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Peer-reviewedCC BY 4.0Frontiers in Public Health

From conceptual domains to operational indicators in palliative end-of-LIFE care: a narrative review

  • Catalina Paredes-Coronel1,2
  • Maria Herrera-Abian3,4,5
  • Javier Rocafort-Gil3
  • Angel Jimenez Rodriguez5
  • Jorge Short Apellaniz6
  • Marta Del Olmo6
  • Bernadette Pfang1,2
6 affiliations
  1. 1Unidades de Cuidados Paliativos, Unidad de Innovación Clínica y Organizativa
  2. 2Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz
  3. 3Cátedra de Cuidados Paliativos, Universidad Francisco de Vitoria
  4. 4Jefe de Servicio de las Unidades de Cuidados Paliativos de los Hospitales Públicos de Quirónsalud en Madrid
  5. 5Hospital Universitario Infanta Elena
  6. 6Hospitales Públicos Quirónsalud (Quirónsalud 4H)
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Abstract

Background: Quality indicators (QIs) are important tools for evaluating and improving care delivery at the end of life. However, despite increasing interest in palliative end-of-life care (PEoLC), there remains limited agreement regarding how quality should be measured, and many proposed indicators remain conceptually rather than operationally defined.

Objectives: To synthesize how quality in PEoLC has been conceptualized in the literature and explore how commonly reported domains may be translated into measurable constructs.

Methods: A narrative (state-of-the-art) review of peer-reviewed literature published between 2015 and 2025 was conducted using MEDLINE (via PubMed), the Cochrane Library, and complementary searches of Google Scholar. Studies addressing quality indicators in PEoLC were identified through a structured search and screened for conceptual relevance. An interpretive synthesis was undertaken to identify recurring domains of quality and explore potential approaches to their operationalization.

Results: Nineteen studies were included. Recurring domains of quality included communication and shared decision-making, symptom management, psychosocial and spiritual support, respect for patient preferences, specialist palliative care involvement, and avoidance of non-beneficial interventions. Although these domains were consistently represented across the literature, they were often described conceptually, with limited attention to how they might be measured in practice. Based on an interpretive synthesis of the evidence, a preliminary framework was developed linking recurrent domains to illustrative examples of potential operational indicators.

Conclusion: While considerable consensus exists regarding the domains that characterize high-quality PEoLC, greater methodological work is needed to translate these concepts into robust and standardized measurement approaches. The framework proposed in this review should be considered exploratory and hypothesis-generating, providing a foundation for future consensus-building and validation studies.

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Cite

BibTeXRIS
BibTeX
@article{paredescoronel2026from,
  title = {{From conceptual domains to operational indicators in palliative end-of-LIFE care: a narrative review}},
  author = {Catalina Paredes-Coronel and Maria Herrera-Abian and Javier Rocafort-Gil and Angel Jimenez Rodriguez and Jorge Short Apellaniz and Marta Del Olmo and Bernadette Pfang},
  journal = {Frontiers in Public Health},
  year = {2026},
  month = oct,
  doi = {10.3389/fpubh.2026.1956490},
  url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1956490/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - From conceptual domains to operational indicators in palliative end-of-LIFE care: a narrative review
AU  - Catalina Paredes-Coronel
AU  - Maria Herrera-Abian
AU  - Javier Rocafort-Gil
AU  - Angel Jimenez Rodriguez
AU  - Jorge Short Apellaniz
AU  - Marta Del Olmo
AU  - Bernadette Pfang
PY  - 2026
DA  - 2026/10/13
JO  - Frontiers in Public Health
DO  - 10.3389/fpubh.2026.1956490
UR  - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1956490/full
AB  - Background: Quality indicators (QIs) are important tools for evaluating and improving care delivery at the end of life. However, despite increasing interest in palliative end-of-life care (PEoLC), there remains limited agreement regarding how quality should be measured, and many proposed indicators remain conceptually rather than operationally defined.  Objectives: To synthesize how quality in PEoLC has been conceptualized in the literature and explore how commonly reported domains may be translated into measurable constructs.  Methods: A narrative (state-of-the-art) review of peer-reviewed literature published between 2015 and 2025 was conducted using MEDLINE (via PubMed), the Cochrane Library, and complementary searches of Google Scholar. Studies addressing quality indicators in PEoLC were identified through a structured search and screened for conceptual relevance. An interpretive synthesis was undertaken to identify recurring domains of quality and explore potential approaches to their operationalization.  Results: Nineteen studies were included. Recurring domains of quality included communication and shared decision-making, symptom management, psychosocial and spiritual support, respect for patient preferences, specialist palliative care involvement, and avoidance of non-beneficial interventions. Although these domains were consistently represented across the literature, they were often described conceptually, with limited attention to how they might be measured in practice. Based on an interpretive synthesis of the evidence, a preliminary framework was developed linking recurrent domains to illustrative examples of potential operational indicators.  Conclusion: While considerable consensus exists regarding the domains that characterize high-quality PEoLC, greater methodological work is needed to translate these concepts into robust and standardized measurement approaches. The framework proposed in this review should be considered exploratory and hypothesis-generating, providing a foundation for future consensus-building and validation studies.
SN  - 2296-2565
ER  -