https://orcid.org/0000-0002-9291-0559
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Abstract
Background
Quality indicators are frequently used to measure the quality of care at the end of life. Whether quality indicators of potential overtreatment (i.e., when the risks outweigh the benefits) at the end of life can be reliably applied to routinely collected data remains uncertain. This study aimed to identify quality indicators of overtreatment at the end of life in the published literature and to investigate their tentative prevalence among older adults dying with solid cancer.
Materials and methods
Retrospective cohort study of decedents including all older adults (≥65 years) who died with solid cancer between 1 January 2013 and 31 December 2015 (n = 54,177) in Sweden. Individual data from the National Cause of Death Register were linked with data from the Total Population Register, the National Patient Register, and the Swedish Prescribed Drug Register. Quality indicators were applied for the last one and three months of life.
Results
From a total of 145 quality indicators of overtreatment identified in the literature, 82 (57%) were potentially operationalisable with routine administrative and healthcare data in Sweden. Unidentifiable procedures and hospital drug treatments were the reason for non-operationalisability in 52% of the excluded indicators. Among the 82 operationalisable indicators, 67 measured overlapping concepts. Based on the remaining 15 unique indicators, we tentatively estimated that overall, about one-third of decedents received at least one treatment or procedure indicative of ‘potential overtreatment’ during their last month of life.
Conclusion
Almost half of the published overtreatment indicators could not be measured in routine administrative and healthcare data in Sweden due to a lack of means to capture the care procedure. Our tentative estimates suggest that potential overtreatment might affect one-third of cancer decedents near death. However, quality indicators of potential overtreatment for specific use in routinely collected data should be developed and validated.
Acknowledgments
The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Ethical approval
The study was approved by the Regional Ethical Review Board in Stockholm (dnr: 2016/1001-31/4).
Author contributions
MS, KJ, LM conceived and designed the study. MS performed the statistical analysis, interpreted the data, drafted, and critically revised the manuscript. JWW, LM, ACL, ML and KJ interpreted the data and critically revised the manuscript. KJ obtained funding and acquired the data. KJ and JWW provided supervision. KJ is the guarantors of the study and data integrity. All authors gave approval for the final version of the manuscript and agree to be accountable for all aspects of the work.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Data availability statement
Data may be obtained from a third party and are not publicly available. Clinical data cannot be made publicly available because of privacy issues. However, additional results and aggregated findings are available in the supplementary files.