ABSTRACT
Objectives:To determine the factors that influence the decision maker regarding end-of-life (EOL) care and to disclose how aggressive care in the last week before death, place of death, and quality-of-life (QOL) affected the decisions made. Methods:The subjects were 409 bereaved family members (cause of death included cancer, stroke, heart disease, and pneumonia) that registered with an internet research agency. Decision-making was controlled either by the patient, family, or physician or shared by the patient, family, and physician. Results:The results of a multinomial logistic regression analysis demonstrated that when a family controlled decision-making, they were less likely to report patient-family EOL discussion [odds ratio (OR)=0.52], and that the patient had good communication with the physician (OR=0.77); they were also likely to report that the patient had dementia (OR=1.94). Families who reported physician-controlled decision-making (vs patient controlled) were less likely to report that the patient had good communication with the physician (OR=0.62). Cardiopulmonary resuscitation in the last week and place of death were not associated with the decision maker. EOL QOL was associated with EOL care of the decision maker. When a physician controlled decision-making, patient EOL QOL was at its lowest. Conclusion:To improve patient-controlled decision-making, it is critical that patients, families, and physicians have more communication regarding EOL care.
ABSTRACT
<b>Purpose: </b>The aim of this study was to clarify the factors contributing to the evaluation of perceived care in inpatient palliative care services from the aspect of informal caregiver after their loss of the patient to cancer. <b>Method: </b>A questionnaire was mailed to 9,684 bereaved subjects who had lost family members at one of 103 palliative care units in Japan to evaluate their sociodemographic characteristics and the evaluation of perceived care. An institution survey was performed to collect organization-related variables. The evaluation of perceived care was rated by the Care Evalutaion Scale (CES), the Good Death Inventory (GDI) and single item of overall satisfation. <b>Result: </b>A total of 5,810 responses were analyzed (response rate＝60％). Uni-variate and multivariate analysis was performed to clarify the determinants of each scale. Significant determinants of the score in the evaluation of care identified were: the rate of private room (100％), independent facility, palliative care physician being night-time duty, the number of nurses at night (＞0.1 per bed), sending a letter to every bereaved family, holding a memorial services for every bereaved family and having a religious background. <b>Conclusion: </b>In conclusion, the evaluation of palliative care from the aspect of informal caregiver was influenced by various organization-related variables.
