Patient and Family Satisfaction with End-of-Life Care
In a large national study, Dr. Joan Teno and colleagues, conducted a mortality
follow-back survey of family members or other knowledgeable informants representing
1578 decedents. A 2-stage probability sample was used to estimate end-of-life
care outcomes for 1.97 million deaths from chronic illness in the United States
in 2000 (Teno).
The results were as follows:
For most patients (68.9%), the last place of care was an institutional
setting, either a hospital or nursing home.
In patients who died in a hospital or a nursing home, bereaved family members
reported high rates of unmet needs for symptom management, concerns with physician
communication about medical decision making, a lack of emotional support for
themselves, and a belief that their dying family member was not always treated
with respect.
Bereaved family members of patients with home hospice services (in contrast
to the other settings of care) reported higher satisfaction, fewer concerns
with care, and fewer unmet needs.
While bereaved family members were most satisfied with end-of-life care provided
by home hospice services, it is to be remembered that until today, most patients
die in an institutional setting. Therefore there is a pressing need for palliative
care in these settings in order to improve quality of care.
