Establishing Metastatic Prostate Cancer Quality Indicators Using a Modified Delphi Approach

Background: There is variation in the care provided to men with metastatic prostate cancer (mPCa). There has been no previous set of quality indicators (QIs) regarding the management of men with mPCa. The objective of this study is to develop a set of international mPCa-specific QIs, which will enable global benchmarking of quality of care.

Materials and methods: Potential QIs were identified through a literature review. Fourteen multidisciplinary mPCa experts (representing medical and radiation oncology, nursing, psychology, palliative care and urology) from eight countries participated in a modified Delphi process, which consisted of two online surveys, one face-to-face meeting and two teleconferences. Panellists were asked to rate each indicator's importance and feasibility on a Likert scale from 1-9. Indicators that received median importance and median feasibility scores ≥7.5, and a disagreement index <1 for both measures, on the final round of voting were included in the final set.

Results: There was consensus on 23 QIs out of total of 662. Four regarding “general management”, 12 “therapies”, three “complications” and four “patient-reported quality of life”. One of the inherent limitations of the Delphi process is that there is a small expert panel involved.

Conclusion: The quality indicator set defined by our process for management of men with mPCa will enable greater understanding of the standard and variation of care globally and will promote consistency of good practice. Future directions will include retrospective evaluation for compliance with these indicators, as well as prospective monitoring.

Microabstract: There has been no previous set of quality indicators (QIs) regarding the management of men with metastatic prostate cancer. Using a modified Delphi process, a panel of fourteen multidisciplinary experts identified 23 quality indicators. The QIs will enable comparison between the quality of care delivered by institutions and can be used to identify potential targets for improvements.
Jia Zheng, Fanny Sampurno, Daniel J. George, Alicia K. Morgans, Hannah Nguyen, Janet L. Abrahm, Anders Bjartell, Ian D. Davis, Margaret I. Fitch, Silke Gillessen, Ravindran Kanesvaran, Andrew Matthew, Jeremy L. Millar, Joe M. O'Sullivan, Heather Payne, Frederic Pouliot, Patsy Yates, Sue M. Evans

Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Medicine, Duke University, North Carolina, USA; Genitourinary Medical Oncologist, Medical Director of Survivorship Program at Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, USA; Department of Urology, Skåne University Hospital/Lund University, Malmö, Sweden; Eastern Health Clinical School, Monash University; Department of Oncology, Eastern Health, Melbourne, Australia; Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Department of Medical Oncology, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland; Faculty of Biomedical Sciences, Universita della Svizzera Italiana (USI), Lugano, Switzerland; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom; Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Departments of Uro-Oncology, and Supportive Care, Princess Margaret Centre, Toronto, Ontario, Canada; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Ireland; Department of Oncology, University College London Hospitals, London, United Kingdom; Department of Surgery, Urology Division, CHU de Québec and Laval University, Québec City, Canada; School of Nursing, Centre for Health Outcomes, Services and Systems, University of Queensland, Brisbane, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Victorian Cancer Registry, Cancer Council Australia, Melbourne, Australia.

Source: Zheng J., Sampurno F., George D. et al. "Establishing Metastatic Prostate Cancer Quality Indicators Using a Modified Delphi Approach." Clinical Genitourinary Cancer. 2022. DOI:
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