Quality Indicators In Neuro-Oncology: Modified Delphi Process For The Development Of A Quality Indicator Set For Assessment Of Glioma Care

Abstract BACKGROUND Quality Indicators (QIs) are important tools to assess the quality and variability of oncological care. However, their application in neuro-oncology is limited. The objective of this study was to develop a set of QIs for glioma, covering process and outcome indicators. METHODS First a systematic literature search was performed in peer-reviewed papers and grey literature to identify existing QIs in neuro-oncology and guidelines or recommendations that could be translated into new QIs. The PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) checklist and flow diagram were taken into account. The search strategy focused on diagnostics, treatment, follow-up and survival. For each (set of similar) recommendation(s) a QI was created that could easily be translated into a measurable proportion. Concordant QIs were rationalized to further reduce redundancy. Secondly a two round Delphi survey was organized amongst a multidisciplinary expert panel that was asked to score relevance for all proposed QIs. The panel consisted of neurosurgeons(4), radiation(3) and medical(3) oncologists, pathologists(3), radiologists(2), neurologists(1), nuclear medicine physicians(2) from university and non-university centers, and representatives of the Belgian Cancer Registry. RESULTS The conducted literature search in PubMed and Embase yielded 2392 abstracts. After screening and duplicate removal, 221 full text articles were assessed of which 79 were retained. In addition 28 references from the Grey literature were added. In total 240 recommendations and 30 QIs could be identified in this way. After translation of these recommendations into a measurable proportion, merging with the QIs found as such in the literature and rationalization, 148 QIs were presented to the expert panel. In the Delphi survey 15 of the 19 (79%) invited experts responded and eventually consensus was reached on 46 QIs that were considered relevant for the assessment of 6 different domains of neuro-oncological care: diagnosis and imaging (10), surgery (4), pathology (6), radio/chemotherapy (14), recurrence (5) and supportive treatment (7). CONCLUSION A set of 46 QIs grouped in 6 categories to assess the quality of care of glioma patients was developed. These QI’s are readily applicable dependent on the availability of population-based health care data