PubMed · 16843244
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Richard O Schamp. 2006-05-11. Managed death.. https://doi.org/10.1016/j.jamda.2006.02.005
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PURPOSE: Measuring quality of care for symptom management and ascertaining patient goals offers an important step toward improving palliative cancer management. This study was designed to identify systematically the quality measures and the evidence to support their use in pain, dyspnea, depression, and advance care planning (ACP), and to identify research gaps. METHODS: English-language documents were selected from MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO (1995 to 2005); Internet-based searches; and contact with measure developers. We used terms for each domain to select studies throughout the cancer care continuum. We included measures that expressed a normative relationship to quality, specified the target population, and specified the indicated care. Dual data review and abstraction was performed by palliative care researchers describing populations, testing, and attributes for each measure. RESULTS: A total of 4,599 of 5,182 titles were excluded at abstract review. Of 537 remaining articles, 19 contained measures for ACP, six contained measures for depression, five contained measures for dyspnea, and 20 contained measures for pain. We identified 10 relevant measure sets that included 36 fully specified or fielded measures and 14 additional measures (16 for pain, five for dyspnea, four for depression, and 25 for ACP). Most measures were unpublished, and few had been tested in a cancer population. We were unable to describe the specifications of all measures fully and did not search for measures for pain and depression that were not cancer specific. CONCLUSION: Measures are available for assessing quality and guiding improvement in palliative cancer care. Existing measures are weighted toward ACP, and more nonpain symptom measures are needed. Additional testing is needed before the measures are used for accountability, and basic research is required to address measurement when self-report is impaired.
BACKGROUND: Patients with advanced cancer and their carers frequently wish to know how long they can expect to live. Improved prognostication would enable patients and their carers to be better prepared for their impending death, and would allow clinicians to make better informed decisions about place of care. However, clinician estimates of survival are inaccurate and systematically overoptimistic. Recently, attempts have been made to improve upon clinician estimates of survival by devising prognostic scales incorporating clinical information with biochemical and haematological results. DESIGN: A descriptive and critical review of palliative prognostic scales, on the basis of the recommendations of the European Association of Palliative Care prognosis working group (2005) supplemented by an Ovid Medline search 1966-March 2006 using the key words 'prognosis', 'neoplasms', 'palliative care' and 'terminal care'. RESULTS: This paper reviews the advantages and limitations of the palliative prognostic score, the palliative prognostic index, the Chuang prognostic scale, the terminal cancer prognostic score and the poor prognostic indicator. CONCLUSIONS: All the currently available prognostic scales have limitations, but nonetheless offer an improvement on unadjusted clinician estimates of survival. Further research is required to systematically develop a prognostic scale on the basis of all the known prognostic variables in patients with advanced cancer.