An important litmus test is whether there is broad consensus or empirical studies that show that health care institutions ought to be held accountable for those outcomes. Previous research has noted that patients with cancer lose the majority of their function and experience most of their symptoms in the last 1-2 months of life. Many instruments focus on this sentinel time period. However, diseases other than cancer may not follow this trajectory. Furthermore, concerns with quality of care can occur throughout the patient's illness.
Unrelieved pain is problematic at any time period.
Different instruments ought to look at important sentinel time periods throughout the illness course to ensure quality medical care. Nearly one in three patients are unable to be interviewed in the last week of life. To simply disregard their experience would miss important information on the quality of medical care. Yet, a proxy is only able to report on their observations or perceptions of the quality of care. Family members are often more critical and provide an important perspective that can lead to improving the quality of care.