Measuring the Quality of End of Life Care Provided in Inpatient Health Care Settings

To explore differences in satisfaction with the quality of care received at end of life in different types of hospital wards/settings and to better understand the organizational barriers and facilitators that influence how well that care is provided.

To explore differences in satisfaction with the quality of care received at end of life in different types of hospital wards/settings and to better understand the organizational barriers and facilitators that influence how well that care is provided.

Research Summary

The quality of care provided to the dying and to their family members has become an important health and social policy issue in Canada and in BC. While a major policy direction for provincial and national government has been to shift more health care delivery into home settings and away from institutions, more than 70% of Canadians, and almost 80% of BC residents, spend their final days and die in inpatient care settings. This is likely to continue as the population ages and more people are diagnosed with cancer and other end-stage medical diseases.

The primary purpose of this study is to assess and increase understanding of the quality of care provided at end of life within different inpatient health care settings including palliative care units, extended care units, medical care units, and intensive care units. The research team will explore family members’ satisfaction with the quality of care received at end of life and the differences in satisfaction experienced in the different inpatient care settings. They will also identify specific components of care that could be improved in each care setting and examine organizational barriers/facilitators within these settings that influence the ability to provide quality end of life care.

The research team’s goal is to provide evidence to inform decisions for improvements in health services and health policy for end of life care.

Research Results

The study surveyed 388 bereaved family members on Southern Vancouver Island, BC. Four care settings were targeted: Four care settings were targeted: (1) palliative care units; (2) extended care units; (3) medical care units; and (4) intensive care units. To supplement these surveys we conducted in-person qualitative interviews with 24 bereaved family member participants, and 14 interviews with senior administrators/decision-makers.

Family members were most satisfied with: availability of nurses; patient’s pain relief; able to be with relative/friend when s/he died; being treated with respect; availability of family conferences; and availability of a hospital bed. In contrast, they were least satisfied with: availability of hospital bed; availability of doctor; availability of family conferences; and coordination of care. Family members who were more psychologically resilient tended to express higher satisfaction with care. As well, family members who had a loved one die on a medical care unit tended to have significantly lower satisfaction than those who had a loved one die on an extended, intensive or palliative care unit.

Senior administrators/decision-makers identified philosophy and attitudes, resource allotment, leadership, organizational flexibility, and staffing models as influencing palliative care delivery. They also identified a lack of a consistent priority focus on establishing and maintaining palliative care infrastructure.

A key conclusion from this research concerns the measurement of satisfaction. Examining satisfaction using a scale may limit our understanding of the complexity of family satisfaction. Family members themselves alerted us to this fact through their reactions to completing the survey. Relative to the other three settings, medical care units tended to receive the lowest satisfaction ratings. However, none of the settings demonstrated consistently high satisfaction, indicating that there is room for improvement in the quality of care offered at end of life, in all inpatient settings.