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The Quality of Dying and DeathMeasuring the Quality of Dying: Is It Ready for Use as an Outcome Measure?

J. Randall Curtis, MD, MPH, FCCP; Lois Downey, MA; Ruth A. Engelberg, PhD
Author and Funding Information

From the Division of Pulmonary and Critical Care, Department of Medicine, Harborview Medical Center, University of Washington.

Correspondence to: J. Randall Curtis, MD, MPH, FCCP, Division of Pulmonary and Critical Care, Box 359762, Harborview Medical Center, University of Washington, Seattle, WA 98104; e-mail: jrc@u.washington.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Funding/Support: This work was supported by the National Institute of Nursing Research [R01NR05226].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(2):289-291. doi:10.1378/chest.12-1941
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The juxtaposition of these two quotes is not novel, but it is particularly appropriate for a discussion of measuring the quality of dying and death. The quote by Lord Kelvin captures the challenge that gave rise to efforts to develop a measure of the quality of dying and death. In the past 3 decades, landmark studies highlighted the poor quality of end-of-life care, with many patients dying with significant pain and other symptoms while receiving a high intensity of life-sustaining treatments they did not want, and families often were left with tremendous emotional and financial burdens.1-4 As a result of these findings, and in line with Lord Kelvin’s adage, efforts arose to develop accurate measures of the quality of the dying experience. The Quality of Dying and Death (QODD) questionnaire was one such measure developed from a conceptual model that separated the following three related concepts: the quality of end-of-life care, the quality of life at the end of life, and the quality of dying and death.5

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