Quality indicators and patient outcome measures for palliative care in cancer patients: a systematic review

Introduction: With the exponential rise in global cancer incidence, the surge in demand for palliative care has outstripped capacity, limiting patients' access to quality and holistic palliative care, especially in low- and middle-income countries. Despite an upturn in research activity, evidence in palliative care remains limited, given its complexity as well as the shortage of standardised quality indicators (QIs) and patient outcome measures (POMs). The objective of this systematic review is to assess the QIs and POMs used to evaluate palliative care service on aggregated and individual levels.

Methods: We undertook a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines to determine the QIs and/or POMs of palliative care in patients with non-communicable diseases. A Web of Science, EMBASE, PubMed and SOCSCI search between 1 January 2013 and 31 Dec 2022 identified 41 articles. We appraised the quality of all studies using the mixed methods appraisal tool.

Results: 26.8% of studies focus on QIs, while 73.2% used POMs. >90% of palliative care research took place in high-income settings. Across domains of palliative care, the outcome of care is most studied, while the structure and process of palliative care are understudied. QIs and POMs identified often had overlapping themes. Due to the multidimensionality and intricacy of palliative care, evidence is limited, patchy and heterogenous in quality.

Discussion: There is an overall lack of standardisation of QIs and POMs, as well as variability in evidence of palliative care research. We recommend that stakeholders collaborate to develop a standardised repository of metrics for monitoring and evaluating palliative care services at both individual and system levels, with a particular focus on structural and process indicators. Incorporating validated, patient-centred measures and selecting key items as quality indicators will enable meaningful tracking of changes, guiding resource allocation and driving improvements in patient-centred care. Furthermore, exploring alternative research designs is essential to enhance feasibility, uphold ethical integrity and strengthen the robustness of future studies.