Factors affecting family satisfaction with inpatient end-of-life care.
BACKGROUND
Little data exists addressing satisfaction with end-of-life care among hospitalized patients, as they and their family members are systematically excluded from routine satisfaction surveys. It is imperative that we closely examine patient and institution factors associated with quality end-of-life care and determine high-priority target areas for quality improvement.


METHODS
Between September 1, 2010 and January 1, 2012 the Canadian Health care Evaluation Project (CANHELP) Bereavement Questionnaire was mailed to the next-of-kin of recently deceased inpatients to seek factors associated with satisfaction with end-of-life care. The primary outcome was the global rating of satisfaction. Secondary outcomes included rates of actual versus preferred location of death, associations between demographic factors and global satisfaction, and identification of targets for quality improvement.


RESULTS
Response rate was 33% among 275 valid addresses. Overall, 67.4% of respondents were very or completely satisfied with the overall quality of care their relative received. However, 71.4% of respondents who thought their relative did not die in their preferred location favoured an out-of-hospital location of death. A common location of death was the intensive care unit (45.7%); however, this was not the preferred location of death for 47.6% of such patients. Multivariate Poisson regression analysis showed respondents who believed their relative died in their preferred location were 1.7 times more likely to be satisfied with the end-of-life care that was provided (p = 0.001). Items identified as high-priority targets for improvement included: relationships with, and characteristics of health care professionals; illness management; communication; and end-of-life decision-making.


CONCLUSIONS
Nearly three-quarters of recently deceased inpatients would have preferred an out-of-hospital death. Intensive care units were a common, but not preferred, location of in-hospital deaths. Family satisfaction with end-of-life care was strongly associated with their relative dying in their preferred location. Improved communication regarding end-of-life care preferences should be a high-priority quality improvement target.
Department of General Surgery, University of Toronto, Toronto, Ontario, Canada.
Erin
E
Sadler
Quality and Patient Safety, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Brigette
B
Hales
Bioethics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Blair
B
Henry
Trauma, Emergency and Critical Care Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Wei
W
Xiong
Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Jeff
J
Myers
Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Lesia
L
Wynnychuk
Quality and Patient Safety, Chief Nursing and Health Professions Executive, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Ru
R
Taggar
Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
Daren
D
Heyland
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario Canada.
Robert
R
Fowler
D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D002423:Cause of Death; D005190:Family; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010549:Personal Satisfaction; D058996:Quality Improvement; D011787:Quality of Health Care; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013727:Terminal Care; D019452:Terminally Ill / Q000523:psychology / Q000706:statistics & numerical data