• Natalia Arias-Casais, Eduardo Garralda, Jesús López-Fidalgo, John Y Rhee, Juan José Pons, Liliana de Lima, and Carlos Centeno.
• ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain. Electronic address: narias@unav.es.
• J Pain Symptom Manage. 2019 Sep 1; 58 (3): 445-453.e1.

ContextInternational consensus on indicators is necessary to standardize the global assessment of palliative care (PC) development.ObjectivesTo identify the best indicators to assess current national-level PC development.MethodsExperts in PC development were invited to rate 45 indicators organized by domains of the World Health Organization Public Health Strategy in a two-round RAND/UCLA-modified Delphi process. In the first round, experts rated indicators by relevance, measurability, and feasibility (1-9). Ratings were used to calculate a global score (1-9). Indicators scoring >7 proceeded to the second round for fine-tuning of global scores. Median, confidence interval, Content Validity Index, and Disagreement Index were calculated. Indicators scoring a lower limit 95% confidence interval of ≥7 and a Content Validity Index of ≥0.30 were selected.Results24 experts representing five continents and several organizations completed the study. 25 indicators showed a high content validity and level of agreement. Policy indicators (n = 8) included the existence of designated staff in the National Ministry of Health and the inclusion of PC services in the basic health package and in the primary care level list of services. Education indicators (n = 4) focused on processes of official specialization for physicians, inclusion of teaching at the undergraduate level, and PC professorship. Use of medicines indicators (n = 4) consisted of opioid consumption, availability, and prescription requirements. Services indicators (n = 6) included number and type of services for adults and children. Additional indicators for professional activity (n = 3) were identified.ConclusionThe first list including 25 of the best indicators to evaluate PC development at a national level has been identified.Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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