Quality indicators for breast cancer care: A systematic review
The Breast: VOLUME 59, P221-231, OCTOBER
01, 2021
Objectives
We evaluated breast cancer (BC) care quality indicators
(QIs) in clinical pathways and integrated health care processes.
Methods
Following protocol registration (Prospero no:
CRD42021228867), relevant documents were identified, without language
restrictions, through a systematic search of bibliographic databases (EMBASE,
Scopus, Web of Science, MEDLINE), health care valuable representatives and the
World Wide Web in April 2021. Data concerning QIs, measurement tools and
compliance standards were extracted from European and North American sources in
duplicate with 98% reviewer agreement.
Results
There were 89 QIs found from 22 selected documents (QI per
document mean 13.5 with standard deviation 11.9). The Belgian (38 QIs) and the
EUSOMA (European Society of Breast Cancer Specialists) (34 QIs) documents were
the ones that best reported the QIs. No identical QI was identified in all the
documents analysed. There were 67/89 QIs covering processes (75.3%) and 11/89
(12.4%) for each structure and outcomes QIs. There were 21/89 QIs for diagnosis
(30.3%), 43/89 for treatment (48.3%), and 19/89 for staging, counselling,
follow-up and rehabilitation (21.4%). Of 67 process QIs and 11 outcome QIs,
20/78 (26%) did not report a minimum standard of care. Shared decision making
was only included as a QI in the Italian document.
Conclusion
More than half of countries have not established a national
clinical pathway or integrated breast cancer care process to achieve the
excellence of BC care. There was heterogeneity in QIs for the evaluation of BC
care quality. Over two-thirds of the clinical pathways and integrated health
care processes did not provide a minimum auditable standard of care for
compliance, leaving open the definition of best practice. There is a need for
harmonisation of BC care QIs.
