Population-Based Quality Indicators for Palliative Care Programs for Cancer Patients in Japan: A Delphi Study

Yoko Nakazawa, Masahi Kato, Saran Yoshida, Mitsunori Miyashita, Tatsuya Morita, Yoshiyuki Kizawa

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14 Citations (Scopus)


Context Cancer control programs in Japan strongly endorse the dissemination of palliative care, and various policy measures have been implemented; however, indicators for evaluating palliative care programs have not been defined. Objectives The aim of this study was to develop quality indicators for palliative care programs taking a population-based view to meet the challenge of cancer control in the Japanese population. Methods We conducted a modified Delphi survey. The panelists rated a list of indicators over three iterative rounds according to four perspectives: 1) consistency with the policy target, 2) relevance to the problem, 3) clarity of expression, and 4) measurement feasibility. The criterion for adoption of candidate indicators was set at a total mean score of 7 or more. Finally, the most relevant and important indicators were selected; consensus was defined by agreement of panelists at the panel meeting. Results Among 49 panelists surveyed, 48 (98%), 39 (80%), and 43 (88%) responded over the three rounds, respectively. The 15 indicators were identified from 11 domains: patient-reported quality of life, bereaved family–reported quality at the end of life, family care, place of death, bereaved family–reported quality of palliative care, specialized palliative care services, opioid utilization, public perceptions about palliative care, palliative care education to primary care providers, specialist palliative care services, and regional palliative care. Conclusion Comprehensive quality indicators for palliative care programs were identified. The indicators are currently being used, and the feasibility of measuring change over time will be examined. It is expected that the indicators will be used effectively in the future. It is important to evaluate outcomes of the program, to improve weaknesses, improve outcomes, and promote the welfare of cancer patients.

Original languageEnglish
Pages (from-to)652-661
Number of pages10
JournalJournal of Pain and Symptom Management
Issue number4
Publication statusPublished - 2016 Apr 1


  • Japan
  • Quality indicator
  • cancer
  • palliative care
  • program evaluation
  • public health


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