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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.
Footnotes
Twitter @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.
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