Methodological challenges for measuring quality of care at the end of life

Floyd Jackson Fowler, Kristen M. Coppola, Joan M. Teno

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Measurement is a fundamental step in improving the quality of care for dying patients and their families. Yet, there are important methodological challenges to be addressed. In conducting surveys about the patient and family experience, research is needed regarding the relative merits and cost- effectiveness of prospective or retrospective surveys after the patient's death. Proxies are an important source of information given that the majority of patients can not be interviewed in the last week of life. Research is needed to understand who is best able to serve as a proxy and the validity of their reports. The cost-effectiveness and comparability of alternative data collection strategies need to be examined. These and other important issues need to be addressed in designing reliable, valid, and clinically manageable measures.

Original languageEnglish (US)
Pages (from-to)114-119
Number of pages6
JournalJournal of Pain and Symptom Management
Issue number2
StatePublished - Feb 1999
Externally publishedYes


  • End-of-life care
  • Palliative care
  • Quality-of-care
  • Terminal illness

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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