Measuring the quality of palliative care and supportive oncology: principles and practice.

Oncology quality measurement programs should include measures in key domains of palliative care and supportive oncology. This article describes an approach to quality measurement in these areas including the key steps of defining the quality measurement goal; identifying stakeholders and audiences; defining the population and setting (including potential characteristics of interest, such as specific conditions or disparities); and choosing the domain, target, and steps in the process of care, such as assessment and treatment. Other key steps include choosing or adapting measures that have been evaluated in other settings or are in widespread use; identifying data sources or collection needs; and considering issues of scientific acceptability, such as evidence to support process-outcome relationships. Other quality measurement considerations include the challenges of measurement, particularly in important domains such as communication and spiritual care, variation in patient preferences, or inconsistent documentation. In addition, potential unintended consequences, such as measurement burden and overemphasis of checklist care, may reduce patient-centeredness and attention to important patient concerns not addressed by quality measures.