title: Communication and Quality of Care on Palliative Care Units: A Qualitative Study.
abstract: BACKGROUND
  Clinician-patient communication is central in palliative care, but it has not been described qualitatively which specific elements of communication are important for high-quality palliative care, particularly in the inpatient setting.
  
  
  OBJECTIVE
  Our aim was to identify elements of communication that are central to quality of care and satisfaction with care on palliative care units (PCUs), as described by inpatients, family caregivers, and health care providers.
  
  
  METHODS
  Qualitative interviews with patients/caregivers and focus groups with staff were conducted on four PCUs. Semi-structured interviews and focus groups elicited thoughts about the characteristics of satisfaction with care and quality of care for PCU inpatients and their family caregivers. Data were analyzed using a grounded theory method with an inductive, constant comparison approach; themes were coded to saturation.
  
  
  RESULTS
  There were 46 interviews and eight focus groups. Communication was the most prevalent theme regarding satisfaction and quality of care, with five subthemes describing elements important to patients, caregivers, and staff. These included: 1) building rapport with patients and families to build trust and kinship; 2) addressing expectations and explaining goals of care; 3) keeping patients and families informed about the patient's condition; 4) listening actively to validate patients' concerns and individual needs; and 5) providing a safe space for conversations about death and dying.
  
  
  CONCLUSIONS
  Patients, family caregivers, and health care providers affirmed that communication is a central element of quality of care and family satisfaction on PCUs. The five subthemes identified may serve as a structure for education and for quality improvement tools in palliative care inpatient settings.
authors.affiliation: 1 Department of Psychosocial Oncology, Sunnybrook Health Sciences Centre , Toronto, Ontario, Canada .|2 Department of Family and Community Medicine, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Dori
authors.initials: D
authors.lastname: Seccareccia
authors.affiliation: 1 Department of Psychosocial Oncology, Sunnybrook Health Sciences Centre , Toronto, Ontario, Canada .
authors.forename: Kirsten
authors.initials: K
authors.lastname: Wentlandt
authors.affiliation: 3 Department of Supportive Care, University Health Network , Toronto, Ontario, Canada .
authors.forename: Nanor
authors.initials: N
authors.lastname: Kevork
authors.affiliation: 2 Department of Family and Community Medicine, University of Toronto , Toronto, Ontario, Canada .|4 Department of Family Medicine, Toronto East General Hospital , Toronto, Ontario, Canada .
authors.forename: Kevin
authors.initials: K
authors.lastname: Workentin
authors.affiliation: 5 Department of Cancer Services Planning and Performance, St. Michael's Hospital , Toronto, Ontario, Canada .
authors.forename: Susan
authors.initials: S
authors.lastname: Blacker
authors.affiliation: 3 Department of Supportive Care, University Health Network , Toronto, Ontario, Canada .|6 Department of Anesthesia and Psychiatry, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .|7 School of Kinesiology and Health Sciences, York University , Toronto, Ontario, Canada .|8 Department of Anesthesia, University Health Network , Toronto, Ontario, Canada .|11 Campbell Family Cancer Research Institute, Ontario Cancer Institute , Toronto, Ontario, Canada .
authors.forename: Lucia
authors.initials: L
authors.lastname: Gagliese
authors.affiliation: 2 Department of Family and Community Medicine, University of Toronto , Toronto, Ontario, Canada .|9 Department of Family and Community Medicine , Baycrest Health Sciences, Toronto, Ontario, Canada .
authors.forename: Daphna
authors.initials: D
authors.lastname: Grossman
authors.affiliation: 3 Department of Supportive Care, University Health Network , Toronto, Ontario, Canada .|10 Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto , Toronto, Ontario, Canada .|11 Campbell Family Cancer Research Institute, Ontario Cancer Institute , Toronto, Ontario, Canada .
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010166:Palliative Care / Q000592:standards*; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D036301:Qualitative Research; D011787:Quality of Health Care