title: What constitutes quality of family experience at the end of life? Perspectives from family members of patients who died in the hospital.
abstract: OBJECTIVE
  Most palliative care efforts focus on assessing and improving the quality of life and quality of care for patients. Palliative care views the family as the unit of care; therefore, excellent comprehensive palliative care should also address the needs of the family and the caregiver(s). While the recent literature has offered detailed descriptions of caregiving needs in the home setting, it is crucial to describe the needs of family members who provide care for patients with advanced illness in an inpatient setting, where family members serve as the key intermediaries and decision makers. Therefore, we sought to define the relevant aspects of quality of experience for families of hospitalized patients.
  
  
  METHODS
  We convened a series of focus groups to identify the domains important for the quality of experience of dying patients' family members. Participants included bereaved family members of patients who had died at a Veterans Administration (VA) or private academic medical center. We conducted four in-depth follow-up interviews to probe for additional details and validate our interpretation of the focus group findings.
  
  
  RESULTS
  Participants (n = 14) ranged in age from 46 to 83, with a mean of 62. All were female; 64% were Caucasian, 21% African American, and 14% did not report their ethnicity. Content analysis yielded 64 attributes of quality of family experience constituting eight domains: completion, symptom impact, decision making, preparation, relationship with healthcare providers, affirmation of the whole person, post-death care, and supportive services.
  
  
  CONCLUSIONS
  Our data have implications for clinical guidance in assisting family members in the inpatient palliative setting, which often includes patient incapacity for communication and decision making. They suggest the importance of developing corresponding methods to assist families with the tasks involved with life completion, being prepared for a crisis and imminent death, and post-death care. Provider communications and relationships are central to the processes of meeting the clinical needs of family members. Our findings should inform the development of measures to assess family experience.
authors.affiliation: Center for Health Services Research in Primary Care, Duke University,Durham,North Carolina.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Steinhauser
authors.affiliation: Center for Health Services Research in Primary Care, Duke University,Durham,North Carolina.
authors.forename: Corrine I
authors.initials: CI
authors.lastname: Voils
authors.affiliation: Center for Health Services Research in Primary Care, Duke University,Durham,North Carolina.
authors.forename: Hayden
authors.initials: H
authors.lastname: Bosworth
authors.affiliation: Center for Health Services Research in Primary Care, Duke University,Durham,North Carolina.
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003643:Death; D005190:Family / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008016:Life Change Events; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods / Q000523:psychology*; D011787:Quality of Health Care
keywords: Caregiving; Palliative care; Quality of life