Introduction
High quality end of life care involves addressing a patient’s physical, psychosocial, and spiritual needs and also
responding to family carer needs. Measuring the quality of care associated with dying and death is an
important component of health care and helps shape how care is delivered. Currently, it appears there is a lack
of evidence-based, systematic processes to examine the quality of dying and death of patients expected to die
from cancer in hospital settings.
Aim Develop a systematic appraisal framework (QualDeath) for reviewing the quality of dying and death for
patients with advanced cancer in the hospital.

Methods
(1) Explore the published evidence with regard to existing tools and processes related to appraisal of end of life
care via a rapid literature review; (2) Scope current practice in several major hospitals in Melbourne, Australia
with regard to existing processes related to appraisal of quality of dying/death via semi structured interviews
and focus groups with key stakehoders; (3) co-design QualDeath based on the aformentioned and workshop
and focus group with key stakeholders (hospital administrators, clinicians and consumers) to foster
acceptability and feasibility and reach consensus.

Results
We developed “QualDeath”: a framework to assist hospital administrators and clinicians to systematically review
the quality of dying and death for patients with an expected death from advanced cancer in hospital settings. It
offers four levels of potential implementation for hospitals to select from and incorporates medical record
review, multidisciplinary meetings, quality of end of life care surveys and bereavement interviews with family
carers.

Conclusion
The QualDeath framework provides relevant hospitals with recommendations to formalise processes to
evaluate end of life care. Although QualDeath was underpinned by several research methods we advocate
further research is conducted to rigorously explore its impact and test feasibility