Family satisfaction with end-of-life care in seriously ill hospitalized adults

OBJECTIVE: To examine factors associated with family satisfaction with end- of-life care in the Study to Understand Prognoses and Preferences for Outco mes and Risks of Treatments (SUPPORT). DESIGN: A prospective cohort study with patients randomized to either usual care or an intervention that included clinical nurse specialists to assist in symptom control and facilitation of communication and decision-making. SETTING: Five teaching hospitals in the United States PARTICIPANTS: Family members and other surrogate respondents for 767 seriou sly ill hospitalized adults who died. MEASUREMENTS: Eight questionnaire items regarding satisfaction with the pat ient's medical care expressed as two scores, one measuring satisfaction wit h patient comfort and the other measuring satisfaction with communication a nd decision-making. RESULTS: Sixteen percent df respondents reported dissatisfaction with patie nt comfort and 30% reported dissatisfaction with communication and decision -making. Factors found to be significantly associated with satisfaction wit h communication and decision-making were hospital site, whether death occur red during the index hospitalization (adjusted odds ratio (AOR) 2.2, 95% CI , 1.3-3.9), and for patients who died following discharge, whether the pati ent received the SUPPORT intervention (AOR 2.0, 1.2-3.2). For satisfaction with comfort, male surrogates reported less satisfaction (0.6, 0.4-1.0), su rrogates who reported patients' preferences were followed moderately to not at all had less satisfaction (0.2, 0.1-0.4), and surrogates who reported t he patient's illness had greater effect on family finances had less satisfa ction (0.4, 0.2-0.8). CONCLUSIONS: Satisfaction scores suggest the need for improvement in end-of -life care, especially in communication and decision making. Further resear ch is needed to understand how factors affect satisfaction with end-of-life care. An intervention like that used in SUPPORT may help family members.