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What constitutes quality of family experience at the end of life? Perspectives from family members of patients who died in the hospital

Published online by Cambridge University Press:  08 July 2014

Karen E. Steinhauser ,
Corrine I. Voils ,
Hayden Bosworth  and
James A. Tulsky
Karen E. Steinhauser*
Affiliation:
Center for Health Services Research in Primary Care, Duke University, Durham, North Carolina Durham VA Medical Center, Durham, North Carolina Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina Center for Palliative Care, Duke University School of Medicine, Durham, North Carolina Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
Corrine I. Voils
Affiliation:
Center for Health Services Research in Primary Care, Duke University, Durham, North Carolina Durham VA Medical Center, Durham, North Carolina
Hayden Bosworth
Affiliation:
Center for Health Services Research in Primary Care, Duke University, Durham, North Carolina Durham VA Medical Center, Durham, North Carolina Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
James A. Tulsky
Affiliation:
Center for Health Services Research in Primary Care, Duke University, Durham, North Carolina Durham VA Medical Center, Durham, North Carolina Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina Center for Palliative Care, Duke University School of Medicine, Durham, North Carolina Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina School of Nursing, Duke University, Durham, North Carolina
*
Address correspondence and reprint requests to: Karen Steinhauser, Center for Palliative Care, VA and Duke Medical Centers, 2424 Erwin Road, Suite 1105, Box 2720, Durham, North Carolina 27705. E-mail: karen.steinhauser@duke.edu
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Abstract

Objective:

Most palliative care efforts focus on assessing and improving the quality of life and quality of care for patients. Palliative care views the family as the unit of care; therefore, excellent comprehensive palliative care should also address the needs of the family and the caregiver(s). While the recent literature has offered detailed descriptions of caregiving needs in the home setting, it is crucial to describe the needs of family members who provide care for patients with advanced illness in an inpatient setting, where family members serve as the key intermediaries and decision makers. Therefore, we sought to define the relevant aspects of quality of experience for families of hospitalized patients.

Method:

We convened a series of focus groups to identify the domains important for the quality of experience of dying patients' family members. Participants included bereaved family members of patients who had died at a Veterans Administration (VA) or private academic medical center. We conducted four in-depth follow-up interviews to probe for additional details and validate our interpretation of the focus group findings.

Results:

Participants (n = 14) ranged in age from 46 to 83, with a mean of 62. All were female; 64% were Caucasian, 21% African American, and 14% did not report their ethnicity. Content analysis yielded 64 attributes of quality of family experience constituting eight domains: completion, symptom impact, decision making, preparation, relationship with healthcare providers, affirmation of the whole person, post-death care, and supportive services.

Significance of results:

Our data have implications for clinical guidance in assisting family members in the inpatient palliative setting, which often includes patient incapacity for communication and decision making. They suggest the importance of developing corresponding methods to assist families with the tasks involved with life completion, being prepared for a crisis and imminent death, and post-death care. Provider communications and relationships are central to the processes of meeting the clinical needs of family members. Our findings should inform the development of measures to assess family experience.

Keywords

Palliative careCaregivingQuality of life
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 4 , August 2015 , pp. 945 - 952
Copyright
Copyright © Cambridge University Press 2014 

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