Development of quality indicators for treatment of ductal carcinoma in situ (DCIS) of the breast using a multidisciplinary Delphi process.

Abstract

248 Background: Ductal carcinoma in situ (DCIS) of the breast accounts for ~30% of new breast cancer diagnoses. Measuring quality of DCIS treatment is problematic due to its distinctively different clinical behaviour from invasive breast carcinoma, where standard outcomes such as mortality are not relevant. Therefore, we sought to develop clinically relevant quality indicators to evaluate treatment of DCIS. Methods: A Delphi consensus process was undertaken using a multidisciplinary panel of nine clinical and methodologic experts from Ontario, Alberta, and British Columbia. Panel members were nominated based on membership in provincial breast tumour site groups. Four criteria for a good quality indicator were used; the indicator measures a treatment that benefits the patient, there is support from scientific literature or professional consensus for benefit; the indicator is under control of the health care provider, the indicator is extractable from the medical record. Candidate indicators were identified from published clinical practice guidelines in North America. Three iterations of ratings using Likert scale rankings were utilized to identify final quality indicators, which were then prioritized. Results: A total of 10 candidate indicators were identified from four clinical practice guidelines encompassing the diagnosis, surgery and adjuvant treatment components of DCIS. A total of eight indicators were identified and prioritized (Table). Conclusions: We successfully developed practical quality indicators for evaluating the treatment of DCIS, which can be used in any jurisdiction to measure key performance benchmarks and identify variations in care warranting intervention or improvement. [Table: see text]