Weiterentwicklung der praktischen Umsetzung von Qualitätsindikatoren auf Palliativstationen in Deutschland – Ergebnisse einer Delphi-Befragung

Abstract

Introduction

The S3 Guideline on Palliative Care for Patients with Incurable Cancer and the quality indicators (QIs) formulated therein are intended to contribute to improving palliative care for patients with incurable cancer. There are reservations and barriers to the practical implementation of the guideline content and QIs. To date, there have been no specific ideas for the further development of the implementation and feasibility of QIs from the S3 guideline on palliative care. The aim of this sub-project is to merge the results from the previous project phases and to agree on recommendations for improving the practical implementation of QIs in palliative care units.

Methods

Recommendations for the implementation of QIs in palliative care units were developed on the basis of a routine data analysis and the qualitative evaluation of two expert workshops. Experts in inpatient palliative care evaluated the recommendations in a Delphi survey via SoSci Survey in terms of relevance and feasibility (consensus threshold 75%). The evaluation is carried out using SPSS.

Results

Twenty-five experts participated in three Delphi rounds (48% female, average age 53 years). A total of 32 recommendations were agreed upon, 5 of which relate to QIs in general and thus to explanatory texts and calculation examples, to the scope of the application in the sense of the setting, meaning and purpose of QIs, to the application of individual assessments and to the wording of quality objectives. 20 recommendations specifically address individual QIs in the sense of, for example, scale values for symptom reduction, specific descriptions of the calculation of individual QIs, the definition of tumor-specific measures, and specific formulations. Seven other recommendations focus on documentation and assessments, including the applicability of documentation systems (automated determination of QIs, correct value designations), as well as multiple documentation and training for documentation and assessment implementation.

Discussion

The recommendations agreed upon highlight specific areas where change is needed and underline that there is room for improvement in terms of calculating and assessing the implementation of QIs in palliative care units. They provide targeted support to specific groups of people in improving the implementation and feasibility of QIs.

Conclusion

The recommendations provide empirically based guidance that may also be useful for the ongoing update process of the S3 Guideline on Palliative Care for Patients with Incurable Cancer, although further analysis is needed, particularly in other regions and care settings.