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