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Resurrecting Treatment Histories of Dead Patients
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To the Editor: In their Special Communication, Dr Bach and colleagues raise important limitations in the use of the retrospective approach to studying end-of-life care.1 However, we believe that research that uses multiple methods is needed to examine a complex phenomenon such as dying. Given the uncertainties of prognostication, retrospective assessment of decedents remains an important methodology to examine the quality of end-of-life care.
Like any study design, the retrospective (mortality follow-back) approach has strengths and limitations. A key advantage of this approach is that the selection of cases is not dependent on inaccurate physician prognostication of survival, important when the decedent is enrolled in hospice or other services predicated on a terminal prognosis. The time frames in relationship to death are known, and researchers can compare experiences in the last week across sites of care. If the research goal is to examine the quality of care in the . . . [Full Text of this Article]
Joan M. Teno, MD, MS
joan_teno@brown.edu
Vince Mor, PhD
Department of Community Health
Brown University School of Medicine
Providence, RI
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