DESCRIPTION (provided by applicant): Far too many patients with advanced cancer still suffer from poor communication and inaccurate understanding of their illness, lack of attention to symptom management leading to unnecessary suffering, and neglect of psychosocial concerns and inadequate psychosocial support. Measuring the quality of oncology palliative care, particularly at point-of-care and with information obtained directly from patients, is criticl for defining quality deficits and how best to address them, with the goal of improving outcomes for patients with advanced cancer and their families. Several evidence-based quality indicator sets for supportive oncology and palliative care in various settings have been rigorously developed and evaluated and are being implemented, including into a palliative care research network, the PCRC (Palliative Care Research Collaborative) across multiple centers. These indicators include the patient perspective and are collected as part of clinical care - so they can
be applied to individual patient quality issues for real-time provider feedback - and are collected
through an established program well-integrated into clinical practice and electronic systems, the Q-DACT (Quality Data Collection Tool). The next step is to evaluate how best to implement these indicators into improving patient and caregiver outcomes. The objective of this proposal is to evaluate barriers and facilitators of implementation of oncology palliative care quality indicators from the stakeholder, patient and family perspectives. This proposal will use our adaptation of the Consolidated Framework for Implementation Research (CFIR) for complex interventions, with input from an interdisciplinary team of PCRC stakeholders across institutions and from experts in social sciences disciplines including teamwork, organizational psychology, and quality culture, to evaluate the implementation process for the quality indicators. The specific aims are: (1) To evaluate barriers, facilitators, and key strategies for implementing quality measurement in palliative care into quality improvement with a convergent mixed- method approach combining quality measurement results, qualitative interviews with a variety of key stakeholders across PCRC sites, quantitative evaluation of key CFIR domains, and evaluation of the potential impact of contextual differences among sites; and (2) To develop a patient- and family-centered approach to implementation of indicator results into palliative care quality improvement through a mixed-methods approach using qualitative interviews and patient/family evaluations of care at selected PCRC sites. The project will result in understanding of the barriers and facilitators of implementation of point-of-care palliative care quality measurement for implementation and changing practice, with the ultimate goals of improving quality and outcomes in palliative care domains for oncology patients and their caregivers.
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