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Development of Generic Quality Indicators for Patient-Centered Cancer Care by Using a RAND Modified Delphi Method

Uphoff, Eleonora P. M. M. BSc; Wennekes, Lianne MSc; Punt, Cornelis J. A. MD, PhD; Grol, Richard P. T. M. PhD; Wollersheim, Hub C. H. MD, PhD; Hermens, Rosella P. M. G. PhD; Ottevanger, Petronella B. MD, PhD

doi: 10.1097/NCC.0b013e318210e3a2

Background: Despite growing attention to patient-centered care, the needs of cancer patients are not always met.

Objective: Using a RAND modified Delphi method, this study aimed to systematically develop evidence-based indicators, to be used to measure the quality of patient-centered cancer care as a first step toward improvement.

Methods: First, key recommendations were identified from literature and were distributed over 5 domains of patient-centered cancer care: communication, physical support, psychosocial care, after-care, and organization of care. Generic key recommendations, with best available evidence, were selected from guidelines. A multidisciplinary panel of patients and medical professionals (n = 14) rated and prioritized these recommendations in a written procedure. Subsequently, the panel discussed the recommendations at a consensus meeting.

Results: Key recommendations were identified for communication (n = 32), physical support (n = 13), psychosocial care (n = 25), after-care (n = 11), and organization of care (n = 11). For all domains, recommendations based on high-level evidence were identified except for after-care and physical support. The panel developed 17 indicators concerning criteria for communication and informed consent, evaluation of communication skills, provision of information, examination of emotional health, appointment of a care coordinator, physical complaints, follow-up, rehabilitation, psychosocial effects of waiting times, and self-management.

Conclusions:  A set of 17 indicators for patient-centered cancer care resulted from this study. Evidence support was available for most indicators.

Implications for Practice: This set provides an opportunity to measure and improve the quality of patient-centered cancer care. It is generic and therefore applies to many patients.

Author Affiliations: Scientific Institute for Quality of Healthcare (Ms Uphoff, Ms Wennekes, and Drs Grol, Wollersheim, and Hermens) and Department of Medical Oncology, Radboud University Nijmegen Medical Centre (Drs Punt and Ottevanger), the Netherlands. No funding was received from the National Institutes of Health, Wellcome Trust, or Howard Hughes Medical Institute. Funding for this research project was received from the Dutch Cancer Society (KUN 2005-3207).

The authors have no conflicts of interest to disclose.

Correspondence: Lianne Wennekes, MSc, PO Box 9101, code 114, 6500 HB, Nijmegen, the Netherlands (

Accepted for publication January 17, 2011.

© 2012 Lippincott Williams & Wilkins, Inc.