Defining and determining quality in end-of-life care

Health care providers are directing increased attention toward improving end-of-life care for patients who are dying and their families (Support Principle Investigators, 1995; Ferrell et al, 2000). Integral to the goal is determining what constitutes quality care for the dying. One of the major problems, however, in making such a determination results from the lack of consensus regarding a conceptual definition of quality. The purpose of this article is to stimulate debate and discussion on the meaning of quality in the context of providing end-of-life care. To aid in this discussion, the various perspectives of what constitutes quality in health-care practice will be discussed with special attention being paid to the delivery of quality end-of-life care. Conceptual decisions drive approaches to research method and measurement (Kristjanson, 1992), therefore an examination of the issues surrounding the measurement of quality health care in the context of care for the dying will also be explored.