Table 1:

List of quality indicators

Indicator	Mean of importance^*
Advance care planning
Before hospital admission, the patient discussed his or her preferences for using or not using life-sustaining treatments with his or her substitute decision-maker.	6.58
Before hospital admission, the doctor talked to the patient and/or a family member about a poor prognosis or indicated in some way that the patient has a limited time left to live.	6.54
Before hospital admission, the patient and/or a family member discussed his or her preferences for using or not using medically appropriate life-sustaining treatments with his or her family doctor or other doctor.	6.25
Before hospital admission, the patient discussed his or her preferences for using or not using medically appropriate life-sustaining treatments with other family members.	6.17
The patient has formally designated, in writing, someone he or she trusts to be his or her substitute decision-maker concerning medical treatment decisions in the event he or she is not able to do so (using appropriate legal documentation depending on jurisdiction). In case of power of attorney, it should be related to health care.	6.04
Before the patient’s admission to hospital, a member of the health care team offered to arrange a time when the patient and his or her family could meet with the doctor to discuss the use of medically appropriate life-sustaining treatments he or she would want, or not want, in the event the patient’s physical health deteriorates.	6.00
The patient has an advance directive or living will or has indicated in some other way (verbal, by video and so on) the medical treatments he or she would want (or not want) in the event he or she is unable to communicate for him- or herself as a result of a life-threatening health problem.	5.88
Before hospital admission, the patient and/or a family member discussed preferences for using or not using medically appropriate life-sustaining treatments with other health care professionals (i.e., nurse, social worker and spiritual carer).	4.83
Goals-of-care discussion
Since admission, a member of the health care team has talked to the patient and/or substitute decision-maker about a poor prognosis or indicated in some way that the patient has a limited time left to live.	6.75
Since admission, a member of the health care team has talked to the patient and/or substitute decision-maker about the outcomes, benefits and burdens (or risks) of life-sustaining medical treatments.	6.63
Since admission, a member of the health care team has talked to the patient and/or substitute decision-maker about outcomes, benefits and burdens of focusing on comfort care as the goal of the patient’s treatment (e.g., palliative care or treating symptoms like pain without trying to cure or control their underlying illness).	6.63
Since the patient’s admission, a member of the health care team has offered to arrange a time when the patient or substitute decision-maker or the patient’s family can meet with the doctor to discuss the treatment options and plans.	6.58
Since the patient’s admission, a member of the health care team has asked if the patient (or substitute decision-maker, if patient is incapable) had prior discussions or has written documents about the use of life-sustaining treatments.	6.50
Since the patient’s admission, a member of the health care team has asked the patient or substitute decision-maker or the patient’s family what is important to them as they consider health care decisions at this stage of the patient’s life (i.e., values, spiritual beliefs and other practices).	6.29
Since admission, a member of the health care team has given the patient the opportunity to express his or her fears or discuss what concerns him or her.	6.29
Since admission, a member of the health care team has asked the patient or his or her family if they had any questions or needed things clarified regarding the patient’s overall goals of care.	6.25
Since admission, a member of the health care team has asked the patient what treatments he or she prefers to have or not have if he or she develops a life-threatening illness.	6.2
Since admission, the patient has been informed that he or she may change his or her mind about decisions around goals of care.	5.92
Since admission, the patient and family have been offered an opportunity to discuss with members of the health care team issues regarding capacity and consent with regard to advance care planning; specifically, what actions would take place in the possible event of losing capacity to consent to care.	5.71
Since admission, the patient and family have been offered support from the allied health care team (e.g., spiritual care, social work and clinical nurse specialist) as needed.	5.63
Since admission, a member of the health care team has provided the patient and his or her family with information about goal-of-care discussion to look at before conversations with the doctor.	5.42
Documentation
Documentation of goals of care is present in the medical record.	6.71
The goals of care present in the medical record are consistent with the patient’s stated preferences.	6.71
If the hospital uses a standardized folder or other strategy to locate advance care planning/goals of care documents in the medical record, these are present in the medical record.^†	6.54
Documentation of the outcomes of advance care planning conversations (including any prior expressed wishes, diaries and power of attorney documents) is present in the patient’s medical record.	6.17
Since admission, a member of the health care team has helped the patient and his or her family to access legal documents to communicate the patient’s advance care planning.^†	5.17

↵* Weights were derived from prior consensus panel.9
↵† Items flagged for removal because of poor internal consistency of this domain.