Patients' ratings of quality and satisfaction with care at the end of life.
OBJECTIVE
To elicit ratings of quality and satisfaction with care from medical inpatients, especially those near the end of life.


METHODS
We conducted a cross-sectional survey of 84 seriously ill medical inpatients at 2 academic medical centers. Forty-five had do-not-resuscitate orders. Patients were interviewed using a valid and reliable instrument, the Quality of End-of-Life Care and Satisfaction With Treatment scale (scored from 1.0-5.0) and standard measures of symptoms, anxiety, depression, and delirium.


RESULTS
Mean patient ratings of quality of care were higher regarding physicians than nurses (4.39 vs 4.24; P =.01). Mean patient ratings of satisfaction with physicians were also higher, but not significantly (4.53 vs 4.43; P =.32). In analysis of variance models, patient ratings of physician quality were lowest for patients with do-not-resuscitate orders who were treated by a house-staff service compared with other patients (P =.01). These patients were also least satisfied with their physicians (P =.03). Nondepressed patients with private attending physicians rated nursing quality the highest (P =.16). These patients also reported the highest satisfaction with nurses (P =.002). Quality and satisfaction were not related to severity of illness, and pain was only weakly associated with satisfaction with physicians.


CONCLUSIONS
Patients with do-not-resuscitate orders who were treated by a house-staff service gave the lowest ratings of physician quality and satisfaction. Only private patients who were not depressed were highly satisfied with their nursing care. Further study is required to better understand these findings and whether they are amenable to quality improvement.
Sulmasy
Daniel P
DP
The John J. Conley Department of Ethics, St Vincent Catholic Medical Centers, St Vincent's Manhattan, 153 W 11th St, New York, NY 10011, USA. daniel_sulmasy@nymc.edu
McIlvane
Jessica M
JM
D000046:Academic Medical Centers / Q000592:standards*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D004219:District of Columbia; D005260:Female; D017051:Hospice Care / Q000523:psychology / Q000592:standards*; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D008297:Male; D008875:Middle Aged; D009518:New York; D009723:Nurse-Patient Relations; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000523:psychology / Q000592:standards*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011785:Quality Assurance, Health Care; D011788:Quality of Life; D016414:Resuscitation Orders; D011795:Surveys and Questionnaires