Table 2

Mortality follow-back survey example: voices

InstrumentVOICES—views of informal carers—evaluation of services84
DescriptionSurvey of experience of care in the last 3 months of life, as reported by the individual who registered the person’s death. In England, VOICES has been used as a population-level metric, with national postal surveys undertaken annually from 2011 to 2016. Modified versions of VOICES have been used to assess end-of-life care quality (eg, in Ontario, Canada).53 The survey was derived from the 1990 Regional Study of care for the Dying,85 itself based on earlier work by Cartwright et al.86 87
Care settingApplicable across all settings.
Patient populationBroadly comprehensive. Applicable to all patient groups. In England, use with representative sample stratified by cause and place of death in survey period.60 Good coverage dependent on high response rate and equal response uptake across demographic groups. In last England survey, black and minority ethnic participants thought to be under-represented.84
Measure feasibilityPostal self-report questionnaire. Resource intensive to administer and analyse. Survey is lengthy (short-form version is 59 questions in a 15 page booklet). England version was administered by the Office of National Statistics on behalf ofNHS England.
Care qualityLimited. Extensive development (including pre-testing with bereaved relatives) ensured questions asked are meaningful and relevant.21 However, retrospective patient proxy views of end-of-life care by questionnaire recipient. Limited information on caregivers’ views of support they received in providing end-of-life care, or of religious or spiritual needs.21