Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Lung Cancer (internet-based) Delphi (LuCiD) : a modified eDelphi consensus to establish Australasian thoracic oncology clinical quality indicators (#60)

Jessica Nash 1 2 , Emily Stone 3 4 , Shalini Vinod 5 6 , Tracy Leong 7 , Paul Dawkins 8 , Rob Stirling 9 10 , Fraser Brims 1 11
  1. Curtin Medical School, Curtin University, Perth, Western Australia, Australia
  2. Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
  3. Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital , Sydney, New South Wales, Australia
  4. School of Clinical Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia
  5. Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia
  6. South Western Sydney Clinical School, University of NSW, Liverpool, NSW, Australia
  7. Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
  8. Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand
  9. Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
  10. Central Clinical School, Monash University, Melbourne, Victoria, Australia
  11. Institute of Respiratory Health, Perth, Western Australia, Australia

Aims

Disparity and inequity in lung cancer care have been repeatedly described in Australia and New Zealand. Quality indicators are an effective tool to systematically identify unwarranted variation in practice, however, are not routinely measured in Australasia. The study aim was to develop clinical quality indicators (CQIs) applicable to lung and other thoracic cancers, to serve as a basis for future quality improvement initiatives.

 Methods

A three-round modified electronic Delphi consensus process was performed. Expressions of interest were sought from clinicians, patient advocates, and researchers. The first two rounds were conducted as online surveys using REDCap, with candidate CQIs rated on a 7-point Likert scale. The final round was a hybrid (in-person and virtual) discussion meeting, with voting conducted using an online platform (Slido). Consensus was set at 70% throughout.

 Results

Participants were medical practitioners, patient advocates, researchers and specialist nurses, with representation from all Australian states and territories, and New Zealand. Clinical disciplines represented included Medical Oncology, Palliative Care, Pathology, Radiology, Radiation Oncology, Respiratory Medicine and Thoracic Surgery.

 In Round 1, 79 participants evaluated 57 CQIs; in Round 2, 63 participants evaluated 60 CQIs; in Round 3, 23 participants evaluated 44 CQIs. On completion, 27 CQIs reached consensus, covering the continuum of lung cancer care: referral and diagnostic investigations (10 CQIs), performance status, staging and multidisciplinary team review (4), supportive care (1), treatment (10), and mortality (2). The indicator set includes CQIs relevant to all thoracic malignancies (8 CQIs), all lung cancer (6), non-small cell lung cancer (9), small cell lung cancer (3) and mesothelioma (1).  

 Conclusion

A modified eDelphi consensus process successfully established 27 CQIs to support the holistic evaluation of the quality of thoracic oncology care in Australia and New Zealand. Implementation will now be performed as part of the Lung Cancer Clinical Quality Data Platform project.