Palliative Care Quality Improvement

Does palliative care improve quality? A survey of bereaved family members

The purpose of this study was to gather the empirical data that would either prove or disprove the validity of the assumption that relatives of patients in palliative care regard the quality of received medicare, on the part of their loved ones, in generally positive terms. This establishes the study in question, as such that was meant to contribute to the ongoing debate, as to whether the very concept of palliative care should be considered thoroughly legitimate.

According to the authors, the study’s subject matter is not well-researched. Nevertheless, they do mention the studies by Teno, Prigerson, Azoulay, Weiner, and Roth, as such that contain several discursively relevant insights, in this respect. The main of them is that it is specifically some people’s impression that their terminally ill relatives are not being adequately cared for in the palliative care units, which represents the issue of concern.

The study’s framework is best identified as empirical research, concerned with collecting the relevant data, quantifying it, and interpreting what should be considered the obtained results’ discursive implications.

Gelfman, Meier, and Morrison refrained from coming up with the articulated hypothesis, in regards to what should be deemed the significance of the would-be obtained findings. Nevertheless, how they proceeded to conduct the study’s sub-sequential phases implies that the authors did aim to find evidence, in support of the idea that the continual legitimization of the palliative care practice does benefit society in several different ways.

The study’s independent variables included: the age of palliative/non-palliative patients and the affiliated family-members (the actual respondents), the specifics of respondents/patients’ racial background/social status, and the severity of the provided diagnosis (cancer vs. non-cancer). The main dependent variable, in this respect, was the varying degree of respondents’ contentment with the manner of how their palliative/non-palliative family members have been treated at the hospital (Mount Sinai Medical Center).

The study does not feature any explicitly stated assumptions. At the same time, however, it appears that, while conducting their research, the authors never ceased being observant of the discursive implications of the earlier mentioned studies. The main of them is that there is indeed a good rationale to expect that there would be a qualitative difference between the respondents’ perception of palliative care, on one hand, and their perception of usual care, on the other.

The main limitations of the study by Gelfman, Meier, and Morrison are as follows: it targeted only English-speaking family members; there is the element of ‘recall bias’ to the obtained answers; the researchers targeted only those family members with the experience of having had their relatives subjected to palliative/non-palliate care on a prolonged basis. This, of course, undermines the cross-sectional soundness of the study’s findings.

The study’s research design is concerned with the author’s decision to conduct “prospective quantitative telephonic interviews of family members of patients who died at Mount Sinai Medical Center between April and December 2005” (Gelfman, Meier, & Morrison, 2008, p. 22). The received responses were consequently quantified, as the mean of allowing the authors to come up with the inductive conclusions, in regards to the researched topic.

Out of 190 of the initially contacted respondents (who met the study’s eligibility criteria), only 149 agreed to provide answers to the interview questions, (54 palliative care family members and 95 non-palliative care family members), which sets the study’s rate of response at 78.4% (Gelfman, Meier, & Morrison, 2008). The respondents’ average age is calculated to account for 53.4 years. The percentile ratio of women-participants is 45.6.

The study’s main method of measurement is concerned with the authors’ decision to use the mathematical function of linear regression, as the mean of identifying the qualitative aspects of the relationship between the researched subject’s independent and dependent variables.

The collection of data was conducted by the mean of asking the selected respondents to participate in the ‘After-Death Bereaved Family Member Interview’ (designed by the study’s authors) over the phone. During conducting their research, Gelfman, Meier, and Morrison were also provided with access to the electronic medical record at Mount Sinai Medical Center – something that allowed them to verify the initially obtained interview-based data.

To analyze the data (after it was quantified), the authors resorted to the Stata Version 9.1. Software, which in turn allowed them to run the so-called T-tests and Chi-square tests, as the mean of figuring out the overall rate of palliative/non-palliative respondents’ satisfaction with the services that their loved ones received at Mount Sinai Medical Center.

In the aftermath of having conducted the study, Gelfman, Meier, and Morrison determined that, as compared to what is being the case with the interviewed usual care family members, the care-related rate of satisfaction among the ‘palliative’ respondents is significantly higher –35% vs. 65%, respectively. The authors interpret this, as the indication that the very concept of palliative care presupposes the integration of family-needs into the methodological approach towards dealing with terminally ill patients.

References

Gelfman, L., Meier, D., & Morrison, R. (2008). Does palliative care improve quality? A survey of bereaved family members. Journal of Pain & Symptom Management, 36 (1), 22-28.