title: Patients' perceptions of palliative care quality in hospice inpatient care, hospice day care, palliative units in nursing homes, and home care: a cross-sectional study.
abstract: BACKGROUND
  Patients' perceptions of care quality within and across settings are important for the further development of palliative care. The aim was to investigate patients' perceptions of palliative care quality within settings, including perceptions of care received and their subjective importance, and contrast palliative care quality across settings.
  
  
  METHODS
  A cross-sectional study including 191 patients in late palliative phase (73 % response rate) admitted to hospice inpatient care, hospice day care, palliative units in nursing homes, and home care was conducted, using the Quality from the Patients' Perspective instrument-palliative care (QPP-PC). QPP-PC comprises four dimensions and 12 factors; "medical-technical competence" (MT) (2 factors), "physical-technical conditions" (PT) (one factor), "identity-orientation approach" (ID) (4 factors), "sociocultural atmosphere" (SC) (5 factors), and three single items (S); medical care, personal hygiene and atmosphere. Data were analysed using paired-samples t-test and analysis of covariance while controlling for differences in patient characteristics.
  
  
  RESULTS
  Patients' perceptions of care received within settings showed high scores for the factors and single items "honesty" (ID) and "atmosphere" (S) in all settings and low scores for "exhaustion" (MT) in three out of four settings. Patients' perceptions of importance scored high for "medical care" (S), "honesty" (ID), "respect and empathy" (ID) and "atmosphere" (S) in all settings. No aspects of care scored low in all settings. Importance scored higher than perceptions of care received, in particular for receiving information. Patients' perceptions of care across settings differed, with highest scores in hospice inpatient care for the dimensions; ID, SC, and "medical care" (S), the SC and "atmosphere" (S) for hospice day care, and "medical care" (S) for palliative units in nursing homes. There were no differences in subjective importance across settings.
  
  
  CONCLUSIONS
  Strengths of services related to identity-orientation approach and a pleasant and safe atmosphere. Key areas for improvement related to receiving information. Perceptions of subjective importance did not differ across settings, but perceptions of care received scored higher in more care areas for hospice inpatient care, than in other settings. Further studies are needed to support these findings, to investigate why perceptions of care differ across settings and to highlight what can be learned from settings receiving high scores.
authors.affiliation: Department of Health Studies, Faculty of Public Health, Hedmark University of Applied Sciences, Postbox 400, 2418, Elverum, Norway. Tuva.Sandsdalen@hihm.no.|Department of Health Science, Faculty of Health, Science and Technology, Discipline of Nursing Science, Karlstad University, 651 88, Karlstad, Sweden. Tuva.Sandsdalen@hihm.no.
authors.forename: Tuva
authors.identifier: http://orcid.org/0000-0002-6699-8059
authors.initials: T
authors.lastname: Sandsdalen
authors.affiliation: Faculty of Health and Social Studies, Østfold University College, Postbox 700, 1757, Halden, Norway.
authors.forename: Vigdis Abrahamsen
authors.initials: VA
authors.lastname: Grøndahl
authors.affiliation: Department of Health Studies, Faculty of Public Health, Hedmark University of Applied Sciences, Postbox 400, 2418, Elverum, Norway.
authors.forename: Reidun
authors.initials: R
authors.lastname: Hov
authors.affiliation: Department of Health Studies, Faculty of Public Health, Hedmark University of Applied Sciences, Postbox 400, 2418, Elverum, Norway.
authors.forename: Sevald
authors.initials: S
authors.lastname: Høye
authors.affiliation: Department of Health Science, Faculty of Health, Science and Technology, Discipline of Nursing Science, Karlstad University, 651 88, Karlstad, Sweden.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Rystedt
authors.affiliation: Department of Health Studies, Faculty of Public Health, Hedmark University of Applied Sciences, Postbox 400, 2418, Elverum, Norway.|Department of Health Science, Faculty of Health, Science and Technology, Discipline of Nursing Science, Karlstad University, 651 88, Karlstad, Sweden.
authors.forename: Bodil
authors.initials: B
authors.lastname: Wilde-Larsson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis; D001294:Attitude to Health; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003631:Day Care, Medical / Q000592:standards*; D004645:Empathy; D005260:Female; D006333:Heart Failure; D006699:Home Care Services / Q000592:standards*; D017051:Hospice Care / Q000592:standards*; D006738:Hospices / Q000592:standards*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis; D009369:Neoplasms; D009664:Norway; D009735:Nursing Homes / Q000592:standards*; D010166:Palliative Care / Q000592:standards*; D010300:Parkinson Disease; D029424:Pulmonary Disease, Chronic Obstructive; D011787:Quality of Health Care; D012931:Social Environment; D011795:Surveys and Questionnaires
keywords: Palliative care; Patient perception; Quality from the patients’ perspective instrument specific to palliative care (QPP-PC); Quality from the patients’ perspective questionnaire (QPP); Quality of healthcare