Measuring the Quality of End-of-Life Care

Engelberg, Ruth A.; Downey, Lois; Wenrich, Marjorie D.; Carline, Jan D.; Silvestri, Gerard A.; Dotolo, Danae; Nielsen, Elizabeth; Curtis, J. Randall

doi:10.1016/j.jpainsymman.2009.11.313

Cited by 50 publications

(41 citation statements)

References 58 publications

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“…Data for this study were part of a survey study measuring physician skills at providing end-of-life care [12]. Participating physicians were recruited from four states: Washington, Oregon, North Carolina and South Carolina.…”

Section: Methodsmentioning

confidence: 99%

“…The QEOLC survey was designed for patients, families and nurses to measure physician skill at end-of-life care. 12 It was developed using focus groups that included patients with HIV/AIDS, cancer, or COPD; families of patients who had died; and nurses and physicians providing palliative care. 13,14 Using the qualitative methods of grounded theory, 54 items were developed and categorized into five domains: a) communication skills; b) technical skills; c) affective skills; d) patient-centered values; and e) patient-centered care systems.…”

Section: Methodsmentioning

confidence: 99%

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Nurses' Identification of Important yet Under-Utilized End-of-Life Care Skills for Patients with Life-Limiting or Terminal Illnesses

Reinke

Shannon

Engelberg

et al. 2010

Journal of Palliative Medicine

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Rationale: This study was designed to identify nurses' perspectives on nursing skills that are important yet under-utilized in end-of-life care. Methods: A 45-item survey was administered to nurses (n ¼ 717) in four U.S. states with a response rate of 79%. We identified skills that were endorsed by more than 60% of nurses as extremely important and also endorsed as not currently practiced by more than 25% of nurses. We used Chi square statistics to examine professional characteristics associated with ratings of end-of-life care skills including practice settings, years of experience, and end-of-life care education. Content analysis was used to examine nurses' responses to open-ended questions. Results: Nineteen items were endorsed as extremely important and also ranked as under-utilized. These end-oflife care skills included communication skills, symptom management competencies especially those concerning anxiety and depression, and issues related to patient-centered care systems. Four complementary themes emerged from qualitative analysis of nurses' comments, which supported the quantitative findings. Conclusions: This study provides a summary of skills nurses feel are important and under-utilized in their care of patients with life-limiting illnesses. The findings support the need to target both nursing education and healthcare system interventions to improve the use of practical end-of-life care skills by nurses with a focus on communication and symptom management skills.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Nurses' Identification of Important yet Under-Utilized End-of-Life Care Skills for Patients with Life-Limiting or Terminal Illnesses

Reinke

Shannon

Engelberg

et al. 2010

Journal of Palliative Medicine

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“…Providers' perspectives are important and have been found to be valid and reliable as well (13).We hypothesize that an IHPCU will enhance the quality of dying of terminally ill cancer patients by providing holistic care to the patient and their family, especially on the domain of physical comfort from the provider's perspective. Since most of the previous studies were retrospective, observational and family-oriented, our aim was to conduct a non-concurrent, prospective, controlled study to evaluate the effectiveness of an IHPCU from the providers' perspectives.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Inpatient Multidisciplinary Palliative Care Unit on Terminally Ill Cancer Patients from Providers' Perspectives: A Propensity Score Analysis

Cheng

Fang

et al. 2012

Japanese Journal of Clinical Oncology

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Objective: The effectiveness of inpatient palliative care units, a complex intervention, is challenging to evaluate due to methodological and practical difficulties. We conducted a study to evaluate providers' perceived effectiveness of one such unit. Methods: A non-concurrent, prospective, controlled study using the Audit Scale for good death services as an indicator of process of care and the Good Death Scale as the outcome of provider assessment of quality of dying was conducted. Eighty of 212 terminally ill cancer patients were matched from a tertiary medical center in Taiwan. Patients in the unit served as the intervention group and patients in the oncology ward served as controls. Multiple logistic regression was applied to estimate the propensity of choosing the unit for each patient, and linear regression analysis was conducted to identify predictive factors for mean change scores of the Good Death Scale. Results: Male gender (P , 0.001, 95% confidence interval ¼ 0.73-2.43) was associated with better quality of dying while having hepatocellular carcinoma (P , 0.004, 95% confidence interval ¼ 22.22 to 20.44) was associated with worse quality. For those in the unit, higher total Audit Scale scores were positively related to the outcome of quality of dying. The unit (P , 0.001, 95% confidence interval ¼ 8.67-12.97) and higher Good Death Scale at admission (P , 0.001, 95% confidence interval ¼ 0.44-1.13) were predictors of Audit Scale scores. Conclusions: Admission to a palliative care unit was associated with higher provider assessments of quality of dying for terminally ill cancer patients. These units should be considered as options for hospitals looking for ways to improve the quality of dying for patients.

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“…[19][20][21][22][23] Those that do assess caregivers, including the After-Death Bereaved Family Member Interview from the Toolkit of Instruments to Measure End-of-Life Care (TIME), 24 have omitted key factors of patient suffering and prolongation of death. 1,25 This omission is important, as memories of prolonged death or suffering may foster postloss symptoms of depression and regret and impede successful grief resolution. 2,26,27 The present study expands on two of the authors' previously published reports in which they used Coping with Cancer I (CwC1) data from 275 patient/caregiver dyads to develop and validate the 13-item Caregiver Evaluation of Quality of End of Life Care (CEQUEL) scale.…”

mentioning

confidence: 99%

Factors Predicting Bereaved Caregiver Perception of Quality of Care in the Final Week of Life: Implications for Health Care Providers

Higgins

Garrido

Prigerson

2015

Journal of Palliative Medicine

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Background: Cancer caregivers are key stakeholders in the final weeks of life and in bereavement. Research has highlighted end-of-life (EOL) factors important to caregivers, as well as factors contributing to caregiver mental health and bereavement outcomes. There has been limited data on factors predicting caregiver perceptions of quality of EOL care. Objective: This study's purpose was to identify modifiable predictors of caregivers' Caregiver Evaluation of Quality of End of Life Care (CEQUEL) scores, with the broader aim of informing clinical interventions to improve caregiver impressions of care and subsequent bereavement adjustment. Methods: Study data came from Coping with Cancer I (CwC1). CwC1 investigators interviewed advanced cancer patients and caregivers prior to the patient's death (Wave 1) and reinterviewed caregivers following the death (Wave 2) (N = 275 dyads). The authors identified potential Wave 1 predictors of CEQUEL scores and performed a series of linear regression analyses to identify a parsimonious predictive model using corrected Akaike's Information Criterion (AICc) values. Results: In adjusted analyses, caregivers rated quality of care as poorer when patients died in a hospital (B = -1.40, SE = 0.40, p = 0.001) (B, unstandardized regression coefficient; SE, standard error) or had less than one week of inpatient hospice care (B = -1.98, SE = -0.70, p = 0.006). Whole-person physician care and caregiver religiosity were associated with perceived higher quality of care in unadjusted, but not adjusted, analyses. Conclusions: Findings suggest that place of death and hospice length of stay best predict bereaved caregiver evaluations of quality of EOL care. These findings equip health care providers with modifiable targets to improve caregivers' experience of EOL care and subsequent bereavement.

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Measuring the Quality of End-of-Life Care

Cited by 50 publications

References 58 publications

Nurses' Identification of Important yet Under-Utilized End-of-Life Care Skills for Patients with Life-Limiting or Terminal Illnesses

Nurses' Identification of Important yet Under-Utilized End-of-Life Care Skills for Patients with Life-Limiting or Terminal Illnesses

Evaluation of Inpatient Multidisciplinary Palliative Care Unit on Terminally Ill Cancer Patients from Providers' Perspectives: A Propensity Score Analysis

Factors Predicting Bereaved Caregiver Perception of Quality of Care in the Final Week of Life: Implications for Health Care Providers

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