Quality indicators of outpatient palliative care: A systematic review

Objective: Outpatient palliative care is an integral part of providing services to patients with life-threatening conditions within health care systems. Identifying indicators of outpatient palliative care can help improve these services. Therefore, this study was conducted to identify quality indicators for the care of patients with lifelimiting conditions in outpatient settings. Methods: This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included a search of databases such as PubMed, ProQuest, Science Direct, Web of Science, Scopus, and the Google Scholar search engine, with no time restrictions. Quality assessment was performed using the Appraisal of Indicators through Research and Evaluation (AIRE) tool. Final indicators were categorized based on a content analysis approach using conventional content analysis and the Donabedian model. Results: Six articles were selected for final analysis among the 659 identified articles. In this review, 32 quality indicators specific to outpatient palliative care were identified: 19 indicators were categorized under the process dimension, 11 under outcomes, and two under structure. These indicators were grouped into areas such as the patient-care provider relationship and mutual understanding (5 indicators), symptom and pain management (22 indicators), supportive care and referrals (5 indicators), and overall patient experience assessment (8 indicators). Conclusions: The findings of this study indicated that the identified indicators primarily focused on the physical and psychological aspects of outpatient palliative care. This review is the first to systematically categorize outpatient palliative care quality indicators and highlight priority areas for future development. There is a need to expand outpatient care quality indicators to include structural, cultural, and social dimensions to provide comprehensive, patient-centered palliative care.