Background & Aims:
Different paradigms exist as a basis to evaluate the quality of health care but none has been universally adopted in the setting of cancer care. The aim was to review the current literature regarding the quality of care in cancer management to develop a specific framework for use in cancer care.
A literature search limited to the English language from 2006-2016, was conducted using Medline with search terms focused on the combination of “quality in health care” (with a subheading of “standards”) “neoplasms” and “neoplasm by site”. Grey literature was also searched for published statements about quality and safety in health care.
120 publications were identified of which 83 were deemed relevant. 33 publications discussed general cancer care, 8 end-of-life care, and 42 specific sub-sites. 37 papers were reviews or editorials, 4 were systematic reviews, 20 retrospective observational studies, 3 prospective cohort studies, 2 case reports, 16 qualitative studies and 4 involved guidelines or mission statements. We identified 12 different domains of quality in cancer care that were discussed. These include: access, structure/staff/organisation, timeliness, safety including errors and adverse events, quality assurance of technical aspects, clinical practice guideline adherence, patient experience and satisfaction, coordinated care, data collection and records, value, disease-specific outcomes and patient-centred outcomes. Based on this we have developed a framework integrating the Donabedian model of structure, process and outcomes with all the domains identified in the current literature to use for assessing quality in cancer care.
We recommend adopting an integrated framework to evaluate quality in cancer care to move toward a more standardized concept on which to base quality indicators, interventions and future research.