Mapping quality indicators for primary Care-Based palliative care: a systematic review.

Abstract

Integrating palliative care into primary care is increasingly recognised as essential for people with life-limiting illness, yet the relevance of existing palliative care quality indicators (QIs) to primary care remains unclear. To identify, map, and appraise quality indicators (Qis) relevant to palliative care delivered in primary care. Systematic review of studies describing QIs applicable to primary care-based palliative care. We searched MEDLINE, Embase, Cochrane databases, and Global Index Medicus (inception to July 2024). Eligible studies described QIs relevant to both palliative care and primary care. Indicators were classified using Donabedian's framework, mapped to National Consensus Project Palliative Care domains and the WHO Primary Health Care (PHC) Measurement and Improvement Framework, and appraised using the Appraisal of Indicators through Research and Evaluation instrument. Twenty-two studies met inclusion criteria, yielding 381 relevant indicators. Most indicators focused on processes of care (64.8%), with fewer addressing structure (27.6%) and outcomes (7.6%). Palliative care indicators were concentrated in PHC domains related to continuity, coordination, person-centredness, and effectiveness. Psychosocial, spiritual, and cultural domains were sparsely represented. PHC structural system elements, including governance and population health approaches, were minimally captured. Methodological quality was highest for clarity of purpose, but variable for stakeholder involvement (28-94%) and low for implementation guidance (17-65%). Current palliative care QIs are predominantly focused on processes of care and may not fully reflect the breadth of primary care-based palliative care, particularly with respect to patient-centred outcomes and psychosocial, spiritual, and cultural domains. Further work is needed to develop and validate indicators that are specifically relevant to primary care practice.