospital.