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American Journal of Hospice and Palliative Medicine®
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Palliative care at the end of life: Comparing quality in diverse settings

Judith A. Paice, PhD, RN

Northwestern University Medical School, Division of Hematology-Oncology, Northwestern Memorial Hospital, Palliative Care and Home Hospice Program, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois

J. Cameron Muir, MD, FAAHPM

The Hospices of the National Capital Region, Fairfax, Virginia

Susan Shott, PhD

Rush Medical Center, Chicago, Illinois

There is growing awareness that pain and other symptoms are often poorly managed at the end of life. The purpose of this quality improvement project was to compare the quality of care provided to a convenience sample of 195 patients who died during a six-month period, using a retrospective chart review. Quality was defined by symptom documentation, use of diagnostic and therapeutic procedures in the final 48 hours of life, and determination of advance directives. Daily and total charges incurred by these patients were also captured. Symptom distress was common, and diagnostic and therapeutic procedures were widespread. These data suggest areas for improvement in clinical practice, in palliative care units, and in all settings where end-of-life care is provided. Also, the data can guide future research into the quality of care provided to dying persons.

Key Words: end of life • palliative care • pain management

American Journal of Hospice and Palliative Medicine®, Vol. 21, No. 1, 19-27 (2004)
DOI: 10.1177/104990910402100107
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