Objectives: Uncertainty among healthcare providers about patients’ ability to make care decisions is a barrier to shared decision-making. We aimed to assess the self-reported decision-making ability of patients with cancer at the end of life. Methods: Data from 11 countries of adults with a limited life expectancy and cancer as the primary diagnosis were used. Participants completed a questionnaire, including one item on decision-making ability and two on decision-making preferences. Correlations between self-reported ability and preferences were tested using Kendall's tau. Associations between decision-making ability and patient characteristics were determined using mixed-effects ordinal regression models. Results: The sample (n = 1076, 53 % identified as men) had a mean age of 69 years (SD: 11.5). Among them, 80 % reported being able to make decisions about their life and care most of the time, 14 % some of the time, 5 % only a little of the time, and 2 % never. Regarding preferences, 95 % preferred to be involved in decision-making and 44 % preferred the doctors to make the decisions. These preferences were weakly correlated with decision-making ability (Kendall's tau: 0.13 and −0.11, respectively). Feeling able to make decisions was less likely for those institutionalized (versus living with relatives, OR: 0.26, 95 % CI: 0.12;0.55), those with tertiary education (versus primary/no education, OR: 0.43, 95 % CI: 0.22;0.85) and those without clear understanding of their health (versus those with understanding, OR: 0.29, 95 % CI: 0.16;0.52). Conclusions: Although most patients felt able to make decisions about their care, two out of every ten did not. About five out of ten preferred their doctors to make decisions. Practice implications: As almost all patients want to be involved in decisions, we suggest that providers discuss with patients how decisions will be made. This may enable providers to identify patients’ needs and adapt the decision-making process to their abilities and preferences. ... Read more

Conclusions: Although readmission rates are a promising quality indicator, several methodological concerns identified in this study need to be addressed, especially when the indicator is intended for accountability or pay for performance. We recommend investing resources in accurate data registration, improved indicator description, and bundling outcome measures to provide a more complete picture of hospital care.Introduction: Hospital readmission rates are increasingly used for both quality improvement and cost control. However, the validity of readmission rates as a measure of quality of hospital care is not evident. We aimed to give an overview of the different methodological aspects in the definition and measurement of readmission rates that need to be considered when interpreting readmission rates as a reflection of quality of care.Methods: We conducted a systematic literature review, using the bibliographic databases Embase, Medline OvidSP, Web-of- Science, Cochrane central and PubMed for the period of January 2001 to May 2013.Results: The search resulted in 102 included papers. We found that definition of the context in which readmissions are used as a quality indicator is crucial. This context includes the patient group and the specific aspects of care of which the quality is aimed to be assessed. Methodological flaws like unreliable data and insufficient case-mix correction may confound the comparison of readmission rates between hospitals. Another problem occurs when the basic distinction between planned and unplanned readmissions cannot be made. Finally, the multi-faceted nature of quality of care and the correlation between readmissions and other outcomes limit the indicator's validity. ... Read more