Development and pilot test of a new set of good practice indicators for chronic cancer pain management

Abstract

Background: Pain is among the most important symptoms in terms of prevalence and cause of distress for cancer patients and their families. However, there is a lack of clearly defined measures of quality pain management to identify problems and monitor changes in improvement initiatives. Methods:We built a comprehensive set of evidence-based indicators following a four-step model: (1) review and systematization of existing guidelines to list evidence-based recommendations; (2) review and systematization of existing indicators matching the recommendations; (3) development of new indicators to complete a set of measures for the identified recommendations; and (4) pilot test (in hospital and primary care settings) for feasibility, reliability (kappa), and usefulness for the identification of quality problems using the lot quality acceptance sampling (LQAS) method and estimates of compliance. Results: Twenty-two indicators were eventually pilot tested. Seventeen were feasible in hospitals and 12 in all settings. Feasibility barriers included difficulties in identifying target patients, deficient clinical records and low prevalence of cases for some indicators. Reliability was mostly very good or excellent (k > 0.8). Four indicators, all of them related to medication and prevention of side effects, had acceptable compliance at 75%/40% LQAS level. Other important medication-related indicators (i.e., adjustment to pain intensity, prescription for breakthrough pain) and indicators concerning patient-centred care (i.e., attention to psychological distress and educational needs) had very low compliance, highlighting specific quality gaps. Conclusions: A set of good practice indicators has been built and pilot tested as a feasible, reliable and useful quality monitoring tool, and underscoring particular and important areas for improvement.

Calidad y cumplimiento de guías de práctica clínica de enfermedades crónicas no transmisibles en el primer nivel

“…Se utilizó el Sistema GRADE para clasificar Evidencias y Fuerza de Recomendaciones, 18 o su equivalencia en el Sistema Unificado, 19 para seleccionar las evidencias con alta gradación (AG: A y B1) y sus respectivas recomendaciones con mayor fuerza (A, y excepcionalmente B). Este sistema, utilizado en investigaciones previas en las que se construyeron indicadores a partir de GPC, 15 es una escala consensuada para lograr una armonización en la interpretación de la evidencia, dado que diversas GPC usan sistemas de gradación diferentes.…”

Association among presence of cancer pain, inadequate pain control, and psychotropic drug use

“…In our sample, 18% of patients reported cancer pain. Pain is the symptom most commonly reported by cancer patients with treatment, and it causes major suffering to patients and their families [ 31 ]. Our findings are in agreement with those of Fischer et al [ 5 ], who found the prevalence of pain to be 20%–50% in a cancer population.…”

Indicadores de calidad de la atención a neonatos con patologías seleccionadas: estudio piloto

“…Dada la existencia de varias escalas de gradación de la evidencia y fuerza de recomendación en las GPC, se utilizó un sistema de armonización de la gradación propio. [22][23][24][25] Se seleccionaron las recomendaciones con mayor gradaje (nivel de evidencia A, fuerza de recomendación fundamentalmente A: debe hacerse).…”