Atsushi Mizuno1, Mitsunori Miyashita2, Takashi Kohno3, Yasuharu Tokuda4, Shuhei Fujimoto5, Masato Nakamura6, Morimasa Takayama7, Koichiro Niwa8, Terunobu Fukuda8, Shinichi Ishimatsu9, Satomi Kinoshita10, Shogo Oishi11, Hiroki Mochizuki12, Akemi Utsunomiya13, Yasuko Takada14, Ryota Ochiai15, Toshiaki Mochizuki16, Ken Nagao17, Saran Yoshida18, Akitoshi Hayashi19, Ryuichi Sekine20, Toshihisa Anzai21. 1. Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan; Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Internal Medicine, University of Pennsylvania, Philadelphia, United States. Electronic address: atmizu@luke.ac.jp. 2. Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. 3. Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan. 4. Muribushi Project for Teaching Hospitals, Okinawa, Japan. 5. Department of Health Informatics, Graduate School of Public Health, Kyoto University, Kyoto, Japan. 6. Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan. 7. Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan. 8. Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan. 9. Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan. 10. Department of Nursing, Faculty of Health & Social Work, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan. 11. Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan. 12. National Cerebral and Cardiovascular Center, Department of Cardiology, Suita, Osaka, Japan. 13. Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 14. Department of Nursing, National Cerebral and Cardiovascular Center, Osaka, Japan. 15. Department of Adult Nursing, Yokohama City University, Yokohama, Japan. 16. Department of Emergency Medicine, Cancer Institute Hospital, Tokyo, Japan. 17. Cardiovascular Centre, Nihon University Hospital, Tokyo, Japan. 18. Graduate School of Education, Tohoku University, Miyagi, Japan. 19. Department of Palliative Care, St. Luke's International Hospital, Tokyo, Japan. 20. Department of Pain and Palliative Care, Kameda Medical Center, Kamogawa, Chiba, Japan. 21. Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Abstract
BACKGROUND: Although recent attention to palliative care for patients with cardiovascular diseases has been increasing, there are no specific recommendations on detailed palliative care practices. We proceed on a discussion of the appropriateness and applicability of potential quality indicators for acute cardiovascular diseases according to our previous systematic review. METHODS: We created a multidisciplinary panel of 20 team members and 7 external validation clinicians composed of clinical cardiologists, a nutritionist, a physiotherapist, a clinical psychologist, a critical and emergent care specialist, a catheterization specialist, a primary care specialist, a palliative care specialist, and nurses. After crafting potential indicators, we performed a Delphi rating, ranging from "1 = minimum" to "9 = maximum". The criterion for the adoption of candidate indicators was set at a total mean score of seven or more. Finally, we subcategorized these indicators into several domains by using exploratory factor analysis. RESULTS: Sixteen of the panel members (80%) were men (age, 49.5 ± 13.7 years old). Among the initial 32 indicators, consensus was initially reached on total 23 indicators (71.8%), which were then summarized into 21 measures by selecting relatively feasible time variations. The major domains were "symptom palliation" and "supporting the decision-making process". Factor analysis could not find optimal model. Narratively-developed seven sub-categories included "presence of palliative care team", "patient-family relationship", "multidisciplinary team approach", "policy of approaching patients", "symptom screening and management", "presence of ethical review board", "collecting and providing information for decision-maker", and "determination of treatment strategy and the sharing of the care team's decision". CONCLUSION: In this study we developed 21 quality indicators, which were categorized into 2 major domains and 7 sub-categories. These indicators might be useful for many healthcare providers in the initiation and enhancement of palliative care practices for acute cardiovascular diseases in Japan.
BACKGROUND: Although recent attention to palliative care for patients with cardiovascular diseases has been increasing, there are no specific recommendations on detailed palliative care practices. We proceed on a discussion of the appropriateness and applicability of potential quality indicators for acute cardiovascular diseases according to our previous systematic review. METHODS: We created a multidisciplinary panel of 20 team members and 7 external validation clinicians composed of clinical cardiologists, a nutritionist, a physiotherapist, a clinical psychologist, a critical and emergent care specialist, a catheterization specialist, a primary care specialist, a palliative care specialist, and nurses. After crafting potential indicators, we performed a Delphi rating, ranging from "1 = minimum" to "9 = maximum". The criterion for the adoption of candidate indicators was set at a total mean score of seven or more. Finally, we subcategorized these indicators into several domains by using exploratory factor analysis. RESULTS: Sixteen of the panel members (80%) were men (age, 49.5 ± 13.7 years old). Among the initial 32 indicators, consensus was initially reached on total 23 indicators (71.8%), which were then summarized into 21 measures by selecting relatively feasible time variations. The major domains were "symptom palliation" and "supporting the decision-making process". Factor analysis could not find optimal model. Narratively-developed seven sub-categories included "presence of palliative care team", "patient-family relationship", "multidisciplinary team approach", "policy of approaching patients", "symptom screening and management", "presence of ethical review board", "collecting and providing information for decision-maker", and "determination of treatment strategy and the sharing of the care team's decision". CONCLUSION: In this study we developed 21 quality indicators, which were categorized into 2 major domains and 7 sub-categories. These indicators might be useful for many healthcare providers in the initiation and enhancement of palliative care practices for acute cardiovascular diseases in Japan.