The Experience of Hospital Death: Assessing the Quality of Care at an Academic Medical Center.
Elise C Carey, Ann M Dose, Katherine M Humeniuk and 5 others
PMID 28103711WHAT IT FOUND
Families of 104 people who died in hospital reported high overall satisfaction but gaps in symptom control, personal care, clear information, and support for their own distress.
Ask families what they need and who is leading care.
Key findings
018% to 29% of family members reported that symptoms such as pain, difficulty breathing, anxiety and sadness were suboptimally managed in the last week.
0257% of participants reported not being directed to someone who could support them when distressed, and 29% reported not always being informed about the patient's condition.
03Families of patients who received only subspecialty or intermittent care were more likely to report being under-informed than families whose patients were at the institution for the first time.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It was done at a large academic medical center, and most participants were white and lived within 140 miles, so it may not apply to more diverse populations. Only 104 of 1,014 inpatient deaths were included, and the survey used a sample of about 10%. Families were asked 3 to 7 months after the death, so memory, grief, and retrospective judgment may affect ratings. The survey domains did not behave as a single score, so results were analysed as individual questions rather than as validated domain scores. High satisfaction created a ceiling effect. Answers were collapsed into any dissatisfaction versus always satisfied, so the detail of how often families were satisfied is lost. The study did not measure whether palliative care consultation occurred. It reports associations, not proof that a particular care process caused dissatisfaction.
Declared interests
The authors reported no conflicts of interest. The paper does not state a funding source.
The easy way to misread this
Do not read the 8% to 29% symptom-management gaps as proof that hospital end-of-life care is generally poor. Most participants reported high satisfaction, and the study sampled families at a large academic center months after death.