Kathryn McPherson and Rod Mac Leod


Understanding what constitutes "quality" is complex. This seems a particular issue in conditions like cancer because they are themselves complex, being variable in nature, presentation, and outcome. Some would argue that we have in fact failed to ask some of the key questions that would really help us develop our understanding of what comprises quality, instead making "health professional" assumptions and therefore ending up somewhat errant in the conclusions we have tended to reach.

An inescapable tension in discussing quality is that the different parties involved (funders, providers, consumers, and taxpayers) may have quite different needs and aims.1 Whilst each of these groups would probably agree that they want the best quality services that can be provided within the resources available, the extent to which they agree on what those components are is frequently less clearly articulated. It may be that understanding this "different-ness" is important in itself (in that some quality components will be more or less relevant to different parties) but also crucial if we are to recognize the strengths and limitations of specific service evaluations.

This chapter sets out to explore how quality in cancer care may be viewed, focusing in particular on how a better understanding of patient/client and family perspectives can contribute to responsive and high-quality service development and delivery for cancer survivors.


We first present an outline of theoretical models in quality of health care. By doing so we aim notjust to add to the "rhetoric" about quality, but to stimulate some thought about issues that are important and yet sometimes overlooked.

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