Quality of dying in head and neck cancer patients: a retrospective analysis of potential indicators of care.
OBJECTIVE
The objective of this study was to evaluate the quality of the dying experience in a cohort of head and neck cancer patients by a retrospective analysis of potential indicators of care.


METHODS
The study design included retrospective case note analysis of previously evaluated factors considered important in the care of terminally ill patients and validated indicators of care obtainable from administrative data. The documented factors were analyzed to indicate specific elements of the quality of death and dying experience.


RESULTS
Pain was a common symptom (84%) and was managed successfully in all patients, with 93% receiving opioids. Management of other symptoms, except neuropsychological problems, were satisfactory. Sixty-three percent of patients died in hospital and only 22% had a relative present at the time of death. Resuscitation status was documented in only 65% of the notes, though none were admitted to the intensive care unit or underwent resuscitation. Fifty-three percent of patients were admitted as an emergency in the last month of life and bleeding was the most common cause of admission.


CONCLUSIONS
Valuable information can be obtained from a focused retrospective analysis. The indicators evaluated suggest that biomedical aspects of care are being recognized and addressed, although there is room for improvement. Psychosocial and spiritual aspects of care were not documented and must be taken into account to assess the "complete quality of dying" experience.
Ethunandan
Madanagopalan
M
Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Cosham, Portsmouth, UK. mgethu@hotmail.com
Rennie
Andrew
A
Hoffman
Gary
G
Morey
Paula J
PJ
Brennan
Peter A
PA
D000328:Adult; D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D011788:Quality of Life; D012189:Retrospective Studies; D013727:Terminal Care / Q000592:standards*