Bereaved family members\u2019 perceptions of the quality of end-of-life care across four types of inpatient care settings

Kelli Stajduhar,Richard Sawatzky,Leah Norgrove,Diane Allan,Anne M Gadermann,S Robin Cohen,Darcee Bidgood,Daren K Heyland

doi:10.1186/s12904-017-0237-5

Abstract

BackgroundThe aims of this study were to gain a better understanding of how bereaved family members perceive the quality of EOL care by comparing their satisfaction with quality of end-of-life care across four different settings and by additionally examining the extent to which demographic characteristics and psychological variables (resilience, optimism, grief) explain variation in satisfaction.MethodsA cross-sectional mail-out survey was conducted of bereaved family members of patients who had died in extended care units (n = 63), intensive care units (n = 30), medical care units (n = 140) and palliative care units (n = 155). 1254 death records were screened and 712 bereaved family caregivers were identified as eligible, of which 558 (who were initially contacted by mail and then followed up by phone) agreed to receive a questionnaire and 388 returned a completed questionnaire (response rate of 70%). Measures included satisfaction with end-of-life care (CANHELP- Canadian Health Care Evaluation Project - family caregiver bereavement version; scores range from 0 = not at all satisfied to 5 = completely satisfied), grief (Texas Revised Inventory of Grief (TRIG)), optimism (Life Orientation Test – Revised) and resilience (The Resilience Scale). ANCOVA and multivariate linear regression were used to analyze the data.ResultsFamily members experienced significantly lower satisfaction in MCU (mean = 3.69) relative to other settings (means of 3.90 [MCU], 4.14 [ICU], and 4.00 [PCU]; F (3371) = 8.30, p = .000). Statistically significant differences were also observed for CANHELP subscales of “doctor and nurse care”, “illness management”, “health services” and “communication”. The regression model explained 18.9% of the variance in the CANHELP total scale, and between 11.8% and 27.8% of the variance in the subscales. Explained variance in the CANHELP total score was attributable to the setting of care and psychological characteristics of family members (44%), in particular resilience.ConclusionFindings suggest room for improvement across all settings of care, but improving quality in acute care and palliative care should be a priority. Resiliency appears to be an important psychological characteristic in influencing how family members appraise care quality and point to possible sites for targeted intervention.

Highlights

The aims of this study were to gain a better understanding of how bereaved family members perceive the quality of EOL care by comparing their satisfaction with quality of end-of-life care across four different settings and by examining the extent to which demographic characteristics and psychological variables explain variation in satisfaction
Little research focuses on how dying in a particular inpatient care setting influences family members’ perceptions of the quality of care
Sample Structured surveys were completed by a sample of bereaved family members who had a relative or friend die on an extended care units (ECU), intensive care units (ICU), medical care units (MCU) or palliative care units (PCU) in one health region in Western Canada in the past 3–6 months

Summary

Introduction

The aims of this study were to gain a better understanding of how bereaved family members perceive the quality of EOL care by comparing their satisfaction with quality of end-of-life care across four different settings and by examining the extent to which demographic characteristics and psychological variables (resilience, optimism, grief) explain variation in satisfaction. Researchers have examined the quality of end-of-life (EOL) care within inpatient care settings such as hospices [6, 7] [8], acute care [9,10,11,12], extended care [13,14,15], critical care [16], and palliative care units [6, 17]. Few studies compare the quality of EOL care across settings from the perspective of family members and, studies that do, tend to focus on comparing inpatient and home care experiences [18] or reporting on barriers to optimal care in general [19]. Little research focuses on how dying in a particular inpatient care setting (i.e., acute care medical units, palliative care units, extended care units and intensive care units) influences family members’ perceptions of the quality of care

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