Questions and Answers
for the pre-consultation questionnaire for the
WHO consultation on strategies to improve and strengthen
cancer control programmes in Europe, 25 to 28 November 2003
Q. What is the purpose of this questionnaire?
A. The purpose of this questionnaire is to allow each country team to review and describe what has been previously decided regarding goals and objectives in their cancer control plan. The structure of the questionnaire is designed to encourage each country team to consider the range of cancer control activities across the full continuum from prevention to end of life care and to provide a useful format for the country team to describe the outcome and output (services) indicators that are used to monitor and evaluate the results.
Q. How will the questionnaires be used?
A. These completed questionnaires will primarily be used at the consultation for the group discussions. This is intended to be an objective approach to identify gaps in health planning and service provision, thus clarifying where efforts should be directed when we discuss strategies on bridging the gaps.
Q. What should be done if no such objectives and indicators are available at this time?
A. This is not a problem at this stage. We are not asking the team to develop objectives and indicators prior to the meeting if they don’t already exist. Please just specify that this information is “Not Available” (NA).
Q. What is the difference between “outcome indicators” and “output indicators”?
A. We are attempting to make the distinction between indicators that involve affecting the traditional epidemiological measures of benefit (outcome indicators; Tables 1.1, 2.1, 3.1, 4.1 and 5.1) and measures of the delivery of cancer control services (output indicators; Tables 1.2, 2.2, 3.2, and 4.2).
Q. What are examples of outcome indicators for overall national cancer control programme goals (Table 5.1)?
A. Examples would be:
i) A reduction of the incidence of lung cancer (number of new cases diagnosed) by 30% from 1990 to 2000,
ii) A reduction in the mortality from cervical cancer (number of cervical cancer deaths) by 20% from 1995 to 2005, and
iii) A reduction in breast cancer mortality by 10% from 1990 to 2020.
Q. What are examples of measures of the delivery of cancer control service (output indicators) goals?
A. Examples would be:
i) An increase in the proportion of high schools that include tobacco control in their course curriculum each year from 20% to 80% by 2005 (Table 1.2),
ii) An increase in the coverage of the women aged 25 to 64 years with a Pap smear at least once in the previous 2 years from 40% to 80% from 1990 to 2010 (Table 2.2), and
iii) An increase in the proportion of women diagnosed and treated according to the national breast cancer treatment protocol within 2 months of initial signs from 40% to 60% from 1990 to 2000 (Table 3.2).
Q. What would be an example of a cancer control service (output indicator) goal at the group level for cancer palliative care (Table 4.2)?
A. An example would be the provision of training materials and financial support to non-governmental community-based groups that provide volunteers who deliver palliative care services for terminal cancer patients in their homes.
Q. What would be an example of a cancer control service (output indicator) goal at the national level (Table 1.2)?
A. An example would be the enactment of national legislation to double the tax on tobacco products by 2010.
Q. What is meant by “service names”?
A. In Tables 1.2, 2.2, 3.2 and 4.2 we deal with the cancer control programme services. We are looking for the provision of a brief description of the cancer control service (i.e. service name) in column b, that corresponds to the objective for that service in column a and the more detailed definition of that output indicator in column c.
Q. What are examples of service names (b) and output indicator descriptions (c)?
A. Examples would be:
i) Anti-tobacco education in high schools (b); the proportion of high schools who include tobacco control in their course curriculum (at least 10 hours) each year (c),
ii) Pap smear coverage (b); proportion of women aged 25 to 64 years with a Pap smear at least once in the previous 2 years (c),
iii) Minimum essential breast cancer treatment (b); the proportion of women diagnosed and treated according to the national breast cancer treatment protocol within 2 months of initial signs (c).
Q. What would be "pain/palliative care indicators" and "quality of life indicators"?
A. There are a couple of ways of obtaining such indicators. Unfortunately most are currently not yet routinely conducted. One way to determine a pain outcome indicator is to periodically conduct surveys of patients diagnosed with cancer (according to a planned sampling scheme organized by type and stage of cancers) and ask about the severity of pain experienced using, for example, the Likert scale or a severity scale from 0 to 10. A pain output (service) indicator would be the proportion of cancer patients who received palliative care services (e.g. defined as at least one visit at home from a palliative care nurse). Another pain output (service) indicator would be the per capita use of morphine as reported by the International Narcotics Control Board (INCB) in Vienna, who has been reporting this data for many years. Perhaps the most common quality of life measure used for cancer patients would be periodic survey results from the use of the SF-36 questionnaire. But again, this would need to be done according to a planned sampling scheme by type and stage of cancers.
Q. What should be done if the current delivery of services needs to be classified in the context of the existing health care services network?
A. Services with respect to the individual, group or national levels should be classified in the context of the structure of health care services network in a particular country or region. If objectives and output indicators have already been established, please just put them down and specify the geographical area or the level of health care system involved.