Quality of Dying APGAR (QODA)

Quality of Dying in End-Stage Kidney Disease

Physical (symptom management) dimensions


Pain (during the last week of life):

0= severe & distressing pain

1= the pain distressed the patient somewhat

2= no pain, or the pain did not distress the patient


Non-Pain symptoms (last week of life) i.e.: confusion, dyspnea, spiritual distress, etc./strong

0= severe & distressing symptom

1= the symptom distressed the patient somewhat

2= no symptom or the symptom did not distress the patient

Psychosocial (peace) dimensions


Advance Care Planning

During the last week of life, to what extent were patient’s wishes followed- regarding a course of treatment that focused on extending life as much as possible even if it meant more pain and discomfort - or, on a plan of care that focused on relieving pain and discomfort as much as possible even if it meant not living as long.

0= formal health care proxy or living will had not been completed, documented, or communicated to staff who managed the terminal care.

1= intermediate

2= formal health care proxy or living will had been completed, documented, and communicated to staff who managed the terminal care.


Peace/Dignity

During the last week of life, did the patient die on his/her own terms? (Consider the following information, if available)? Was the patient lucid, coherent, able to take leave of loved-ones or have them say good-bye, complete most of the desired tasks, attend to spiritual matters, die where the patient chose, and leave the family united?

0= mostly not peaceful/dignified

1= mostly peaceful/dignified – intermediate

2= peaceful/dignified

Duration dimension


Time – Dying was prolonged or brief?

0= prolonged - in that the dying period lasted 6 months or more. If dialysis was discontinued, then death occurred 3 weeks or more after the last dialysis treatment.

1= intermediate - in that the dying period (terminal period) was less than 6 months but more than 1 month. If dialysis discontinued, death occurred between 2 and 3 weeks after the last dialysis session.>

2= brief - the dying took place in sleep/suddenly/unexpectedly, or occurred within one month of being in a terminal state. If dialysis was discontinued, then death took place 2 weeks or less from the time of the last treatment.

TOTAL DIALYSIS QODA SCORE ________

(Mark the score with an asterisk *, if some aspect was unusual and warrants a narrative)

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