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To the Editor: Dr Teno and colleagues¹ reported that "[a]bout one quarter of all patients with pain or dyspnea did not receive adequate treatment" and that "[s]uch national information on the quality of end-of-life care in the United States has been sorely lacking." The data were obtained from individuals identified on death certificates or someone those individuals recommended. The authors commented that such proxies "may have inaccurately perceived patients' unmet needs for symptom management. . . . " They continued, "however, a recent synthesis of literatures suggests that families are able to accurately report on many quality-of-care domains" and cited an article by McPherson and Addington-Hall.²

As Drs McPherson and Addington-Hall pointed out, many studies have found a consistent pattern in the reliability of reports collected from proxies. It seems that proxies may provide reliable information on some aspects of care, "most notably service provision and evaluation, and for symptoms . . . [Full Text of this Article]

Carlos O. Weiss, MD
cweiss9@jhmi.edu
Johns Hopkins Center on Aging and Health

Thomas E. Finucane, MD
Division of Geriatric Medicine and Gerontology
Johns Hopkins Geriatrics Center
Baltimore, Md

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