Family Views of End-of-Life Care in Acute and Community Hospitals

by Ciarán O'Boyle; Siobhán McCarthy

Aug 1, 2010
The Hospice friendly Hospitals Programme (HfH) commissioned this study to assess the quality of end-of-life care in acute and community hospitals from the perspectives of bereaved relatives. A major rationale for the study was to develop and test methodology to survey bereaved relatives' views of end-of-life care that covers the HfH Programme themes of Integrated Care, Communication, Patient Autonomy and Design & Dignity. Another driver was to inform the set-up of a Nationwide Audit of End-of-Life Care (McKeown et al., 2010). The overall aim of the study was to assess the quality of end-of-life care in two acute and two community hospitals from the perspectives of bereaved relatives. Study subobjectives were to conduct a literature review to ascertain important ethical and methodological issues; to describe a census of deaths across study sites; to field test a survey instrument aimed evaluating the impact of the Hospice friendly Hospitals (HfH) Programme; to collect data about HfH Programme themes; and to establish if there were any differences in the pattern of results between acute and community hospitals.
  • Conducting postal surveys of bereaved relatives is an acceptable form of end-of-life care research in Ireland, with 40% consenting to receive a questionnaire, and, of that number, an 83.1% response rate.
  • Relatives of patients in community hospitals have a tendency to rate the quality of end-of-life care better than relatives of patients who died in acute hospitals.
  • Research demonstrates that hospital staff should have have increased discussion with patients and families regarding type of room during the last hospital stay and at time of dying.
  • Two thirds of respondents in the acute hospital group indicated that the patients' personal care needs were "always" taken care of well, as compared to 83.8% of respondents in the community hospital group.
  • Findings suggest that healthcare professionals in acute hospitals may be better positioned to respond to the emotional and support needs of families than of dying patients.
  • The overall satisfaction score for the community hospital group was higher than the score for the acute hospital group.
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