P21.05 Quality criteria for glioma care: development of clinical indicators

Abstract

Background: Glioma diagnosis, treatment and care poses many challenges, requiring multidisciplinary expertise. When defining quality of care in this matter, neuro-oncology professionals should preferably rely on a generally agreed care standard, for instance in the form of evidence-based clinical practice guidelines. Given the generally uncertain prognosis, patients' perspectives should also be accounted for. We describe the development of quality criteria for glioma care based on both patients' preferences and the prevalent guidelines, and provide insight into their implementation. Methods: In the Netherlands, the current standard of care is described in multidisciplinary evidence-based guidelines. Preferences and viewpoints among patients and their carers were assessed by the patients association Hersenletsel.nl, which resulted in a list of aspects of care that were most valued by them. After several consensus meetings with representatives of medical professions as well as the patients association, a final set of criteria was submitted to all relevant medical societies, and national approval was achieved in May 2014. Results: The final set of quality criteria for glioma care comprises the following: 1) in case of suspicion of a brain tumour, MRI diagnosis has high priority, after which the results should be discussed with the patient within five working days; 2) treatment takes place according to predefined clinical pathways, and patients' individual treatment plans are documented and discussed by a neuro-oncology tumour working group; 3) the weekly meetings of the tumour working group are attended by the following professionals: neurosurgeon, neurologist, radiotherapist, medical oncologist, radiologist, pathologist, and the neuro-oncology nurse; 4) a tumour working group discusses a minimum of 50 newly diagnosed patients per year; 5) patients are structurally screened on physical, cognitive, emotional and behavioural limitations during their treatment and follow up, and on the need for psychosocial support for themselves as well as their loved ones; 6) hospitals treating glioma patients facilitate access to a neuro-oncology nurse with regular consultation hours; 7) hospitals actively participate in (pre-)clinical research, or refer patients for studies elsewhere; 8) neurosurgery centres perform at least 50 brain-tumour-related procedures annually; 9) hospitals participate in a national quality registry. Hospitals were given until 2016 to meet the mentioned criteria, and an evaluation is scheduled at the end of this year. Conclusions: Successful development and implementation of quality criteria for glioma care requires adequate input from both neuro-oncology professionals and patients. The procedures we describe may serve as an example for other trajectories in neuro-oncology.