Quality of Death and Dying is Significantly Higher for People Who Die at Home

Development and validation of an instrument to assess quality of hospice end-of-life care

From August 1999 through July 2002, J. Randall Curtis, MD, MPH, and his colleagues at the University of Washington School of Medicine, Seattle, developed and validated the Quality of Dying and Death tool, a questionnaire designed to measure the quality of the dying experience.

The project was part of the Robert Wood Johnson Foundation's (RWJF) national program Targeted End-of-Life Projects Initiative.

Key Findings

  • The principal investigator reported the following findings:

    • Higher Quality of Dying and Death scores were associated with reports of satisfaction with the amount of time providers spent with patients, how often providers explained treatments, and how often treatment plans were followed.
    • The investigators found that the Quality of Dying and Death instrument holds promise as a reliable and valid measure for assessing and improving the quality of the dying experience.

Additional Findings

  • The investigators administered the Quality of Dying and Death questionnaire to more 200 family members of individuals who died in Missoula County, Mont., in 1996 and 1997. During the study, which ran from 1997 through 2000, family members completed a number of other questionnaires, and the investigators examined medical records for 90 percent of the deceased.

    The principal investigator reported the following findings in an article in the Journal of Pain and Symptom Management:

    • Scores were significantly higher for the deceased who died at home, died in their preferred setting, discussed their end-of-life care preferences with a loved one, received care in line with their preferences, or felt listened to by their health care team.
    • Scores were higher for the deceased who had greater access to a member of their health care team at night and on weekends and had one physician primarily responsible for orchestrating care.
    • Scores were lower for the deceased who had more physical ailments or who died in pain. Neither an intensive care stay nor use of a mechanical ventilator was significantly associated with the Quality of Dying and Death score.

Most Requested