Seven End-of-Life Care Domains

Associated Quality Indicators and Related Clinician and Organizational Interventions/Behaviors

May 5, 2003

These domains, quality indicators and interventions or behaviors were generated in a modified Delphi approach as described in the following article: Clarke EB, Curtis JR, Luce JM, Levy M, Nelson J, Solomon MZ, for The Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup Members. Quality indicators for end-of-life care in the intensive care unit. Critical Care Medicine 2003, in press.

The items under each domain represent potential suggestions for clinician and/or organizational interventions or behaviors that may improve the quality of end-of-life care in the ICU setting. Most of these interventions or behaviors have not been tested in randomized trials and the majority of them represent expert clinician opinion.

Table of Contents

The quality indicators under each end-of-life-care (EOLC) domain are in bold print and the clinician and organizational interventions/behaviors associated with the quality indicators are the bulleted items. This document is available in both HTML (via the hyperlinks below) and as a PDF download.
End-of-Life Care Work Sheets - 15 page PDF

Domain 1 -Patient and Family Centered Decision Making
Domain 2 -Communication within the Team & Patients/Families
Domain 3 -Continuity of Care
Domain 4 - Emotional & Practical Support for Patients/Families
Domain 5 - Symptom Management & Comfort Care
Domain 6 - Spiritual Support for Patients/Families
Domain 7 - Emotional & Organizational Support for ICU Clinicians
Acknowledgements

AUTHORS OF THESE DOMAINS:
Ellen B. Clarke, RN, MS, Ed.D - Center for Applied Ethics and Professional Practice, Education Development Center, Inc., Newton, MA;
J. Randall Curtis, MD, MPH - Division of Pulmonary and Critical Care, University of Washington, Seattle, WA
John M. Luce, MD - University of California, San Francisco, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital;
Mitchell Levy, MD - Brown University, Rhode Island Hospital;
Marion Danis, MD - Department of Clinical Bioethics, National Institutes of Health, Bethesda, MD;
Judith Nelson, MD, JD - Division of Pulmonary and Critical Care Medicine, Mount Sinai School of Medicine, New York, NY;
Mildred Z. Solomon, EdD - Center for Applied Ethics and Professional Practice, Education Development Center, Inc., Newton, MA for The Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup Members

CORRESPONDING AUTHOR:
J. Randall Curtis, MD, MPH, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Box 359762, Seattle WA 98104

FINANCIAL SUPPORT: The Robert Wood Johnson Foundation

Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in healthcare institutions to substantially improve care for dying people and their families.