Assessing the quality of care for people dying of cancer in hospital: development of the QualDeath framework

Abstract

Objective High-quality end-of-life care involves addressing patients’ physical, psychosocial, cultural and spiritual needs. Although the measurement of the quality of care associated with dying and death is an important component of health care, there is a lack of evidence-based, systematic processes to examine the quality of dying and death of patients in hospital settings. Our purpose was to develop a systematic appraisal framework (QualDeath) for reviewing the quality of dying and death for patients with advanced cancer. The objectives were to: (1) explore the evidence regarding existing tools and processes related to appraisal of end-of-life care; (2) examine existing practices related to appraisal of quality of dying and death in hospital settings; and (3) develop QualDeath with consideration of potential acceptability and feasibility factors. Methods A co-design multiple methods approach was used. For objective 1, a rapid literature review was undertaken; for objective 2 we carried out semi-structured interviews and focus groups with key stakeholders in four major teaching hospitals; and for objective 3 we interviewed key stakeholders and held workshops with the project team to reach consensus. Results We developed QualDeath, a framework to assist hospital administrators and clinicians to systematically and retrospectively review the quality of dying and death for patients expected to die from advanced cancer. It offers four levels of potential implementation for hospitals to select from and incorporates medical record review, multidisciplinary meetings, quality of end-of-life care surveys and bereavement interviews with family carers. Conclusions The QualDeath framework provides hospitals with recommendations to formalise processes to evaluate end-of-life care. Although QualDeath was underpinned by several research methods, further research is needed to rigorously explore its impact and test its feasibility.