Quality of Dying APGAR (QODA)
Quality of Dying in End-Stage Kidney Disease
The Quality of Dying APGAR tool, developed by clinician researchers at Baystate Medical Center, consists of five domains (pain, non-pain symptoms, advance care planning, peacefulness, and time) that are scored from zero to two (Cohen, 2004). The score of the domains are summed with a higher score representing a higher quality of death.
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)
Cohen LM, Germain MJ. Measuring quality of dying in end-stage renal disease. Semin Dial. 2004 Sep-Oct;17(5):376-9. doi: 10.1111/j.0894-0959.2004.17348.x. PMID: 15461747.
