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.