Development of a self-assessment quality improvement tool for small cell lung cancer.

Abstract

717 Background: Despite treatment advances in small cell lung cancer (SCLC), significant variability persists in care delivery across institutions. Differences in diagnostic approaches, treatment coordination, and supportive care can impact patient outcomes. To address these gaps, the Association of Cancer Care Centers (ACCC), in partnership with the American Society for Radiation Oncology (ASTRO) and LUNGevity, conducted a Delphi consensus initiative to develop standardized quality benchmarks and a companion Quality of Care implementation tool for SCLC. Methods: A multidisciplinary planning committee of 6 clinicians developed 68 draft quality statements across 6 domains: diagnosis/staging, patient education/communication, limited-stage treatment planning, extensive-stage treatment planning, treatment monitoring/care coordination, and supportive care. A 24-member multidisciplinary Delphi panel evaluated statements through iterative electronic surveys using 3 response options: include as written, include with modifications, or exclude. Consensus thresholds guided statement retention and revision. Statements meeting consensus criteria were incorporated into a Quality of Care document that included clinically relevant implementation examples, a 4-point self-assessment scale, and guidance for quality improvement prioritization and workflow evaluation. Results: Fifty of 68 statements achieved ≥75% consensus and were included in the final Quality of Care document. Highest agreement (96%–100%) was observed for benchmarks focused on patient-centered communication, symptom management, and care coordination, including coordination across care settings, routine pain assessment, and clear communication regarding treatment options and adverse events. Additional high-consensus benchmarks emphasized the use of navigation services, psychosocial support, proactive adverse event monitoring, and advance care planning. Lower-consensus statements (78%–83%) involved referral timelines, invasive mediastinal staging, and selected treatment approaches, reflecting variability in institutional resources and workflows. Conclusions: This Delphi initiative established multidisciplinary consensus benchmarks for SCLC care and translated them into a practical implementation and self-assessment resource. The companion Quality of Care document operationalizes these benchmarks through real-world implementation examples and structured self-assessment criteria, enabling cancer care teams to evaluate whether they meet established quality thresholds, identify gaps in care delivery, prioritize improvement efforts, and monitor progress over time.