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Supporting older people at the end of their lives is the core business of health and aged care services. But this raises a challenging question; how do we measure the quality of something as deeply personal and varied as end‑of‑life care?
Quality indicators offer one way to approach this complexity. These indicators provide measurable criteria that can help identify performance gaps and guide improvements. Our recently published literature review set out to identify a suite of indicators that could support health and aged care services in strengthening palliative care for older people. [1]
Across the literature, we identified 658 unique quality indicators spanning a wide range of care domains. Some indicators focused on organisational responsibilities, such as having policies and procedures for advance care planning, ensuring an appropriate environment for palliative care, and the training requirements for staff.
Other indicators were drawn from individuals’ health records and had a stronger focus on clinical aspects of care. These included the assessment and management of symptoms, whether discussions occurred about an individual’s life‑limiting condition, and whether their wishes and preferences for care were documented and followed. Indicators also examined whether advance care planning documentation was offered, completed, and reviewed.
A third group of indicators explored the individual’s experience of care. These were designed to be asked directly of the individual or their supporters and focused on satisfaction with care, the timeliness of support, and how well information was communicated and understood.
There are several limitations in the use of these indicators. Many quality indicators were underdeveloped, unclear, or overlapped significantly with others. As such, these indicators require further refinement to create a smaller, more practical set that services can realistically use to guide improvement.
Still, these quality indicators have real value. They help build a clearer picture of what good care looks like across a service and prompt important questions: Are we recognising early enough when someone would benefit from palliative care? Are symptoms being managed effectively? Are families feeling supported? Are individuals’ preferences being respected and documented? When these elements are tracked consistently, patterns may emerge which can drive meaningful improvement.
Palliative and end‑of‑life care will always be complex, emotional, and deeply individual. No set of numbers will ever capture its full richness. But when used thoughtfully, quality indicators can support health and aged care services to strengthen their practice, honour each individual’s experience, and ensure that the final chapter of life is approached with the care and dignity it deserves.
Reference
- Hutchison A, Spooner A, Parker D, Yates P. Quality indicators for palliative care for older people: An umbrella review. Palliat Med. 2026.
Authors
Amy Hutchison
PhD Candidate at the Queensland University of Technology
Senior Research Assistant for the End of Life Directions for Aged Care (ELDAC) Project