Measuring and improving the quality of dying and death

Article Abstract:

Improving end-of-life experience is a major challenge to successful aging. Deaths that are reasonably free of discomfort, in accordance with patients' wishes, and within acceptable professional and ethical standards are high-quality deaths. The authors developed a 31-item measure of the quality of dying and death and applied it in a community sample and a sample of hospice enrollees. Scores on the Quality of Dying and Death Instrument and measures of perceived quality of care were collected from patients' loved ones after death. Higher overall after-death ratings of the quality of care received from all providers and from physicians were associated with higher-quality dying and death. How well patients' symptoms were controlled in the community study and how well wishes were followed and treatments were explained in the hospice study were associated with higher-quality dying. Major challenges to end-of-life research include recruiting representative population samples, given widespread reluctance of patients and loved ones to participate in research at the end of life; important variation in evaluations among different reporters after death; reluctance of loved ones to assign negative evaluations to dying experiences after death; and the highly individual and dynamic nature of dying experiences. Overcoming these challenges is of great importance in the search for the social, organizational, and individual determinants of high-quality dying in the U.S. cultural and health care context.

Product quality, Quality management, Author Abstract

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Measuring health-related quality of life

Article Abstract:

Health-related quality of life (HRQL) is an indicator of the impact of chronic disease on patients' well-being. Increasingly, measuring HRQL is becoming important to physicians in managing patient care, choosing among available interventions and informing patients of their options. It is also important to health care administrators who use the information for such things as determining clinical effectiveness and making decisions about reimbursement. In general there are two types of HRQL measures: generic instruments that attempt to measure all aspects of HRQL and specific instruments that focus on certain aspects of the disease or affected population. HRQL measures should be discriminatory, that is differentiate between people with a high HRQL and those with a low HRQL. They should reflect how HRQL has changed, and they should be reliable and responsive. They should actually measure what they attempt to measure and their results should be easily interpreted by clinicians and administrators.

Methods, Measurement, Quality of life, Health, Health surveys

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Validation of preferences for life-sustaining treatment: implications for advance care planning

Article Abstract:

Many patients will reject life-sustaining treatment if it results in a state they perceive as being worse than death. Researchers asked 341 Seattle adults whether they would accept six life-sustaining treatments during five states of health. The treatments were antibiotics, short- and long-term artificial ventilation, hemodialysis, feeding tube, and CPR. The health states included their current state, coma, dementia, severe pain and severe stroke. Overall, 85% of the time, the participants rejected treatment if it resulted in states worse than death and accepted treatment 62% of the time if it resulted in states better than death.

Planning, Surveys, Consumer preferences, Right to refuse treatment, Treatment refusal

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