title: Variations in Care Quality Outcomes of Dying People: Latent Class Analysis of an Adult National Register Population.
abstract: Symptom relief is a key goal of palliative care. There is a need to consider complexities in symptom relief patterns for groups of people to understand and evaluate symptom relief as an indicator of quality of care at end of life.
  
  
  
  The aims of this study were to distinguish classes of patients who have different symptom relief patterns during the last week of life and to identify predictors of these classes in an adult register population.
  
  
  
  In a cross-sectional retrospective design, data were used from 87,026 decedents with expected deaths registered in the Swedish Register of Palliative Care in 2011 and 2012. Study variables were structured into patient characteristics, and processes and outcomes of quality of care. A latent class analysis was used to identify symptom relief patterns. Multivariate multinomial regression analyses were used to identify predictors of class membership.
  
  
  
  Five latent classes were generated: "relieved pain," "relieved pain and rattles," "relieved pain and anxiety," "partly relieved shortness of breath, rattles and anxiety," and "partly relieved pain, anxiety and confusion." Important predictors of class membership were age, sex, cause of death, and having someone present at death, individual prescriptions as needed (PRN) and expert consultations.
  
  
  
  Interindividual variability and complexity in symptom relief patterns may inform quality of care and its evaluation for dying people across care settings.
authors.affiliation: Palliative Research Centre and Department of Health Care Science, Ersta Sköndal University College, Stockholm, Sweden; Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Sweden. Electronic address: joakim.ohlen@gu.se.
authors.forename: Joakim
authors.initials: J
authors.lastname: Öhlén
authors.affiliation: Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada; School of Nursing, University of Victoria, British Columbia, Canada.
authors.forename: Lara
authors.initials: L
authors.lastname: Russell
authors.affiliation: Palliative Research Centre and Department of Health Care Science, Ersta Sköndal University College, Stockholm, Sweden; Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Håkanson
authors.affiliation: Palliative Research Centre and Department of Health Care Science, Ersta Sköndal University College, Stockholm, Sweden; Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anette
authors.initials: A
authors.lastname: Alvariza
authors.affiliation: The Institute for Palliative Care and Department of Clinical Sciences, Lund University, Sweden.
authors.forename: Carl Johan
authors.initials: CJ
authors.lastname: Fürst
authors.affiliation: Department of Health and Caring Sciences, Linæus University, Kalmar, Sweden; Department of Medical and Health Sciences, Linköping University, Sweden.
authors.forename: Kristofer
authors.initials: K
authors.lastname: Årestedt
authors.affiliation: Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada; School of Nursing, Trinity Western University, Langley, British Columbia, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Sawatzky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000592:standards*; D011787:Quality of Health Care; D011788:Quality of Life; D012042:Registries; D012189:Retrospective Studies; D013548:Sweden; D013727:Terminal Care / Q000592:standards*; D019452:Terminally Ill; D055815:Young Adult
keywords: Dying; end of life; palliative care; public health; quality of health care; symptom clusters