International Journal of Health Policy and Management

International Journal of Health Policy and Management

From Measuring Performance to Measuring What Matters: Rethinking Quality Indicators in Breast Cancer Care; Comment on “Comprehensive Evaluation of Quality Indicators: Analyzing the Dutch Breast Cancer Audit”

Articles in Press

Document Type : Commentary

Author
Marta Maes-Carballo
Department of General Surgery, Hospital Público de Verín, Ourense, Spain
Abstract
Quality indicators (QIs) are central to benchmarking, accountability, and quality improvement, yet their ability to capture meaningful differences in healthcare quality cannot be assumed. Building on Verheul and colleagues’ evaluation of the Dutch NABON Breast Cancer Audit (NBCA), this commentary argues that methodological robustness is necessary but not sufficient for meaningful quality measurement. Breast cancer care involves preference-sensitive decisions for which guideline adherence, treatment rates, and clinical outcomes alone cannot define high-quality care. We propose broadening quality assessment across four complementary domains: clinical quality, patient-reported outcomes, patient experience, and decision quality, including shared decision-making (SDM) and preference concordance. Patient-centred measures used for provider comparison should undergo the same rigorous evaluation as conventional clinical indicators. The next generation of breast cancer QIs should assess clinical standards, outcomes that matter to patients, care experience, informed involvement, and concordance between care and informed preferences.

Keywords
Breast Cancer
Quality Indicators
Quality of Care
Shared Decision-Making
Patient-Centred Care
Patient-Reported Outcomes
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International Journal of Health Policy and Management

Articles in Press, Corrected Proof
Available Online from 29 September 2026

  • Received Date 28 July 2026
  • Revised Date 08 September 2026
  • Accepted Date 11 September 2026
  • First Published Date 29 September 2026
  • Published Date 29 September 2026