13. Quality indicators – Psycho-oncology
Quality indicators are measured variables whose collection serves to assess the quality of the underlying structures, processes or results. Quality indicators are an important quality management tool [1190]. The aim of their use is the continuous improvement of care by presenting the results of care, critically reflecting on them and, if necessary, improving them. The present selection of quality indicators was created according to the methodology of the German Guideline Program in Oncology [1191]. For the derivation process, a „Quality Indicators Working Group“ (WG QI) was constituted. This group created the final set of quality indicators based on the already existing quality indicators of the 2014 Guideline Psycho-oncology and, the new strong recommendations („shall“) from the updated Guideline Psycho-oncology. In addition, the group took into consideration the results of the search for existing national and international quality indicators. Results of the already existing quality indicators from the Certified Cancer Centers were not available. The methodology and composition of the WG QI are outlined in the Guideline Report (see https://www.leitlinienprogramm-onkologie.de/leitlinien/psychoonkologie/).
After two online meetings of this WG, two new quality indicators (QIs) were defined and one existing QI (QI 5: Psycho-oncological interventions: Concepts and general principles for the indication of psycho-oncological treatment) was omitted.
The final set thus consists of 8 QIs (QI 5 unoccupied).
Table 11: Quality indicators
- The numerator is always a subset of the denominator.
- None of the quality indicators are to be documented with the basic oncology data set of the cancer registries. (As of 06/2022).
Structural requirements of psycho-oncological care areas: cross-sector coordination of psycho-oncological care (since 2014).
Numerator
Denominator patients receiving information about psycho-oncology support services.
Denominator
All cancer patients with initial diagnosis, recurrence or first distant metastasis
Quality target / reference range
EK
Notes
Supplementary notes:
Definition „"Psycho-oncological support service": psychosocial counseling, individual or group psychotherapeutic intervention, psychoeducational intervention, couples intervention, relaxation procedures, provided by the appropriately qualified person.
The aim of the indicator: the facility should provide the patient with specific contacts as an example reference. This is intended to encourage the formation of networks within and across facilities.
Reference recommendations
Patient-oriented information about psycho-oncological support services shall be provided at an early stage and accompany the course of the disease.
- Consensus
- Strong consensus (100%)
- References
- [118]
Structural requirements of psycho-oncological care areas: self-help (modified 2022)
Numerator
Patients of the denominator who have received information about cancer self-help support services.
Denominator
All cancer patients with initial diagnosis, recurrence or first distant metastasis
Quality target / reference range
EK
Notes
Additional note: The information can be conveyed by flyer, the flyer should be handed over personally. In the flyer, the institution in question states specifically where which offer can be found and names contact persons.
Reference recommendations
Cancer patients and their relatives shall be informed about qualified support services offered by cancer self-help/peer-support groups (discussions with people affected by the same disease, assistance in dealing with the disease, therapies and effects of therapy in everyday life) in all phases of the care process.
- Consensus
- Strong consensus (98%)
Diagnostics: Screening, Diagnostic Procedures (modified 2022)
Numerator
Patients of the denominator who were screened psycho-oncologically*.
Denominator
Primary case patients + patients with new (local) recurrence and/or distant metastases
Quality target / reference range
Literature on validated screening instruments with a defined cut-off: see chapter 7.3.1.
Notes
Distress screening includes the implementation of a valid distress instrument (analogous to BestPractice [1] or S3 guideline Psycho-oncological diagnosis, counseling and treatment of adult cancer patients:
- Distress Thermometer (DT),
- the Hospital Anxiety and Depression Scale (HADS),
- the Cancer Patient Stress Questionnaire (FBK),
- the depression module of the Patient Health Questionnaire (PHQ-9) or
- the Generalized Anxiety Disorder Scale-7 (GAD-7)).
Reference recommendations
Validated and standardized screening instruments shall be used to assess psychosocial distress.
The screening instruments that shall be used are the Distress Thermometer (DT), the Hospital Anxiety and Depression Scale (HADS), the Questionnaire on Distress in Cancer Patients (FBK), the Depression Module of the Patient Health Questionnaire (PHQ-9), or the Generalizied Anxiety Disorder Scale-7 (GAD-7).
- Recommendation grade
- A: Starke Empfehlung für oder gegen ein Maßnahme - verwendete Ausdrucksweise = soll/soll nicht
- Level of evidence
- 1b
- Consensus
- Consent (87%)
- References
- [467] [468] [469] [470] [471] [472] [473] [474] [475] [476] [477] [478] [479] [480] [336] [481] [482] [339] [483] [484] [485] [486]
Change note
EC: Validated and standardized screening instruments should be used to assess psychosocial stress. The distress thermometer or the HADS-D are recommended as screening instruments. In addition, individual psychosocial support needs should be assessed.All cancer patients shall be screened for psychosocial stress.
- Consensus
- Strong consensus (96%)
Change note
All patients should be screened for psychosocial stress. Psycho-oncological screening should be performed as early as possible, at appropriate intervals, if clinically indicated, or repeatedly during the course of the disease if a patient's disease status changes (e.g., recurrence or progression of the disease).Psycho-oncological screening should be performed as early as possible, at appropriate intervals, during the course of the disease, when clinically indicated or if a patient's disease status changes (e.g., recurrence or progression of the disease).
- Consensus
- Strong consensus (96%)
Change note
All patients should receive screening for psychosocial distress. Psycho-oncological screening should be performed as early as possible at appropriate intervals, when clinically indicated, or repeatedly during the course of the disease if there is a change in a patient's disease status (e.g., recurrence or progression of the disease).Diagnostics: Diagnostic procedures (since 2014)
Numerator
Patients of the denominator with a diagnostic interview for clarification of psychosocial stress and mental comorbidity
Denominator
All cancer patients with initial diagnosis, recurrence or first distant metastasis and with positive screening for psychosocial distress.
Quality target / reference range
EK
Notes
Definition „Diagnostic interview“: The diagnostic interview includes the identification of psychosocial stress, mental disorders and other problem situations with the aim of describing existing problems and disorders and their change. In addition, clarification is made as to whether these problem situations are subsyndromal or fulfill the criteria for a mental disorder. The clarification and classification of the existing problems and disorders is carried out according to a classification system (ICD-10 or DSM IV), whereby in the diagnosis of a clinically relevant comorbid disorder, the differentiation from somatic complaints or an appropriate psychological reaction to the tumor disease as well as the appropriate consideration of biological-organic consequences of the cancer disease or treatment must be taken into account.
Actors: Specialists in psycho-oncology
Reference recommendations
If the screening is positive and/or there is a subjective need for support identified, a diagnostic interview shall be offered to clarify psychosocial distress, psychiatric comorbidity, as well as the need for support and treatment.
- Consensus
- Consent (90%)
Psycho-oncological Interventions: Concepts and general principles for the indication of psycho-oncological treatment (Deleted Version 2).
Reference recommendations
Psycho-oncological Interventions: Concepts and general principles for the indication of psycho-oncological treatment, psychosocial counseling (modified 2022).
Numerator
Patients of the denominator with offer of psychosocial counseling with psychological and social focus
Denominator
Cancer patients with initial diagnosis, recurrence or first distant metastasis
Quality target / reference range
EK
Notes
Supplementary note: Psychosocial counseling should be offered personally by social workers/social pedagogues and psycho-oncology specialists (cf. QI 2: the personal handing over of a flyer).
Actors: Social workers/social pedagogues and psycho-oncology professionals.
Reference recommendations
Psychosocial counseling with a psychological and social focus shall be offered to cancer patients and their relatives in all phases of the disease according to their needs and as early as possible.
- Consensus
- Strong consensus (98%)
Change note
Psychosocial counseling should be offered to cancer patients and their relatives in all phases of the disease, according to their needs and as early as possible.Patients with no or low distress (determined through screening and further diagnostics) shall be offered or given patient-oriented information and psychosocial counseling.
- Consensus
- Strong consensus (97,2%)
Change note
Patients with no or low burden (determined via screening and by further diagnostics) should be offered patient-oriented information and psychosocial counseling.Patient-centered communication: training interventions to improve practitioners' communication skills and their effectiveness (modified 2022)
Numerator
All physicians and nurses with quality-assured communication skills training to improve their communication skills.
Denominator
All physicians and nurses working in the field of oncology.
Quality target / reference range
EK
Literature: Barth and Lannen (2011)
Notes
Supplementary note: Continuing education and training measures to teach specific interview skills: Postgraduate; number of teaching units must be proven (e.g. certificate of participation). Training should be at least 3 days (24 hours) in length.
Reason for deviation of the QI from the guideline recommendation: In accordance with the prioritization of measures of the National Cancer Plan, the focus is on physicians and nurses, as these two professional groups are considered to have priority in patient care. It can be assumed that psychotherapeutic practitioners have been taught communication and conversation skills in their respective basic training.
Reference recommendations
Physicians and other professionals working in oncology should participate in a quality-assured communication skills training to improve their communication skills.
- Consensus
- Strong consensus (97%)
Change note
Physicians and other professional groups working in oncology should undergo further education and training measures to improve their communication skills.Human resources (new 2022)
Numerator
Cumulative full-time equivalent psycho-oncology positions of the center/non-certified clinic.
Denominator
All cancer patients* with the exception of prostate or melanoma patients with initial diagnosis, locoregional recurrence, or secondary distant metastasis at the center/non-certified clinic.
Quality target / reference range
Target: ≥ 0.0033
Notes
Note:
Denominator must be adapted to specific organs per entity.
Prostate and melanoma patients should also be cared for, but the requirement of one full-time psycho-oncologist for 300 cases per year does not apply.
Reference recommendations
In certified centers as well as in non-certified clinics, one full-time psycho-oncological staff member shall be provided for every 300 cases per year for all oncological diagnoses with the exception of prostate cancer or melanoma patients.
- Consensus
- Consent (79%)
- References
- [1187]
Suitable premises (new 2022)
Numerator
Number of suitable rooms, which are available for psycho-oncological conversations
Denominator
Full-time equivalent psycho-oncology = cancer patients* other than prostate or melanoma patients with initial diagnosis, locoregional recurrence, or secondary distant metastasis * 0.0033 at center/non-certified clinic
Notes
Annotation:
Suitable rooms = Undisturbed consultation, furniture, confidential and pleasant atmosphere.
Reference recommendations
In certified centers as well as in non-certified clinics, one full-time psycho-oncological staff member shall be provided for every 300 cases per year for all oncological diagnoses with the exception of prostate cancer or melanoma patients.
- Consensus
- Consent (79%)
- References
- [1187]
References
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