Kirsten Wentlandt1, Dori Seccareccia2, Nanor Kevork3, Kevin Workentin4, Susan Blacker5, Daphna Grossman6, Camilla Zimmermann7. 1. Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. 2. Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 3. Department of Supportive Care, University Health Network, Toronto, Ontario, Canada. 4. Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto East General Hospital, Toronto, Ontario, Canada. 5. Department of Cancer Services Planning and Performance, St. Michael's Hospital, Toronto, Ontario, Canada. 6. Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Baycrest, Toronto, Ontario, Canada. 7. Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology & Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Campbell Family Cancer Research Institute, Ontario Cancer Institute, Toronto, Ontario, Canada. Electronic address: camilla.zimmermann@uhn.on.ca.
Abstract
CONTEXT: There is little research on quality of care specific to palliative care units (PCUs). OBJECTIVES: To delineate important aspects of satisfaction with care and quality of care on a PCU, as described by inpatients, family caregivers, and health care professionals. METHODS: Qualitative interviews and focus groups were conducted across four Toronto PCUs, with a total of 46 patient/caregiver interviews and eight staff focus groups. Interviews and focus groups were semistructured to elicit comments about satisfaction with care and quality of care for inpatients and families on a PCU. Data were analyzed using a grounded theory method, with an inductive, constant comparison approach to identify themes, and were coded to saturation. RESULTS: Key elements of quality care and patient satisfaction on a PCU were grouped into six domains: 1) interprofessional team: a team of experts comprising multiple disciplines functioning as a unit; 2) communication: developing rapport, addressing expectations, providing information, listening actively, and facilitating end-of-life discussions; 3) attentive, personalized care: anticipatory and responsive compassionate care with tailored management of physical and nonphysical symptoms; 4) family-centered: support of patients and caregivers within a family; 5) accessible and consistent: appropriate resources and adequate staff to provide consistent care; and 6) supportive setting: a bright noninstitutionalized setting allowing both privacy and socialization. CONCLUSION: The elements identified support the delivery of quality care. They may act as a guide for those planning to develop PCUs and form the basis for measures of satisfaction with care.
CONTEXT: There is little research on quality of care specific to palliative care units (PCUs). OBJECTIVES: To delineate important aspects of satisfaction with care and quality of care on a PCU, as described by inpatients, family caregivers, and health care professionals. METHODS: Qualitative interviews and focus groups were conducted across four Toronto PCUs, with a total of 46 patient/caregiver interviews and eight staff focus groups. Interviews and focus groups were semistructured to elicit comments about satisfaction with care and quality of care for inpatients and families on a PCU. Data were analyzed using a grounded theory method, with an inductive, constant comparison approach to identify themes, and were coded to saturation. RESULTS: Key elements of quality care and patient satisfaction on a PCU were grouped into six domains: 1) interprofessional team: a team of experts comprising multiple disciplines functioning as a unit; 2) communication: developing rapport, addressing expectations, providing information, listening actively, and facilitating end-of-life discussions; 3) attentive, personalized care: anticipatory and responsive compassionate care with tailored management of physical and nonphysical symptoms; 4) family-centered: support of patients and caregivers within a family; 5) accessible and consistent: appropriate resources and adequate staff to provide consistent care; and 6) supportive setting: a bright noninstitutionalized setting allowing both privacy and socialization. CONCLUSION: The elements identified support the delivery of quality care. They may act as a guide for those planning to develop PCUs and form the basis for measures of satisfaction with care.
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