title: Factors Predicting Bereaved Caregiver Perception of Quality of Care in the Final Week of Life: Implications for Health Care Providers.
abstract: BACKGROUND
  Cancer caregivers are key stakeholders in the final weeks of life and in bereavement. Research has highlighted end-of-life (EOL) factors important to caregivers, as well as factors contributing to caregiver mental health and bereavement outcomes. There has been limited data on factors predicting caregiver perceptions of quality of EOL care.
  
  
  OBJECTIVE
  This study's purpose was to identify modifiable predictors of caregivers' Caregiver Evaluation of Quality of End of Life Care (CEQUEL) scores, with the broader aim of informing clinical interventions to improve caregiver impressions of care and subsequent bereavement adjustment.
  
  
  METHODS
  Study data came from Coping with Cancer I (CwC1). CwC1 investigators interviewed advanced cancer patients and caregivers prior to the patient's death (Wave 1) and reinterviewed caregivers following the death (Wave 2) (N=275 dyads). The authors identified potential Wave 1 predictors of CEQUEL scores and performed a series of linear regression analyses to identify a parsimonious predictive model using corrected Akaike's Information Criterion (AICc) values.
  
  
  RESULTS
  In adjusted analyses, caregivers rated quality of care as poorer when patients died in a hospital (B=-1.40, SE=0.40, p=0.001) (B, unstandardized regression coefficient; SE, standard error) or had less than one week of inpatient hospice care (B=-1.98, SE=-0.70, p=0.006). Whole-person physician care and caregiver religiosity were associated with perceived higher quality of care in unadjusted, but not adjusted, analyses.
  
  
  CONCLUSIONS
  Findings suggest that place of death and hospice length of stay best predict bereaved caregiver evaluations of quality of EOL care. These findings equip health care providers with modifiable targets to improve caregivers' experience of EOL care and subsequent bereavement.
authors.affiliation: 1 Brigham & Women's Hospital and the Dana-Farber/Brigham & Women's Cancer Center , Boston, Massachusetts.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Higgins
authors.affiliation: 2 James J Peters Veterans Affairs Medical Center , Bronx, New York.|3 Icahn School of Medicine at Mount Sinai , New York, New York.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Garrido
authors.affiliation: 4 Center for Research on End-of-Life Care, Weill Cornell Medical College , New York, New York.
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001294:Attitude to Health; D001601:Bereavement; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D010465:Perception; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D011787:Quality of Health Care / Q000592:standards*; D011788:Quality of Life / Q000523:psychology*; D012044:Regression Analysis; D012068:Religion and Medicine; D012944:Social Support; D013727:Terminal Care / Q000523:psychology* / Q000592:standards; D055815:Young Adult