Agreement among family members in their assessment of the quality of dying and death

Richard Mularski, J. Randall Curtis, Molly Osborne, Ruth A. Engelberg, Linda Ganzini

Research output: Contribution to journalArticlepeer-review

67 Scopus citations


Improving end-of-life care requires accurate indicators of the quality of dying. The purpose of this study was to measure the agreement among family members who rate a loved one's dying experience. We administered the Quality of Dying and Death instrument to 94 family members of 38 patients who died in the intensive care unit. We measured a quality of dying score of 60 out of 100 points and found moderate agreement among family members as measured by an intraclass correlation coefficient (ICC) of 0.44. Variability on individual items ranged from an ICC of 0.15 to 1.0. Families demonstrated more agreement on frequencies of events (ICC 0.54) than on determinations of quality (ICC 0.32). These findings reveal important variability among family raters and suggest that until the variability is understood, multiple raters may generate more comprehensive end-of-life data and may more accurately reflect the quality of dying and death.

Original languageEnglish (US)
Pages (from-to)306-315
Number of pages10
JournalJournal of Pain and Symptom Management
Issue number4
StatePublished - Oct 2004
Externally publishedYes


  • Death
  • attitude to death
  • end-of-life care
  • family
  • outcome assessment
  • proxy
  • quality indicators health care
  • quality of dying
  • quality of health care
  • terminal care

ASJC Scopus subject areas

  • General Nursing
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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