title: Quality of dying in head and neck cancer patients: a retrospective analysis of potential indicators of care.
abstract: 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.
authors.affiliation: Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Cosham, Portsmouth, UK. mgethu@hotmail.com
authors.forename: Madanagopalan
authors.initials: M
authors.lastname: Ethunandan
authors.forename: Andrew
authors.initials: A
authors.lastname: Rennie
authors.forename: Gary
authors.initials: G
authors.lastname: Hoffman
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Morey
authors.forename: Peter A
authors.initials: PA
authors.lastname: Brennan
mesh_terms: 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*