Enhancing Death Documentation in Lung Cancer: Lessons from a Clinical Pathway Audit on Multi-Causal Mortality

Accurate mortality data analysis is essential for public health as it informs policy and clinical practice. Clinical pathways (CP) ensure standardized patient identification and management, while multiple causes of death (MCOD) reporting provides a broader understanding of complex mortality patterns. However, incomplete or inconsistent documentation of causes of death may lead to epidemiological bias as well as legal and ethical consequences. This analytical observational study used a retrospective cohort design at Dr. Wahidin Sudirohusodo Hospital from January to December 2024. Data from 209 deceased lung cancer patients were reviewed. Compliance with cause-of-death documentation was assessed against CP standards and MCOD forms using a structured scoring system. Agreement between the two methods was analyzed with Cohen’s kappa test. Documentation of causes of death showed high compliance with CP standards (80.9%) but very low adherence in MCOD forms (1.4%). Agreement between CP-based diagnoses and MCOD documentation was poor, with a kappa value of 0.007 and p-value of 0.396 (p > 0.05), indicating inconsistency between the two approaches. These findings suggest that CP prioritizes clinical management documentation, whereas MCOD requires broader mortality detail that is often neglected. There is a substantial gap in accuracy and completeness of cause-of-death documentation in lung cancer patients. Low compliance with MCOD standards highlights the need for enhanced training, systematic auditing, and stricter policy enforcement. Inadequate documentation compromises epidemiological validity and may constitute administrative negligence with ethical and disciplinary implications.