Quality of the End of Life Care

Quality of the End of Life Care for Adult Patients With Advanced Cancer in Saudi Arabia

End-of life care is one of the principle components of cancer care. Measurement of the quality of care provided for end-of-life cancer patients is an important issue. Recently there has been an increased emphasis on measuring and monitoring the quality of cancer care for the purpose of improving clinical practice. Despite increasing attention paid to end-of-life care in recent years, many studies have described difficulties in the final phase of life, including problems with access to hospice, inadequate symptom management, care giving burdens, care mismatched with patient preferences, and inappropriate resource use. Measuring quality of life is an important issue for monitoring clinical practice and improving outcome. Although patient assessment is the best quality measure, it is impractical to measure the quality of end-of-life care because of the difficulties of accurate prognostication for end-of-life and many patients are too ill to provide assessments. In contrast, several recent studies developed quality indicators (QIs) of palliative and end-of-life care, which assess the quality from existing sources such as administrative data or medical chart data.

Study Overview

• Status: Completed
• Conditions: Cancer
• Intervention / Treatment: Other: survey

Detailed Description

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.

• Study Type: Observational
• Enrollment (Actual): 180

Contacts and Locations

Study Locations

• Saudi Arabia
  • Riyadh, Saudi Arabia
    • King Abdul Aziz Medical City for National Guard

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 90 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Adult patients with advanced cancer defined as patients who are 18 years or older with stage IV or metastatic disease at the last month of their life.

Description

Inclusion Criteria:

1. Documented confirmed cancer diagnosis.
2. 18 year or older.
3. Patients with advanced cancer (stage IV or with metastasis).
4. Any hospital admission within the last 30 days.

Exclusion Criteria:

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

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
To measure the quality of care provided by oncology department to adult patients with advanced cancer in the last month of their life using The Cancer Quality-ASSIST QI (Assessing Symptoms Side Effects and Indicators of Supportive Treatment	6 months

Collaborators and Investigators

• Sponsor: National Guard Health Affairs

Study record dates

Study Major Dates

• Study Start: October 1, 2015
• Primary Completion (Actual): March 1, 2016
• Study Completion (Actual): March 1, 2016

Study Registration Dates

• First Submitted: May 12, 2016
• First Submitted That Met QC Criteria: May 15, 2016
• First Posted (Estimate): May 18, 2016

Study Record Updates

• Last Update Posted (Estimate): May 19, 2016
• Last Update Submitted That Met QC Criteria: May 18, 2016
• Last Verified: May 1, 2016

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Death
• Other Study ID Numbers: C15/003/R

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO