Email updates

Keep up to date with the latest news and content from BMC Health Services Research and BioMed Central.

Open Access Research article

Development of a set of process and structure indicators for palliative care: the Europall project

Kathrin Woitha1*, Karen Van Beek2, Nisar Ahmed3, Jeroen Hasselaar1, Jean-Marc Mollard5, Isabelle Colombet67, Lukas Radbruch4, Kris Vissers1 and Yvonne Engels1

Author Affiliations

1 Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Geert Grote Plein 10, Nijmegen 6500 HB, The Netherlands

2 Department of Radiotherapy-Oncology and Palliative Medicine, University Hospital Leuven, Leuven, Belgium

3 Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences, The University of Sheffield, Sykes House, Little Common Lane, Sheffield, S11 9NE, UK

4 Department of Science and Research in Palliative Medicine, University of Bonn, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany

5 Réseau de Santé, Paris Sud, France

6 Université Paris Descartes, Sorbonne Paris Cité, Public Health, Paris, F-75006, France

7 AP-HP, Cochin Teaching Hospital, Palliative Medicine, Paris, F-75014, France

For all author emails, please log on.

BMC Health Services Research 2012, 12:381  doi:10.1186/1472-6963-12-381

Published: 2 November 2012



By measuring the quality of the organisation of palliative care with process and structure quality indicators (QIs), patients, caregivers and policy makers are able to monitor to what extent recommendations are met, like those of the council of the WHO on palliative care and guidelines. This will support the implementation of public programmes, and will enable comparisons between organisations or countries.


As no European set of indicators for the organisation of palliative care existed, such a set of QIs was developed. An update of a previous systematic review was made and extended with more databases and grey literature. In two project meetings with practitioners and experts in palliative care the development process of a QI set was finalised and the QIs were categorized in a framework, covering the recommendations of the Council of Europe.


The searches resulted in 151 structure and process indicators, which were discussed in steering group meetings. Of those QIs, 110 were eligible for the final framework.


We developed the first set of QIs for the organisation of palliative care. This article is the first step in a multi step project to identify, validate and pilot QIs.

Quality indicator; Organisation; Europe; Public health; Palliative care; Europall