title: Using satisfaction to measure the quality of palliative care: a review of the literature.
abstract: BACKGROUND
  The advent of clinical governance in British health policy has placed increased demands on health care providers and practitioners to ascertain the quality of their services. Traditional indicators of quality of health care, such as death or recovery rates, are not appropriate in palliative care. Thus, it is important to establish alternative approaches to measuring the quality of palliative care services and interventions.
  
  
  OBJECTIVE
  Satisfaction levels have been used widely in palliative care to assess quality. A literature review was conducted which aimed to explore the strengths and weaknesses of using satisfaction as an indicator of the quality of palliative care services. It also aimed to provide a solid basis upon which further work could be built.
  
  
  METHODS
  Five electronic databases were searched using key words and phrases and key authors. Hand searches were conducted of four journals that contributed significantly to the concept of satisfaction, and reference lists of reviewed papers were scrutinized. Relevant papers were reviewed, data were extracted and these data were thematically analysed.
  
  
  RESULTS
  There are a number of important unresolved issues in the literature with regard to using satisfaction as an indicator of the quality of palliative care services. First, few alternatives to satisfaction are available. Secondly, satisfaction is under-theorized and no widely accepted definition exists. Thirdly, there are methodological inconsistencies across studies. It is important to take into account these findings when planning and implementing change following service evaluation using satisfaction as a measure.
  
  
  CONCLUSIONS
  Relying on findings of satisfaction surveys to determine clinical and policy amendments in palliative care may not result in improvements in overall quality of care. Using satisfaction as a method of assessing the quality of health care services is particularly problematic and requires further investigation in both practical and conceptual terms.
authors.affiliation: Department of Palliative Care and Policy, Guy's, King's and St Thomas' School of Medicine, King's College London, Weston Education Centre, London, UK. fiona.aspinal@kcl.ac.uk
authors.forename: Fiona
authors.initials: F
authors.lastname: Aspinal
authors.forename: Julia
authors.initials: J
authors.lastname: Addington-Hall
authors.forename: Rhidian
authors.initials: R
authors.lastname: Hughes
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
mesh_terms: D006801:Humans; D010166:Palliative Care / Q000592:standards*; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care