Assessing family members' satisfaction with information sharing and communication during hospital care at the end of life

Measuring the quality of patient-provider relationships in serious illness: A scoping review

BACKGROUND

People affected by serious illness face several threats to their well-being: physical symptoms, psychological distress, disrupted social relations, and spiritual/existential crises. Relationships with clinicians provide a form of structured support that promotes shared decision-making and adaptive stress coping. Measuring relationship quality may improve quality assessment and patient care outcomes. However, researchers and those promoting quality improvement lack clear guidance on measuring this.

AIM

To identify and assess items from valid measures of patient-provider relationship quality in serious illness settings for guiding quality assessment.

DESIGN

Scoping review.

DATA SOURCES

We identified peer-reviewed, English-language articles published from 1990 to 2023 in CINAHL, Embase, and PubMed. Eligible articles described the validation of measures assessing healthcare experiences of patient populations characterized by serious illness. We used Clarke et al.'s theory of relationship quality to assess relationship-focused items.

RESULTS

From 3868 screened articles, we identified 101 publications describing 47 valid measures used in serious illness settings. Measures assessed patients and other caregivers. We determined that 597 of 2238 items (26.7%) related to relationships. Most measures (n = 46) included items related to engaging the patient as a whole person. Measures evaluated how providers promote information exchange (n = 35), foster therapeutic alliance (n = 35), recognize and respond to emotion (n = 27), and include patients in care-related decisions (n = 23). Few instruments (n = 9) assessed patient self-management and navigation.

CONCLUSIONS

Measures include items that assess patient-provider relationship quality in serious illness settings. Researchers may consider these for evaluating and improving relationship quality, a patient-centered care and research outcome.

End-of-Life Decision Making and Communication of Bereaved Family Members of African Americans with Serious Illness

OBJECTIVE

The study objective was to examine factors that influence African American (AA) family members' end-of-life care decision outcomes for a relative who recently died from serious illness.

METHODS

A cross-sectional descriptive study design was used. Binary logistic and linear regressions were used to identify factors associated with decision regret and decisional conflict. Forty-nine bereaved AA family members of AA decedents with serious illness who died two to six months prior to enrollment were recruited from the palliative care program in a safety net hospital and a metropolitan church in the Midwest. Measurements used were the Decisional Conflict, Decision Regret, Beliefs and Values, and Quality of Communication scales.

RESULTS

Family members who reported higher quality of communication with health care providers had lower decisional conflict. Family members of decedents who received comfort-focused care (CFC) had significantly less decision regret than family members of those who received life-prolonging treatment (LPT). Family members who reported stronger beliefs and values had higher quality of communication with providers and lower decisional conflict.

CONCLUSIONS

This research adds to a small body of literature on correlates of end-of-life decision outcomes among AAs. Although AAs' preference for aggressive end-of-life care is well-documented, we found that receipt of CFC was associated with less decision regret. To reduce decisional conflict and decision regret at the end of life, future studies should identify strategies to improve family member-provider communication, while considering relevant family member and decedent characteristics.

Test-retest reliability and agreement of the Satisfaction with the Assistive Technology Services (SATS) instrument in two Nordic countries

PURPOSE

The purpose of this study was to investigate test-retest reliability, agreement, internal consistency, and floor- and ceiling effects of the Danish and Finnish versions of the Satisfaction with the Assistive Technology Services (SATS) instrument among adult users of powered wheelchairs (PWCs) or powered scooters (scooters).

METHOD

Test-retest design, two telephone interviews 7-18 days apart of 40 informants, with mean age of 67.5 (SD 13.09) years in the Danish; and 54 informants with mean age of 55.6 (SD 12.09) years in the Finnish sample.

RESULTS

The intra-class correlation coefficient varied between 0.57 and 0.93 for items in the Danish and between 0.41 and 0.93 in the Finnish sample. The percentage agreement varied between 54.2 and 79.5 for items in the Danish and between 69.2 and 81.1 in the Finnish sample, while the Cronbach's alpha values varied between 0.87 and 0.96 in the two samples. A ceiling effect was found in all items of both samples.

CONCLUSIONS

This study indicates that the SATS may be reliably administered for telephone interviews among adult PWC and scooter users, and give information about aspects of the service delivery process for quality development improvement purposes. Further psychometric testing of the SATS is required.