Relatives’ perceived quality of palliative care: comparisons between care settings in which patients die

Abstract

BackgroundDying in the preferred setting is an indicator of good palliative care quality. Most people prefer to die at home. But does the quality of care as perceived by their relatives vary depending on the care setting that is the place of death?The aim is to compare (from the relatives perspective) whether there are perceived differences in the quality of palliative care between the settings in which people die.MethodsMultivariate linear regression analyses have been carried out using an existing dataset containing information collected using the relatives’ version of the Consumer Quality Index (CQ-index) Palliative Care. The dataset includes 1368 relatives of patients with a wide variety of conditions who died in various locations: at home, in hospital, in residential care for the elderly, a hospice, palliative care unit or in another institution (e.g. institutions for people with intellectual disabilities or mental healthcare institutions). The relatives were the first contacts (family members or other people close to the patient) and they received the survey between 6 weeks and 6 months after the bereavement.ResultsBased on the raw data, differences between locations in terms of the perceived quality of care initially appeared inconsistent. The multivariate regression analyses however showed that relatives of people who died at home were generally the most positive about the palliative care that the patient and they themselves received when the patient was dying. The care provided by hospices also received a relatively good rating. In hospitals and in residential settings for care of the elderly, the care was rated less highly by the relatives.ConclusionsThe quality of palliative care as experienced from the relatives’ perspective is highest when the patient dies at home or in a hospice. This is an argument for letting people die at home, if they so wish, as far as possible and feasible.

Bereaved Family Members' Satisfaction with Care during the Last Three Months of Life for People with Advanced Illness

“…This is in line with other studies on access to specialist palliative care for non-cancer patients [40][41][42]. The importance of the care place/type of care services for family satisfaction as well as the quality of the care at the end of life has been shown in previous studies, where specialized palliative care units have been rated with higher satisfaction than hospitals, nursing homes, and primary health care [17][18][19][20]25,26,43,44]. The higher satisfaction with the care received in specialized palliative care units may be explained by the fact that specialized palliative care units are expected to provide palliative care to all their patients, compared to general care units that have both a curative and palliative aim with their care.…”

Factors Associated With Symptom Relief in End-of-Life Care in Residential Care Homes: A National Register-Based Study

“…10,11 Family members have reported a lower quality of EOL care regarding psychosocial and spiritual well-being in RCHs and hospitals compared to at home or in hospices. 12 The goal of palliative care is to include every dying person, wherever they are cared for, irrespective of diagnosis. 13 The most common causes of death for older residents in RCHs in Sweden are diseases of the circulatory system 14,15 and dementia.…”

Bereaved Family Members’ Satisfaction with Care during the Last Three Months of Life for People with Advanced Illness

“…This is in line with other studies on access to specialist palliative care for non-cancer patients [40,41,42]. The importance of the care place/type of care services for family satisfaction as well as the quality of the care at the end of life has been shown in previous studies, where specialized palliative care units have been rated with higher satisfaction than hospitals, nursing homes, and primary health care [17,18,19,20,25,26,43,44]. The higher satisfaction with the care received in specialized palliative care units may be explained by the fact that specialized palliative care units are expected to provide palliative care to all their patients, compared to general care units that have both a curative and palliative aim with their care.…”