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New quality outcome indicators for bone metastases: expert consensus analysis of patients, their families and specialist healthcare professionals
  1. Samantha Downie1,
  2. Hasnain Chohan2,
  3. Lauren Ross3,
  4. Conor McCann3,
  5. Peter Hall4,
  6. Alison Stillie5,
  7. Matthew Moran3,
  8. Cathie Sudlow6 and
  9. A Hamish RW Simpson1
  1. 1 Trauma & Orthopaedics, The University of Edinburgh, Edinburgh, UK
  2. 2 Department of Trauma & Orthopaedics, NHS Tayside, Dundee, UK
  3. 3 Trauma & Orthopaedics, NHS Lothian, Edinburgh, UK
  4. 4 Institute of Genetics and Cancer, University of Edinburgh Western General Hospital, Edinburgh, UK
  5. 5 Clinical Oncology, NHS Lothian, Edinburgh, UK
  6. 6 Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
  1. Correspondence to Dr Samantha Downie; sdownie04{at}gmail.com

Abstract

Objectives As workload increases, surgical care for patients with bone metastases is increasingly decentralised, with a shift in management away from primary bone tumour units to local centres. We must ensure that patients have similar outcomes regardless of where they receive their treatment. The aim was to develop and validate a set of quality outcome indicators (QOIs) to evaluate treatment success for patients undergoing surgery for bone metastases.

Methods Outcome recommendations were adapted from the literature and field tested in a retrospective patient cohort to determine feasibility. The provisional outcome indicators were assessed during a modified RAND/Delphi consensus process by a group of patients, relatives and healthcare professionals with validated targets added.

Results 1534 articles were reviewed. 38 quality objectives were extracted and assessed for feasibility using clinical records for 117 patients. 28 provisional outcome indicators proceeded to expert consensus and were reviewed by a group of 22 panellists including 10 patients and 4 relatives/carers. After two rounds, 15 QOIs were generated, with validated targets based on expert consensus. These included specific statements such as ‘surgery improves pain and reduces the need for morphine, target: at follow-up, pain is documented in 80% of individuals and 50% of these have reduced need for morphine’.

Conclusions The published evidence and guidelines were adapted into a set of outcome indicators validated by patients, their family/carers and healthcare professionals. These can be used to compare care between centres and identify units of excellence in maximising good outcome after surgery for bone metastases.

  • quality of life
  • bone
  • end of life care
  • pain
  • service evaluation
  • supportive care

Data availability statement

Data are available upon reasonable request. Study data available upon reasonable request by contacting the first author.

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Data availability statement

Data are available upon reasonable request. Study data available upon reasonable request by contacting the first author.

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Footnotes

  • X @sdownie04, @peterhall001

  • Contributors SD: conceptualisation, methodology, formal analysis, writing-original draft preparation—validation, writing-reviewing and editing. HC: validation, writing-reviewing and editing. LR: validation, writing-reviewing and editing. CMC: validation, writing-reviewing and editing. PH, AS, MM, CS: writing-reviewing and editing, supervision. AHRWS: conceptualisation, methodology, writing-reviewing and editing, supervision. SD accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding Funding statement: this work was supported by the Royal College of Surgeons of Edinburgh & Robertson Trust (RCSEd, grant numbers SPPG/19/132 & RTRF/19/009) and the Royal College of Physicians Surgeons of Glasgow (Aileen Lynn Bequest Fund 119741)

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.