Patients’ Perceptions Of The Quality Of Palliative Care And Satisfaction – A Cluster Analysis

Abstract

Purpose

Palliative care services are multidisciplinary, and the quality needs to be evaluated from the patients’ perspectives. The aim was to explore the patient profiles in palliative care with respect to patients’ perception of the quality of palliative care received and patient satisfaction, and to describe and compare person-related and organization-related conditions that characterize the patient profiles.

Patients and methods

A cross-sectional study, including 140 patients from four different multidisciplinary palliative care contexts in Norway, was conducted in 2014. The Quality from the Patient’s Perspective questionnaire for Palliative Care, which is based upon a person-centered theoretical model, was used. Satisfaction was measured by the Emotional Stress Reaction questionnaire. Person- and organization-related conditions were measured. Hierarchical cluster analysis, ANOVA, Pearson Chi-Square Test and ANCOVA were used.

Results

Three unique patient clusters with different patterns of perceptions of quality of care and satisfaction were identified; Cluster 1 (41%) had the best perception of care quality and were more satisfied, Cluster 2 (34%) had better perceptions of care quality and were most satisfied and Cluster 3 (25%) had worst perceptions of care quality and were less satisfied. The clusters were characterized by person-related conditions (eg, patients’ sense of coherence and perceptions of subjective importance of the quality) as well as organization-related conditions (eg, physicians’ competence and type of care services).

Conclusion

The results can be used by multidisciplinary healthcare personnel to tailor quality work and improve person-centered care in palliative care contexts. Improvement initiatives should focus on implementing a person-centered approach, increasing the palliative care competence of the personnel and facilitate specialized palliative care services in the homecare context.

Keywords:

• emotional stress reaction questionnaire
• ESRQ
• patient satisfaction
• quality of healthcare
• quality from the patients' perspective specific for palliative care
• QPP-PC

Acknowledgments

The authors wish to thank all the patients participating in this study. We also want to thank the nurses responsible for screening and recruiting patients, and the leaders and head administrators from the participating wards.

Abbreviations

ANOVA, analysis of variance; ANCOVA, analysis of covariance; ESRQ, Emotional Stress Reaction Questionnaire; EQ-VAS, EuroQol-visual analogue scale; ID, identity-oriented approach dimension; MT, medical–technical competence dimension; PR, perceived reality; PT, physical–technical conditions dimension; QPP-PC, quality from the patients’ perspective specific to palliative care; RRN, registered nurse responsible for recruiting patients; SC, sociocultural atmosphere dimension; SI, subjective importance; SOC, sense of coherence; QoC, quality of care.

Ethical Considerations And Approval

The study was reported to the Regional Committee for Medical and Health Research Ethics in south-east Norway (REC no. 2013/865) and approved by the Norwegian Social Science Data Services (NSD, no. 34770). Approval for the study to be conducted was obtained from the head administrators of all the settings included. Verbal and written consent for participating in the study was obtained from the patients who were offered an opportunity to withdraw from the study. Information was provided that whether or not a patient decided to participate would have no consequences for their care. Patients had the opportunity to ask about the questions and talk about any emotional aspects that emerged after filling out the questionnaire with the first author (about the questionnaire and the study) and/or the RRN (about emotional aspects). Permission was obtained to use the QPP/QPP-PC, ESRQ, SOC scale and EQ-5D-3L questionnaires.

Author Contributions

All the authors (TS, BWL and VAG) were involved in developing the design and method. TS performed the acquisition of data. TS, BWL and VAG performed the analysis of data. All authors (TS, BWL and VAG) were involved in the interpretation of analysis. TS and VAG wrote the draft manuscript. All authors (TS, BWL and VAG) contributed to data analysis, drafting and revising the article, gave final approval of the version to be published and agree to be accountable for all aspects of the work.

Disclosure

The data used was collected with financial support from Inland Norway University of Applied Sciences and partly from Lovisenberg Diaconal Hospital. The authors report no conflicts on interest in this work.