Background: The colorectal cancer (CRC) care continuum is complex and should be delivered by a multi-disciplinary team (MDT) of professionals. To ensure consistent high quality care, measurement and benchmarking to identify and rectify variations in care is essential. This requires the identification of clinically relevant, evidence-based quality indicators (QIs).
Aim: The aim of this systematic review was to identify and categorise evidence based QIs used in CRC management and identify potential gaps for further QI development.
Methods: The search strategy was guided by the PICO Framework and was executed in three databases (MEDLINE, EMBASE, CINAHL) in August 2019. Two independent reviewers screened abstracts and full-text manuscripts. QIs and QI characteristics were extracted using a tailored abstraction tool. Due to the heterogeneity, a quality assessment of individual studies was conducted using a grading system for methodological quality.
Results: A total of 118 studies were included and 96 unique QIs were extracted and categorised into domains of care within the CRC patient pathway. The quality of evidence supporting identified QIs was variable. The majority of QIs were process indicators (72%). Most involved more than one discipline. The highest number of QIs pertained to surgery (32%). The QI describing adequate lymph node retrieval (>12 lymph nodes) was reported in the largest number of studies (40%), followed by a number of other surgical QIs. The number of QIs pertaining to supportive care (6%) and neo-adjuvant therapy (8%) were low.
Conclusion: This review identified a large number of QIs that could be used to measure quality of CRC care and has highlighted a gap in QIs in disciplines outside of surgery. Future work with CRC MDTs will focus on a modified Delphi consensus process to define a priority set of QIs that could be routinely used by CRC MDTs to monitor care delivery.