Quality Assurance in Oncology: Definition of Treatment Goal and Assessment of Its Achievement

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Abstract
Background: Quality may be assured at 3 different levels: structure, process, and outcomes. In this paper we describe a method for assessing the quality of outcomes in the case of oncological recommendations for treatment. Material and Methods: For different therapies several goals were defined and the extent to which they were attained was evaluated. Several dimensions of the treatment goal were distinguished: the direction, specification and quantification of the goal. The direction may be either cure or palliation. If the goal is cure, the prolongation of life is intended. In the case of palliation as goal it should be specified whether alleviation of existing symptoms or prevention of impending problems is desired. Results: Based on 85 treatment recommendations provided by the Interdisciplinary Oncologic Conference of the Cancer Center University of Ulm we were able to demonstrate that a specification of palliative therapy was performed in 60% of all recommendations. The intended goal could actually be realized in half of these cases, i.e. in 30%. Conclusions: These data show that analysis of palliative therapy is a useful aid for assessing the rate of goal achievement and for modifying either the goals or the treatment if considered necessary.

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