The Quality of Dying and Death (QODD) questionnaire is used as a self-reported measure to allow families and clinicians to assess patients’ quality of dying and death. We evaluated end-of-life (EOL) experiences as measured by the QODD completed by families and nurses in the United States (US) and the Netherlands (NL) to explore similarities and differences in these experiences and identify opportunities for improving EOL care.
Questionnaire data were gathered from family members of patients dying in the ICU and nurses caring for these patients. In NL, data were gathered in three teaching hospitals; in the US from 12 sites participating in a randomized trial. The QODD is consists of 25 items and has been validated in the US.
Data from 446 patients were analysed, (346 in US; 100 in NL). Dutch patients were older than those in the US (72 +10.2 vs. 65 +16.0, p<0.0025). The family-assessed overall QODD score (medians [IQR]) was the same in both countries: NL 9 [8-10], US 8[5-10]. US family members rated the quality of two items higher than NL families: “time spent with loved ones” and “time spent alone”. Nurse-assessed QODD ratings varied: the single-item QODD summary score was significantly higher in NL (NL 9 [8-10] vs US 7 [5-8]; p<0.0025), while the QODD total score was higher in the US (NL 6.9 [5.5-7.6] vs US.7.1 [5.8-8.4]; p=0.014), although not meeting our criteria for statistical significance. Of the 22 nurse-assessed items, 10 were significantly different between NL and US with 8 higher in the US and 2 higher in NL.
The QODD was rated similarly by family members in the US and the Netherlands but varied when assessed by nurses. These differences may be due to organizational or cultural differences between the two countries or to expectations of respondents.