Background and Context:
Radiotherapy (RT) is an important treatment for cancer but is unavailable in many low and middle-income countries (LMICs). There is a UICC initiative to quantify the global investment necessary to make RT universally accessible. An important consideration is assuring quality and safety. Many existing RT quality and safety guidelines were developed in a top-down manner from experience in developed nations, are not readily adapted to LMICs and are not well suited to measuring programmatic or systems-level performance as drivers of quality improvement.
Develop and validate RT key quality indicators (KQIs) to motivate practice improvement and harmonization of care
The Canadian Partnership for Quality Radiotherapy (CPQR) used a Delphi process with engagement of front-line providers to develop KQIs that are adaptable to different environments and changing practice patterns over time.
A literature review identified an initial set of KQIs. The first Delphi round involved oncologists, physicists, therapists and administrators from across Canada who were asked to rate each KQI for importance, clarity and feasibility. This was followed by a second in-person Delphi round, during which the KQIs were revised to build consensus. Participants reviewed and endorsed the final set of KQIs prior to dissemination.
Outcomes/What was learned:
The literature review identified 454 RT quality guidelines that were consolidated to form 51 KQIs in four categories: programmatic organization, personnel, equipment and policies/procedures. From the initial Delphi round, there was high agreement about importance in 63% of the KQIs, clarity in 49% and feasibility in 45%. The KQIs were revised during the in-person meeting, resulting in a final set of 45 KQIs (available at www.cpqr.ca). There was >90% agreement for >90% of these KQIs, which are now used extensively in Canada. They are easily adapted to LMICs using a similar methodology with engagement of local practitioners.