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Variation in quality of palliative care provided to patients with cancer, chronic organ failure, old age or dementia: the views from bereaved relatives.

Raijmakers, N.J.H., Hofstede, J.M., Hoek, L. van der, Francke, A.L., Veer, A. de. Variation in quality of palliative care provided to patients with cancer, chronic organ failure, old age or dementia: the views from bereaved relatives. European Journal of Palliative Care: 2015 263. Abstract. 14th World Congress of the European Association for Palliative Care: Building Bridges. 8-10 mei 2015, Copenhagen.
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Background
There is a recognised need for palliative care for patients with non-malignant diseases, like chronic heart failure or dementia. However, the often unpredictable illness trajectories of people with conditions other than cancer may hamper provision of highquality palliative care.

Aim
The aim is to compare the quality of care in the last week of life of patients with cancer, organ failure and frailty, as experienced by bereaved relatives.

Methods
An existing dataset of 458 bereaved relatives was analysed to determine the differences in the quality of care for three groups of patients; cancer, organ failure and frailty. Data had been collected with the validated questionnaire Consumer Quality Index Palliative Care for bereaved relatives. Multilevel analysis, logistic regression and linear regression were used to calculate differences between groups.

Results
Differences existed regarding the perceived quality of care as received by the patient in the last week of life: bereaved relatives of patients with organ failure (n=61) and with frailty (n=182) both reported more negative experiences regarding expertise of the healthcare professionals involved, respectively OR 9.8;95%CI 1.8–52.9 and OR 4.5;95%CI1.0– 19.1. Furthermore, patients with frailty had less frequent access to a counsellor for spiritual problems compared patients with cancer (n=215), OR 5.4;95%CI 1.4–20.8, as experienced by their bereaved relatives. The bereaved relatives’ quality rating of the care in the last week of the patient’s life was significantly lower in the frailty group compared to the cancer group (p=0.01). No significant differences were found between the three groups regarding psychosocial/spiritual care for the patient.

Conclusion
The quality of care as perceived by bereaved relatives differs between patients with cancer, organ failure and frailty. Overall, bereaved relatives of cancer patients have more positive experiences regarding the care for the patient in the last week of life.