Research indicates that health prof...

Research indicates that health professionals make secure high-quality end-of-life care when the following objectives are achieved: desired physical comfort and emotional support are provided; shared decision-making is promoted; the dying bodily form is treated with respect; information and emotional support are provided to family members; and care is coordinated across settings. Teno and colleagues assessed whether, in applying these domains, family members' perceptions of the quality of end-of-life care differs through last place of care.

The researchers identified 335 informants traced end death certificate information who could be interviewed about the circumstances of a decedent's death and the dying experience. Respondent were asked about the quality of care at the last place where the patient exhausted at least 48 hours. issue measures included several domains: physical and emotional support, specifically regarding pain and its attendant manifestations; physician communication; and regard For the remaining three domains, a esteem was made of the number of quality-of-care belong tos that were identified by the respondents

For the majority of respondent (689 percent) the site of death and the last place of care was an institutional setting--a hospital or nursing domestic circle For 31.1 percent, home was the last place of care, with approximately undivided half of these (51.5 percent) receiving abiding-place hospice services, 36.1 percent receiving no nursing services, and 124 percent receiving to one's home nursing services. Of the 242 percent of patients who did not receive enough help with pain, more had unmet pain be in want ofs if they were in a nursing family circle or at home with nursing services, although unmet lacks with regard to dyspnea were the same in all settings.

undivided half of families reported that the patient did not receive enough emotional support, although unmet distresss were fewer with hospice dwelling care than in other settings. united quarter of families had make uneasys about physician communication, and more affairs about respect were reported when the last place of care was a nursing household or hospital or the patient's family circle with health services than with those dying at abode with hospice services. Families had fewer belong tos about the emotional support provided to them when the patient died at hearth with hospice services, and overall satisfaction was greater with hospice services, which were rated as "excellent" by dint of 70.7 percent of reporting families, as oppos to les than 50 percent for other settings.

The authors gather that home hospice care, while by means of no means fully satisfactory, is associated with higher quality end-of-life care than either hospitals or nursing households One limitation of these findings is that the last place of care generally is self-select possibly introducing bias into the findings. This meditation is particularly important because it sampled families from 22 states and therefore take the part ofs a national spectrum. The studious mood results suggest a need for coordinated improvement of end-of-life care, regardless of location.

Teno JM et al. Family perspectives onward end-of-life care at the last place of care. JAMA January 7 2004;291:88-93

COPYRIGHT 2004 American Academy of Family Physicians

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